What Are Left, Right, and Biventricular Heart Failure?

Reviewed by: HU Medical Review Board | Last reviewed: October 2019

There are two sides to every heart. Sometimes we think of feelings of the heart as being opposites, love and hate, happy and sad. But the structure of the heart really is divided in two: the left and right sides of the heart. It is also divided into upper and lower portions of the heart. The upper chambers are called the left and right atria. The lower chambers are called the left and right ventricles. The location of heart dysfunction is the key to making a diagnosis of heart failure (HF).1,2

Left side of the heart

The job of the heart muscle is to transport oxygenated blood coming from the lungs to the left atrium and on through to the left ventricle. The left ventricle is the main pumping portion of the heart. It is larger than the other chambers and plays a fundamental role in normal heart function. When there is HF on the left side of the heart, the heart muscle has to work harder to squeeze out the same volume of blood. This is referred to as left ventricular (LV) heart failure. It is the most common type of HF.1

Systolic heart failure

Heart failure on the left side can be of two different types, systolic and diastolic heart failure. Systolic heart failure is when the left ventricle no longer contracts with enough force to allow the blood to flow adequately through the body. This results in a decreased supply of oxygen-rich blood available to nourish the body. The left ventricle works harder to compensate, and over time becomes weaker and thinner. This condition permits blood to flow backward into organs, causing fluid buildup in the lungs and/or swelling in other parts of the body.2

Diastolic heart failure

Diastolic heart failure occurs when the left ventricle has gotten stiff or thickened and cannot sufficiently fill with blood. This reduces the amount of blood pumped out to the body.2 When the body doesn’t get enough oxygen-rich blood and the pumping power is reduced, blood can back up in the lungs causing shortness of breath (dyspnea) and fluid buildup (congestion). Other symptoms include chronic coughing or wheezing, fatigue, difficulty concentrating, swelling in the legs, and a rapid or irregular heartbeat.2

Right side of the heart

The right ventricle (RV) normally pumps depleted or “used” blood from the right atrium into the lungs where it is resupplied with oxygen. RV heart failure can be the result of chronic left-sided failure. As the left ventricle no longer works normally, the right side has to work harder to pump returning blood through the lungs. An increase in fluid pressure can affect the lungs, causing blood to back up in the veins throughout the body. This can result in swelling, which in turn damages the right side of the heart and causes it to lose pumping power.1 Common symptoms include swelling in your legs and abdomen, bloating, nausea and a poor appetite, and difficulty catching your breath.2

Biventricular heart failure

Heart failure most typically occurs on the left side of the heart. When the damage expands and also impacts the right side it is referred to as biventricular heart failure. Symptoms can be reflective of both left and right-sided heart failure, including shortness of breath and swelling due to a build-up of fluid.3 Heart failure is diagnosed with the use of technology like imaging, electrical, and exercise-based tests, as well as blood tests which can all provide a cardiologist with important information in determining the location and severity of heart failure.2

Lifestyle choices

Lifestyle choices and changes can help prolong the length and quality of life when living with heart failure. Maintaining a normal weight, eating a healthy, low-salt diet, and not smoking are important steps. Always follow a doctor’s instructions, but for most people, exercise and a general increase in physical activity are also beneficial in managing heart failure. Other treatments include prescription medications, surgery, and medical devices.2

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