Breathlessness in heart failure

Breathlessness is a basic symptom of heart failure. In spite of the importance accorded to the disease in giving insight to the severity of dyspnoea, heart failure has only been recently spoken of as a terminal disease. This chapter hence concentrates on the pathophysiology of breathlessness in heart failure and the palliative clinical management options for this symptom. Heart failure is the reduction of cardiac output and the increase in venous pressure. It is caused by several factors such as hypertension, coronary artery disease, valvular disorders, and cardiomyopathy. Among the indicators that suggest a failing heart are changes in the pulmonary haemodynamics, skeletal muscle, pulmonary function, gas exchange, and alveolar capillary structure. To counter breathlessness, palliative management approaches such as the induction of oxygen, opioids, beta-2 agonists, and benzodiazepines can be used. In addition to these pharmacological approaches, non-pharmacological methods such as introduction of exercises and improvement of the patient's morale are also crucial in the management of breathlessness in heart failure.