3. INTRODUCTION
• Heart failure (HF) is often referred as congestive
heart failure (CHF)
• Occurs when heart is unable to pump sufficiently to
maintained blood flow to meets the body needs
This condition results from -
• SYSTOLIC DYSFUNCTION
• DIASTOLIC DYSFUNCTION
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4. Heart Failure: Key Concepts
•
Cardiac output (CO) = Stroke Volume (SV) x Heart Rate
(HR)
– Becomes insufficient to meet metabolic needs of body
•
•
Ejection Fraction (EF) (proportion of blood pumped out)
Normal EF = 55 to 75 percent
•
Classifications HF–
–
Systolic failure – decrease contractility
Diastolic failure – decrease filling
Mixed
8. LHF
• left ventricle cardiac output is decreased.
• blood accumulates in the left ventricle, left atrium.
• Result is pulmonary congestion
• pulmonary interstitial edema and impaired gas
exchange.
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9. RHF
• Right ventricle cardiac output is less then volume
received from the peripheral venous circulation
• blood accumulates in RA, RV and peripheral venous
system
• Increased venous pressure lead increased
capillary hydrostatic and peripheral Edima.
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12. ACUTE V/S CHRONIC
• Acute failure occurs in response to a sudden
decrease in cardiac output which results in rapid
decrease in tissue perfusion. Ex: drug toxicity
• Chronic failure occurs slowly, giving time to the
body to adjust to decrease in cardiac output
through compensatory mechanisms which
results in systemic congestion.
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13. INCIDENCE
• More than 20 million people have heart failure
worldwide
• Prevalence of heart failure in India due to
• Coronary heart disease
• Hypertension
• Obesity
• Diabetes
• Rheumatic heart disease
• Ranges from 1.3 to 4.6 million, with an annual
incidence of 491 600-1.8 million.
• Heart failure is the leading cause of
hospitalization > 65 years age 13
14. ETIOLOGY
The incidence of heart failure increases with
advancing age and coronary artery disease
• Diabetes
• Cigarette Smoking
• Obesity
• Elevated Total Cholesterol
• Abnormally High or Low Hematocrit Level
• Chronic Kidney Disease and Proteinuria
Common precipitating causes of Heart Failure are as
follows
• Anaemia
• Infection
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17. SURGICAL MANAGEMENT
HEART TRANSPLANTATION:
When the heart is irreversibly managed and no
longer functions adequately and when the client is
at risk of dying
cardiac transplantation and use of an artificial
heart to assist or replace the failing heart are
soluitions
A heart transplant, or a cardiac transplant, is a
surgical transplant procedure performed on
patients with end-stage heart failure or severe
coronary artery disease when other medical or
surgical treatments have failed as a last resort.
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18. CARDIOMYOPLASTY
• Cardiomyoplasty is a surgical procedure in which
healthy muscle from another part of the body is
wrapped around the heart to provide support for
the failing heart.
• VENTRICULAR ASSIST DEVICE(VAD):
• It is a Electromechanical device for assisting
cardiac circulation, which is used either to
partially or to completely replace the function of
a failing heart.
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19. MANAGEMENT
• Cardiac rehabilitation
• should be offered to all cardiac patients who would
benefit:
• Recent myocardial infarction
• Acute coronary artery syndrome
• Chronic stable angina
• Congestive heart failure
• After coronary artery bypass surgery
• After a percutaneous coronary intervention
• Valvular surgery
• Cardiac transplantation
• CR begins as soon as possible in ICU (only if the patient
is in stablemedical condition).
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20. Goals of Cardiac Rehabilitation
• Comprehensive cardiac rehabilitation program should contain
specific corecomponents.
• These components should optimize cardiovascular risk
reduction, reduce disability, encourage active and healthy lifestyle
changes, and help maintain those healthy habits after rehabilitation is
complete..
• Reduce the risk of sudden death or reinfarction,
• Control cardiac symptom,
• Stabilize and reverse the atherosclerotic process and
• Enhance the psychological and vocational status of selective patients
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22. Phase I Cardiac Rehabilitation
• Involves immediate inpatient exercise rehabilitation that emphasizes:
a) Patient education (informal discussions with nurses and physicians) and
b) Counselling.
• Exercise therapy-
a) Musculoskeletal ROM activities.
b) ADLs (sitting, standing, and walking).
• Purpose:
a) Counter the deconditioning effects of prolonged bed rest,
b) Prepare patient for a return to normal daily activities.
23. Phase II: Outpatient cardiac rehab
• Once a patient is stable and cleared by cardiology, outpatient cardiac
rehabilitation may begin.
• Phase II typically lasts three to six weeks though some may last up to
up to twelve weeks. Initially, patients have an assessment with a focus
on identifying limitations in physical function, restrictions of
participation secondary to comorbidities, and limitations toactivities.
• A more rigorous patient-centered therapy plan is designed, comprising
three modalities: information/advice, tailored training program, and a
relaxation program. The treatment phase intends to promote
independence and lifestyle changes to prepare patients to return to
their lives at home.
24. Phase III: Post-cardiac rehab. Maintenance
• This phase involves more independence and self-monitoring. Phase III
centers on increasing flexibility, strengthening, and aerobic
conditioning.
• Goal: facilitate long term maintenance of lifestyle changes,
monitoring risk factor changes and secondaryprevention.
• FIIT PRINCIPLE:
Frequency
3-5 times/week
Intensity
60-80 % HRmax
Duration
30-60 min
Activity
ROM, biking, jogging, swimming,
25. Patient shouldn’t exercise if they are generally unwell,
symptomatic or clinically unstable on arrival;
• Fever/acute systemic illness
• Unresolved/unstable angina
• Resting BP systolic >200mmHg and diastolic >110mmHg
• Significant drop in BP
• Symptomatic hypotension
• Resting/uncontrolled tachycardia (>100bpm)
• Uncontrolled atrial or ventricular arrhythmias
• New/recurrent symptoms of breathlessness, lethargy, palpitations,
dizziness
• Unstable heart failure
• Unstable/uncontrolled diabetes
