Like heart disease, prognostication for those with chronic lung disease is extremely difficult. The terminal stage is marked by increasing visits to the emergency department and hospitalizations for infections and failing respiratory function.
Respiratory failure occurs when the lungs cannot oxygenate the blood (hypoxemia) and cannot eliminate elevated levels of carbon dioxide (hypercapnia).
Hypoxemia causes deteriorating mental status and cyanosis; pulse and blood pressure are initially increased and then diminish as death nears.
Hypercapnia has a sedative effect (carbon dioxide narcosis) and increases respiration and air hunger.
End-stage progression of pulmonary disorders often includes:
Regardless of etiology, many chronic cardiac diseases have a common end-point of right, left, or biventricular heart failure (HF). According to the 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 the 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 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 is 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:
Neurological disorders are among the leading causes of morbidity and death worldwide. While strokes is the 3rd leading cause of death, after heart disease and cancer, in the United States, other neurological disease, such as Parkinson’s disease, amyotrophic lateral sclerosis 肌萎缩性侧索硬化 (ALS), and multiple sclerosis 多发性硬化症 (MS), have a more chronic course that leads to protracted disability, morbidity, and ultimately, death.
End-stage disease progression of neurologic disorders varies but there are some commonalities: