Congestive heart failure legs
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Summary
10 papers analyzed
These studies suggest that congestive heart failure affects leg function through mechanisms like impaired blood flow, edema, and abnormal reflex regulation, with treatments such as exercise, contrast baths, and pneumatic compression showing varying degrees of benefit.
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Congestive Heart Failure and Leg-Related Complications
Restless Legs Syndrome (RLS) in Congestive Heart Failure Patients
Restless Legs Syndrome (RLS) is a common but often undiagnosed condition in patients with congestive heart failure (CHF) and chronic renal failure (CRF). A study found that 39.5% of anemic CHF-CRF patients experienced RLS, with symptoms occurring at least six days a week in 66.7% of these cases. Despite treatment for anemia with erythropoietin (EPO) and intravenous iron, RLS symptoms did not improve over a 12-month period, indicating that anemia treatment alone is insufficient for managing RLS in these patients.
Hemodynamic Responses During Leg Press Exercise
Resistance exercises, such as leg presses, are beneficial for increasing muscle mass and strength in CHF patients. A study assessing the safety of leg press exercises in CHF patients found that during exercise at 60% and 80% of maximum voluntary contraction, there were significant increases in heart rate, mean arterial blood pressure, and cardiac index. These changes suggest enhanced left ventricular function and stability of left ventricular function during resistance exercise in well-compensated CHF patients.
Blood Flow During Exercise in Severe Heart Failure
Patients with severe CHF exhibit impaired blood flow to the lower limbs during exercise. Unlike normal subjects, CHF patients could not increase limb blood flow during one-leg bicycle exercise. This inability to augment blood flow is not improved by local alpha-adrenergic blockade, indicating that the muscular vasculature's capacity to vasodilate during exercise is compromised, limiting maximal exercise capacity.
Edema Reduction Through Contrast Bath and Leg Elevation
Edema is a significant issue in CHF patients. A study demonstrated that using a contrast bath combined with 30-degree leg elevation significantly reduced edema in CHF patients. This method showed a notable reduction in edema compared to a control group, suggesting its potential as an effective nursing intervention for managing edema in CHF patients.
Venous Pressure and Exercise
Exercise can increase venous pressure in CHF patients due to an efferent sympatho-adrenal discharge causing peripheral vein constriction. This response is more pronounced in patients with overt CHF compared to those who have recovered, indicating that venous pressure regulation during exercise is a critical factor in managing CHF symptoms.
Periodic Leg Movements and Heart Transplantation
Periodic leg movements (PLM) during sleep are associated with CHF. A case study reported that a patient with severe PLM and CHF experienced a dramatic reduction in PLM and resolution of insomnia following a successful heart transplant. This suggests that heart transplantation can significantly improve sleep-related leg movement disorders in CHF patients.
Impaired Skeletal Muscle Nutritive Flow
CHF patients often have reduced exercise capacity due to inadequate skeletal muscle nutritive flow. A study found that even with increased cardiac output induced by dobutamine, there was no significant improvement in muscle nutritive flow during maximal exercise. This indicates that the impaired nutritive flow is not solely due to the heart's inability to increase cardiac output, but also involves other factors limiting exercise capacity.
Pneumatic Compression Leg Sleeves
Intermittent sequential pneumatic compression (ISPC) leg sleeves can improve cardiac output in CHF patients without exacerbating symptoms. A study showed that ISPC leg sleeves increased cardiac output and stroke volume while reducing systemic vascular resistance, suggesting that ISPC is a safe and effective method to enhance hemodynamic function in CHF patients.
Reflex Regulation of Microvasculature Post-Transplantation
Cardiac transplantation can normalize abnormal reflex regulation of the microvasculature in the lower leg seen in severe CHF patients. Post-transplant, patients exhibited normal decreases in subcutaneous blood flow during head-up tilt, similar to healthy controls. This normalization helps regain an edema-protective mechanism, reducing the risk of capillary hypertension and microcirculatory stress.
Baroreceptor-Mediated Vasodilation
CHF patients, especially those with idiopathic dilated cardiomyopathy, exhibit abnormal baroreceptor-mediated vasodilation in the lower leg during orthostasis. This abnormal response increases with disease severity and leads to capillary hypertension and hyperemia, contributing to edema development and microangiopathy in the leg.
Conclusion
Leg-related complications in CHF patients, such as RLS, impaired blood flow, and edema, significantly impact their quality of life. Various interventions, including resistance exercises, contrast baths, pneumatic compression, and heart transplantation, show promise in managing these complications. However, further research is needed to optimize these treatments and improve outcomes for CHF patients.
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