Inroduction to Congestive Heart Failure

Congestive heart failure (CHF) is a condition in which the heart can no longer sufficiently supply the body with the blood needed to maintain homeostasis. This condition can result from other cardiovascular complications such as infarctions, valve defects, lung disease, and hypertension. Left-sided heart failure occurs more frequently than right-sided, creating symptoms like shortness of breath and irregular heart rhythm which can induce compensatory mechanisms of the body. This compensation begins with a decrease in systemic blood flow as a result of increased peripheral resistance or congestion in the pulmonary system. This reduced blood flow to the kidneys will stimulate the release of renin and aldosterone, both of which increase the workload on the heart by increasing blood volume and peripheral resistance via vasoconstriction. Newly imposed demands weaken the left ventricle and create congestion within in the pulmonary system. Backflow into the pulmonary system causes an increase in resistance and in turn results in right-sided heart failure[1].

CHF is an epidemic spread across the entire world; it is estimated that 23 million people in the world are afflicted with CHF, approximately 5.8 million of them being from the United States. Risk factors for developing CHF include coronary artery disease, hypertension, diabetes, obesity (BMI>30), and 65 years old or greater[2]. The total cost of care for those with CHF is approximately $30.7 billion, and that value is expected to reach $69.8 billion by 2030. About 1% of people aged 55-64 and 17.4% of people 85 and older suffer from heart failure[3].

Physical therapy can play a key role in improving the wellbeing and quality of life for patients who are diagnosed with CHF. Patients who have a biventricular pacemaker implant, which helps to synchronize contractions between the left and right sides of the heart, are often cleared for therapeutic exercise. Therapists should be aware of red flags such as infection, malfunction, and contraindications with electric modalities for these devices during therapy sessions. In addition, decreased muscle mass, VO2peak, quality of life, and exercise capacity are factors that the therapist should take into consideration for treatment[4]. Beta-blockers, ACE inhibitors, glycosides, and diuretics are the key medications used for managing congestive heart failure through regulating renal function and the sympathetic nervous system. Adverse effects of these drugs will also be covered, providing implications of each drug in regards to physical therapy activity.

  1. VanMeter, K. C., & Hubert, R. C. (2014). Gould's Pathophysiology for the Health Professional. 5th ed. St. Louis, MO: Elsevier.
  2. Komanduri, S., Jadhao, Y., Guduru, S. S., Cheriyath, P., & Wert, Y. (2017). Prevalence and risk factors of heart failure in the USA: NHANES 2013 – 2014 epidemiological follow-up study. Journal of Community Hospital Internal Medicine Perspectives, 7(1), 15–20. http://doi.org/10.1080/20009666.2016.1264696
  3. Dunlay, S. M., Pereira, N. L., & Kushwaha, S. S. (2014). Contemporary Strategies in the Diagnosis and Management of Heart Failure. Mayo Clinic Proceedings, 89(5), 662–676. http://doi.org/10.1016/j.mayocp.2014.01.004
  4. Haennel, R. G. (2012). Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants. Cardiopulmonary Physical Therapy Journal, 23(3), 23–28.