Heart failure presents a cluster of symptoms related to the heart's inability to adequately pump blood into the system to meet the body's metabolic demands. Five million Americans, or 2 percent of the population, have heart failure. Heart failure is a progressive disease which ends in complete pump failure. The American Heart Association has classified the different stages of heart failure based on symptoms. There are four classes and Class IV represents the last stage of failure. A patient with Class IV heart failure experiences symptoms even at rest.
Shortness of Breath
Because the heart cannot adequately pump all the blood that the system brings to it, the blood backs up into the pulmonary veins and subsequently into the lungs. In Class IV heart failure, patients will feel short of breath even at rest. They may breathe rapidly. When they sleep, they may wake suddenly unable to "catch their breath" and may need to sleep propped up on pillows. Patients who cannot breathe adequately often feel anxious and fretful. Patients with Class IV heart failure are restless sleepers and frequently feel tired and fatigued with the slightest effort.
Confusion
Confusion is created due to poor oxygenation and disturbances in the body's natural chemicals or electrolytes. When the heart cannot pump enough blood to the system to meet the demand, it also means that the body is not getting enough oxygen and the brain suffers because of it. Hypoxia is a state of poor oxygenation and the inability to eliminate carbon dioxide from the lungs. This can create moments of delirium for Class IV heart failure patients. The diuretics that heart failure patients take can also eliminate necessary electrolytes such as sodium from the body. A very low sodium can cause symptoms of confusion and delirium.
Edema
Swelling of the ankles and feet is common for patients with heart failure. Because of the backup of fluid from the heart's inability to keep up, patients experience edema, or fluid in the tissues. Class IV heart failure patients not only have swelling of their feet and ankles, but also can have swelling of the abdomen. Patients also may note a sudden large weight gain, which is indicative of fluid accumulation in the body.
