End-Stage Heart Failure: Signs and Diagnostic Indicators

End-stage heart failure is a serious condition that requires careful evaluation. While there are no universally fixed criteria, doctors often rely on a combination of symptoms, lab results, and imaging findings to determine if a patient has reached this advanced stage of heart failure.

Symptoms of End-Stage Heart Failure

One of the most telling signs is the severity of a patient's symptoms, particularly when they align with Class IV heart failure according to the New York Heart Association (NYHA) classification. At this stage, individuals typically experience shortness of breath and chest tightness even at rest. Many patients are unable to lie flat at night and may require elevated positioning using one or two pillows to ease breathing. In more severe cases, the head of the bed may need to be raised to a 30-degree angle or more, indicating significant fluid buildup in the lungs and severely reduced cardiac function.

Blood Biomarkers for Heart Failure

Clinical assessments often include blood tests such as NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. This biomarker tends to be significantly elevated in patients with chronic heart failure. In healthy individuals, NT-proBNP levels usually remain below 100 pg/mL, while older adults may have normal levels up to 500 pg/mL. Persistently high levels of NT-proBNP indicate increased left ventricular filling pressure and worsening heart function, which are common in end-stage heart failure.

Heart Function Evaluation Through Echocardiography

Echocardiography plays a critical role in diagnosing advanced heart failure. A key indicator is a reduced ejection fraction (EF), which measures the heart's pumping efficiency. In end-stage cases, the EF often drops below 35%, signaling a dramatic decline in the heart's ability to contract effectively. Patients with such low EF values not only experience severe heart failure symptoms but also face an increased risk of sudden cardiac death due to life-threatening arrhythmias like ventricular tachycardia or fibrillation.

Conclusion

Identifying end-stage heart failure involves a comprehensive approach that includes evaluating symptoms, blood biomarkers, and cardiac imaging results. Recognizing these signs early can help guide treatment decisions and improve quality of life for patients facing this advanced stage of the disease.