End-of-Life Symptoms in Patients with Severe Heart Failure

Patients suffering from severe heart failure often experience a range of symptoms as they approach the end of life. These symptoms can affect multiple organ systems and vary in intensity and presentation.

Cardiovascular Symptoms

Chest discomfort and shortness of breath are commonly observed in late-stage heart failure. Patients may find it difficult to breathe while lying down, often resorting to sitting upright to ease their breathing. This condition, known as orthopnea, is frequently accompanied by chest pain, labored breathing, persistent coughing, and the production of mucus.

Respiratory Complications

One of the more alarming signs is the presence of pink, frothy sputum, which indicates severe pulmonary congestion. In advanced cases, patients may develop refractory hypoxemia—a condition where oxygen levels in the blood remain dangerously low despite treatment. This can lead to a combination of heart and respiratory failure, requiring urgent medical attention.

Neurological Manifestations

Severe heart failure can also impact the nervous system, leading to symptoms such as dizziness, headaches, confusion, and altered consciousness. Some patients may experience transient loss of consciousness, while others may fall into a state of unresponsiveness, drowsiness, or even coma. These signs often reflect reduced blood flow and oxygen delivery to the brain.

Gastrointestinal Issues

In the final stages of heart failure, many patients suffer from loss of appetite, nausea, acid reflux, and heartburn. In more critical cases, upper gastrointestinal bleeding may occur, presenting as vomiting blood or passing black, tarry stools. This complication is often linked to reduced blood flow to the digestive tract and prolonged use of certain medications.