Heart Failure Symptoms in Elderly Patients at Advanced Stages

Heart failure in elderly individuals, particularly those aged 90 and above, can manifest through a range of severe symptoms. As the condition progresses into its advanced stages, it typically presents with signs of both arterial insufficiency and venous congestion. Understanding these symptoms is crucial for providing appropriate care and improving the patient's quality of life.

Arterial Insufficiency

Reduced blood flow due to arterial insufficiency can lead to low blood pressure and inadequate cerebral perfusion. This often results in dizziness, fatigue, and in more severe cases, fainting or loss of consciousness. Some elderly patients may experience confusion or even fall into a coma. When vital organs like the kidneys receive insufficient blood supply, it can trigger kidney failure, leading to decreased urine output or complete anuria.

As kidney function deteriorates, the body's acid-base balance becomes disrupted. This can result in metabolic acidosis, respiratory failure, and dangerous electrolyte imbalances, all of which pose serious health risks for elderly patients with advanced heart failure.

Venous Congestion

Excess fluid buildup in the circulatory system causes venous congestion, which can lead to significant swelling throughout the body. In most cases, edema begins in the lower extremities—particularly around the ankles and calves. However, as heart failure progresses, fluid retention worsens and may spread to the thighs, abdomen, and chest cavity.

Complications of Fluid Accumulation

When venous congestion is severe, fluid can accumulate in multiple body cavities, a condition known as multi-serous effusion. This includes pericardial effusion (fluid around the heart), pleural effusion (fluid in the lungs), and ascites (fluid in the abdominal cavity). These accumulations can significantly worsen breathing difficulties and cause extreme discomfort.

Additionally, liver congestion impairs normal digestive function, resulting in a marked decrease in appetite and the inability to consume adequate nutrition. In more advanced cases, liver damage may lead to jaundice, internal bleeding, and even gastrointestinal hemorrhaging, such as vomiting blood or passing black, tarry stools.