Heart Failure Symptoms in the Elderly Leading to End-of-Life

Heart failure in elderly patients, especially those nearing the end of life, often presents with significant respiratory distress. As the condition progresses, individuals may experience chest tightness and shortness of breath, which can worsen during physical activity or even at rest. In more severe cases, symptoms such as paroxysmal nocturnal dyspnea—sudden shortness of breath during the night—can occur, often accompanied by pleural effusion and ascites.

Left-Sided Heart Failure: Respiratory Complications and Oxygen Deprivation

When left-sided heart failure becomes critical, it primarily affects the lungs, causing progressive difficulty in breathing. Severe hypoxia may develop, leading to cyanosis of the lips and mucous membranes. Patients may eventually suffer from respiratory failure, with signs of reduced consciousness and disorientation due to inadequate oxygen supply to the brain.

Right-Sided Heart Failure: Fluid Retention and Systemic Effects

Right-sided heart failure manifests differently, with widespread edema being a key symptom. This includes peripheral swelling, particularly in the legs and ankles, as well as elevated pressure in the pulmonary arteries. In advanced stages, patients may also exhibit severe cyanosis, carbon dioxide retention, and altered mental status such as drowsiness or confusion, which are signs of worsening respiratory and metabolic function.

Global Heart Failure: Multi-Organ Impact and Circulatory Congestion

When both sides of the heart are affected—resulting in global heart failure—systemic congestion becomes apparent. This includes visible swelling in the lower extremities, distended neck veins, fluid accumulation in the chest and abdominal cavities, and enlargement of the liver. Additionally, gastrointestinal congestion impairs digestion and nutrient absorption, leading to symptoms such as bloating, loss of appetite, malnutrition, low protein levels in the blood, and anemia.

Conclusion: Recognizing the Signs for Timely Palliative Care

Recognizing these symptoms is crucial for providing timely and appropriate palliative care to elderly patients with end-stage heart failure. Understanding the progression of the disease can help caregivers and medical professionals offer better support and comfort during the final stages of life.