Chronic heart failure worsens at night: symptoms to watch out for

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Chronic heart failure (CHF) is a serious cardiac condition characterized by the heart’s inability to pump blood effectively to meet the body’s needs. While it can affect quality of life at any time of the day, symptoms are often observed to worsen during the night. This nocturnal exacerbation requires special attention as it may indicate imminent decompensation and increase the risk of severe complications.

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Why does heart failure worsen at night?

Several pathophysiological mechanisms explain the worsening of heart failure symptoms at night. When lying down, fluid redistribution in the body is favored, which can lead to increased pulmonary congestion and fluid accumulation in peripheral tissues. This process exacerbates breathing difficulties and edema, which are typical symptoms of cardiac decompensation.

Moreover, reduced physical activity and a slowed metabolism during sleep can decrease cardiovascular efficiency, further worsening the condition.

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Nocturnal symptoms to watch for

Patients with chronic heart failure should be particularly vigilant about symptoms worsening at night, including:

• Paroxysmal nocturnal dyspnea: sudden episodes of shortness of breath awakening the patient, often several hours after falling asleep. 
• Orthopnea: difficulty breathing when lying flat, often requiring sleeping with multiple pillows or in a semi-upright position. 
• Persistent nocturnal cough, often dry, caused by fluid accumulation in the lungs. 
• Excessive fatigue upon waking, reflecting poor oxygenation during sleep. 
• Swelling in the lower limbs which may increase at night, indicating fluid retention. 

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When to consult a doctor?

The onset or worsening of these nocturnal symptoms should prompt prompt consultation with a healthcare professional. Untreated decompensation can lead to complications such as acute respiratory failure, arrhythmias, or even sudden death.

Regular follow-up, medication adjustments, and sometimes hospitalization are essential to prevent deterioration of cardiac function.

Tips to improve sleep quality and alleviate symptoms

• Elevate the head of the bed to reduce pulmonary congestion. 
• Limit fluid intake in the evening. 
• Monitor daily body weight to detect rapid weight gain due to fluid retention. 
• Strictly adhere to prescribed medications. 
• Avoid aggravating factors such as smoking, alcohol, or excessive salt intake. 

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Chronic heart failure, especially when worsening at night, demands increased vigilance. Recognizing signs of nocturnal worsening is crucial for timely intervention and improving patients’ survival and quality of life. Close communication between patient and healthcare provider, along with appropriate follow-up, is indispensable for managing this chronic disease effectively.

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