Congestive Heart Failure – Hospice of Huntington

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Congestive Heart FailureHannah3020-11-25T09:37:21-05:00

Hospice of Huntington has a special program for hospice patients with Congestive Heart Failure (CHF). Congestive Heart Failure occurs when your heart does not pump blood well enough to supply your body with enough oxygen and nutrients it needs.

Two types of heart failure are right side failure and left side failure. When the left side of your heart does not pump blood properly, blood backs up into your lungs causing pulmonary edema or a buildup of fluids in your lungs. This can cause severe shortness of breath that can have a gradual or sudden onset. Right side failure causes fluid to back up in the veins and capillaries in your body. This backup can cause pressure on the capillaries and fluid seeps out into the tissue causing swelling and even “weeping” of tissue, especially in the legs and feet. You can experience both types of heart failure at the same time.

Heart failure can also be caused by a heart attack that severely damages the heart muscle causing chest pain, weakness and shortness of breath. These symptoms can be managed in the comfort of your own home.

Hospice patients with CHF lived 81 days longer than patients with CHF who did not have hospice care according to a study sponsored by the National Hospice and Palliative Care Organization and reported in the March 2007 edition of the Journal of Pain and Symptom Management.

Hospice of Huntington’s “Love Your Heart” program helps hospice patients:

• Avoid repeated ER visits and hospitalizations
• Reduce shortness of breath
• Manage increasing weakness and fatigue
• Reduce swelling in feet and ankles
• Reduce anxiety
• Reduce pain or angina
• Feel more confident in managing your symptoms

The “Love Your Heart” program provides hospice patients with:

• Weekly nurse visits
• Individualized advanced symptom management and monitoring
• Family education and caregiver support
• Help available day or night when you are in a crisis
• Emergency kits for quick symptom relief
• Complete hospice services

If a hospice patient experiences two or more of the following, now is the time to call Hospice of Huntington.

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Swelling of your abdomen (ascites)
• Swelling (edema) in your legs, ankles and feet
• You have been optimally treated for heart disease and are not a candidate for a surgical procedure
• Need assistance with bathing and dressing and activities of daily living
• Difficulty concentrating or decreased alertness
• Chest pain, if your heart failure is caused by a heart attack
• An ejection fraction of equal to or less than 20%

Call us at (304) 529-4217 or (800) 788-5480 to request a free evaluation to determine if you are eligible for the “Love Your Heart” program with Hospice of Huntington.

Hospice of Huntington

P: 304.529.4217 Toll-Free: 800.788.5480

P.O. Box 464 | Huntington, WV 25709
1101 Sixth Avenue | Huntington, WV 25701

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Understanding Heart Failure and Edema

Edema is the clinical term for swelling caused by fluid retention. It can be triggered by any number of injuries, illnesses, or health conditions. But among the more serious conditions that can cause edema is heart failure.

This happens when the heart muscle weakens and can no longer pump enough blood to meet the body’s needs. It can also happen if the pressure is increased, forcing the fluid to back up into the legs or abdomen, or when a leaky heart valve causes fluid retention.

Proper treatment of heart failure, or whatever is causing your edema, should help relieve your swelling and other symptoms. In this article, we’ll look more at why heart failure causes edema, as well as other types of edemas, and current treatment options.

Although it sounds like the heart is failing to work at all, the term heart failure really means that the heart has grown weaker or stiffer. It still pumps blood, but it’s not enough to meet the body’s needs.

Heart failure can result from several issues, including:

• heart attack
• high blood pressure
• various types of heart disease
• valve disease

Diseases like diabetes and sleep apnea can also weaken the heart.

Since the heart isn’t able to adequately pump blood out through the arteries and bring it back through the veins, blood can begin to pool, especially in the legs and feet.

The veins require a certain amount of force from the heart to keep blood flowing up to the heart and lungs, where it receives oxygen and other nutrients. The pressure inside the veins is also higher due to higher pressures in those with heart failure.

Without medications or devices to improve the heart muscle’s strength, blood doesn’t circulate properly in someone with heart failure. Excess blood and other fluids in the capillaries can leak out into bodily tissues, causing edema.

Sometimes edema is the first sign of heart failure. Once heart failure is diagnosed, it becomes important to monitor increases in body weight that may result from increased fluid retention.

One 2021 review of studies suggests that increases in edema may also predict worsening heart failure.

Fluid buildup in the feet and legs, known as pedal edema, is a common early sign of heart failure. But there are other types of edema that may be the result of heart failure, including:

• Peripheral edema: swelling of the the hands or lower legs.
• Pitting edema: swelling in the feet, legs, or anywhere else. Pitting edema gets it name because it leaves a “pit” or dent in the skin on the affected area.
• Pulmonary edema: a buildup of fluid in the lungs.

Other causes of edema

The main potential causes of edema range from the temporary and harmless to more serious and chronic conditions that require ongoing medical care. Other than heart failure, some common causes of edema include:

• Sitting or lying down in one position for too long. Simply getting up and moving around usually alleviates swelling in the legs and feet.
• Menstruation and pregnancy. Both conditions can lead to temporary fluid retention and swollen feet and legs.
• Eating a lot of salty foods. Consuming excess sodium causes the body to retain more fluid to help keep sodium levels from getting too high. The additional sodium is excreted in urine.
• Venous insufficiency. Problems with the veins that keep them from moving blood along its path to the heart allow fluid to leak into nearby tissue.
• Kidney disease. When the kidneys don’t remove enough fluid and sodium, pressure inside blood vessels increases and edema follows. Kidney-related edema may affect the legs and/or the face.
• Lung disease. Serious respiratory conditions, like emphysema, can lead to lower leg edema when the right side of the heart starts to fail because the pressure in the heart and lungs becomes too great for proper circulation to continue.
• Liver disease (cirrhosis). With cirrhosis, blood cannot pass through the liver properly. This increases pressure in the vein that brings blood to the liver from the intestines and spleen, causing fluid to accumulate in the legs.

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There are three main types of heart failure. Each one reduces the heart’s ability to pump effectively.

Left-sided heart failure

The left side of the heart is responsible for pumping blood out of the heart to the rest of the body. Left-sided heart failure can develop when the left ventricle (lower left chamber of heart) can no longer pump enough blood out of the heart and into circulation.

It can also occur when the left ventricle becomes too stiff and can’t fill with enough blood in between heart beats. This keeps the heart from meeting the body’s requirements for oxygenated blood. Left-sided heart disease sometimes involves edema in the lungs.

Right-sided heart failure

When blood returns to the heart, it enters the right atrium (top right chamber) and then moves to the right ventricle (bottom chamber), which pushes blood into the lungs to receive oxygen.

When the right side of the heart weakens, blood coming in from the veins can start to back up. This is called right-sided heart failure, which usually results in edema in the lower extremities.

Congestive heart failure

The term congestive heart failure is often used interchangeably with heart failure. But it really just refers to a state of heart failure in which fluid buildup in the body is serious enough to require medical attention. In this instance, “congestion” is another word for fluid. This can result in both pulmonary edema and edema of the abdomen, lower legs, and feet.

Other symptoms of heart failure to know

While edema may be the most obvious external heart failure symptom, there are some other common symptoms that you should know about. This is especially true if you’re a heart attack survivor or otherwise at high risk for heart failure.

Other heart failure symptoms include:

• shortness of breath, especially when lying down or during exertion
• fatigue
• rapid or fluttering heartbeat
• nagging cough that may produce pink or blood-tinged phlegm
• lack of appetite
• difficulty paying attention
• increased need to urinate at night
• sudden weight gain
• chest pain, tightness or pressure

If you notice any of these symptoms, see a doctor soon. Sudden swelling in one leg could be a blood clot and should be treated as a medical emergency. Likewise, the onset of shortness of breath should be evaluated immediately since it can be a sign of a heart attack or other emergency.

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Treating edema usually means treating the underlying cause of the swelling. In the case of heart failure, that could involve the use of medications like:

• diuretics to reduce fluid levels in the body
• medications like ACE inhibitors and ARBs or ARNI to help the blood vessels relax, so circulation is a little easier
• beta blockers and ivabradine to reduce the burden on the heart
• mineralocorticoid receptor antagonists (MRAs)
• SGLT2 inhibitors

In very serious cases, implantable pumps or defibrillators are needed to help the heart muscle keep up with the body’s demand for blood. And in the most severe cases of heart failure, a heart transplant may be necessary.

Treating the edema itself may include:

• compression stockings to help increase the pressure in your lower legs, which may help push blood up to the heart
• exercise to get the leg muscles affected by edema working harder and pumping blood back to the heart
• elevating your legs or other swollen part of the body above the heart to help keep blood returning to the central circulation.