Heart Failure Symptoms in the Final Stages of Life

When heart failure reaches a critical stage, it can become life-threatening and present with severe symptoms. Acute left-sided heart failure, for instance, can lead to extreme difficulty breathing, often referred to as orthopnea, where the patient cannot lie flat and must sit upright to breathe comfortably. This condition is especially noticeable at night, when individuals may be forced to sleep in a seated position due to severe breathlessness. Symptoms can also include coughing, wheezing, and the production of frothy, pink-tinged sputum. In addition, abnormal lung sounds such as crackles may be present, along with a rapid heartbeat, palpitations, and a feeling of tightness or pressure in the chest.

Progression to End-Stage Heart Failure

As heart failure progresses to its final stage, it often affects the entire heart, leading to symptoms of both left and right heart failure. Right-sided heart failure typically results in systemic congestion, where blood backs up in the body's circulation. This can cause swelling in the lower extremities, fluid accumulation in body cavities such as the abdomen and chest, and congestion in organs like the liver and intestines.

Common Signs of Right-Sided Heart Failure

Among the most noticeable symptoms are significant leg swelling, distended neck veins, and fluid retention leading to conditions like ascites (fluid in the abdominal cavity) and pleural effusion (fluid around the lungs). Patients may also experience a reduced appetite or even complete loss of appetite due to gastrointestinal congestion. At this stage, the focus of treatment should shift from curing the disease to managing symptoms and enhancing the patient's comfort and quality of life.

Managing End-of-Life Care

In the terminal phase of heart failure, it becomes crucial to provide palliative care that prioritizes relief from distressing symptoms. This includes proper medication management, oxygen therapy when needed, and emotional and psychological support for both the patient and their family. The goal is not only to ease physical discomfort but also to offer dignity and peace during the final days.