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End Stage Congestive Heart Failure
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End Stage Congestive Heart Failure


  My father is 66 years old and has lived with CHF for 10 years (+) now.  We recently lost our mother to cancer and we are now faced with losing our father  to CHF.  We have been told by the cardiologist that he may only have one year to live, with the most recent admission to hospital where they were considering ventilating him.  I am a registered nurse but I work in rehab and I'm not sure what to look for in the months to follow.  Among the medications he has been on for some time include:  Digoxin, Isordril, Amiloride, Zaroxolyn (the dosages I am unsure of since he lives in Canada), and Lasix (500 mg).  Yes 500 mg Lasix daily.  He has a pacemaker as well.  Cardiac monitoring shows an underlying A-fib. On this admission, his BP has been extremely low (e.g. 80/50, 70/46), however he seems to be asymptomatic.  My questions are:  Will his BP remain low as part of the end-stage CHF?  Are there any new drugs that are indicated in such a case.  I have heard of Coreg?  Would that be an appropriate drug to ask his primary care physician?  What signs/symptoms of end stage CHF should we be aware of?  My father is alone at home during the day with my sister away at work.  He is out of hospital now, feeling somewhat better than when he went in, however, has been readmitted because he was feeling weak, not eating, related to possible abscessed tooth.
  Your attention to this matter is greatly appreciated.
  Thank you.
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Dear Caroline
His low blood pressure is most likely related to his weak heart. That will not improve.
Coreg, and beta blockers in general, have turned out to be very useful in CHF. However, your father's condition sounds tenuous. In patients like him, starting Coreg, especially outside the hospital can lead to a life-threatening deterioration in his condition. Only his cardiologist should consider instituting this medication.
End stage heart failure usually causes worsening shortness of breath., as the lungs fill up with fluid. The other major problem is arrhythmia, which is often the cause of death in such patients.
You could consider taking him to a cardiology center that specializes in heart failure to see if he is a candidate for more aggressive therapies or heart transplantation.
I hope this has been useful. I wish you the best of luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.





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