hi and pleased to answer you Heart failure is a condition, a set of symptoms where the heart cannot provide the blood flow necessary for the needs to the body. Heart failure usually develops slowly after a heart damage, caused by a heart attack, excessive heart fatigue after years of untreated hypertension or valvulopathy. Symptoms of heart failure are not always obvious. In the early stages of heart failure, some people have no symptoms. Others may present symptoms such as fatigue or breathing difficulty due to old age. But sometimes the symptoms of heart failure are more obvious. Due to the inability of the heart to effectively feed your organs (such as the kidneys and the brain), you may experience a number of symptoms, such as: A breathing difficulty, swelling of the feet and legs, Lack of energy, feeling tired, sleeping difficulty at night due to breathing problems, swelling of the abdomen, loss of appetite. Some people are more likely than others to develop heart failure. No one can predict who will develop it, but there are known risk factors. Knowing the risk factors and consulting a doctor for early treatment is a good strategy for managing heart failure. Risk Factors for Heart Failure are: Hypertension, Heart Attack (Myocardial Infarction), Valvar Abnormalities, Cardiomyopathy, Family History of Heart Failure, Diabetes. Your doctor may recommend lifestyle changes such as quitting smoking, limit salt intake, lose weight or reduce stress levels. These changes can help alleviate some of the symptoms of heart failure and decrease the fatigue of your heart. Many medications are used to treat heart failure. Your doctor may prescribe ACE inhibitors, beta-blockers, anticoagulants, and diuretics, among others. Generally, a combination of drugs is used. May be that the implantation of a cardiac device called a cardiac resynchronization device is indicated for you. It sends tiny electrical pulses to the lower chambers of your heart to help them beat in a more coordinated or synchronized way. This can help improve the pumping efficiency of the heart. Some people feel the need to meet other patients. Hospitals, health centers and local newspapers can provide information on patient associations or associations for the caregivers. During palliative care in heart failure three components are essential: palliative medical treatment of heart failure, education of the patient and his family, accompaniment by the doctor and the caregivers. During Palliative medical treatment two points are necessary to emphasize: - Optimal use of combination therapy: diuretics + IEC + beta blocker and ivabradine + spironolactone and / or ARAII, each stage of which reduces the death rate under optimal conditions of use by 30% (studies MERIT-HF, TRACE, SOLVD and SHIFT), insofar as it does not aggravate the patient s discomfort by hypotension, hyponatremia, bradycardia or asthenia. - The value of cardiological follow-up. Indeed, regardless of the stage of heart failure, adherence to treatment and patient education divide morbi-mortality by 2, according to the Mahler multicenter study. This emphasizes the importance of effective follow-up in the networking of a doctor-treating physician-cardiologist network. The education of the cardiac insufficiency is fundamental, because the patient must understand his treatment to grasp the importance of each medication; It should also be informed of the potential side effects of each therapeutic class, and the purchase of a quality scales and cuff tensiometer is necessary for home follow-up. At all stages of heart failure, physical activity is theoretically a necessary complement, but it will be gradually decreased, depending on the patient s exhaustion (reduced stair climbing, walking in a corridor, gymnastics, sometimes simple movements repeated in the chair or the bed, without objective performance). Relationships with the family are essential at this stage Sometimes it is the partner alone who ensures a watchful eye and participates in the monitoring of dyspnea and edema. It must be informed about the severity of the illness without worrying about it, train it in the monitoring of anticoagulant treatments, the use of nitrates or diuretics and the adaptation of a balanced diet and, stable as to the amount of salt. It must acquire a certain knowledge, the doctor and the care team being of course the guarantors of this learning, which must be adapted to each person, to each couple, according to the knowledge and the anxiety of each one. It is difficult to give a schema that will have to be adapted to the patient s sensitivity and to the experience of the disease. This participation of the entourage is fundamental, especially during outbreaks of heart failure. It makes possible treatments that the patient could no longer provide alone. It makes it possible to mobilize it, to ensure a hygiene of life and a dietetic which it is impossible to guarantee in the isolated patient. Rehabilitation, which could, before this palliative period, of course be carried out in specialized centers, is rather deleterious and exhausting in this context. It is at this stage that palliative care takes its place, but the mere evocation comes at first to offset the patient s vision of the long course of his illness sustained by the unrelenting hope of a prolonged life. The illusion of the omnipotence and endless mastery of this fragile heart is brutally thwarted by the reality of the patient s exhaustion and permanent dyspnea, and by the aggravation of edema. The work in collaboration with the generalist is essential here: adjustment of strategies and consistency of discourse, in order not to induce contradictions or misunderstandings. This is the time for the progressive release and taking of modalities - even injunctions! - previously usual in the patient: - acceptance of decreased exercise, periods of decubitus, especially in the elderly patient; - tolerance of deviations of diet, because it is necessary to privilege feeding pleasure (the salt cursed will restore taste!); - decrease in biological controls, because the reduction of technical constraints is crucial for the quality of life in this period (this point is especially difficult for the prescriber ...); - at the ultimate stage: use of small doses of morphine to slow tachypnea (starting with 3-5 mg orally, 2-4 times daily depending on symptom efficacy) and sedative to Doses important and regular in front of an anguish sometimes serious because it occurs while the subject is lucid; - some particularly painful dyspneic situations, which the patient describes as unbearable, fall within the scope of the recommendations for progressive sedation for severe symptoms: these sedations are easier to perform in hospitals, but the involvement of an attentive generalist and Good team of nurses makes this strategy also possible at home; sometimes, patients with severe heart failure but not letting go remain both eager to live and desperate for their addiction; A hospitalization in a palliative care unit, where the intensity of relational support will facilitate the end of life, can then be justified. These patients present insoluble logistical difficulties to the acute services because their life spans far exceed the administrative possibilities of these services ... in terms of average length of stay. Palliative care units often see these patients who, after 3 or 4 weeks of precarious situation enameled by episodes of terminal dyspnea leading to an imminent death, stabilize and continue for months a minimalist life (bed-chair)! This time can sometimes give them the opportunity to move towards the gradual abandonment of activities that their bodies can no longer assume ... but in this context, we can guess all the work of accompaniment and psychological support necessary for these patients and Confronted with an incomprehensible prolongation of the patients slowed-down life. The desire for life that persists beyond this ineffective myocardium: that is the real delicate challenge, and which requires a great humility to accompany the great cardiac insufficiency. may this help you and best wishes.