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What to Expect in the Last Days of Congestive Heart Failure

written by: Dr Mike C • edited by: Emma Lloyd • updated: 5/19/2011

Heart disease is the leading cause of mortality in the Western world. It accounts for 1 in 4 of all deaths in America. This article addresses what to expect in the last days of congestive heart failure.

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    Leading Cause Of Death In The West

    In the Western world, heart disease is the leading cause of mortality. For instance, in the USA, more that 616 000 people died from heart disease in 2007. As just over 2.4 million Americans died in 2007, heart disease accounted for almost one quarter of all deaths. This article will explain what to expect in the last days of congestive heart failure.

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    Role Of The Heart

    The heart is a muscle which acts as a pump and its function is to circulate blood around the body. The heart enables oxygenated blood to be brought to cells and to remove carbon dioxide from them. The carbon dioxide is expelled from the body through the lungs as we exhale and fresh oxygen is supplied by the same organ as we inhale. The heart responds to increased demands for oxygen (during vigorous exercise, for example) by beating faster and so increasing the rate at which blood is pumped around the body.

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    Heart Failure

    Heart failure is simply any condition that causes the heart to become unable to pump enough oxygenated blood around the body to meet all its needs. This can be due to the heart itself becoming weak, or stiff, narrowing of the arteries which feed blood to the heart or a leaking heart valve, damage due to a heart attack or an abnormal heart rhythm for instance. Heart failure can start at any age, but tends to be more common in old age.

    If you have heart failure, it doesn’t mean that you are about to die; just that your heart is unable to deliver enough oxygenated blood to the rest of your body that you can function normally. Consequently, activities that the rest of us take for granted (walking upstairs, for instance) may leave somebody with the condition short of breath and exhausted. Heart failure has a number of causes and can be treated depending upon the underlying reason and the age and general health of the patient. Some 5.7 million Americans are living with heart failure at the moment and the condition will result in about half of the heart disease fatality statistics each year.

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    Congestive Heart Failure

    The term “congestive heart failure” refers to a condition where the heart slows as blood is pumped out of it, this causes the venous return (blood carrying carbon dioxide) to back-up somewhat and may typically lead to oedema (or swelling) in the legs and ankles as fluid builds up, but this can also happen in other parts of the body. Fluid may also build up on the lungs (particularly when the patient is lying down) making breathing even more difficult and exacerbating shortness of breath. Congestive heart failure decreases the kidney’s ability to eliminate excess salt and water from the body and it is this that causes the oedema. Often, shortness of breath, oedema and the resulting weight gain, are the symptoms which point to congestive heart failure in the first place.

    The truism; “In this world nothing can be said to be certain, except death and taxes" was attributed to US President Benjamin Franklin. Sadly, for many people, congestive heart disease will prove to be what causes their own death. “What to expect in the last days of congestive heart disease?” will be the question on the minds of these patients and their loved ones. The end of any life is always a sad time, but it need not be a time of pain or fear because of advances made in palliative care and in nursing; in the Western World, at least.

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    Planning For The End

    Congestive heart failure is likely to be fatal if the underlying causes cannot be dealt with and the patient is not suitable for a heart transplant. However, it is usually a gradual disease that leaves the sufferer and their family with time to put matters in order and to establish instructions which clearly express the patient’s wishes about what they want to happen if they are no longer capable of expressing their own wishes. For example, would the patient wish to be resuscitated if their heart should stop or they could no longer breathe without the aid of a machine; how vigorously should a complication such as pneumonia be dealt with; or should emphasis be put on ensuring that they receive effective palliative care only? If you or a loved one is faced with this decision, it is worth reading reference 6.

    The cause of death may not be due to be heart failure as such, but the complications which arise from insufficient blood flow to other organs, notably the kidneys, or heart arrhythmia. As fluid builds up on the lungs, it will become increasingly difficult for the patient to breathe and they will suffer from shortness of breath. The fluid means that there is a smaller active surface for blood gas exchange to take place in and, to that extent, it is similar to drowning. Towards the end, the patient may become confused, dizzy or have problems with memory as the oxygen flow to the brain becomes diminished, affecting some neurological functions.

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    References

    1. University of California, Santa Cruz: http://ucatlas.ucsc.edu/cause.php

    2. CDC: http://www.cdc.gov/nchs/fastats/lcod.htm

    3. British Heart Foundation; brochure “Living with Heart Failure” (Source 6): http://www.bhf.org.uk/search/results.aspx?m=simple&q=congestive+heart+failure&subcon=BHF_main_site

    4. National Institutes of Health, Heart Failure: http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_WhatIs.html

    5. Congestive Heart Failure, American Heart Association: http://www.americanheart.org/presenter.jhtml?identifier=4585

    6. Living with advanced congestive heart failure: http://www.medicaring.org/educate/download/chfbookfinal.pdf