If a diseased heart is suddenly forced to work beyond its strength, it may dilate markedly and become filled with blood, but be unable to pump this blood out into the arteries. This condition is a serious menace to life. If the left side of the heart is chiefly affected, the victim will develop cyanosis, weakness, breathlessness, and cough with much sputum. If the right side of the heart is chiefly affected, there will be pain and pulsation in the liver, pulsation in the large veins, and other symptoms suggesting appendicitis or gallbladder involvement.
As heart failure approaches, the real symptoms of the heart ailment manifest themselves. At first these may not seem related to the heart. Shortness of breath on slight exertion is an early symptom. Distress and an abnormal feeling of fullness after eating are common. In fact, the person with heart disease often complains of stomach trouble, not suspecting the real cause. A person past middle age who has never had stomach trouble, but who now is persistent indigestion or similar symptoms, should consult a physician without delay.
Other early symptoms are weakness and lack of endurance, particularly in the legs; dull pain and soreness in the region of the liver or over the heart; and palpitation of the heart, with fullness in the chest and dry cough. Swelling of the ankles may be an early symptom, and it may be present long before other pronouns symptoms appear. The swelling is usually worse in the evening and subsides during sleep. The person also finds that he needs to raise his head higher than usual to sleep comfortably. Spells of difficult breathing at night may occur. Still, at this stage, it is often hard to convince the person concerned that anything serious is wrong.
As the heart muscle grows weaker, symptoms become more marked, and congestive heart failure becomes fully manifest. Weakness increases until the victim finds himself utterly exhausted on the slightest exertion. His legs are swollen, and his breathing grows increasingly difficult, until he cannot lie down. Pains develop through the chest and back. He is restless and sleepless; and at last, no matter how stoical he may have been, he realizes that he is really sick and ought to be on a program of complete rest. Many people who have seemed to be at death’s door from congestive heart failure have been brought back to a fair degree of health, and with care have been able to live on for several years.
WHAT TO DO:
A patient with symptoms of heart failure should be placed under a physician’s supervision and follow instructions implicitly. Depending on facilities and circumstances, the physician may prefer to have the patient in the hospital or he may arrange for nursing care in the home. There are three principles in treatment of a heart-failure patient:
1. Reduce the heart’s workload. The patient’s physical activities should be reduced to the heart limit of tolerance. This implies bed rest until the condition of the heart improves enough to allow other activities. If the patient has high blood pressure, the physician will use medications to bring this within reasonable limits. The physician may also consider treating other heart defects if these are adding to the heart’s workload.
2. Provide competent nursing surveillance. The nurse must be in constant attendance, both to detect changes in the patient’s condition and to sustain his morale. In heart failure fluid tends to accumulate in the body’s tissues. The nurse must keep the doctor informed on the patient’s “water balance.” It may be necessary to administer oxygen and to restrict salt intake.
3. Improve the heart’s efficiency. The use of proper medications is a life saving measure in the treatment of heart failure. The two kinds of medications most commonly needed are diuretics to help remove excess fluid from the body’s tissues, and digitalis to reinforce action of the heart’s muscle.
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