Short Term Hemodynamic Effects of Controlled Slow Breathing With Biofeedback in Patients With Heart Failure

Inclusion Criteria: NORMAL SUBJECTS

1. Normal subject without history, signs-symptoms or diagnosis of heart failure
2. Age over 18 and willing and able to provide informed consent.

Exclusion Criteria: NORMAL SUBJECTS

1. Known allergy to electrode gel and medical adhesive used on electrocardiographic electrodes.
2. Pregnancy (as any effect of this device use on pregnancy is not known).
3. Patient belonging to a vulnerable population such as institutionalized persons, prisoners and persons with decisional incapacity or dementia.
4. Presence of severe aortic regurgitation.
5. Second degree Mobitz type II or third degree heart block, unless treated with a cardiac pacemaker.
6. Implantation of a left ventricular assists device, hemodynamic monitor, activated minute ventilation pacemaker, or biventricular pacemaker (Cardiac Resynchronization Therapy) with the V-to-V interval set at more than 5 milliseconds offset.
7. Implantation of a cardiac resynchronization device within the last 30 days.

Inclusion Criteria: CHRONIC AMBULATORY HEART FAILURE

1. Patients over the age of 18 and able to give consent
2. Ability to understand and willing to sign informed consent
3. Diagnosis of Chronic Heart Failure and currently on optimal medical therapy

Exclusion Criteria: CHRONIC AMBULATORY HEART FAILURE

1. NYHA class III/ IV heart failure symptoms despite treatment with diuretics.
2. Co-existent pulmonary disease such as asthma/ COPD/ interstitial lung disease.
3. Known allergy to electrode gel and medical adhesive used on electrocardiographic electrodes.
4. Pregnancy (as any effect of this device use on pregnancy is not known).
5. Patient belonging to a vulnerable population such as institutionalized persons, prisoners and persons with decisional incapacity or dementia.
6. Presence of severe aortic regurgitation.
7. Second degree Mobitz type II or third degree heart block, unless treated with a cardiac pacemaker.
8. Implantation of a left ventricular assists device, hemodynamic monitor, activated minute ventilation pacemaker, or biventricular pacemaker (Cardiac Resynchronization Therapy) with the V-to-V interval set at more than 5 milliseconds offset.
9. Implantation of a cardiac resynchronization device within the last 30 days.

Inclusion Criteria: ACUTE HEART FAILURE

1. Patients over the age of 18 willing to and able to provide informed consent.
2. Patients admitted to the hospital with acute congestive heart failure (evidenced by pulmonary edema by CXR, BNP> 500 pg/ml, jugular venous distension (JVD), crackles/ rales, dependent edema) who have been stabilized with medical therapy with evidence of euvolemia by at least two of the following: clearance of rales/ crackles, decrease in JVD, reduction in peripheral edema, decrease in BNP by at least 20%, no evidence of pulmonary edema on CXR.

Exclusion Criteria: ACUTE HEART FAILURE

1. NYHA class III/ IV despite treatment with diuretics.
2. Co-existent pulmonary disease such as asthma/ COPD/ interstitial lung disease.
3. Known allergy to electrode gel and medical adhesive used on electrocardiographic electrodes.
4. Pregnancy (as any effect of this device use on pregnancy is not known)..
5. Patient belonging to a vulnerable population such as institutionalized persons, prisoners and persons with decisional incapacity or dementia.
6. Presence of severe aortic regurgitation.
7. Second degree Mobitz type II or third degree heart block, unless treated with a cardiac pacemaker.
8. Implantation of a left ventricular assist device, hemodynamic monitor, activated minute ventilation pacemaker, or biventricular pacemaker (Cardiac Resynchronization Therapy) with the V-to-V interval set at more than 5 milliseconds offset.
9. Implantation of a cardiac resynchronization device within the last 30 days.