Definition

Heart failure is a long term, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload. (American Heart Association, 2010) So, heart failure is a condition with symptoms and signs caused by cardiac dysfunction which results in reduced longevity.

Causes (Etiology)

According to Klatsky et.al (2007) heart failure has diverse causes. In most of the cases, etiology is multifactor. The factors causing heart failure can be as follows:  Coronary Artery Disease (Atherosclerosis)  High blood pressure (Hypertension)  Heart muscle diseases (Cardiomyopathies)  High blood sugar (Diabetes)  Heavy alcohol  Cancer  Less red blood cell or less than normal Hemoglobin (Anemia)  Kidney failure (Creatinine > 2mg/dl)  Obesity  Use of heart affecting drugs

Types and Pathophysiology
(Left Sided Heart Failure) M a in ly 2 ty p e s o f h e a rt fa ilu re :
 SYSTOLIC FAILURE: D IA S T O L IC FA ILU R E :

Types and Pathophysiology
(Right Sided Heart Failure) Usually, occurs as a result of left sided heart failure

Types and Pathophysiology
(Congestive Heart Failure) It is a type of HF, which requires medical attention. Most of the times, CHF term is used interchangeably with H.

(American Heart Association, 2010

Class of heart failure
 CLASS 1: Mild CHF

Comfortable at rest, ordinary activity; does not cause unwanted fatigue, increased heart beats (palpitations), shortness of breath (dyspnea) or chest pain (anginal pain) Slight limitations in physical activity; comfortable at rest, ordinary physical activity results in fatigue, increased heart beats (palpitations), shortness of breath (dyspnea) or chest pain (anginal pain) Marked limitation of physical activity; comfortable at rest, less than ordinary activity causes fatigue, increased heart beats (palpitations), shortness of breath (dyspnea) or chest pain (anginal pain) Unable to carry out any physical activity without any discomfort; fatigue, increased heart beats (palpitations), shortness of breath (dyspnea) or chest pain (anginal pain) results even at rest and increases with exercise
(O’Sullivan et.al, 2007, P.160) 

 CLASS 2: Slight CHF

 CLASS 3: Marked CHF

 CLASS 4: Sever CHF

Signs and symptoms

O’ Sullivan et.al (2007) has presented signs and symptoms of HF as follows: (Signs and symptoms of right sided heart failure)
 Nausea  Lack of appetite  Weight gain  Right sided chest pain  Right sided heave  Jugular vein distension  Peripheral swelling  Enlarged liver  Cyanosis

Signs and symptoms

O’ Sullivan et.al (2007) has presented signs and symptoms of HF as follows: (Signs and symptoms of right
sided heart failure)
          

Cough Fatigue Shortness of breath (SOB) SOB while lying down (Orthopnea) SOB during night Increased sweating (Diaphoresis) Rapid heart rate (Tachycardia) Changes in heart sound Adventitious lung sounds (Crackles) Confusion Arterial pulse showing strong and weak pulse (Pulses Alterans)  Decreased urine output

Diagnosis
 Chest x-ray 

Shows the size and shape of the heart, the large blood vessels in the chest lungs.
 Electrocardiogram (EKG):  Provides a picture of the electrical activity which produces heart beat.  Detects conditions such as an abnormal heart rhythm or a previous heart attack that could cause heart failure.  Echocardiogram:
 Uses ultrasound (high frequency sound waves) to

assess the size of the heart's chambers, and the movement of the heart valves.  Measures the amount of blood pumped by heart

Diagnosis
 Exercise testing:

An exercise test ("stress test") determines the performance of heart during exercise. It is one way to look for signs of a shortage of blood supply to your heart caused by blockages in the coronary arteries. Measures functioning of heart and provides pictures of the coronary arteries blockages. A thin tube (the catheter) is inserted through a large blood vessel in the groin (or arm) and advanced into the heart. A dye is injected into the catheter to view the arteries and the structure of the heart by x-ray. Computed tomography (CT) or magnetic
(Colucci, 2009)

 Heart (cardiac) catheterization:

 Noninvasive imaging:

Treatment

Treatment of heart failure involves life style changes, medications, and medical procedures and surgery. Do not hesitate to discuss food plans or exercise plans with your health care professional.
A. Healthy diet:
§ § § § Increase intake of green leafy vegetables, fruits and whole grains Take food low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar Reduce salt intake (2 g/ day) Add potassium in diet by taking white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans

 Life style changes:

§
B. Proper fluid intake:
§ Stop taking alcohol

Treatment
C.Other life style changes:
§ Loose weight, if needed § Be active, plan out exercise program with the help of health care professional § Quit smoking § Maintenance of life style changes is very important § Pace work to reduce undue stress on heart § check blood pressure regularly

Medicines

Usually multidrug treatment is used.
 Diuretics (water or fluid pills):

Reduces fluid buildup  ACE inhibitors: Lower blood pressure and reduce strain on your heart  Aldosterone antagonists : Trigger the body to get rid of salt and water through urine.  Angiotensin receptor blockers: Relax your blood vessels and lower blood pressure to decrease the workload on your heart
 Beta blockers:

Slow your heart rate and lower your blood pressure to decrease the workload on your heart.  Digoxin:

Medical procedures and surgeries
 Cardiac resynchronization therapy (CRT)

device or an implantable cardioverter defibrillator (ICD): Sets the rhythm of heart

 Left ventricular assist device: A mechanical

heart pump, pumps blood from the heart to the body end-stage heart failure when medical treatment and less drastic surgery have failed.

 Heart transplant: A life-saving measure for

 Open-heart surgery or angioplasty: A

(National heart lung and blood institute, procedure used to open clogged heart

2010

Other informative links:
 Aim for a Healthy Weight  "Your Guide to a Healthy Heart,"

 "Your Guide to Lowering Your Blood Pressure wi  "Your Guide to Lowering Cholesterol With TLC

.”
 Obesity calculator

Glossary

Coronary Artery Disease: It begins when cholesterol, fatty material, and calcium build up in the arteries, a process known as atherosclerosis. Cyanosis: A blue coloration of the skin and mucous membranes due to the presence of > 5g/dl deoxygenated hemoglobin in blood vessels near the skin surface. Pathophysiology: The functional changes associated with or resulting from disease or injury.

Reference

American Heart Association (2010) What is heart failure? Retrieved on 26th January, 2010 from http://www.americanheart.org/presenter Colucci, W. Patient information: Heart failure causes, symptoms, and diagnosis, Retrieved on 26th January, 2010 from http://www.utdol.com/patients/content/topic Klatsky, A., Gronningen, S., Udaltsova, N., Chartier, D., Brar, S., Schipper, J., and Lundstrom, R (2007) Heart failure etiology is usually pluricausal whether or not there is associated coronary disease. The Permanente Journal, 11(1). National Heart Lung and Blood Institute- Disease and Condition Index. Heart failure, How is heart failure treated? Retrieved on 26th January, 2010 from http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_Treatments O’Sullivan, S. and Schmitz, T., (2001) Physical Rehabilitation Assessment and Treatment. 4th Edition, Jaypee Brothers, New Delhi, India. O’ Sullivan (2007), Cardiovascular system. National Physical Therapy Examination Study and Review Guide, p.150-193.

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