Life expectancy and CHF

My 65 year old brother is suffering from CHF.  First, a history ... At age 40 he had a major myocardial infarction and lost most of the posterior wall of his left ventricle.  He later had a second heart attack the affected the septum between his ventricles.  He later had a 3rd small heart attack (location not known).  After the third attack his ejection fraction (ef) dropped to <30% and has slowly decreased over the years.  Four years ago he had a stroke from which he had a major loss of short term memory.  About 6 weeks ago he had another stroke and seems to have lost a lot of his appetite since.

A few weeks ago he had an echo-cardiogram and his ef was diagnosed at 20%.  His legs and feet began to swell but nothing was done.  Two weeks ago he started to complain about breathing problems and more loss of appetite.  He was hospitalized, given a diuretic (Lazik?) and lost 20 pounds (~2.5 gallons) of fluid.  He went home a week ago and felt great.  He could walk a quarter of a mile where in the weeks before he had difficulty walking across a room.

Over the past three or four days he has dramatically and suddenly deteriorated.  His ef was measured at 15% ... he has no appetite despite taking an appetite stimulant and has lost another 9 pounds this week.  He is totally listless.

So, my question ... is he looking at the end of his life?  What is his prognosis?  CHF is not a pretty way to die ... what can be done to make his last days more comfortable?

Thanks, in advance for your reply.

[gmachris518]

It's hard to say if your brother is nearing the end of his life or not.  CHF acts the same no matter where you are at in your lifetime.  It causes swelling, nausea, pain, and a "full" feeling.  It makes it hard to breathe, and makes you uncomfortable when you try to lay down to sleep.  I slept upright for over 3 years before I got help and started to feel better.

I can't speak for your brother, but for myself, if I could have one medication that would help me the most while I was going through the worst part of the CHF, it would have been large doses of Lasix......it was the only medication that seemed to do any good for me.  

After lasix, then I would opt for albuterol to help with the breathing problems.  The medical arena is stingy with albuterol unless your lungs are almost 100% filled with fluid.  I don't understand why a person with a terminal illness can't have anything they want to make them more comfortable.  CHF may or may not be terminal, at least in the short term, but sooner or later we are all going to die, and it makes sense to me to give a dying person anything that is available in the interest of keeping them comfortable.  Whether it be hardcore pain medication, huge doses of a diurectic, or something to clear their lungs and make it easier to breathe....it doesn't matter, it should not be withheld.  

I know of several people who were dying of Cancer and the doctor put them on a schedule for hardcore pain medication.  When the end was near and the patient was begging for more pain medication, the nurses would remind them that the drug was addictive....what's up with that????  

An unspoken truth is, Hospice will give a patient whatever they are wanting, even a cigarette when they are dying of lung cancer.  So perhaps checking into hospice care for your brother is what you need to do, to make him as comfortable as possible.  However, if his doctor doesn't think he is nearing the end, then Hospice might not be available for him.

I think that dialysis would help a person with CHF, as it pulls fluid from the body, and I wonder why it's not used in severe cases of CHF.  Perhaps because it's expensive and insurance companies don't want to pay for it, who knows.


Again, he may or may not be nearing the end, but being comfortable when he is so ill should still be the first order of business.