Sunday, January 29, 2023

Final Stage Congestive Heart Failure

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Stage 3 Of Congestive Heart Failure

Heart failure and breathlessness in end stage care | Dr Kulasagaram Ranjadayalan

Its not uncommon for congestive heart failure to be accompanied by other heart conditions. If you are diagnosed with stage three CHF, along with another heart condition, its likely that youll have difficulty performing regular tasks. Small bouts of exercise or minimal doses of physical activity will cause the same symptoms mentioned in stage two fatigue, shortness of breath, and heart palpitations. In stage three, lifestyle changes are not as effective, and a surgical procedure may be necessary. However, its never too late to talk to a doctor about your heart condition and what the future may look like.

Talking To Loved Ones

Although death is a normal part of life its rarely something we talk about, even with the people closest to us. It can feel very difficult to speak about your condition or the fact that youre approaching the end of your life. Some people find that their family members dont want to discuss what is going to happen. Other people worry that theyll be a burden for their family. But talking about it can help you feel closer and more able to deal with the future together. There is no right or wrong way to start conversations, and its important that you do what feels right for you. You dont have to talk about everything at once, take things at your own pace.

Stage C Treatment Options

Treatment at this stage focuses on managing your symptoms, optimizing your heart function, and preventing worsening of your condition.

Medications to treat stage C heart failure include:

  • Diuretics to reduce fluid retention
  • Beta blockers to help make your heart work less hard
  • SGLT2 inhibitors to reduce the risk of cardiovascular death and hospitalization for heart failure
  • Angiotensin-converting enzyme inhibitors
  • Angiotensin II receptor blockers
  • Entresto , which reduces the risk of death and hospitalization among patients with chronic heart failure
  • Aldosterone antagonists
  • Digoxin to help the heart beat stronger and more regularly
  • Possible cardiac resynchronization therapy
  • Possible implantable cardiac defibrillator therapy

In addition to the lifestyle changes for stages A and B, you may need to make the following changes:

  • Reduce your sodium intake
  • Restrict fluid intake
  • Keep track of your weight daily

Remember that even if the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression of your condition to stage D.

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What Are The Symptoms Of End

Heart Failure: Quick Facts

1. More than 6 million U.S. adults have heart failure.

2. About half of people who develop heart failure die within 5 years of diagnosis.

3. Most people with end-stage heart failure have a life expectancy of less than 1 year.

4. The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes.

Heart failure worsens over time, so symptoms are most severe during the final stages. It causes fluid to build up in the body, which produces many of these symptoms:

  • Shortness of breath . In the final stages of heart failure, people feel breathless both during activity and at rest.
  • Persistent coughing or wheezing. This may produce white or pink mucus. The cough may be worse at night or when lying down.
  • Weight gain or swelling of the feet, ankles, legs, abdomen, or neck veins.
  • Tiredness, weakness.

In addition, people in the final stages of heart failure may suffer from:

  • depression, fear, insomnia, and isolation
  • anxiety about their future
  • trouble navigating the health care system

What Are The Risk Factors Of Congestive Heart Failure

Stages of Congestive Heart Failure in 2020

Congestive heart failure primarily originates from problems with cardiovascular system of the body. Thus, it gets extremely important to go for regular routine checkups to ensure proper functioning of the heart and its valves. The risk factors include-

Hypertension: Increased blood pressure may lead to congestive heart failure. Hypertension is one of the chief causes of increased blood pressure.

Artery Blockage: Blockages in the arteries can lead to congestive heart failure. These blockages occur due to accumulation of fat and cholesterol in the blood vessels. Thus increased cholesterol content in the blood is a risk factor. Such blockages inhibit proper blood from the blood vessels thereby damaging them.

Heart Valve Conditions: This brings to the next risk factor which is the heart valve condition. Heart valves are extremely important as they carry blood to and fro from the heart to the organs in the body. In case these valves are damaged due to leak or blockage, the circulation gets affected. In turn the human heart pumps the blood harder which can lead to heart infection.

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Mechanical And Surgical Management Of End Stage Heart Failure

Fig 11 presents a suggested algorithm for the treatment of patients with end stage heart failure. In patients with reduced LV function , sinus rhythm, left bundle branch block or echocardiographic signs of ventricular dyssynchrony and QRS width 120ms, who remain symptomatic despite optimal medical treatment, cardiac resynchronisation therapy using biventricular pacing improves symptoms and exercise capacity while decreasing hospitalisations and mortality.1,2,3,23,24,25 In the COMPANION trial, heart failure patients in NYHA class IIIIV with LVEF 35% and QRS width 120ms were randomised to optimal pharmacological treatment alone or in combination with either CRT or CRT plus implantable cardioverterdefibrillator .23 Importantly, while mortality was reduced in both device arms there was no significant difference in mortality between CRT and CRT/ICD. Therefore, currently available data indicate that the use of an ICD in combination with CRT should be based on the indications for ICD therapy.3

Table 3Absolute and relative indications for heart transplantation

Heart Failure Expectations Unrealistic

In the study, researchers surveyed 122 people with moderate to advanced congestive heart failure about their perception of their life expectancy.

They found the heart failure patients tended to overestimate their life expectancy by about three years. The average patient survival estimate was 13 years compared with a validated medical model estimate of 10 years.

Overall, 63% of people with heart failure overestimated their remaining life expectancy by an average of 40% compared with medical model predictions. Those who were younger and with more advanced disease were most likely to overestimate how long they had left to live.

During the three-year follow-up period, 29% of the people involved in the survey died. Researchers found no relationship between longer life expectancy perceptions and survival.

How Long Can A Chihuahua Live With Heart Failure?

Is dying of congestive heart failure painful? Pain. Some people with heart failure can experience pain or discomfort towards the end of their life. They should be assessed using a pain scale. Pain-relieving medicines can be used to relieve pain and discomfort this can include opioid and non-opioid medicines .

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Strengths And Limitations Of The Study And Method

Our study has a consistent and in-depth focus on the patients perspective. A major strength is the inclusion of very old patients . It is in the nature of qualitative studies to have a small number of participants. Therefore, the findings cannot be generalised, but they provide specific in-depth insights into the perception and personal experience of old and very old patients with severe heart failure. The patients were only recruited in an inpatient setting at two geriatric hospitals and not in general practice or other outpatient settings. Furthermore, the tendency towards socially desirable statements must be considered. To reduce social bias, the interviewer was not involved in the delivery of health care for the patients and was not employed by either of the geriatric hospitals.

Planning Ahead Heart Failure And The End Of Life

Stages of Congestive Heart Failure – Stage D (End-Stage)

To be told that youre approaching the end of your life, even if youve been ill for a long time, can be very upsetting and difficult to come to terms with.

If you or a loved one is approaching the end of their life, it may be particularly hard during the coronavirus pandemic. The rules on visiting people in hospital, care homes and hospices have changed, as have funeral arrangements. Its important to be aware of these changes and take them into account when making plans for the end of life. If youve already made plans, you might need to alter them. Although it can seem tough at first, sorting out practical matters such as your will, finances and how and where youd like to be cared for, can be a very positive thing to do and give you peace of mind. Its a good idea to start thinking about these plans and putting things in place as soon as you feel well enough to do so.

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Preventing Congestive Heart Failure In Dogs

To prevent CHF, owners need to be aware of the signs and symptoms associated with heart problems and address them right away. Proper nutrition is important, but supplements can also play a role heart disease prevention.

Some preliminary studies have shown a link between grain-free diets and heart disease . If your dog is eating a grain-free diet, speak with your veterinarian about whether your dog should change to a diet containing grain.

What Is An Ejection Fraction

An ejection fraction is a measurement of the blood pumped out of your heart with each beat, expressed in a percentage. It can be measured using an echocardiogram , multigated acquisition scan, nuclear stress test, magnetic resonance imaging , or during a cardiac catheterization. A normal ejection fraction is between 50% and 70%.

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Talk To Them About Their Symptoms

People with heart failure may feel worried about their symptoms, treatment or risk of dying suddenly. Reassure them by talking openly and honestly about their concerns. Speak to their cardiac or palliative care team if you need support. If the patient has a plan for managing symptoms or emergencies, they may feel less anxious.

How Is Heart Failure Treated

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Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every treatment plan. Your healthcare provider will talk to you about the best treatment plan for you. Treatment is the same, regardless of gender.

As heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you cant move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure.

Stage A treatment

The usual treatment plan for people with Stage A heart failure includes:

  • Regular exercise, being active, walking every day.
  • Stopping the use of tobacco products.
  • Treatment for high blood pressure .
  • Treatment for high cholesterol.
  • Not drinking alcohol or using recreational drugs.
  • Angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
  • Beta-blocker if you have high blood pressure.

Stage B treatment

The usual treatment plan for people with Stage B heart failure includes:

Stage C treatment

The usual treatment plan for people with Stage C HF-rEF includes:

If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.

Stage D treatment

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Helping Individuals With End

According to the National Hospice and Palliative Care Organization, heart disease is on the rise in the United States. Additionally, the disease comes with a high symptom burden, specifically at the end-of-life. Therefore, individuals with end-stage heart disease and congestive heart failure can benefit from hospice services.

Hospice of Southern Illinois focuses on comfort care for individuals with heart disease and CHF rather than curative treatment. Keeping in mind that your loved ones wishes are most important, our team including the medical director, pharmacist, nurse practitioner, nurses, social workers, counselors, hospice aides and volunteers will work together to create an individualized plan of care to reduce pain and keep symptoms managed, including but not limited to, chest pain, shortness of breath and fatigue. We will cover medications, equipment and services related to the patients terminal prognosis. Contact us today for more information on hospice for CHF, care for individuals with heart disease, and care for advanced heart failure. No one has to go through the dying process alone. Hospice of Southern Illinois is here to help.

Early Attention To Heart Disease

Congestive heart failure is one of the leading causes of death in the elderly and is not curable. The best course is to avoid or treat early known causes of the disease to prevent or limit damage to the heart. See your doctor if you notice early signs that might indicate CHF such as shortness of breath or fluid in your legs.

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End Stages Of Heart Failure: What To Expect

Congestive heart failure is one of the most common reasons for hospital admissions for senior citizens. In fact, over 5 million adults in the United States experience heart failure.

Heart failure occurs when the heart muscle becomes damaged and can no longer pump blood effectively. Although symptoms can be managed, this is a chronic condition with no cure. In time, patients will reach the final stages of congestive heart failure.

Patients in the end stages of heart failure want to know what to expect. The symptoms of end-stage congestive heart failure include dyspnea, chronic cough or wheezing, edema, nausea or lack of appetite, a high heart rate, and confusion or impaired thinking.

What Is Congestive Heart Failure In Dogs

What Is End Stage Congestive Heart Failure?

Congestive heart failure in dogs occurs when the heart is unable to pump an adequate amount of blood to the body, thus causing an increase in pressure and fluid that eventually leaks into the lungs and, less frequently, other major organs.

When fluid accumulates in or around a dogs lungs, it prohibits the lungs from expanding normally and prevents oxygen from moving into the bloodstream properly. This can cause a variety of symptoms and health issues.

CHF can be a slow-onset condition that develops over time.

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Can The Heart Repair Itself After Congestive Heart Failure

But the heart does have some ability to make new muscle and possibly repair itself. The rate of regeneration is so slow, though, that it cant fix the kind of damage caused by a heart attack. Thats why the rapid healing that follows a heart attack creates scar tissue in place of working muscle tissue.

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Cardiac Cachexia Or Anorexia

Cardiac cachexia or anorexia is characterised by loss of appetite, profound weight loss and loss of muscle and fat tissue. You could suggest the person tries eating small, frequent meals. You should consider high calorie, high protein food, and supplement drinks. There are more tips on our page about hydration and nutrition. A dietitian may be able to provide you and your patient with further guidance.

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Caring For Someone At The End Of Their Life

When someone you love is facing the end of life, its an extremely worrying and upsetting time. Given the current situation with coronavirus, you might have lots of questions about what youre allowed to do, especially if your loved one is in a hospice or care home. Many care homes are limiting visitors but government guidance has specified that visiting loved ones who are at the end of their life is important and should continue. Check with your loved ones hospice or care home about what restrictions they have in place. Unfortunately, if you have coronavirus symptoms, you wont be able to visit a loved one. Government guidance states that carers are still able to perform their caring duties if the carer doesnt have coronavirus symptoms. If you live with the person you care for and you have coronavirus symptoms, the government are advising you to ask friends and family for help with providing care or contact your local authority or healthcare provider. If someone you care for has a heart condition, they are at higher risk of severe complications of coronavirus. Be mindful of this when visiting and always follow NHS guidance around hand washing and hygiene.

Is My Loved One Eligible For Care Heres When To Call Hospice For Heart Failure Heart Disease And Chf

What are the Stages of Heart Failure?
  • End-stage heart disease, advanced heart failure and congestive heart failure symptoms to look for: chest pain, shortness of breath, cognitive decline, increased confusion, recurrent hospitalization for heart-related condition, treatment resistant dysrhythmias, fatigue, unintentional weight loss, significant limitations in physical activity, loss of appetite, anxiety, lightheadedness, fluid retention and/or swelling and increased sleeping.
  • The presence of other chronic disease or conditions such as diabetes or chronic pulmonary obstructive disease may also be a factor in determining eligibility for hospice care
  • A prognosis of 6 months or less, if the disease takes its regular scientific course. No one really knows a definite timeframe.
  • Curative treatment is no longer the patients choice or option.
  • Comfort care, symptom management, and goals of care are the primary focus.

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