Heart failure - fluids and diuretics
HF - fluids and diuretics; CHF - ICD discharge; Cardiomyopathy - ICD discharge
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes fluid to build up in your body. Limiting how much you drink and how much salt (sodium) you take in can help prevent these symptoms.
If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.
What to Expect at Home
When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you drink too many fluids, you may get symptoms such as swelling, weight gain, and shortness of breath. Limiting how much you drink and how much salt (sodium) you take in can help prevent these symptoms.
Your family members can help you take care of yourself. They can keep an eye on how much you drink. They can make sure you are taking your medicines the right way. And they can learn to recognize your symptoms early.
Your health care provider may ask you to lower the amount of fluids you drink:
- When your heart failure is not very bad, you may not have to limit your fluids too much.
- As your heart failure gets worse, you may need to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.
Tips to Limit Fluids
Remember, some foods, such as soups, puddings, gelatin, ice cream, popsicles and others contain fluids. When you eat chunky soups, use a fork if you can, and leave the broth behind.
Use a small cup at home for your liquids at meals, and drink just 1 cupful (240 mL). After drinking 1 cup (240 mL) of fluid at a restaurant, turn your cup over to let your server know you DO NOT want more. Find ways to keep from getting too thirsty:
- When you are thirsty, chew some gum, rinse your mouth with cold water and spit it out, or suck on something such as hard candy, a slice of lemon, or small pieces of ice.
- Stay cool. Getting overheated will make you thirsty.
If you have trouble keeping track of it, write down how much you are drinking during the day.
Eating too much salt can make you thirsty, which can make you drink too much. Extra salt also makes more fluid stay in your body. Many foods contain "hidden salt," including prepared, canned and frozen foods. Learn how to eat a low-salt diet.
Diuretics help your body get rid of extra fluid. They are often called "water pills." There are many brands of diuretics. Some are taken 1 time a day. Others are taken 2 times a day. The three common types are:
- Thiazides: Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn)
- Loop diuretics: Bumetanide (Bumex), furosemide (Lasix), and torsemide (Demadex)
- Potassium-sparing agents: Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium)
There are also diuretics that contain a combination of two of the drugs above.
When you are taking diuretics, you will need to have regular checkups so that your provider can check your potassium levels and monitor how your kidneys are working.
Diuretics make you urinate more often. Try not to take them at night before you go to bed. Take them at the same time every day.
Common side effects of diuretics are:
- Fatigue, muscle cramps, or weakness from low potassium levels
- Dizziness or lightheadedness
- Numbness or tingling
- Heart palpitations, or a "fluttery" heartbeat
- Urinary incontinence (not being able to hold your urine)
- Loss of sex drive (from potassium-sparing diuretics), or inability to have an erection
- Hair growth, menstrual changes, and a deepening voice in women (from potassium-sparing diuretics)
- Breast swelling in men or breast tenderness in women (from potassium-sparing diuretics)
- Allergic reactions -- if you are allergic to sulfa drugs, you should not use thiazides.
Be sure to take your diuretic the way you have been told.
Weighing Yourself Regularly
You will get to know what weight is right for you. Weighing yourself will help you know if there is too much fluid in your body. You might also find that your clothes and shoes are feeling tighter than normal when there is too much fluid in your body.
Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it.
Call your provider if your weight goes up by more than 2 to 3 pounds (1 to 1.5 kilograms, kg) in a day or 5 pounds (2 kg) in a week. Also call your provider if you lose a lot of weight.
When to Call the Doctor
Call your provider if:
- You are tired or weak.
- You feel short of breath when you are active or when you are at rest.
- You feel short of breath when you lie down, or an hour or two after falling asleep.
- You are wheezing and having trouble breathing.
- You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
- You have swelling in your feet, ankles, or legs.
- You have to urinate a lot, particularly at night.
- You have gained or lost weight.
- You have pain and tenderness in your belly.
- You have symptoms that you think might be from your medicines.
- Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.
Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960-2984. PMID: 2423992
Mann DL. Management of patients with heart failure with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25.
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. PMID: 28455343
Zile MR, Litwin SE. Heart failure with a preserved ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 26.
Last reviewed on: 7/25/2018
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.