Introduction to Congestive Heart Failure

What is 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, causing pulmonary hypertension. 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].

Physiotherapy Management

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[4].

A 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[5].

Physical therapy can play a key role in improving the well-being 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[6].

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[7],

Pharmacological Management

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. For more information on medications used to manage CHF see here


  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.
  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.
  4. Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical therapist clinical practice guideline for the management of individuals with heart failure. Physical Therapy. 2020 Jan 23;100(1):14-43.
  5. Gomes-Neto M, 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 Oct 15;293:165-75.
  6. Haennel, R. G. (2012). Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants. Cardiopulmonary Physical Therapy Journal, 23(3), 23–28.
  7. 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.