IMPORTANCE OF REST AND SLEEP IN HEART FAILURE

Rest and sleep are of fundamental importance in the management of every patient with cardiac failure. However, in the past rest has often been abused. Unnecessarily prolonged confinement to bed is harmful. When signs of heart failure are first manifest complete rest in bed should be enforced until treatment has resulted in the maximal benefit which can be obtained. Thereafter the return to activity must be graduated and it will become apparent how much rest during the day and how much restriction of exertion area required to prevent further failure. There should be no fixed rules such as the ‘six weeks in bed’ formerly advised following myocardial infarction. Each case must be assessed on its merits.

DISADVANTAGES OF BED REST

When breathlessness is extreme the patient is compelled to sit up (orthopnoea). The vital capacity is increased in this position and on occasion it will be found that sitting in a chair is more comfortable than sitting up in bed. Moreover, the central venous pressure is increased in the recumbent posture and this adds to the work of the heart. Oedema will tend to collect in thev legs rather than in the lungs when the patient is sitting and this may be an advantage when fluid retention is difficult to combat. Confinement to bed necessitates the use of the bed pan, but this may be a considerably greater strain than a bedside commode or sani-chair which should be used whenever possible. In bed the circulation rate is slowed and the risk of venous thrombosis and its attendant dangers is increased. Finally hypostasis in the lungs predisposes to pneumonia.

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