Dear Doctors: Our grandfather was diagnosed with congestive heart failure a few years ago. His strength and endurance have declined a lot, and now he’s on oxygen. What are some of the signs that his congestive heart failure is advanced?
Dear Reader: When someone has congestive heart failure, it means that the heart muscle, along with the structures of the heart, are no longer able to pump enough blood and oxygen throughout the body to meet its needs. An estimated 6.2 million adults in the United States are living with congestive heart failure, according to the Centers for Disease Control and Prevention. The condition cannot be cured, but it can be managed with medication, exercise and lifestyle changes. At some point, however, a patient will enter the end stages of heart failure. For family members, and for the patients themselves, it’s important to be able to identify the symptoms.
Shortness of breath, which is often present even in the early stages of congestive heart failure, becomes progressively more pronounced as congestive heart failure advances. A patient often finds they are short of breath not only during activity, but also while at rest. When this occurs, the use of supplemental oxygen, as in your grandfather’s case, can help to relieve symptoms. Addressing shortness of breath also helps to allay the fear and anxiety that quite understandably arise when someone is struggling to breathe.
When the ability of the heart to pump blood throughout the body declines, it results in swelling due to a buildup of fluid in the tissues, which is known as edema. This swelling is often first observed in the feet, ankles and lower legs. As congestive heart failure advances, fluid often builds up in the abdomen and within the lungs. Fluid buildup in the tiny sacs of the lungs, known as alveoli, reduces the surface area needed for oxygen exchange. This contributes to shortness of breath, as well.
As the flow of blood to the body slows down, fatigue becomes increasingly common. At the same time, the brain responds by directing the heart to beat faster. This can result in the sensation of a racing or throbbing heart, and may also contribute to feeling weak and dizzy. The patient may begin to have trouble with balance and become weak enough that they have trouble walking, or even getting out of a chair or bed. As blood flow throughout the body slows down, it triggers a number of chemical changes. These can lead to cognition changes, mental lapses, confusion, memory loss and feeling disoriented.
As with many people who are feeling unwell, people living with advanced congestive heart failure often lose their appetites. The digestive system is receiving less blood, which can lead to feelings of fullness or nausea. Along with this range of physical symptoms, many patients will also experience anxiety and become depressed.
For patients whose health care providers believe that they have less than six months to live, the supportive medical and emotional services offered through hospice care may be a good option. A range of supportive hospice services are covered through Medicare.
(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)
