Heart Failure: Difference between revisions

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== Definition/Description  ==
== Introduction ==
[[File:Heartfailure.jpg|right|frameless]]
[[File:Heart failure.png|right|frameless|457x457px]]
Heart failure (HF) is a complex clinical syndrome that results from either functional or structural impairment of ventricles resulting in symptomatic left ventricle (LV) dysfunction.
[[Anatomy of the Human Heart|Heart]] failure is a syndrome of cardiac ventricular dysfunction, where the heart is unable to pump sufficiently to meet the body's [[Blood Physiology|blood]] flow requirements.
* The symptoms come from an inadequate cardiac output, failing to keep up with the metabolic demands of the body.
* It is a leading cause of cardiovascular morbidity and mortality worldwide despite the advances in therapies and prevention.
* It can result from disorders of the pericardium, myocardium, endocardium, heart valves, great vessels, or some metabolic abnormalities.<ref>Hajouli S, Ludhwani D. [https://www.ncbi.nlm.nih.gov/books/NBK553115/ Heart Failure And Ejection Fraction] 2020.Available from:https://www.ncbi.nlm.nih.gov/books/NBK553115/ (last accessed 11.8.2020)</ref><br>
The condition can be acute, transient, or chronic:
*'''Acute''' is the first presentation of heart failure or a sudden onset of heart failure
*'''Transient''' is when heart failure is recurrent or episodic
*'''Chronic''' is heart failure that is persistent, worsening, or decompensate (to lose ability to function). It usually offset at first by compensatory mechanisms to maintain tissue perfusion, but eventually cardiac function declines and symptoms develop.<ref name="p1" /><br>


== Classification of HF  ==
* The symptoms come from an inadequate cardiac output, failing to keep up with the metabolic demands of the body.
* Heart failure can be classified as predominantly left ventricular, right ventricular or biventricular based on the location of the deficit.
* It is a leading cause of cardiovascular morbidity and mortality worldwide despite the advances in therapies and prevention.
* Depending on the time of onset, HF is classified as acute or chronic.
* It can result from disorders of the pericardium, myocardium, endocardium, heart valves, great vessels, or some metabolic abnormalities.<ref name=":3">Hajouli S, Ludhwani D. [https://www.ncbi.nlm.nih.gov/books/NBK553115/ Heart failure and ejection fraction.]Available: https://www.ncbi.nlm.nih.gov/books/NBK553115/<nowiki/>(accessed 19.9.2021)</ref>
* Clinically, it is typically classified into two major types based on the functional status of heart: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF)<ref>Inamdar AA, Inamdar AC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961993/ Heart failure: diagnosis, management and utilization.] Journal of clinical medicine. 2016 Jul;5(7):62. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961993/ (last accessed 12.8.2020)</ref>.


==== '''Left Ventricular Failure (LVF)''': ====
Heart failure is a major public health concern in [[Global Health|countries worldwide]].  The increasing prevalence of heart failure in the population is most likely secondary to the aging of the population, increased risk factors, better outcomes for [[Acute Coronary Syndrome|acute coronary syndrome]] survivors, and a reduction in mortality from other [[Chronic Disease|chronic conditions]]<ref>King KC, Goldstein S. [https://www.statpearls.com/ArticleLibrary/viewarticle/19880 Congestive Heart Failure and Pulmonary Edema]. StatPearls [Internet]. 2021 Jan 20.Available: https://www.statpearls.com/ArticleLibrary/viewarticle/19880<nowiki/>(accessed 2.6.2021)</ref>. It is estimated that globally more than 25 million people are affected by HF.<ref name=":1">Britannica [https://www.britannica.com/science/heart-failure Heart Failure] Available: https://www.britannica.com/science/heart-failure<nowiki/>(accessed 1.6.2021)</ref>
This is the most common form of heart failure, gradually pushing up the pressure in the left atrium and pulmonary vascular system. The resulting pulmonary hypertension may force fluid into the alveoli creating pulmonary oedema. This can cause compensatory mechanisms<ref name="p3" />:
== Epidemiology ==
[[Image:Hf.png|right|frameless|620x620px]]
Heart failure is a significant public health problem with a prevalence of over 5.8 to 6.5 million in the U.S. and around 26 million worldwide<ref name=":0">Hajouli S, Ludhwani D. [https://www.ncbi.nlm.nih.gov/books/NBK553115/ Heart Failure And Ejection Fraction] 2020.Available from:https://www.ncbi.nlm.nih.gov/books/NBK553115/ (last accessed 11.8.2020)</ref>.


*Fast-acting neural systems increase sympathetic acting, raising heart rate and myocardial contractility
Multiple conditions can cause HF, including systemic diseases, a wide range of cardiac conditions, and some hereditary defects.
*The slower response of the renin-angiotensin mechanism promotes the retention of sodium and water by the kidney, increasing preload and encouraging myocardium to contract


The compensatory mechanisms raise the workload of the left ventricle further because angiotensin is an arterial vasoconstrictor and increases the afterload. Other factors that can increase the workload of the left ventricle are increased volume load as in aortic valve regurgitation, or increased resistance to flow such as with systemic hypertension.<ref name="p2">British Society for Heart Failure. National Heart Failure Audit. London. November 2013.</ref>
* Etiologies of HF vary between high-income and developing countries, and patients may have mixed etiologies.  
**[[Coronary Artery Disease (CAD)|Coronary artery disease]] and chronic obstructive pulmonary disease ([[COPD (Chronic Obstructive Pulmonary Disease)|COPD]]) are the most common underlying causes of HF in high-income regions.
** Conversely, hypertensive heart disease, [[Rheumatic Heart Disease|rheumatic heart disease]], [[Cardiomyopathies|cardiomyopathy]], and myocarditis are the primary conditions for HF in low-income regions, according to a systemic analysis for the Global Burden of Disease Study.
* More than two-thirds of all cases of HF are attributable to ischemic heart disease, COPD, hypertensive heart disease, and rheumatic heart disease.<ref name=":3" />  


==== '''Right Ventricle Failure (RVF):''' ====
== Aetiology ==
This generally occurs secondary to cardiopulmonary disorders such as pulmonary hypertension, right ventricle infarction, congenital heart disease, pulmonary embolism or [[COPD (Chronic Obstructive Pulmonary Disease)|COPD]]. It is usually irreversible unless the ventricles are under-loaded e.g. by lung transplant for pulmonary hypertension. Enlargement of the right ventricle that has resulted from lung disease is referred to as cor pulmonale and is caused by hypoxic vasoconstriction and pulmonary hypertension.<ref name="p3" />
There are multiple risk factors for heart failure, including older age (65 years or over), being male, having a family history of the condition, or having certain underlying conditions, particularly [[Myocardial Infarction|myocardial infarction]] , cardiac valve insufficiency (leaking) or stenosis (narrowing), and [[diabetes]]. Certain lifestyle factors—such as tobacco smoking, [[Alcoholism|alcohol]] consumption, [[Physical Inactivity|physical inactivity]], and a diet that predisposes individuals to [[Hyperlipidemia|high cholesterol]] and high blood pressure—also raise the risk of developing heart failure<ref name=":1" />


==== '''[[Inroduction to Congestive Heart Failure|Congestive Cardiac Failure]] (CCF): ''' ====
== Clinical presentation ==
The combination of LVF and RVF with congestion in the pulmonary and systemic circulations<ref name="p3" />
Although it is useful to divide the signs and symptoms of heart failure according to the degree of left or right ventricular dysfunction, the heart is an integrated pump, and patients commonly present with both sets of signs and symptoms.


<br>
Left ventricular failure: Patients usually report fatigue, [[Dyspnoea|dyspnea]] on exertion, and if severe, at rest. Orthopnea, paroxysmal nocturnal dyspnea and Cheyne-Stokes respiration can also be a feature.


[[Image:Large.png|center]]  
* On examination tachypnea, dyspnea, tachycardia, [[hypotension]] and cyanosis may be observed. Palpation may reveal a laterally displaced apex beat while cardiac auscultation may elicit murmurs such as aortic stenosis or mitral regurgitation. Features of [[Pulmonary Oedema|pulmonary edema]] eg inspiratory bibasal crackles not cleared on coughing, diminished [[Auscultation|breath sounds]] and dullness to percussion, may also be noted.


<br>
Right ventricular failure: Symptoms include [[Oedema Assessment|ankle swelling]], fatigue, abdominal bloating/discomfort and nocturia.


<u>'''Helpful Terminology:'''</u>
* Evidence of right ventricular failure can manifest as peripheral edema (if severe extending to thighs and sacrum), ascites, hepatomegaly, elevated jugular venous pressure (JVP). JVP can be further accentuated by hepatojugular reflux. Cardiac murmurs may also be heard, commonly tricuspid regurgitation.


*'''Stroke volume: '''volume of blood ejected by the ventricle in one contraction, usually 70ml
Clinical severity varies significantly and usually classified according to the New York Heart Association, which is graded according to how much physical activity is decreased<ref name=":4" />.
*'''End diastolic volume:''' volume of blood in the ventricle at the end of filling, just before it contracts, usually 120ml
*'''Ejection fraction: '''stroke volume expressed as a percentage of end-diastolic volume, normally &gt;55%
*'''Systolic heart failure:''' reduced or weakened pumping action of the heart, with ejection fraction &lt;55%
*'''Diastolic heart failure:''' low compliance of myocardium, but with normal contraction and normal ejection fraction
*'''Preload:''' degree of stretch applied to the ventricle before contraction
*'''Afterload:''' the load that the ventricle must overcome to eject blood<ref name="p3" /><br>


==== NYHA GRADING<ref>http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.WF1jIFN97IU</ref>  ====
== Pathology ==
[[File:Fig-2-Changes-in-the-myocardium-during-aging-Heart-and-vasculature-undergo-alterations.png|right|frameless|583x583px]]Myocardial damage due to [[Myocardial Infarction|myocardial infarcts]], [[Cardiomyopathies|cardiomyopathy]] and myocarditis can cause or aggravate heart failure.  


{| width="400" border="1" cellpadding="1" cellspacing="1"
Additionally, [[Cardiac Valve Defects|valvular disease]] such as aortic stenosis or mitral regurgitation may result in heart failure as well.  
|-
| CLASS
| PATIENT SYMPTOMS
|-
| I
| No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath
|-
| II
| Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).<br>
|-
| III
| Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea
|-
| IV
| Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
|}


{{#ev:youtube|YLjLFSdGxEU}}<ref>classification system of heart failure</ref><br>
Further causes include conduction defects, [[Heart Arrhythmias: Assessment|cardiac arrhythmia]] and infiltrative/matrix disorders.


== Epidemiology  ==
Systemic factors that may contribute or exacerbate heart failure include [[Anaemia|anemia]], [[hyperthyroidism]] or [[hypertension]]<ref name=":4">Radiopedia [https://radiopaedia.org/articles/heart-failure-summary?lang=us heart failure] Available: https://radiopaedia.org/articles/heart-failure-summary?lang=us<nowiki/>(accessed 19.9.2021)</ref>.


It is estimated that around 800,000 people in the UK suffer from heart failure, a number which will continue to rise due to an ageing population, improved survival rates following a heart attack, and more effective treatments.<ref name="p2" /> The prevalence of heart failure doubles with each decade. The British Heart Foundation statistics estimate the incidence and prevalence of heart failure in the UK, using the Clinical Practice Research data, show that both rise steeply with age.<ref name="p2" /> The British Heart Foundation reports that 0.9% of men and 0.7% of women in the UK suffer from heart failure, rising to 13.1% of men and 11.9% of women aged over 75 years old.<ref name="p2" />
See also [[Cardiovascular Considerations in the Older Patient]]


<br>Heart failure is the leading cause of hospitalisation in the elderly population and accounts for one million inpatient bed-days<ref name="p1" />. Survival rates for heart failure patients are variable, dependent on the age and severity of disease of the patient, and the quality of care they receive<ref name="p1" />. Outcomes are consistently poor for patients who receive suboptimal care, but input from heart failure specialists and prescription of evidence-based heart failure therapies have a significant impact on prognosis and life expectancy<ref name="p2" />. The National Heart Failure Audit has reported around one in ten patients dying in hospital, and of those who survive between one-quarter and one-third dying within the year of their admission<ref name="p2" />. However, these mortality rates are beginning to reduce, reflecting more consistent implementation of guidelines for recommended practice.<ref name="p2" /><br>
== Management  ==
[[File:Digoxin vial.jpg|right|frameless|496x496px]]Prognosis is usually poor unless the underlying cause is reversed. As a result, patients generally gradually deteriorate with episodes of acute decompensation and ultimately death.


== Aetiology  ==
In addition to treating the underlying cause of heart failure, management is directed at dietary and lifestyle changes, medications including [[ACE Inhibitors: Congestive Heart Failure|ACE inhibitors]] or [[Beta-Blockers in the treatment of congestive heart failure|beta blockers]] and if appropriate, [[Cardiac Implantable Electronic Devices (CIEDs)|implantable cardioverter-defibrillator]] (ICD) or cardiac resynchronisation therapy (CRT).<ref name=":4" /> [[Diuretics|Diuretic]]<nowiki/>s are prescribed to remove excess fluid. [[Glycosides and Congestive Heart Failure|Digoxin and digitoxin]] are commonly prescribed to increase the strength of heart contraction<ref name=":1" />.


It is rare for heart failure to be derived from one cause, it is normally multi-factorial. A number of health conditions increase your chances of developing heart failure but in general, it is caused by an excess workload placed on the heart<ref name="p3" />. The excess workload on the heart involves on or both ventricles and is thought to relate to oxidative stress and inflammation which leads to one or more of the following:<ref name="p3" />
Patients are also advised to limit their intake of salt and fluids, avoid alcohol and nicotine, optimize their body weight, and engage in [[Aerobic Exercise|aerobic exercise]] as much as possible. Much can be done to prevent and treat heart failure, but ultimately the prognosis depends on the underlying disease causing the difficulty as well as the severity of the condition at the time of presentation.


*Impaired contractibility of the myocardium, e.g. after acute coronary syndromes
See also [[Congestive Heart Failure - Pharmacotherapy|Pharmacological Management of Heart Failure]]
*Increased afterload e.g. with hypertension or aortic valve stenosis
*Increased preload e.g. with mitral or aortic valve regurgitation


In addition anaemia, overactive thyroid gland (hyperthyroidism), pulmonary hypertension, diabetes, chronic renal impairment, chronic obstructive pulmonary disease (COPD), and asthma are reported as potential causes of heart failure.<ref name="p1" /><br>
=== Physiotherapy ===
 
[[File:Exercise older person.jpg|right|frameless]]
== Pathophysiology  ==
Physiotherapy is important in the management of heart failure. The cornerstone of physiotherapy management is [[Cardiac Rehabilitation|cardiac rehabilitation]]. In patients undergoing heart surgery, physiotherapy can also help with recovery after surgery.
 
In response to increased load, the left ventricular myocardium hypertrophies. The greater size and number of myocytes raise myocardial oxygen demand and increases diffusion distance for oxygen. Some muscle fibres become ischaemic, leading to patchy fibrosis, stiffness and reduced contractability<ref name="p1" />. The workload may cause the ventricle to stretch and dilate, leading to further force being required to maintain cardiac output<ref name="p1">Dickstein, K.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure. 2008. Aug;10:933-989.</ref>. Systolic failure is by reduced ejection fraction and diastolic failure is by reduced end-diastolic volume. Metabolic effects include loss of bone mineralisation, skeletal muscle and fat<ref name="p3">Hough, A. Physiotherapy in Respiratory and Cardiac Care: An Evidence Based Approach. Hampshire. Cengage Learning EMEA; 2014.</ref>.
 
The stiffness and reduced contractibility push up end-diastolic pressure, which is transmitted back along the pulmonary veins to the pulmonary capillaries, which causes fluid to be forced into the interstitial spaces and, if severe, into the alveoli, causing pulmonary oedema. The increased pulmonary vascular pressure raises the afterload of the right ventricle, in the same way as chronic systemic hypertension raises the afterload of the left ventricle<ref name="p2" />. Hypertrophy, patchy fibrosis, stiffness and reduced contractibility of the right ventricular myocardium then ensues, as with left ventricle, and congestive cardiac failure develops<ref name="p1" />.
 
<br>
 
== Clinical Manifestations  ==
 
[[Image:Hf.png|center]]
 
==== Typical ====
*Breathlessness
*Ankle swelling
*Fatigue
*Orthopnea
*Reduced Exercise Tolerance<br> <br>
 
These are the typical signs and symptoms of heart failure. Research suggests abnormalities of the pulmonary system leads to the exertional dyspnea and exercise intolerance and treating the pulmonary symptoms yield positive results in patients with chronic heart failure<ref>Lalande S, Cross TJ, Keller-Ross ML, Morris NR, Johnson BD, Taylor BJ. [https://www.ncbi.nlm.nih.gov/pubmed/31453845 Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System.] Exercise and sport sciences reviews. 2019 Aug.</ref>. Another study suggests that patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications, which was a result of the decrease of autonomic nervous activity<ref>ISHIHARA K, MORISAWA T, KAWADA J, NAGARE Y, KOYAMA T, YAGI H, SUEOKA M, YOSHIDA T, TAMAKI A. [https://pubmed.ncbi.nlm.nih.gov/32015945-influence-of-complications-of-diabetes-mellitus-on-exercise-tolerance-of-patients-with-heart-failure-focusing-on-autonomic-nervous-activity-and-heart-rate-response-during-cardiopulmonary-exercise-tests/ Influence of Complications of Diabetes Mellitus on Exercise Tolerance of Patients with Heart Failure: Focusing on autonomic nervous activity and heart rate response during cardiopulmonary exercise tests.] Physical Therapy Research. 2019 Dec 20;22(2):81-9.</ref>. However, heart failure may be hard to diagnose using only these characteristics, especially in women, elderly, pregnant or obese patients as they are fairly common and widespread symptoms found in many other diseases. Due to this, suspected heart failure and patients following this pattern should be assessed carefully and using different methods to get a full picture of the condition.  


Fatigue is an essential symptom of heart failure. The cause of fatigue includes low cardiac output, peripheral hypoperfusion, and skeletal muscle deconditioning and is confounded by difficulties in quantifying this symptom. ☃☃Peripheral oedema, raised venous pressure, and hepatomegaly are the characteristic signs of congestion of systemic veins. Clinical signs of heart failure should be assessed in clinical examinations including palpation observation,and auscultation of the patient. <br>
Up until the late 1980s, exercise was considered unsafe for the patient with HF. It was unclear whether any benefit could be gained from rehabilitation, and concern also existed regarding patient safety, with the belief that additional myocardial stress would cause further harm. Since this time, considerable research has been completed and the evidence resoundingly suggests that exercise for this patient group is not only safe but also provides substantial physiological and psychological benefits. As such, exercise is now considered an integral component of the non pharmacological management of these patients


==== More Specific&nbsp; ====
==== Aims of effective treatment for heart failure ====
*Elevated Jugular Venous Pressure
*Heptojugular Reflux
*Third Heart Sound (Gallop Rhythm)
*Laterally Displaced Apical Impulse
*Cardiac Mumur<br>
 
== Management  ==
 
=== Physiotherapy ===
Effective treatment for heart failure should aim to:
*Strengthen the heart  
*Strengthen the heart  
*Improve symptoms  
*Improve symptoms  
*Reduce the risk of a flare-up or worsening of symptoms  
*Reduce the risk of a flare-up or worsening of symptoms  
*Improve Quality of Life  
*Improve [[Quality of Life]]
*Offer longevity<br>
*Offer longevity
 
With all patients, especially heart failure populations, the complex interactions between the multidisciplinary teams involved is imperative. The study suggested a positive outcome of exercise training on heart rate variability in patients with heart failure after percutaneous coronary intervention<ref>Stein PK, Ehsani AA, Domitrovich PP, Kleiger RE, Rottman JN. [https://www.ncbi.nlm.nih.gov/pubmed/30881939 Effect of exercise training on heart rate variability in healthy older adults.] American heart journal. 1999 Sep 1;138(3):567-76.</ref>.
 
A physiotherapist's role is to be involved before an incident occurs as a preventative method (if possible) whilst also improving quality of life, continuing recovery immediately after surgery, and providing education to leading a more balanced life. Research suggests that physical therapists, along with other health care members, enhance the physical activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related hospital re-admissions.<ref>Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. [https://pubmed.ncbi.nlm.nih.gov/31972027/ Physical therapist clinical practice guideline for the management of individuals with heart failure.] Physical Therapy. 2020 Jan 23;100(1):14-43.</ref> A cross-sectional study recommends cardiopulmonary exercise testing (CPET) as an efficient tool in assessing functional capacity and prognosis in Heart Failure and COPD patients<ref>da Luz GC, Rossi CF, Tinoco AG, Marinho RS, de Faria CP, da Silva AT, Oliveira CR, Borghi-Silva A, Mendes RG, Goi RM. [https://pubmed.ncbi.nlm.nih.gov/32152432/ The Value of Cardiopulmonary Exercise Testing in Determining Severity in Patients with both Systolic Heart Failure and COPD]. Scientific Reports (Nature Publisher Group). 2020 Dec 1;10(1).</ref>. A recent study published in Clinical Cardiology suggested ventricular arrhythmias not meeting the criteria for terminating Cardiopulmonary Exercise Testing (CPET) predicts the prognosis and severity of disease in Heart Failure patients<ref>Popovic D, Arena R, Jakovljevic D, Ristic A, Guazzi M. [https://pubmed.ncbi.nlm.nih.gov/32271482/ Ventricular arrhythmias not meeting criteria for terminating cardiopulmonary exercise testing stratify prognosis and disease severity in heart failure of preserved, midrange, and reduced ejection fraction.] Clinical Cardiology. 2020 Apr 9.</ref>.
 
Systematic review and meta-analysis show a significant effect of aerobic and resistance training on peak oxygen consumption, muscle strength, and health-related quality of life in patients with heart failure with a reduced left ventricular ejection fraction<ref>Neto MG, Durães AR, Conceição LS, Roever L, Silva CM, Alves IG, Ellingsen Ø, Carvalho VO. [https://www.ncbi.nlm.nih.gov/pubmed/31345646 Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis.] International Journal of Cardiology. 2019 Jun 24.</ref>
 
Likewise, a recent study published in the Journal of Cardiopulmonary Rehabilitation and Prevention 2020, comparing the effects of β-blockers and non-β-blockers on Heart Rate (HR) and Oxygen Uptake (VO2) during exercise and recovery in older patients with heart failure with a preserved ejection fraction (HFpEF) demonstrated no significant differences in values (HRpeak, HRresv, HRrecov, or VO2) between both the groups, along with significant correlation between HRresv and VO2peak, suggesting the efficacy of these measures in prognostic and functional assessment and clinical applications, including the prescription of exercise, in elderly HFpEF patients<ref>Maldonado-Martín S, Brubaker PH, Ozemek C, Jayo-Montoya JA, Becton JT, Kitzman DW. [https://pubmed.ncbi.nlm.nih.gov/31899703-impact-of-blockers-on-heart-rate-and-oxygen-uptake-during-exercise-and-recovery-in-older-patients-with-heart-failure-with-preserved-ejection-fraction/ Impact of β-Blockers on Heart Rate and Oxygen Uptake During Exercise and Recovery in Older Patients With Heart Failure With Preserved Ejection Fraction.] Journal of Cardiopulmonary Rehabilitation and Prevention. 2020 Jan 2.</ref>.


The study by Lan NSR et al. shows a contrasting effect of aerobic training and resistance training on some echocardiographic parameters in patients with heart failure with reduced ejection fraction. While aerobic training was associated with evidence of worsening myocardial diastolic function, this was not apparent after resistance training. Further studies are indicated to investigate the long-term clinical significance of these adaptations<ref>Lan NS, Lam K, Naylor LH, Green DJ, Minaee NS, Dias P, Maiorana AJ. [https://pubmed.ncbi.nlm.nih.gov/31812550-the-impact-of-distinct-exercise-training-modalities-on-echocardiographic-measurements-in-patients-with-heart-failure-with-reduced-ejection-fraction/ The Impact of Distinct Exercise Training Modalities on Echocardiographic Measurements in Patients with Heart Failure with Reduced Ejection Fraction.] Journal of the American Society of Echocardiography. 2019 Dec 4.
==== Recent research findings ====
* Systematic review and meta-analysis show a significant effect of aerobic and resistance training on peak oxygen consumption, muscle strength, and health-related quality of life in patients with heart failure with a reduced left ventricular ejection fraction<ref>Neto MG, Durães AR, Conceição LS, Roever L, Silva CM, Alves IG, Ellingsen Ø, Carvalho VO. [https://www.ncbi.nlm.nih.gov/pubmed/31345646 Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis.] International Journal of Cardiology. 2019 Jun 24.</ref>
* A study published in the Journal of Cardiopulmonary Rehabilitation and Prevention 2020, comparing the effects of β-blockers and non-β-blockers on Heart Rate (HR) and Oxygen Uptake (VO2) during exercise and recovery in older patients with heart failure with a preserved ejection fraction (HFpEF) demonstrated no significant differences in values (HRpeak, HRresv, HRrecov, or VO2) between both the groups, along with significant correlation between HRresv and VO2peak, suggesting the efficacy of these measures in prognostic and functional assessment and clinical applications, including the prescription of exercise, in elderly HFpEF patients<ref>Maldonado-Martín S, Brubaker PH, Ozemek C, Jayo-Montoya JA, Becton JT, Kitzman DW. [https://pubmed.ncbi.nlm.nih.gov/31899703-impact-of-blockers-on-heart-rate-and-oxygen-uptake-during-exercise-and-recovery-in-older-patients-with-heart-failure-with-preserved-ejection-fraction/ Impact of β-Blockers on Heart Rate and Oxygen Uptake During Exercise and Recovery in Older Patients With Heart Failure With Preserved Ejection Fraction.] Journal of Cardiopulmonary Rehabilitation and Prevention. 2020 Jan 2.</ref>.
* Studies show a contrasting effect of aerobic training and resistance training on some echocardiographic parameters in patients with heart failure with reduced ejection fraction. While aerobic training was associated with evidence of worsening myocardial diastolic function, this was not apparent after resistance training. Further studies are indicated to investigate the long-term clinical significance of these adaptations<ref>Lan NS, Lam K, Naylor LH, Green DJ, Minaee NS, Dias P, Maiorana AJ. [https://pubmed.ncbi.nlm.nih.gov/31812550-the-impact-of-distinct-exercise-training-modalities-on-echocardiographic-measurements-in-patients-with-heart-failure-with-reduced-ejection-fraction/ The Impact of Distinct Exercise Training Modalities on Echocardiographic Measurements in Patients with Heart Failure with Reduced Ejection Fraction.] Journal of the American Society of Echocardiography. 2019 Dec 4.
</ref>.
</ref>.
 
* А single-blind, prospective randomized controlled trial suggests: modified group-based High-intensity aerobic interval training (HIAIT) intervention showed more considerable improvement as compared to moderate-intensity continuous training (MICT) in the rehabilitation of patients with chronic heart failure (CHF). Physical and rehabilitation medicine (PRM) physicians should apply Group based Cardiac intervention in routine cardiac rehabilitation (CR) practice<ref>MEDICA EM. [https://pubmed.ncbi.nlm.nih.gov/31976639/ Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial.] European Journal of Physical and Rehabilitation Medicine. 2020 Jan 23.</ref>.
А single-blind, prospective randomized controlled trial suggests that modified group-based High-intensity aerobic interval training (HIAIT) intervention showed more considerable improvement as compared to moderate-intensity continuous training (MICT) in the rehabilitation of patients with chronic heart failure (CHF). Thus, encouraging physical and rehabilitation medicine (PRM) physicians to apply Group based Cardiac intervention in routine cardiac rehabilitation (CR) practice<ref>MEDICA EM. [https://pubmed.ncbi.nlm.nih.gov/31976639/ Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial.] European Journal of Physical and Rehabilitation Medicine. 2020 Jan 23.</ref>.
* An article published online (March 2020) suggests positive outcomes with the High-intensity interval training (HIIT) for patients with heart failure along with preserved ejection fraction<ref>Paul J Beckers, Andreas B Gevaert [https://journals.sagepub.com/doi/pdf/10.1177/2047487320910294 High intensity interval training for heart failure with preserved ejection fraction: High hopes for intense exercise] European Journal of Preventive Cardiology 0(00) 1–3 The European S
 
An article published online (March 2020) suggests positive outcomes with the High-intensity interval training (HIIT) for patients with heart failure along with preserved ejection fraction<ref>Paul J Beckers, Andreas B Gevaert [https://journals.sagepub.com/doi/pdf/10.1177/2047487320910294 High intensity interval training for heart failure with preserved ejection fraction: High hopes for intense exercise] European Journal of Preventive Cardiology 0(00) 1–3 The European S
Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487320910294 journals.sagepub.com/home/cpr
Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487320910294 journals.sagepub.com/home/cpr
</ref>.
</ref>.
 
* A study assessing patients carrying out 5-months cardiac rehabilitation CR showed a lower rate of clinical events with higher maximal inspiratory pressure, suggesting that the changes in respiratory muscle strength independently predicted the occurrence of clinical manifestations in patients with Heart Failure HF<ref>Hamazaki N, Kamiya K, Yamamoto S, Nozaki K, Ichikawa T, Matsuzawa R, Tanaka S, Nakamura T, Yamashita M, Maekawa E, Meguro K. [https://pubmed.ncbi.nlm.nih.gov/32235491/ Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure.] Journal of Clinical Medicine. 2020 Apr;9(4):952.</ref>.
A study assessing patients carrying out 5-months cardiac rehabilitation CR showed a lower rate of clinical events with higher maximal inspiratory pressure, suggesting that the changes in respiratory muscle strength independently predicted the occurrence of clinical manifestations in patients with Heart Failure HF<ref>Hamazaki N, Kamiya K, Yamamoto S, Nozaki K, Ichikawa T, Matsuzawa R, Tanaka S, Nakamura T, Yamashita M, Maekawa E, Meguro K. [https://pubmed.ncbi.nlm.nih.gov/32235491/ Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure.] Journal of Clinical Medicine. 2020 Apr;9(4):952.</ref>.
* The results of a cross-sectional study in Spain by Raul Juarez-Vela et al. show that Heart Failure patients depend on others' care, especially for moving, dressing, personal hygiene, participating in daily and recreational activities, suggesting a weaker relationship between care dependency and the patients' physical deterioration<ref>Juárez-Vela R, Durante Á, Pellicer-García B, Cardoso-Muñoz A, Criado-Gutiérrez JM, Antón-Solanas I, Gea-Caballero V. [https://pubmed.ncbi.nlm.nih.gov/32993058/ Care Dependency in Patients with Heart Failure: A Cross-Sectional Study in Spain.] International Journal of Environmental Research and Public Health. 2020 Jan;17(19):7042.</ref>.


=== Multidisciplinary team members ===
=== Multidisciplinary team members ===
The other members of the MDT are vast but include  
The other members of the MDT are vast but include  
 
* Surgeons and consultants ''-'' They operate if needed. Numerous operations are available and may be suitable for certain patients. For example, [[Cardiac Valve Defects|Heart Valve Surgery]], Angioplasty or Bypass, Left Ventricular Assist Devices, [[Cardiac Implantable Electronic Devices (CIEDs)|Cardiac Inplant Electronic Devices]], Heart Transplant. However, this is individual and would need to be discussed with the consultant in charge of the case.
==== Surgeons and consultants ''-'' ====
* Nutritionists - They work out a diet plan to suit the individual needs of the patient. As diet is a risk factor for CHD this is an extremely important member of the MDT for further prevention.
They operate if needed. Numerous operations are available and may be suitable for certain patients. For example, Heart Valve Surgery, Angioplasty or Bypass, Left Ventricular Assist Devices, Heart Transplant.
* Counselor - As Heart failure is normally a lifelong condition the patient may have difficulty coming to terms with the impact this will have on their life. A counsellor will be available for sessions on coping with the disease.
 
* Personal Trainer- As with a Physiotherapist will help to provide a more balanced lifestyle and improve fitness levels. This is something that will not only give the patient goals to work towards but also important social interaction with someone who is seen as less of a medical figure and therefore adds more normality to the individuals day to day life.
However, this is individual and would need to be discussed with the consultant in charge of the case.
* Family and Friends- This support network is an extremely important factor contributing to recover of a patient and should not be overlooked.
 
The list of people involved in this team is huge and is not exhaustive in this piece, however, Pharmacists, Social Groups, GP’s, Nurses and Podiatrists are all members of this MDT. Recovery cannot occur without input and communication from every member of the team.  
==== Nutritionists - ====
They work out a diet plan to suit the individual needs of the patient. As diet is a risk factor for CHD this is an extremely important member of the MDT for further prevention.  
 
==== Counselor - ====
As Heart failure is normally a lifelong condition the patient may have difficulty coming to terms with the impact this will have on their life. A counsellor will be available for sessions on coping with the disease.  
 
==== Personal Trainer- ====
As with a Physiotherapist will help to provide a more balanced lifestyle and improve fitness levels. This is something that will not only give the patient goals to work towards but also important social interaction with someone who is seen as less of a medical figure and therefore adds more normality to the individuals day to day life.  
 
==== Family and Friends- ====
This support network is an extremely important factor contributing to recover of a patient and should not be overlooked.  
 
The list of people involved in this team is huge and is not exhaustive in this piece, however, Pharmacists, Social Groups, GP’s, Nurses and Podiatrists are all members of this MDT.  
 
Recovery cannot occur without input and communication from every member of the team. <br>


== Prevention  ==
== Prevention  ==


There are many factors that increase the risk of developing heart failure. And with some lifestyle changes and sometimes drug intervention this risk could be dramatically reduced. Hypertension and smoking are major risks for heart failure.  
There are many factors that increase the risk of developing heart failure. And with some lifestyle changes and sometimes drug intervention this risk could be dramatically reduced. Hypertension and smoking are major risks for heart failure.  
* [[Smoking Cessation and Brief Intervention|Stop smoking]]. Quitting smoking is noted as the single best way to reduce risk of heart failure. Smoking has many physiological effects forcing the heart to walk harder.
* Reduce [[Blood Pressure|blood pressure]]. High blood pressure increases the work demand put on the heart to transport blood around the body, this increased work causes a hypertrophic reaction of the heart muscle, eventually leading to a weakened or stiff heart.
* [[Hyperlipidemia|Reduce Cholesterol Level]]. High levels of cholesterol can cause furring and narrowing of the arteries termed atherosclerosis and eventually heart failure.
* Lose weight. Being overweight increases demand placed on the heart and increases risk of heart failure and attack.
* [[Nutrition|Eat a healthy diet]]. A healthy diet can help reduce your risk of developing coronary heart disease and therefore heart failure.
* Keep active. Regular [[Physical Activity|physical activity]] will help keep the heart healthy and also maintain a healthy weight.
* Reduce [[Alcoholism|Alcohol]] intake. Drinking excess of the recommended amount of alcohol per week can increase your blood pressure. Heavy drinking for long periods of time can cause damage to your heart muscle leading directly to heart failure.
* Cut your salt intake. Excessive salt intake increases blood pressure and again, increases stress put on the heart.


==== Stop smoking ====
== Viewing  ==
Quitting smoking is noted as the single best way to reduce risk of heart failure. Smoking has many physiological effects forcing the heart to walk harder. <br>Smoking increasing viscosity of the blood, slowing the blood and therefore increasing risk of thrombosis (blood clots). It also causes damage to the arterie lining leading to atherosclerosis and reduction in artery diameter.
The below is a 12 minute video on HF
 
{{#ev:youtube|v=2aiRpr5UCZs&list=PLbKSbFnKYVY2LhsYihIVUBpW6DJGMSSC4}}<ref>reference</ref>  
==== Reduce blood pressure====
High blood pressure increases the work demand put on the heart to transport blood around the body, this increased work causes a hypertrophic reaction of the heart muscle, eventually leading to a weakened or stiff heart. <br>Blood pressure medications and exercise can be used to modulate blood pressure.
 
==== Reduce Cholesterol Level ====
High levels of cholesterol can cause furring and narrowing of the arteries termed atherosclerosis and eventually heart failure.
 
==== Lose weight ====
Being overweight increases demand placed on the heart and increases risk of heart failure and attack.
 
==== Eat a healthy diet ====
A healthy diet can help reduce your risk of developing coronary heart disease and therefore heart failure.<br>Keep active<br>Regular physical activity will help keep the heart healthy and also maintain a healthy weight.
 
==== Reduce Alcohol intake ====
Drinking excess of the recommended amount of alcohol per week can increase your blood pressure.<br>Heavy drinking for long periods of time can cause damage to your heart muscle leading directly to heart failure.
 
==== Cut your salt intake ====
Excessive salt intake increases blood pressure and again, increases stress put on the heart.
 
== Resources  ==


*http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/What-is-Heart-Failure_UCM_002044_Article.jsp#.WEfn2rJ97IU<br>
== Resources ==
*http://www.heart.org/HEARTORG/Conditions/HeartFailure/WarningSignsforHeartFailure/Warning-Signs-of-Heart-Failure_UCM_002045_Article.jsp#.WEiD7LJ97IU
[https://www.racgp.org.au/getattachment/4342f9ab-e202-4f8e-b9aa-751ab2c45441/Exercise-based-rehabilitation-for-heart-failure.aspx Exercise based rehabilitation for heart failure]
*https://youtu.be/2aiRpr5UCZs?list=PLbKSbFnKYVY2LhsYihIVUBpW6DJGMSSC4<br>


== References  ==
== References  ==

Latest revision as of 06:47, 8 February 2023

Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.

Top Contributors - Lucinda hampton, Jayati Mehta, Vidya Acharya, Doireann Church, Caoimhe Mackey, Kim Jackson, Areeba Raja, Admin, WikiSysop, 127.0.0.1, Evan Thomas, Michelle Lee, Karen Wilson and Aminat Abolade

Introduction[edit | edit source]

Heart failure.png

Heart failure is a syndrome of cardiac ventricular dysfunction, where the heart is unable to pump sufficiently to meet the body's blood flow requirements.

  • The symptoms come from an inadequate cardiac output, failing to keep up with the metabolic demands of the body.
  • It is a leading cause of cardiovascular morbidity and mortality worldwide despite the advances in therapies and prevention.
  • It can result from disorders of the pericardium, myocardium, endocardium, heart valves, great vessels, or some metabolic abnormalities.[1]

Heart failure is a major public health concern in countries worldwide. The increasing prevalence of heart failure in the population is most likely secondary to the aging of the population, increased risk factors, better outcomes for acute coronary syndrome survivors, and a reduction in mortality from other chronic conditions[2]. It is estimated that globally more than 25 million people are affected by HF.[3]

Epidemiology[edit | edit source]

Hf.png

Heart failure is a significant public health problem with a prevalence of over 5.8 to 6.5 million in the U.S. and around 26 million worldwide[4].

Multiple conditions can cause HF, including systemic diseases, a wide range of cardiac conditions, and some hereditary defects.

  • Etiologies of HF vary between high-income and developing countries, and patients may have mixed etiologies.
    • Coronary artery disease and chronic obstructive pulmonary disease (COPD) are the most common underlying causes of HF in high-income regions.
    • Conversely, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, and myocarditis are the primary conditions for HF in low-income regions, according to a systemic analysis for the Global Burden of Disease Study.
  • More than two-thirds of all cases of HF are attributable to ischemic heart disease, COPD, hypertensive heart disease, and rheumatic heart disease.[1]

Aetiology[edit | edit source]

There are multiple risk factors for heart failure, including older age (65 years or over), being male, having a family history of the condition, or having certain underlying conditions, particularly myocardial infarction , cardiac valve insufficiency (leaking) or stenosis (narrowing), and diabetes. Certain lifestyle factors—such as tobacco smoking, alcohol consumption, physical inactivity, and a diet that predisposes individuals to high cholesterol and high blood pressure—also raise the risk of developing heart failure[3]

Clinical presentation[edit | edit source]

Although it is useful to divide the signs and symptoms of heart failure according to the degree of left or right ventricular dysfunction, the heart is an integrated pump, and patients commonly present with both sets of signs and symptoms.

Left ventricular failure: Patients usually report fatigue, dyspnea on exertion, and if severe, at rest. Orthopnea, paroxysmal nocturnal dyspnea and Cheyne-Stokes respiration can also be a feature.

  • On examination tachypnea, dyspnea, tachycardia, hypotension and cyanosis may be observed. Palpation may reveal a laterally displaced apex beat while cardiac auscultation may elicit murmurs such as aortic stenosis or mitral regurgitation. Features of pulmonary edema eg inspiratory bibasal crackles not cleared on coughing, diminished breath sounds and dullness to percussion, may also be noted.

Right ventricular failure: Symptoms include ankle swelling, fatigue, abdominal bloating/discomfort and nocturia.

  • Evidence of right ventricular failure can manifest as peripheral edema (if severe extending to thighs and sacrum), ascites, hepatomegaly, elevated jugular venous pressure (JVP). JVP can be further accentuated by hepatojugular reflux. Cardiac murmurs may also be heard, commonly tricuspid regurgitation.

Clinical severity varies significantly and usually classified according to the New York Heart Association, which is graded according to how much physical activity is decreased[5].

Pathology[edit | edit source]

Fig-2-Changes-in-the-myocardium-during-aging-Heart-and-vasculature-undergo-alterations.png

Myocardial damage due to myocardial infarcts, cardiomyopathy and myocarditis can cause or aggravate heart failure.

Additionally, valvular disease such as aortic stenosis or mitral regurgitation may result in heart failure as well.

Further causes include conduction defects, cardiac arrhythmia and infiltrative/matrix disorders.

Systemic factors that may contribute or exacerbate heart failure include anemia, hyperthyroidism or hypertension[5].

See also Cardiovascular Considerations in the Older Patient

Management[edit | edit source]

Digoxin vial.jpg

Prognosis is usually poor unless the underlying cause is reversed. As a result, patients generally gradually deteriorate with episodes of acute decompensation and ultimately death.

In addition to treating the underlying cause of heart failure, management is directed at dietary and lifestyle changes, medications including ACE inhibitors or beta blockers and if appropriate, implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT).[5] Diuretics are prescribed to remove excess fluid. Digoxin and digitoxin are commonly prescribed to increase the strength of heart contraction[3].

Patients are also advised to limit their intake of salt and fluids, avoid alcohol and nicotine, optimize their body weight, and engage in aerobic exercise as much as possible. Much can be done to prevent and treat heart failure, but ultimately the prognosis depends on the underlying disease causing the difficulty as well as the severity of the condition at the time of presentation.

See also Pharmacological Management of Heart Failure

Physiotherapy[edit | edit source]

Exercise older person.jpg

Physiotherapy is important in the management of heart failure. The cornerstone of physiotherapy management is cardiac rehabilitation. In patients undergoing heart surgery, physiotherapy can also help with recovery after surgery.

Up until the late 1980s, exercise was considered unsafe for the patient with HF. It was unclear whether any benefit could be gained from rehabilitation, and concern also existed regarding patient safety, with the belief that additional myocardial stress would cause further harm. Since this time, considerable research has been completed and the evidence resoundingly suggests that exercise for this patient group is not only safe but also provides substantial physiological and psychological benefits. As such, exercise is now considered an integral component of the non pharmacological management of these patients

Aims of effective treatment for heart failure[edit | edit source]

  • Strengthen the heart
  • Improve symptoms
  • Reduce the risk of a flare-up or worsening of symptoms
  • Improve Quality of Life
  • Offer longevity

Recent research findings[edit | edit source]

  • Systematic review and meta-analysis show a significant effect of aerobic and resistance training on peak oxygen consumption, muscle strength, and health-related quality of life in patients with heart failure with a reduced left ventricular ejection fraction[6]
  • A study published in the Journal of Cardiopulmonary Rehabilitation and Prevention 2020, comparing the effects of β-blockers and non-β-blockers on Heart Rate (HR) and Oxygen Uptake (VO2) during exercise and recovery in older patients with heart failure with a preserved ejection fraction (HFpEF) demonstrated no significant differences in values (HRpeak, HRresv, HRrecov, or VO2) between both the groups, along with significant correlation between HRresv and VO2peak, suggesting the efficacy of these measures in prognostic and functional assessment and clinical applications, including the prescription of exercise, in elderly HFpEF patients[7].
  • Studies show a contrasting effect of aerobic training and resistance training on some echocardiographic parameters in patients with heart failure with reduced ejection fraction. While aerobic training was associated with evidence of worsening myocardial diastolic function, this was not apparent after resistance training. Further studies are indicated to investigate the long-term clinical significance of these adaptations[8].
  • А single-blind, prospective randomized controlled trial suggests: modified group-based High-intensity aerobic interval training (HIAIT) intervention showed more considerable improvement as compared to moderate-intensity continuous training (MICT) in the rehabilitation of patients with chronic heart failure (CHF). Physical and rehabilitation medicine (PRM) physicians should apply Group based Cardiac intervention in routine cardiac rehabilitation (CR) practice[9].
  • An article published online (March 2020) suggests positive outcomes with the High-intensity interval training (HIIT) for patients with heart failure along with preserved ejection fraction[10].
  • A study assessing patients carrying out 5-months cardiac rehabilitation CR showed a lower rate of clinical events with higher maximal inspiratory pressure, suggesting that the changes in respiratory muscle strength independently predicted the occurrence of clinical manifestations in patients with Heart Failure HF[11].
  • The results of a cross-sectional study in Spain by Raul Juarez-Vela et al. show that Heart Failure patients depend on others' care, especially for moving, dressing, personal hygiene, participating in daily and recreational activities, suggesting a weaker relationship between care dependency and the patients' physical deterioration[12].

Multidisciplinary team members[edit | edit source]

The other members of the MDT are vast but include

  • Surgeons and consultants - They operate if needed. Numerous operations are available and may be suitable for certain patients. For example, Heart Valve Surgery, Angioplasty or Bypass, Left Ventricular Assist Devices, Cardiac Inplant Electronic Devices, Heart Transplant. However, this is individual and would need to be discussed with the consultant in charge of the case.
  • Nutritionists - They work out a diet plan to suit the individual needs of the patient. As diet is a risk factor for CHD this is an extremely important member of the MDT for further prevention.
  • Counselor - As Heart failure is normally a lifelong condition the patient may have difficulty coming to terms with the impact this will have on their life. A counsellor will be available for sessions on coping with the disease.
  • Personal Trainer- As with a Physiotherapist will help to provide a more balanced lifestyle and improve fitness levels. This is something that will not only give the patient goals to work towards but also important social interaction with someone who is seen as less of a medical figure and therefore adds more normality to the individuals day to day life.
  • Family and Friends- This support network is an extremely important factor contributing to recover of a patient and should not be overlooked.

The list of people involved in this team is huge and is not exhaustive in this piece, however, Pharmacists, Social Groups, GP’s, Nurses and Podiatrists are all members of this MDT. Recovery cannot occur without input and communication from every member of the team.

Prevention[edit | edit source]

There are many factors that increase the risk of developing heart failure. And with some lifestyle changes and sometimes drug intervention this risk could be dramatically reduced. Hypertension and smoking are major risks for heart failure.

  • Stop smoking. Quitting smoking is noted as the single best way to reduce risk of heart failure. Smoking has many physiological effects forcing the heart to walk harder.
  • Reduce blood pressure. High blood pressure increases the work demand put on the heart to transport blood around the body, this increased work causes a hypertrophic reaction of the heart muscle, eventually leading to a weakened or stiff heart.
  • Reduce Cholesterol Level. High levels of cholesterol can cause furring and narrowing of the arteries termed atherosclerosis and eventually heart failure.
  • Lose weight. Being overweight increases demand placed on the heart and increases risk of heart failure and attack.
  • Eat a healthy diet. A healthy diet can help reduce your risk of developing coronary heart disease and therefore heart failure.
  • Keep active. Regular physical activity will help keep the heart healthy and also maintain a healthy weight.
  • Reduce Alcohol intake. Drinking excess of the recommended amount of alcohol per week can increase your blood pressure. Heavy drinking for long periods of time can cause damage to your heart muscle leading directly to heart failure.
  • Cut your salt intake. Excessive salt intake increases blood pressure and again, increases stress put on the heart.

Viewing[edit | edit source]

The below is a 12 minute video on HF

[13]

Resources[edit | edit source]

Exercise based rehabilitation for heart failure

References[edit | edit source]

  1. ↑ 1.0 1.1 Hajouli S, Ludhwani D. Heart failure and ejection fraction.Available: https://www.ncbi.nlm.nih.gov/books/NBK553115/(accessed 19.9.2021)
  2. ↑ King KC, Goldstein S. Congestive Heart Failure and Pulmonary Edema. StatPearls [Internet]. 2021 Jan 20.Available: https://www.statpearls.com/ArticleLibrary/viewarticle/19880(accessed 2.6.2021)
  3. ↑ 3.0 3.1 3.2 Britannica Heart Failure Available: https://www.britannica.com/science/heart-failure(accessed 1.6.2021)
  4. ↑ Hajouli S, Ludhwani D. Heart Failure And Ejection Fraction 2020.Available from:https://www.ncbi.nlm.nih.gov/books/NBK553115/ (last accessed 11.8.2020)
  5. ↑ 5.0 5.1 5.2 Radiopedia heart failure Available: https://radiopaedia.org/articles/heart-failure-summary?lang=us(accessed 19.9.2021)
  6. ↑ Neto MG, Durães AR, Conceição LS, Roever L, Silva CM, Alves IG, Ellingsen Ø, Carvalho VO. Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis. International Journal of Cardiology. 2019 Jun 24.
  7. ↑ Maldonado-Martín S, Brubaker PH, Ozemek C, Jayo-Montoya JA, Becton JT, Kitzman DW. Impact of β-Blockers on Heart Rate and Oxygen Uptake During Exercise and Recovery in Older Patients With Heart Failure With Preserved Ejection Fraction. Journal of Cardiopulmonary Rehabilitation and Prevention. 2020 Jan 2.
  8. ↑ Lan NS, Lam K, Naylor LH, Green DJ, Minaee NS, Dias P, Maiorana AJ. The Impact of Distinct Exercise Training Modalities on Echocardiographic Measurements in Patients with Heart Failure with Reduced Ejection Fraction. Journal of the American Society of Echocardiography. 2019 Dec 4.
  9. ↑ MEDICA EM. Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2020 Jan 23.
  10. ↑ Paul J Beckers, Andreas B Gevaert High intensity interval training for heart failure with preserved ejection fraction: High hopes for intense exercise European Journal of Preventive Cardiology 0(00) 1–3 The European S Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487320910294 journals.sagepub.com/home/cpr
  11. ↑ Hamazaki N, Kamiya K, Yamamoto S, Nozaki K, Ichikawa T, Matsuzawa R, Tanaka S, Nakamura T, Yamashita M, Maekawa E, Meguro K. Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure. Journal of Clinical Medicine. 2020 Apr;9(4):952.
  12. ↑ Juárez-Vela R, Durante Á, Pellicer-García B, Cardoso-Muñoz A, Criado-Gutiérrez JM, Antón-Solanas I, Gea-Caballero V. Care Dependency in Patients with Heart Failure: A Cross-Sectional Study in Spain. International Journal of Environmental Research and Public Health. 2020 Jan;17(19):7042.
  13. ↑ reference
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