Congestive Heart Failure

Overview of Heart Failure

This condition is due to the heart being unable to supply enough blood to the body's tissues. The lungs are significantly affected as a backup of blood in the pulmonary veins leads to pulmonary hypertension. This condition also affects the function of numerous organs and tissues. Heart failure is usually the consequence of ischemic and hypertensive heart disease. There are four types of heart failure, based on the cause and location of myocardium damage. The Functional Classification of Heart Failure, based on the client's tolerance to physical activities, is used to help determine the progression of the disease.^1,2 Treatment is focused on the primary cause of the condition, using diet, medication, and exercise to manage it. Some clients will have undergone heart valve replacement, coronary artery bypass grafting, or heart reduction surgery. Clients experience significant dyspnea and fatigue with physical activities due to the heart's inability to adequately supply blood to extremities, which in turn leads to atrophy of extremity muscles.¹

Functional Classification of Heart Failure

• Class I: Mild—Ordinary physical activity does not result in fatigue, palpitation, or dyspnea

• Class II: Mild—Ordinary physical activity results in fatigue, palpitation, or dyspnea

• Class III: Moderate—Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea

• Class IV: Severe—Unable to carry out any physical activity without discomfort

Comorbidities to Consider

• Clients may experience significant weight gain and peripheral edema that will affect their mobility.

Client Examination

Keys to Examination of Clients

• Clients have undergone numerous tests for heart and lung function.

• Perform frequent assessments of vital signs and heart and lung sounds to determine clients' tolerance to exercise activities.

• Discuss with clients their barriers and potential barriers to beginning and maintaining a regular exercise program.³

Recommended Baseline Testing of Fitness Levels

• Treadmill walking and the 6-minute walk test are common methods for measuring exercise tolerance and assessing cardiopulmonary function.

• Muscle strength and functional mobility are important to assess for clients with moderate to severe (class III and IV) heart failure.^1,2

• Measure clients' dyspnea and fatigue levels before and during exercise sessions.

Exercise Prescription

Type: Walking, treadmill walking, cycle ergometry³

Intensity: Start at 50% of Vo₂ maximum or heart rate reserve^3,4

Duration: Start with short bouts with rest periods

Frequency: Three to four times per week.

Getting Started

Clients with mild to moderate heart failure (class II and III) can begin an endurance exercise program at 50% of maximum Vo₂ or their heart rate reserve.^3,4 Short bouts of 10 minutes of ...