Abstract: With water immersion, the water exerts a pressure on the body surface. Thus there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This article illustrated hemodynamic and hurohumoral responses of hydrotherapy, and dicussed whether patients with left ventricular dysfunction (LVD) or chronic heart failure (CHF) can immerse, take balneotherapy, exercise in the water and swimming. A positive effect of therapeutic warm-water tub bathing has been observed in patients with LVD and CHF, which was assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. Optimal swimming as used for cardiovascular training programs may be allowed exclusively for NYHA class Ⅱ patients with myocardial infarction older than 6 weeks, myocarditis suffered more than 6 months ago, and cardiomyopathy. Patients with previous severe myocardial infarctions and/or CHF may bathe in a half sitting position, but immersed no deeper than the xiphoid process, because immersion up to the neck could produce abnormal increase in mean pulmonary pressure and pulmonary capillary wedge pressure temporarily. In coronary artery disease (CAD) patients with reduced LV function the heart is working more efficiently with mild cycling in water than cycling outside of water. Decompensated heart failure is the absolute contraindication to hydrotherapy.

Key words: chronic heart failure, left ventricular dysfunction, hydrotherapy, review