An elderly man came to the clinic in crashing heart failure. In developed countries it is rare to still see such cardinal signs at presentation. The bulging external jugular vein signifies significant fluid overload, and venous back pressure fills the lungs with fluid, causing significant shortness of breath, tiredness and immobility. The heart is under strain and unable to pump efficiently, often complicated by associated lung or kidney disease.
The upper chest evidences a usually thin man, but fluid has built up from his feet to midway up his back and abdomen, his stomach taut and the abdominal cavity evidencing significant fluid collection. It's a struggle to lie back comfortably.
Unable to lie flat, walk or even talk for long he had been like this for some months.
Heart failure has a prognosis worse than many cancers, and care is directed at symptom control. Diuretics and close monitoring of kidney function allows a gradual removal of the fluid from the body, with daily weight measurements evidencing a weight loss of 12kg over a week, equating to a 12 litre loss of accumulated fluid.
.
After eight days the jugular vein is no longer engorged and the strain on the heart has been relieved. Able to lie flat and with better sleep this gentleman was discharged with suitable medications to live a better quality of life... a health care worker will check him at home periodically as he lives outside the community..
