Hospice & Palliative Care

End Stage Disease Progression and Complications – Cardiac Disorders (Learning Hospice)

Regardless of etiology, many chronic cardiac disease have a common end-point of right, left, or biventricular heart failure (HF). According to Center for Disease Prevention and Control (CDC) data, in 2010, 57,757 deaths were caused by HF in the United States, making cardiac disease or heart failure (HF) was listed as the most common cause of death in the United States.

Death is often sudden. Some people with advanced coronary disease die quickly and without warning from arrhythmias. However, many live for prolonged periods of time with HF managed by medical and surgical interventions. Yet, reversal of HF is rare, unless a surgical intervention is available. It is therefore difficult to predict the end of life.

The disease course can be one of chronic illness with a long period of general decline in function, interspersed with exacerbation and partial recovery. The degree of HF is not clearly correlated with life expectancy or symptoms; because of those with very poor ventricular function can live with only minimal symptoms, whereas others with similar ventricular function can be very symptomatic.

The patient who is dying of advanced heart failure are those who are no longer respond to drug therapy, not a candidate for further invasive procedures, and present with significant symptoms due to the underlying pathophysiology.

End stage disease progression of cardiac disorders often includes:

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Hospice & Palliative Care

End Stage Neurological Disorders – Multiple Sclerosis 多发性硬化症 (MS) (Learning about Hospice)

Multiple sclerosis (MS) is the most frequent inflammatory demyelination disorder of the central nervous system. The clinical picture reflects the pathological mechanism of inflammation, demyelination, and axon degeneration.

Specific challenges in MS patients:

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Hospice & Palliative Care

End Stage Neurological Disorders – Stroke 中风 (Learning about hospice)

Stroke is the 3rd leading cause of death in the United States, making the need for hospice care for many victims essential.

A stroke takes time to manifest its full effect, and some early symptoms might be transitory. The physician might consider a referral to hospice if the patient remains comatose or has a severely reduced level of consciousness (obtundation) with abnormal muscle contraction (myoclonus) for 3 days or longer.

Patients who survive 4 weeks and regain significant function during that time are more likely to need active rehabilitation than palliative care.

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Hospice & Palliative Care

End Stage Neurological Disorders – Amyotrophic Lateral Sclerosis 肌萎缩侧索硬化 (ALS) (Learning about Hospice)

ALS is a rapidly progressing degenerative neuromuscular disease with an unknown origin, results in muscle weakness, disability, respiratory insufficiency, and eventually death. The median survival duration for patients is approximately 3 years, yet 10% will survive for > 10 years.

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Hospice & Palliative Care

End Stage Neurological Disorders – Parkinson’s Disease 帕金森病 (Learning about Hospice)

Parkinson’s disease is a fairly common disease of the central nervous system. It is a chronic, progressive neurodegenerative disease defined by the classic trial of tremor, rigor 僵直, and akinesis 运动消失 (There is a slow progression of motor skill complications, including resting tremors, excessive slowness in activity, and rigidity). Classic signs include pill-rolling movements in the hands, loss of facial expression, difficulty initiating movements, and gait changes. Because of its slow progression, patients may initially present with generalized weakness, aching, fatigue, and malaise. A slight tremor of an extremity may also be noted. Symptoms result from an imbalance between dopamine-activated and acetylcholine-actived neural pathways in the basal ganglia and are generally found in people older than 65 years. Parkinson-like symptoms can also be caused by medication toxicity, head trauma, or other degenerative conditions.

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