From 9 April 2015, St Christopher’s End of Life Journal will be published and hosted online by BMJ

All journal articles will be transferred to the new BMJ journal website and our current journal website will close

Existing journal subscribers will need to sign up to the new BMJ site in order to access journal articles as we are unable to share subscriber details due to data protection. We will email all subscribers on 9 April with a quick link to sign up.

If you have any questions, please email:

Penny Hansford, Editor in Chief, St Christopher’s End of Life Journal

Breathlessness, thirst and anxiety in the end stages of heart failure

Nursing case review
First published in this online journal
Declaration of interests: 
Clare Young
Author profile (accurate when this article was originally published): 
Clare Young, Advanced Nurse Practitioner, Hospital at Night, Sheffield Teaching Hospitals NHS Foundation Trust (formerly Deputy Ward Sister, Speciality Admissions Unit, Nottingham City Hospital, University of Nottingham NHS Trust). Email:

Heart failure is associated with a high symptom burden, which can have a negative effect on the life of the person with heart failure as well as their relatives/loved ones. One of the main symptoms of heart failure is breathlessness, which reduces the ability of the person to maintain independence and is associated with anxiety, fear and distress. When a patient in heart failure is approaching the end stages of the disease process, the potential benefits of treatment strategies need to be carefully balanced against the potential side-effects. This article discusses the case of John, who was admitted to hospital in heart failure, the signs and symptoms of which included breathlessness, reduced exercise tolerance and peripheral oedema in his legs, abdomen and groin. It concentrates on John’s primary symptoms of breathlessness, thirst and anxiety. Thirst resulted from the side-effects of diuretic therapy that had been administered in the management of John’s breathlessness. For the purpose of this article the patient’s name has been changed in order to protect patient confidentiality, privacy and dignity (Nursing and Midwifery Council (NMC), 2008).

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