How Do I Know if My Loved One's Heart Failure Is Getting Worse?

If you're worried that your loved one's heart failureis worsening, watch for signs that his or her heart isn't pumping well and isn't delivering oxygen to the See also:
Does congestive heart failure happen quickly?

See all 82 questions about Heart Concerns tissues. These symptoms include cold extremities, confusion, irritability, fatigue, and decreased urination.

Watch for arrhythmia, which happens when the heart speeds up to try to compensate for the weak heart, leading to palpitations. Also look for symptoms of fluid buildup, or congestion. The best way to monitor fluid buildup is with daily weighing and watching for symptoms. Write down the results so you can track these symptoms over time. Keep track of any changes, such as difficulty breathing when lying down, or waking up in the middle of the night short of breath (shortness of breath will be relieved when sitting up). Pay attention to other signs of swelling (edema) as well, such as tight shoes or shirts that won't button. Some people measure girth to track abdominal swelling.

If you notice a relatively rapid worsening of symptoms, such as a three-pound weight gain over three days, let the doctor know. These may be signs of an exacerbation. Sometimes people with heart failure suffer an exacerbation, then their condition stabilizes and they're able to return to the same level of functioning as before; other times, the overall condition worsens after each exacerbation and the person becomes more disabled. It's difficult to predict who will get better and who will gradually worsen.

If symptoms are worsening, this can be a sign that heart failure is progressing, but it can also mean that the person you're caring for needs more effective medication management. Another possibility is that a drug prescribed for another condition is causing fluid buildup as a side effect. Talk to the doctor about your concerns and ask if medications should be changed.

All of these symptoms are important, but the doctor will also assess progress by tracking the structural damage to the heart. Heart failure typically causes the heart to stretch, enlarge, and change shape, becoming rounder -- a process known as remodeling. The medications used to treat heart failure can "reverse remodel" the heart, getting it closer to its original shape and size. It's difficult for doctors or caregivers to know that heart failure is worsening without tests. The main way you'll know is if the person you're caring for is having more frequent hospitalizations, with less time between them.

One of the most common tests used to look at heart structure is an echocardiogram. Also called an "echo," this is an ultrasound that can detect and measure valve disease, heart size, blood flow, and pressure inside the heart. If heart failure is worsening, the echo will show an increase in pulmonary pressures and enlargement of the heart chambers. The echo also measures the heart's pumping strength by measuring how much blood the heart "ejects" with each contraction, a measurement known as the ejection fracture (EF).

Familiarize yourself with measurements such as the ejection fracture, and ask the doctor what this measurement has been in the past, and what he's hoping for in terms of improvement. This will help you know if your loved one's heart failure is worsening or getting better. Other tests the doctor might order: A blood test can reveal hyponatremia, which is low sodium in the blood. And a cardiopulmonary stress test can reveal if exercise tolerance is worsening even without fluid overload. Keep in mind, though, that some older patients can't tolerate an exercise stress test.

Was this answer helpful?

Yes

No

Yes

No