Pain is emerging clinically as an important but overlooked symptom in heart failure. The symptom of pain is poorly described in chronic disease and not a symptom immediately associated with heart failure. Despite this, in studies pain is commonly reported by heart failure patients. Heart failure patients may experience pain from a variety of causes, which may be acute, chronic or in end-stage disease, the concept of ‘Total Pain’ may apply. Treatment can be a challenge as it must take into account any contraindications the patient’s diagnosis or other medications impose. Established pain management may need to be adapted to include a combination of drugs with different modes of action and non pharmacological strategies
Gastro-intestinal (GI) symptoms in advanced heart failure can cause distress to both the patient and his/her carer. While GI symptoms are common at the end stages of many diseases, management must reflect the specific causes of these symptoms in the heart failure patient. Breathlessness, fatigue, limited mobility and depression—all symptoms associated with advancing heart failure—and the treatment of the heart failure itself can potentiate or exacerbate GI symptoms. Early assessment, recognition of the impact and pro-active management of GI symptoms is recommended. Cachexia is common at the advanced stages of many diseases and is associated with poor outcomes for heart failure patients. The mechanisms and suitable treatments for this remain a case for further investigation.
Breathlessness is a common and distressing symptom in end-stage heart failure, impacting adversely on quality of life for both the patient and the carer. Breathlessness is recognized as being a multi-factorial subjective experience. Research into effective therapies is surprisingly sparse, although this is a common feature in the end stages of a number of diseases. A complex holistic assessment must first exclude a treatable underlying cause and ensure that medications have been optimized. A variety of both pharmacological and non-pharmacological therapies are available for breathlessness. Treatment is likely to require an approach incorporating both and addressing identified physical, social, psychological and spiritual needs to provide optimum relief. A skilled and experienced specialist cardiac nurse is ideally placed both to assess the breathlessness and to support the patient in finding effective therapies at the end of life.
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