Heart Failure That's a Terrible Name
Congestive heart failure is a terrible name for a disease. The name makes it sound as though your heart is failing, and you could die any minute. That’s not true. The truth is that there are over 5 million Americans living with heart failure. Many of those Americans with heart failure live normal, healthy lives. And, if you take care of yourself, you can too.
In order to better understand exactly what is “failing” in heart failure, it helps to take a look at how the heart works. The heart is a muscle, just like any other in the body. But the heart is a special muscle, because it works as a pump. With each beat, the heart pumps blood around your body. To work well, that pump has to do two things – it has to relax and fill up with blood, and then it has to push it out. If the heart isn’t doing either of these things well – relaxing or pumping – then patients can experience symptoms of heart failure.
While pumping would seem like the most important thing a heart does, relaxing between beats is just as important. This is the time when the heart fills up with oxygen-rich blood coming from the lungs. And diastolic heart failure (the kind of failure where the heart does not relax well) is actually just as common as systolic heart failure (the kind where the heart does not pump well.)
If the heart does not relax or pump well, then pressure builds up in the heart. That pressure is transferred back to the lungs, where the pressure there also increases. When this occurs, the increased pressure pushes fluid out of the blood vessels and into the tissue of the lungs. This is called pulmonary edema, and it makes it difficult to breathe.
Typically, pulmonary edema makes it most difficult to breathe when you are lying down, but you can also get short of breath doing simple activities like walking to the mailbox, or even putting on your shoes. When pulmonary edema is very severe, you can feel so short of breath that it is difficult to even complete a sentence.
The increased pressure in the heart can also affect the rest of the body. Just like in the lungs, the increased pressure pushes fluid out of the blood vessels and into the tissues of your body. This is called peripheral edema. Most often, patients notice this as swelling in their feet or ankles. When it is severe, the swelling can go all the way up your legs, and even in to the abdomen.
For a patient with heart failure, these are two symptoms that are very important to recognize – difficulty breathing (from pulmonary edema) and increased swelling in the legs (from peripheral edema). If you develop either of these symptoms, you should contact your primary care provider immediately.
Thankfully, there are many actions you can take to get control of heart failure. The first is weighing yourself daily. The second is taking your medications as directed. And, the third is following a low-salt diet.
One of the ways you can take charge of heart failure is by recognizing symptoms before they start. One of the earliest signs of worsening heart failure is weight gain. For most people, their weight remains fairly stable from day-to-day and week-to-week. For patients with heart failure, weight gain is a warning sign that you are retaining fluid. If you notice your weight increase by 2 or more pounds in 24 hours, or 5 pounds in a week, you should contact your primary care provider. They can then make changes in your medications to get rid of that extra fluid. By weighing yourself every day, you can catch heart failure before it starts, and help prevent unwanted hospitalizations.
The next important thing you can do to stay healthy is to take your medications as directed. There are several different kinds of medications that are used to manage heart failure, but almost every patient with heart failure takes a diuretic.
Diuretics are medicines that help get rid of fluid or edema. Some people call them, “water pills.” Simply, they work by making you pee. Since patients with congestive heart failure tend to retain fluid, these medications are extremely important. The most common diuretic is lasix (or furosemide), but we also use zaroxolyn (or metolazone) and bumex (or bumetadine).
Some patients don’t like taking diuretics because they do make you pee a lot. This can be a nuisance if you are out running errands or going to an appointment. It can be particularly challenging for people with limited mobility. Diuretics can also keep you up at night if you take them too close to bedtime.
In general, it’s best to take diuretics first thing in the morning. And if you take a diuretic twice a day, then the second dose can be taken around 3 p.m. That way, it won’t keep you up at night running to the bathroom. If you only take your diuretic once a day, and you know that you will be out running errands, then it’s fine to take it later in the morning or early afternoon. Just don’t forget to take it. If you have difficulty walking or getting to the bathroom, your physician can order a bedside commode for your home.
During the 1600-1700s the Disease was Called Dropsy
The afflicted would simply drop.