End-Stage Congestive Heart Failure Signs and Symptoms
by DR. C. RICHARD PATTERSON Last Updated: Apr 21, 2015
C. Richard Patterson is a retired surgeon and chief medical officer with special interest and experience in gastrointestinal, breast, cancer and trauma surgery. He is the author or co-author of 17 scientific publications, including textbook chapters.
Midsection of man in robe with medication touching his chest Photo Credit Ken Tannenbaum/iStock/Getty Images
The entire body relies upon the heart’s ability to pump that’s blood rich in nutrients and oxygen. When the heart is damaged by high blood pressure, heart attack, infections or other diseases, other organs begin to show symptoms of damage. In the late stages of heart failure, the symptoms are severely disabling and call for either extraordinary treatment — such as a heart transplant — or end-of -life, comfort care.
The lungs are composed of millions of tiny, delicate air sacs among which the heart pumps blood. The air sacs transfer oxygen to the blood in exchange for carbon dioxide. The oxygen-enriched blood then returns to the heart for distribution to the rest of the body. Heart failure causes a back pressure in the blood, and the air sacs begin to fill with fluid, making gas exchange increasingly less efficient. In end-stage heart failure, no amount of activity can be undertaken without severe shortness of breath. Lying flat cannot be tolerated because the fluid-stiffened lungs cannot expand without the aid of gravity. Even with the head elevated, sleep is often interrupted by sudden spasms of breathlessness. Coughing up frothy fluid is common.
Fluid Retention and Swelling
The fluid buildup that occurs in the lungs also affects other parts of the body, especially the legs and abdomen. The fluid buildup manifests as swelling. Both legs are affected from the groins to the toes by heart failure. Pressing on the skin with one finger will produce indentations that resolve very slowly. In medical parlance, this is called pitting edema. The tendons of the feet and the bones of the ankles are no longer visible due to profound swelling, and shoes will not fit. Free fluid accumulation in the abdominal cavity causes an increase in girth and rotundity, and only loose garments can be tolerated.
Abnormal Heart Rate
In late-stage failure, the heart becomes incapable of maintaining a coordinated rhythm in its contractions. The progressive inefficiency increases the heart’s inadequacy as a pump. For some people, implantation of an electrical device for stimulating the heart muscle may help, but for most people, the changes are irreversible.
Poor Kidney Function
Approximately half of people with late-stage heart failure develop kidney insufficiency or failure because of the heart disease. Kidney malfunction causes worsening of fluid accumulation and further overloading of the already compromised heart. Kidney failure is a sign of impending death in people with heart failure.
Admission to the hospital is frequently necessary in late-stage heart failure. Weight gain of more than 2 pounds in a day, sudden worsening in shortness of breath, decrease in or cessation of urine, rapid heartbeat and onset of confusion signal the need for emergency evaluation and treatment for someone with advanced heart failure.
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