My Sister Has CHF

[VivaLasViejas, ASN, RN]

Well, as wonderful as my life is for the most part these days, there always has to be SOMETHING that's not quite right, and here it is: My 58-year-old sister has just been diagnosed with heart failure.

What we don't know is why this has crept up on her all of a sudden. One day she was feeling her usual self and going about her appointed rounds, and the next day she woke up horribly short of breath, more tired than when she went to bed, and with more edema than usual in both ankles. In addition, her blood pressure was sky-high (200/110 as opposed to her usual 150/80 range), and she was weak and dizzy. So she went to the doctor and they drew a BNP, which was somewhere in the 540 range, but her cardiac enzymes and EKG were normal. They also did an echocardiogram which showed slight enlargement of the heart, but nothing to account for the dramatic symptoms she's been experiencing.

They put her on Lasix, 40 mg. BID, which had the appropriate effect of diuresing her and improving her breathing within 24 hours, and now she's on Cozaar and atenolol as well as potassium replacement therapy. Her labs look much better this week---her electrolytes are back within normal limits, anyway---and her lungs are much better, but she continues to feel tired all the time, and becomes exhausted with even minor exertion. She is a legal secretary and recently had to go to four-hour workdays because of all this, but even the minimal physical effort required is too much for her. So I'm very concerned, to say the least.

Now, as a med/surg nurse I've seen CHF in almost every type of patient imaginable, but I'm having a hard time understanding why my normally hale and hearty sister has come down with it. She hasn't smoked in almost 10 years, she's had some mild HTN for a few years but it's always been controlled with medication, she is almost NEVER sick, she eats well, and while she's overweight, she can hardly be considered morbidly obese. Her main issue is stress---her employer is a nasty, demanding, cheap, slave-driving sonuvabee who treats her like a piece of machinery, and sometimes is even verbally abusive to her. The family and I have all tried to get her to look elsewhere, but she's gotten so beaten down by this @$$**** that whatever confidence she had in herself has pretty much evaporated, especially after being rejected for a new job with the city government. I've half-joked for years that this job was going to be the death of her, and now I'm afraid I might end up being right after all---dead right.

On top of all this, I can't get her to deal with the 'indigestion' she keeps having---even her MD said that the second she starts feeling discomfort ANYWHERE in the chest or epigastric region, she is to take some NTG and call 911---but she doesn't want to 'endanger her insurance' by taking more time off work. I understand that, but what good will insurance do her if she's not here to use it? Of course, that's what really bothers me.......she's the last surviving member of my family of origin, and I'm just not ready to lose her. She hasn't had an MI, at least not yet, but the doctor thinks one may be in the offing, particularly if the stress level and the BP don't come down soon. And neither looks like it's going to happen; her systolic's staying in the 170-180 range even with the meds, and the more she stresses over work (specifically NOT being there), the worse she feels.

If any of you have any ideas/suggestions for her (or me!), would you please share them? It's one thing to take care of CHF patients in one's practice; it's quite another when the patient is your best friend and only living relative!

Thank you, and once again, Merry Christmas to everyone here at allnurses :icon_bigg

[SmilingBluEyes]

This is sad to hear, Marla. I am so sorry. 58 is young....hopefully she can receive good treatment in order she can live her life most fully, despite this disturbing diagnosis......HUGS marla.

[Mystery5]

Very sad news for you. My heart goes out to you and your sister.

[Tweety, BSN, RN]

I'm sorry to heart that. Failure and cardiomyopathies can sneak up on a person.

I'm sure you've experience the patient who is fine one minute and full of fluid the next.

Take care.

[ERNurse752, RN]

Have they discussed doing a cardiac cath? Stress test? Might be good to know if she has any blockages, which could also be contributing to her fatigue and discomfort.

[saskrn]

I'm sorry to hear about your sister. I wish I had some good suggestions, but unfortunately it comes down to meds, etc.

On a more positive note, my sister was diagnosed with CHF and A fib at the age of 30. She's almost 44 now, has a life very much filled with stress, doesn't eat right ("no time", she says), gets 4-5 hours of sleep a night, smokes and is mildly overweight, and she is doing extremely well. Nothing slows her down. She was having such sever chest pain that they pulled her off all of her meds, though. But, she's still doing well!

Hang in there, support your sister, reinforce teaching and try to think positively.

[VivaLasViejas, ASN, RN]

Thank you, everyone............They are going to do an adenosine myoview on the 5th, as she cannot tolerate the treadmill even under the best of circumstances (she's always been one of those "I hate to sweat" people :chuckle ), and hopefully that will tell us more about her condition---and prognosis---than we know now.

It's the waiting that's hard, especially at the holidays.......At least, she's not bad enough that she needs to be in the hospital---all this is being managed on an outpatient basis right now---but who knows when or if the other shoe will drop? She just looks bad........her color's off, she appears worn to a frazzle, she's got no appetite, and she's weak. Lord, I hope this can be fixed.......so much for clinical objectivity. :stone

[NRSKarenRN, BSN, RN]

came across this article this week...hope it helps.

acc/aha guidelines for the evaluation and management of chronic heart

failure in the adult

http://www.acc.org/clinical/guidelines/failure/hf_index.htm

wishing your sister better days ahead.

[VivaLasViejas, ASN, RN]

Thank you........very informative! I'll definitely peruse the site more thoroughly after Christmas. :)

[jnette, ASN, EMT-I]

Aww, Marla.

Hate to hear that. Dang, it's just always gotta be SOMETHING, right? Sux, doesn't it?

I do hope you all can get to the bottomn of this, and that things will then improve. I hear you about the "family" thing.. my sis is the only one I've got left, too, when my mom nears her final days at some point (which is not all that far off, I feel safe in saying)...

Yep.. Just me and Pati.. and we're TIGHT, too. I can't even consider the possibility of ever losing her....

Hope things start looking up for your sis real soon. (((HUGS)))

[plumrn, BSN, RN]

It has been my observation that when they pull off all that fluid with diuretics, the pt breathes better, pain-if any goes away, -but they feel like a limp noodle. Fatigue carries over for awhile. I hope after a few weeks/months, she will say she feels better than she has in a long time. Glad she found out before she had a heart attack, and under a cardiologists care, she can regain her health.

[VivaLasViejas, ASN, RN]

I just talked to her, and she's not even coming over for Christmas Eve......she's having increased trouble breathing, and I can't get her to leave her warm bed to go to the hospital, which is where she probably belongs right now. What do you do with someone when they insist they're fine, but they a) can't get out of bed because they're so tired, b) can't walk across the room without being out of breath, and c) are in denial so deep they don't realize how sick they are?? AAAAAAGGGGGGGGHHHHH!!