What You Need To Know About Fluid Retention In Chf
Congestive heart failure is a chronic heart condition in which the heart pumps ineffectively and fluid builds up throughout the body. CHF might be referred to as “heart failure, but that doesnt mean the heart stops it just means that the heart is underperforming. CHF is a specific type of heart failure that includes severe fluid retention . But why exactly does the body retain fluid? And what does that mean for a senior with CHF?
What Is Heart Failure Or Congestive Heart Failure
A diagnosis of heart failure means that ones heart is not pumping as strongly as it should be. Sometimes the terms heart failure and congestive heart failure are used interchangeably, although CHF has the added meaning that a backup of blood is causing swelling in body tissues.
HF/CHF is a chronic disease that cannot be cured, but with timely health care, it can be well managed to slow the progression of symptoms and extend the length and quality of life.
New Treatment Option Shown For Heart Failure Fluid Overload
Shared by Will Sansom
Higher doses of spironolactone, a diuretic , can prevent the need for dialysis in selected heart failure patients, a UT Health San Antonio study found. The aggressive approach relieved fluid overload safely and effectively in patients who were not responding to conventional diuretics.
The findings are in the journal Annals of Internal Medicine. UT Health San Antonio kidney and cardiovascular specialists conducted a pilot study in 19 patients to show that the higher doses of spironolactone, which prevents reabsorption of excess salt in the kidneys and maintains potassium levels, could be used safely in these very-ill patients, who admit to the hospital with heart failure exacerbation and dont respond to conventional diuretics.
Spironolactone is usually given to these types of patients in doses of 25-50 milligrams. In this study, the dose was increased to 100 and, at some administrations, even 200 milligrams.
Symptoms
Heart failure patients come into our care with excessive fluid on their body, making them short of breath, unable to walk and unable to lie flat, said Shweta Bansal, M.D., associate professor in the Division of Nephrology at UT Health San Antonio. They are miserable because of shortness of breath and distension in their abdomen and legs.
But about 15% to 20% of patients do not get better, Dr. Bansal said. They continue to have fluid overload.
Targeting a different mechanism
Significant improvement
# # #
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How The Lungs And Heart Work Together
When oxygen is inhaled, it travels through the lungs and into the bloodstream. The blood then travels to the heart where it is pumped to the rest of the body. If your blood isnt receiving enough oxygen from your lungs, the heart has to work harder to pump enough oxygen throughout the body. Overworking the heart for an extended period of time will wear it out more quickly. This is why many lung disease sufferers experience heart problems as the disease progresses.
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Why Do Patients With Heart Failure Retain Fluid
The development of peripheral oedema in patients with HF is related to fluid excess. As the heart starts to fail, renal perfusion falls. The kidneys respond by increasing the production of renin, leading to more aldosterone production, which is consequently followed by sodium and water retention. Arginine vasopressin is also released, further enhancing fluid retention and stimulating thirst. The activation of the reninangiotensinaldosterone and AVP systems maintain cardiac preload and afterload , thereby maintaining the homeostasis of the cardiovascular system but at a cost of increased systemic venous pressure . The heart itself tends to worsen with time as the failing LV tends to dilate, as does the left atrium, particularly if mitral regurgitation develops. The elevated VP can further reduce renal blood flow as the gradient between mean renal arterial pressure and VP declines. Glomerular filtration rate falls, enhancing and perpetuating the vicious cycle.
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What Is Heart Failure
Heart failure doesnât mean the heart has stopped working. Rather, it means that the heart works less efficiently than normal. Due to various possible causes, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart canât pump enough oxygen and nutrients to meet the body’s needs.
The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. The kidneys may respond by causing the body to retain fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.
What Happens In Congestive Heart Failure
The heart has two upper chambers and two lower chambers . Normally, blood:
But in heart failure, the heart cant work as it should and not enough blood and oxygen get to the organs. And blood backs up in the heart and then into the lungs.
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Manual Lymph Drainage Compression Wrapping And Elevation
One approach to treat scrotal lymphedema includes compression and wrapping. For people with severe scrotal edema this approach may not be appropriate due to skin irritation and increased risk for pressure sores.
According to a journal article published from the University of California, the following techniques may be helpful for patients with mild scrotal lymphedema:
Manual lymph drainage
- Identify the inguinal nodes of the lower abdomen or pubic areas and upper legs.
- Next, perform manual lymph drainage for the scrotum. Start from the center or midline of the scrotum and gently massage using circular motions to the left and right inguinal nodes. Continue for 5-10 minutes or to the patients pain tolerance.
- Train family, caregivers, or nursing to perform these techniques every hour or as frequently as possible during the day.
Note: If the patient has skin sensitivity on the scrotum use the squeeze method by applying pressure.
wrapping
- Use a breathable non-elastic threading such as mollelast.
- Add proffer #3 as a light compression bandage
- Wrapping should be removed after 2 hours by nursing or family/caregivers.
Elevation
Positioning can be very difficult for patients experiencing scrotal edema, because the scrotum isnt a joint and moving the scrotum can be extremely painful.
- I would recommend after applying the mollelast to position the patient, so movement in bed isnt causing friction to the skin.
How Can I Prevent Heart Failure
You can prevent heart failure by preventing coronary heart disease and heart attack. The best way to do this is to reduce or eliminate the risk factors that lead to heart failure. You could:
- drink alcohol in moderation
- reduce stress and look after your mental wellbeing
If you have had a heart attack, its even more important to manage your risk factors and follow your treatment plan. Make sure you check in frequently with your healthcare team.
Some risk factors such as your age, whether you have other health conditions, or your genes may be outside your control. Speak with your doctor if you have concerns about developing heart failure, and how you can manage it.
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Treating Congestion In Heart Failure And Normal Ejection Fraction
In patients with HF and HeFNEF, there is no clear evidence that ACE-inhibitors affect NP levels. In a study that enrolled 150 patients with HeFNEF randomised to diuretics alone or diuretics plus irbesartan or ramipril, all treatments improved quality of life quickly . Plasma NT-proBNP fell after 12 months in the three groups, but the fall only reached statistical significance in the irbesartan pg/ml P=0.01) and ramipril pg/ml P=0.03) groups, suggesting a synergistic effect between the reninangiotensin system inhibitors and diuretics.
In patients with HeFNEF, and compared with valsartan, LCZ 696 was effective in reducing NT-proBNP after 12 weeks of treatment in the PARAMOUNT trial although the difference between treatment groups was no longer significant after 36 weeks of follow-up. Whether this translates into outcome benefits is currently under investigation in the large PARAGON trial, which should complete in 2019.
How Is Congestive Heart Failure Treated
Doctors will assess the current health status of the patient to establish a baseline, and develop a long-term health plan. This may involve the optimization of medicines and therapies, adding new medication, or possibly enrollment in a clinical trial.
Stabilizing and/or reversing a patients condition often involves long-term, collaborative follow-up with a referring cardiologist or physician.
In serious situations, advanced therapies, which include mechanical solutions, a heart transplant, or hospice, may be offered.
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Find Alternative Thirst Quenchers
Its tempting to guzzle a bunch of water when youre thirsty. But sometimes, just moistening your mouth can do the trick.
The next time youre tempted to gulp down some water, try these alternatives.
- Swish water around your mouth and spit it out.
- Suck on sugar-free candy or chew sugar-free gum.
- Roll a small ice cube around the inside of your mouth.
Congestive Heart Failure Procedures And Interventions
Other treatments or procedures may be offered, depending on the underlying cause of the heart failure.
Angioplasty: This is an alternative to coronary bypass surgery for some people whose heart failure is caused by coronary artery disease and may be compounded by heart damage or a previous heart attack. Angioplasty is performed to treat narrowing or blockage of a coronary artery that supplies the left ventricle with blood. The narrowing or blockage is caused by cholesterol deposits.
- Angioplasty begins with the cardiac catheterization procedure during which a long, thin tube called a catheter is inserted through the skin, into a blood vessel, and threaded into the affected artery. This procedure is performed while the person is under local anesthesia.
- At the point of the atherosclerotic narrowing or blockage, a tiny balloon and/or an expandable metal stent, attached to the end of the catheter, is inflated and/or deployed.
- The expanded stent pushes aside the cholesterol deposits that are blocking the artery so that blood can flow through in a more normal manner.
Pacemaker: This device controls the rate of the heartbeat. A pacemaker may keep the heart from going too slow, increasing heart rate when the heart is not increasing enough with activity. It also helps sustain regular rates when the heart is not beating in a coordinated way. Or, the pacemaker performs some combination of these.
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What Are The Types Of Heart Failure
Systolic dysfunction happens when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood pumped throughout the body.
Diastolic dysfunction happens when the heart contracts normally, but the ventricles donât relax properly or are stiff, and less blood enters the heart during normal filling.
A calculation done during an echocardiogram, called the ejection fraction , is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.
How Is Chf Diagnosed
After reporting your symptoms to your doctor, they may refer you to a heart specialist, or cardiologist.
The cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms.
To confirm an initial diagnosis, a cardiologist might order certain diagnostic tests to examine your hearts valves, blood vessels, and chambers.
There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, your doctor may recommend a few to get a full picture of your current condition.
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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 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 a day.
Effects Of Fluid Retention
As fluid settles in different areas of the body, seniors may experience a range of symptoms.
- The fluids can settle in the lungs or chest cavity, resulting in shortness of breath or cough.
- If fluids settle in the extremities, individuals may experience swelling and weight gain due to fluid retention.
- Seniors may also experience bloating in their stomachs as fluid settles in the abdomen, reducing their appetite or causing nausea.
If a senior notices sudden swelling or changes in symptoms, they should seek medical attention immediately. The symptoms of CHF and fluid buildup as a result of the condition are gradual, so any sudden change is a sign that something else could be going on.
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Congestive Heart Failure : What Is It
Before understanding the best ways to reduce the risk of an unwanted hospitalization, you first must understand a disease. Heart failure, also known as congestive heart failure , is not something that occurs suddenly like a heart attack. Heart failure is a condition that develops gradually over time. The heart keeps pumping, but its not pumping blood throughout the body as efficiently as it once did. Congestive heart failure may involve one part or multiple parts of the heart. There are many symptoms to look out for, according to the Mayo Clinic.
While CHF may shorten lives, a good care plan implemented by a team of clinicians, caregivers, and the patient themselves, can extend and improve the quality of life. Chapters Health System has a continuum of care suited toward CHF patients. Vice President of Medical Services, Dr. Stewart Stein, explains them in the following video:
While a team of trained nurses, nurse practitioners and doctors can certainly help, there are several simple things caregivers and patients can do at home. With that in mind, here are the top 10 tips to avoid hospitalizations for CHF.
About Congestive Heart Failure
Heart failure, sometimes called congestive cardiac failure , is a condition in which the heart muscle is weakened and cant pump as well as it usually does. The main pumping chambers of the heart can change size and thickness, and either cant contract or cant relax as well as they should. This triggers fluid retention, particularly in the lungs, legs and abdomen.
The major causes of heart failure include coronary heart disease and heart attack, high blood pressure, damage to the heart muscle , heart valve problems and abnormal heart rhythms. Of these, coronary heart disease and heart attack are the most common causes.
The major factors that contribute to coronary heart disease include:
- reduced emotional and social wellbeing
- physical inactivity.
Heart failure is more common in elderly people. The survival rate for people with this disorder depends on the severity of their condition.
Most common treatments for heart failure are medications and self-managed lifestyle changes. Some less-common treatments may require insertion of implantable cardiac devices or valve replacement.
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Quality Of Patient Care
Brigham and Womens Hospital is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and follow established protocols that have been shown to improve patient outcomes. Our inpatient satisfaction survey, sent to patients to assess their total care experience, helps us to monitor what we are doing well and areas for improvement. We pride ourselves in the quality of patient care we provide and how we are measured compared with other hospitals.
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When Dialysis Is An Option
Recent research suggests that people with advanced heart failure who no longer respond well to diuretics may benefit from a procedure called peritoneal dialysis, which can be done at home. A tube called a catheter is inserted into your abdomen, and a sterile cleansing fluid gets pumped in. Its later drained through the tube, carrying excess fluids out with it. One method requires the procedure be done up to five times a day the other method, which is machine-assisted, works overnight as you sleep.
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What Are The Symptoms Of Heart Failure
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:
- Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
- Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen , and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
- Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
- Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.
If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.