Because early treatment of worsening CHF is most effective in preventing hospitalizations, it is very important for the patient to recognize when his symptoms are getting worse. The early symptoms or warning signs of a CHF exacerbation can be different for each person. The patient is the best person to know if he or she is having difficulty breathing, feeling more tired, or gaining more weight. Family members or friends may also recognize some of these signs. Therefore, it is important that you inform your family and friends of these warning signs and let them know what to do if they see them. A change or increase in the symptoms usually experienced may be the only early warning signs you get.
You may notice one or more of the following signs of worsening CHF:
Weight gain: A gain of more than 3 pounds in 24 hours or 5 pounds in a week, no matter what your symptoms are.
Shortness of breath: This symptom is called dyspnea by physicians; it can occur during activity, at rest, or while sleeping. It can come on gradually during the day or may come on suddenly and wake you from sleep. Patients with worsening CHF often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows.They often complain of waking up tired or feeling anxious and restless. Shortness of breath occurs when your blood “backs up” in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can’t keep up with the sup-ply. This causes fluid to leak into the lungs and it interferes with the lungs’ ability to get oxygen into your body. Typically, the skin is clammy and pale; when severe, it can appear nearly blue. This is a life-threatening situation and the patient must go immediately to an emergency room (ER).
Persistent coughing or wheezing: Though some-times misinterpreted by patients and doctors as a chest cold or bronchitis, coughing and wheezing can be a sign of worsening CHF. It results from a build-up of fluid in the lungs. When it is severe, the patient may notice white or pink blood-tinged mucus. This is a serious sign and should prompt a call to your physician and requires a trip to the emergency room.
Swelling of the hands or feet:A build-up of excess fluid in body tissues is a symptom called edema by physicians. It is a sign of worsening CHF. This excess fluid leads to swelling in the feet, ankles, legs, or abdomen or sometimes just weight gain. You may find that you can’t get your rings on or that your shoes feel tight. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.
Excess tiredness: If you’re experiencing a tired feeling all the time or having difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries, or walking, your CHF may be acting up. The fatigue happens because your heart can’t pump enough blood to meet the needs of your body tis-sues. Your body then diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. If this remains un-treated, you may gradually lose muscle mass as the tissues become oxygen depleted.
Appetite loss:For some people, a loss of appetite or a feeling of being “stuffed” after eating a small meal can be a sign of worsening CHF. Others may experience nausea after eating. This occurs because the digestive system is receiving less blood, thus causing problems with digestion. The body shunts the blood away from the digestive system and to the brain and heart. Although appetites are often depressed, patients with congestive heart failure gain weight be-cause they retain salt and water.
Confusion:When CHF is severe, the heart has a hard time getting enough blood and oxygen to the brain. This can result in confusion, memory loss, and feelings of disorientation. The patient may have difficulty carrying on a conversation or reading a book. Other signs of poor circulation to the brain include prolonged headaches, forgetfulness, confusion, slurring of speech, and excessive sleepiness. A spouse or other caregiver may notice this before the patient does. This is why family members and caregivers should be made aware of these symptoms of worsening CHF. They should act quickly to call the physician or an ambulance when they see them.
Palpitations:An increased heart rate or palpitations is a sign that your heart is working hard. It needs to work harder to make up for the loss in pumping capacity of the failing heart. Patients may complain of a racing heartbeat or throbbing in their chest.
Sleeping problems:When the amount of fluid in the lungs increases, it becomes difficult to sleep. Patients with this condition often use more pillows to prop themselves up in bed, sleep in a chair instead of a bed, or complain of waking up at night with short-ness of breath.
Malaise:Any feeling of ill health, increased fatigue, and lack of energy that continues for more than 24 hours.
Cyanosis:Any blue color in the lips or fingernails.
All patients with CHF should have an action plan to deal with worsening symptoms. The action plan should be developed with the help of your doctor and dis-cussed with your family, friends, or caregivers.
Victoria’s comment: I know that I’m getting into trouble when I can’t lie down in bed without getting short of breath. Through painful experience and the nagging of my cardiologist, I have got-ten into the habit of weighing myself every day. When my weight increases more than a pound or two above the last couple of days’ weights, I know that I have to take more diuretics and call my cardiologist. If I ignore it, I’ve found that it doesn’t take too long before I’m back in the emergency room.