Shortness of breath when laying down is a common heart failure symptom that results from increased lung congestion of the lungs caused by the shift of fluids from the legs to the torso. While upright, gravity promotes the distribution of fluid to the legs; while flat, the fluid accumulates in the lungs. Hemoptysis can occur in patients with congestive heart failure, particularly when they are taking blood thinners such as warfarin. This is caused by blood along with fluid crossing into the air pockets of the lungs. A heart failure patient’s symptoms are the most reliable markers of lung congestion and acute worsening. That said, even when in severe heart failure, patients may have normal vital signs and normal oxygen levels.
Congestive heart failure is a progressive syndrome culminating in gradually worsening symptoms and death. The medications for heart failure act by decreasing the workload of the heart to help the weakened pump work more efficiently. These medications decrease the filling pressures within the heart chambers and, in doing so, reduce fluid accumulation in the lungs. As a result, a patient’s symptoms usually improve markedly and remain well-controlled while they take these medications. Medications, including carvedilol, spironolactone, hydralazine, and isosorbide, have all been shown to improve survival in patients with heart failure. Hence, taking medications consistently is critical to a patient’s well-being and stability. Aside from isosorbide, medications to help lower blood pressure and keep it within a normal range are necessary.
As a patient’s heart failure severity worsens acutely, they become increasingly short of breath. The increased work of breathing places even further demands on the heart which creates a vicious cycle leading to worsening heart failure. It is during these times that hospitalization is critically important to treat acutely worsening heart failure and prevent further deterioration. Without hospitalization and aggressive medical treatment, lungs will become more congested and experience worsening respiratory muscle fatigue due to the high work of breathing. When this is combined with worsening function of the heart muscle (i.e., pump failure) patients may suffer cardiac arrest and die.
When a patient is hospitalized for heart failure, they are treated with intravenous diuretics, such as furosemide, that act on the kidney to increase sodium and water excretion and, in doing so, diminish lung congestion. During this treatment, patients are monitored carefully and have frequent blood draws to assure the treatment is working. If a patient does not improve quickly with this approach, other intravenous medications are often used to diminish the workload of the heart (i.e., unload) and help it pump more effectively.