Why Fluid Builds Up

When you have  heart failure, your heart does not pump out enough blood. This causes blood to sit longer in blood vessels increasing the pressure inside which pushes fluids out into tissues. When the fluid is pushed out into the lungs you will get shortness of breath. When the fluid is pushed out from the blood vessels of in the legs it shows up as swelling in feet, ankles, and even up into the thighs.

What’s the story with salt (sodium)? Thanks for asking. Salt (sodium) is an essential mineral needed to sustain life. However when there is too much sodium in the blood it causes fluid (water) to be retained and too much fluid in the blood raises blood pressure contributing to hypertension. The excess fluid retained due to high blood sodium also increases the risk for worsening heart failure symptoms. First, the more fluid there is in the blood the harder the heart has to work. Second all that fluid has to go somewhere and you are likely to get more swelling and shortness of breath as a result.

Your health care provider may ask you to lower the amount of fluids you drink:

Tips to Limit Fluids

Remember, some foods, such as soups, puddings, gelatin, ice cream, popsicles and others contain fluids and salt. When you eat chunky soups, use a fork if you can, and leave the broth (fluid and sodium) 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.
• 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. 
• Remember, eating too much salt can make you thirsty, which can make you drink too much.
• Many foods contain “hidden salt,” including prepared, canned and frozen foods.

Diuretics 

Diuretics are sometimes called “water pills” because they help your body get rid of extra fluid. There are many brands of diuretics. Some are taken 1 time a day. Others are taken 2 times a day.

When you are taking diuretics, you will need to have regular checkups and lab tests so we 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. The best time is at least 3 hours before your bedtime.

Try to take diuretics (as well as your other medications) at the same time every day.

There are many different types of diuretics used to treat heart failure. Occasionally they are even combined to get a better response from the kidneys. The table below lists the common types of diuretics used to treat heart failure. The dosages in the table are a guide and you may be prescribed more or less because everyone responds differently.

TABLE

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
• Gout
• Depression
• Irritability
• 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.

Diuretic Herbs and Supplements: Avoid with Heart Failure Medicines

A number of dietary herbs and supplements have varying degrees of diuretic properties. To avoid dehydration and kidney problems you should avoid these completely. Unlike medications, there is no knowing how much, if any, of the touted herb or supplement is in the bottle. Studies have shown that a number of other substances can be found which may be detrimental to your health.  You should discuss with your CHFCare provider or primary care before taking any over the counter supplement.

You should avoid the following herbs and supplements with diuretic effects

• Dandelion
• Hawthorn
• Horsetail
• Juniper
• Black seed
• Hibiscus
• Ginger 
• Parsley