When caring for a family member with congestive heart failure, it is helpful to understand the signs and symptoms of disease progression. Where some people may live many years with cardiovascular disease, about one in five patients will die from congestive heart failure within one year of diagnosis. Hospital discharges for CHF have increased as much as 164% in the last 20 years. Therefore, caregivers should know what sorts of symptoms are exhibited to better know how to care for the family member.
Symptoms of Congestive Heart Failure
Congestive heart failure presents multiple symptoms that are related to the heart’s inability to pump blood out fast enough. As blood flow out of the heart slows down, blood backs up causing fluid build up in the tissues. Some common symptoms are shortness of breath due to fluid leaking into the lungs and persistent coughing or wheezing for the same reason. The patient will experience shortness of breath, not only during activity, but at rest. They will complain of weakness, fatigue and restlessness. The patient may also suffer from swelling feet, ankles, legs or abdomen. The fatigue symptom is also due to the heart’s inability to pump enough blood to meet the needs of the body tissues. As the digestive system receives less blood the family member may lose his/her appetite. As congestive heart failure moves into the end stages of cardiovascular disease, confusion and impaired thinking may set in. Caregivers are usually the first to notice memory loss and feelings of disorientation in the patient. Also, to make up for loss in pumping capacity, the heart will beat faster.
Signs of End Stage Cardiovascular Disease
As symptoms become more frequent, these may be signs that the patient is appropriate for hospice care. The symptoms of congestive heart failure increase significantly with multiple incidents of shortness of breath, edema (swelling), weakness, chest pain and an abnormal heart rhythm. Additional signs can include sweating, profound weight loss, distended neck veins, wet crackles in the lungs, and a doctor’s report that the liver is enlarged. You may also hear the doctor say your loved one has an ejection fraction of less than 20%. That means the ability to pump blood is seriously decreased. If the patient has received optimum therapy for diuretics and vasodilators, such as Lasix or a Nitro patch, then it is probable that the patient is terminal.
Managing Signs and Symptoms of Congestive Heart Failure
Because congestive heart failure patients seem to “go up and down” with good days and bad days, families are often confused as to what the best plan of care would be. Good days and bad days are the nature of the disease. As a caregiver, you can better understand the disease progression by being observant of the symptoms. Things to pay attention to are shortness of breath (even at rest), swelling in the extremities, multiple ER visits within a 6 month period, confusion, and the loss of ability for one to take care of basic activities of daily living – like bathing, toileting, dressing, or preparing meals. It may be a good idea to keep a journal of symptoms so that you can have a measurable guide for when it is time to shift your care and thinking to the end stages of cardiovascular disease. Hospice is always an excellent resource when dealing with such a difficult, and sometimes, unpredictable disease. Hospice can provide you with the necessary medical equipment to make life easier for you and your family member. An oxygen concentrator can provide continuous respiratory support. A wheel chair can help the patient move around with less fatigue. A hospital bed can allow the patient to raise the head of the bed to be more comfortable lying down. Shower chairs and bedside commodes allow the patient to stay in the home with good care for as long as possible; if not until death. Hospice will also provide the necessary medications to manage the symptoms of end stage congestive heart failure. Most of all, the hospice team can support the caregiver with the physical care of the family member while offering emotional and spiritual support to everyone involved.