How do I know if my CHF is getting worse?

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Because early treatment of worsening CHF is most ef-fective in preventing hospitalizations, it is very impor-tant for the patient to recognize when his symptomsare getting worse. The early symptoms or warningsigns of a CHF exacerbation can be different for eachperson. The patient is the best person to know if he orshe is having difficulty breathing, feeling more tired, orgaining more weight. Family members or friends mayalso recognize some of these signs. Therefore, it is im-portant that you inform your family and friends ofthese warning signs and let them know what to do ifthey see them. A change or increase in the symptomsusually experienced may be the only early warningsigns you get.

You may notice one or more of the following signs ofworsening CHF:

Weight gain: A gain of more than 3 pounds in 24hours or 5 pounds in a week, no matter what yoursymptoms are.

Shortness of breath: This symptom is called dyspneaby physicians; it can occur during activity, at rest, orwhile sleeping. It can come on gradually during theday or may come on suddenly and wake you fromsleep. Patients with worsening CHF often have dif-ficulty breathing while lying flat and may need toprop up the upper body and head on two pillows.They often complain of waking up tired or feelinganxious and restless. Shortness of breath occurswhen your blood “backs up” in the pulmonary veins(the vessels that return blood from the lungs to theheart) because the heart can’t keep up with the sup-ply. This causes fluid to leak into the lungs and it in-terferes with the lungs’ ability to get oxygen intoyour 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 imme-diately to an emergency room (ER).

Persistent coughing or wheezing: Though some-times misinterpreted by patients and doctors as achest cold or bronchitis, coughing and wheezing canbe a sign of worsening CHF. It results from a build-up of fluid in the lungs. When it is severe, the patientmay notice white or pink blood-tinged mucus. This isa serious sign and should prompt a call to your physi-cian and requires a trip to the emergency room.

Swelling of the hands or feet: A build-up of excessfluid in body tissues is a symptom called  edema byphysicians. It is a sign of worsening CHF. This ex-cess fluid leads to swelling in the feet, ankles, legs, orabdomen or sometimes just weight gain. You mayfind that you can’t get your rings on or that yourshoes feel tight. As blood flow out of the heart slows,blood returning to the heart through the veins backsup, causing fluid to build up in the tissues. The kid-neys are less able to dispose of  sodium and water,also causing fluid retention in the tissues.

Excess tiredness: If you’re experiencing a tired feel-ing all the time or having difficulty with everydayactivities, such as shopping, climbing stairs, carryinggroceries, or walking, your CHF may be acting up.The fatigue happens because your heart can’t pumpenough blood to meet the needs of your body tis-sues. Your body then diverts blood away from lessvital 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 thetissues become oxygen depleted.

Appetite loss: For some people, a loss of appetite ora feeling of being “stuffed” after eating a small mealcan be a sign of worsening CHF. Others may expe-rience nausea after eating. This occurs because thedigestive system is receiving less blood, thus causingproblems with digestion. The body shunts the bloodaway from the digestive system and to the brain andheart. Although appetites are often depressed, pa-tients with congestive heart failure gain weight be-cause they retain salt and water.

Confusion: When CHF is severe, the heart has ahard time getting enough blood and oxygen to thebrain. This can result in confusion, memory loss,and feelings of disorientation. The patient may have difficulty carrying on a conversation or read-ing a book. Other signs of poor circulation to thebrain include prolonged headaches, forgetfulness,confusion, slurring of speech, and excessive sleepi-ness. A spouse or other caregiver may notice thisbefore the patient does. This is why family mem-bers and caregivers should be made aware of thesesymptoms of worsening CHF. They should actquickly to call the physician or an ambulance whenthey see them.

Palpitations: An increased heart rate or palpitationsis a sign that your heart is working hard. It needs towork harder to make up for the loss in pumping ca-pacity of the failing heart. Patients may complain ofa racing heartbeat or throbbing in their chest.

Sleeping problems: When the amount of fluid inthe lungs increases, it becomes difficult to sleep. Pa-tients with this condition often use more pillows toprop 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 24hours.

● Cyanosis: Any blue color in the lips or fingernails.All patients with CHF should have an action plan todeal with worsening symptoms. The action plan shouldbe developed with the help of your doctor and dis-cussed with your family, friends, or caregivers.

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