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)

 CLASS 2: Slight CHF

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)

 CLASS 3: Marked CHF

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)

 CLASS 4: Sever CHF

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) 
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.
 Heart (cardiac) catheterization:
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.
 Noninvasive imaging: (Colucci, 2009)
Computed tomography (CT) or magnetic
Treatment

 Treatment of heart failure involves life style

changes, medications, and medical procedures and
surgery.
 Life style changes:
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
§
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
 Heart transplant: A life-saving measure for
end-stage heart failure when medical
treatment and less drastic surgery have
failed.
 Open-heart surgery or angioplasty: A
(National heart lung and blood institute, 2010
procedure used to open clogged heart
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.