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Potassium And Heart Failure

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How Do You Get Potassium

Living with Heart Failure: Diuretics and Potassium

Even if youre not dealing with heart failure or major health concerns, you should make sure that youre getting enough potassium in your diet.

The easiest way to get more potassium is to increase your salad to seven to ten cups of salad.

Why?

Because it takes that much potassium, and we need a lot – like 4700 milligrams of potassium a day. Potassium is also good for rheumatoid arthritis and inflammatory conditions.

As you can see, this mineral is vital.

For more information on nutrition, health, and how to create a healthy body, check out my website at drberg.com. Ill see you there.

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How Is It Diagnosed

It can be difficult to diagnose hyperkalemia. Often there are no symptoms. When there are, symptoms may include nausea a slow, weak or irregular pulse irritability, paraesthesia , muscle weakness, diarrhea, abdominal cramping or sudden collapse if the heartbeat slows or stops.

In many cases, hyperkalemia diagnosis must rely on clinical information such as a history of kidney failure or the use of medicines known to cause hyperkalemia.

Laboratory data and electrocardiographic changes can also be used along with clinical information to reach a diagnosis. For most people, their potassium level should be between 3.5 and 5.0 millimoles per liter . Hyperkalemia is a potassium level of greater than 5.5. Patients with hyperkalemia may have a normal electrocardiogram or only subtle changes.

Can It Be Prevented

Dietary changes can help prevent and treat high potassium levels. Talk to your doctor to understand any risk you might have for hyperkalemia. Your doctor may recommend foods that you may need to limit or avoid. These may include:

  • asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, cooked spinach
  • oranges and orange juice, nectarines, kiwifruit, bananas, cantaloupe, honeydew, prunes and raisins or other dried fruit.

If you are on a low-salt diet, avoid taking salt substitutes.

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An Article From The E

Prof. Petr Widimsky ,FESC

Practicing cardiologists must keep potassium levels within normal limits in all their cardiac patients. Unrecognised hypokalemia is a leading cause of iatrogenic mortality among cardiac patients who have an inherent risk for arrhythmias and who frequently use medications that increase the risks of hypokalemia and/or arrhythmia. Symptomatic or severe hypokalemia should be corrected with a solution of intravenous potassium: 10-40 mEq infused over two to three hours . In less urgent situations, oral supplementation is preferred and safer: 50-100 mEq/d divided two-four times per day. Long-term treatment should be based on the recognition of the hypokalemia cause.

Ncx: The Link Between Nka Inhibition And Ca2+ Overload In Hypokalemia

How to Recognize the Signs and Symptoms of Low Potassium Hypokalemia ...

Na+ and Ca2+ homeostasis are coupled through the Na+/Ca2+-exchanger that uses the electrochemical gradient of Na+ and Ca2+ to exchange 3 Na+ for 1 Ca2+. This allows NKA to indirectly regulate cardiac Ca2+ fluxes through the regulation of i. NKA is an ATP- and voltage-dependent ion transporter that exchanges 3 Na+ ions from the cytosol with 2 K+ ions from the extracellular compartment, leading to a net outward current . NKA is the only major Na+ efflux mechanism in cardiomyocytes, and regulates intracellular by balancing Na+ efflux against Na+ influx .

Despa et al. demonstrated that a similar degree of NKA1 and NKA2 inhibition yielded a comparable rise in intracellular Na+, but only NKA2 inhibition increased the Ca2+ levels in cardiomyocytes . This study and others suggest that the ability of NKA2 to regulate Ca2+ fluxes and cardiac contractility is most likely due to close localization with NCX, but this remains to be shown. NKA1 is more abundant at the sarcolemma, whereas NKA2 preferentially localizes to the transverse T-tubules . The anchoring protein Ankyrin B coordinates a NKA/NCX microdomain, but both NKA1 and NKA2 coprecipitate with Ankyrin-B . More studies are needed to determine the precise mechanism through which NKA2 specifically can control Ca2+ homeostasis and cardiac contractility.

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Planning A Low Potassium Diet

High potassium levels in the blood can cause serious heart troubles, especially if you are at high risk of heart failure, but before you severely restrict the potassium in your diet you may want to check in with a healthcare professional to talk about the risks of high potassium and how a low-potassium diet can help.

Talk To Your Healthcare Provider

If you are at high risk for hyper- or hypo- kalemia or experience any of the aforementioned symptoms, seek immediate medical attention. Dietary changes can help prevent and treat high or low potassium levels.

Talk to a healthcare professional to understand any risk you might have for hypo- or hyper- kalemia, as they may recommend foods that you may need to limit, avoid, or increase depending on your potassium status.

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Are You Eating Enough High

If you’re eating a well-balanced diet high in fruits and vegetables, you don’t have to worry about getting too much potassium. “The challenge is that most Americans do not get enough potassium in their diets,” Dr. Day says. You can actually lose a lot of potassium from excessive sweating during endurance sports or while exercising on a hot summer day, Day notes.

And unless you have kidney failure or are on certain medications, you don’t need to worry about getting too much potassium. “Fortunately, if you get enough potassium in your diet the kidneys do a remarkable job at regulating the body’s potassium level,” Day says.

Jeffers agrees that eating too many high potassium foods is only a concern for patients with kidney problems, who should consult with their doctor about how to balance potassium levels.

Foods High In Potassium

Heart Failure | Pharmacology (ACE, ARBs, Beta Blockers, Digoxin, Diuretics)
  • Potato, 1 medium has 926 mg potassium
  • Sweet potato, 1 medium has 540 mg potassium
  • Spinach, ½ cup cooked has 290 mg potassium
  • Zucchini, ½ cup cooked has 280 mg potassium
  • Tomato, ½ cup fresh has 210 mg potassium

Legumes and Nuts

  • Soybeans, ½ cup cooked has 440 mg potassium
  • Lentils, ½ cup cooked has 370 mg potassium
  • Kidney beans, ½ cup cooked has 360 mg potassium
  • Split peas, ½ cup cooked has 360 mg potassium
  • Almonds, one third of a cup has 310 mg potassium

Fruits

  • Bananas, 1 medium has 420 mg potassium
  • Oranges, 1 medium has 237 mg potassium
  • Cantaloupe, ½ cup has 214 mg potassium

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Risks From Low Potassium In Heart Failure Patients With Chronic Kidney Disease

Date:
University of Alabama at Birmingham
Summary:
New research finds that low potassium levels produce an increased risk of death or hospitalization in patients with heart failure and chronic kidney disease . Researchers say that even a mild decrease in serum potassium level increased the risk of death in this patient group.

New research from the University of Alabama at Birmingham says low potassium levels produce an increased risk of death or hospitalization in patients with heart failure and chronic kidney disease .

In findings reported in January in Circulation: Heart Failure, a journal of the American Heart Association, the researchers say that even a mild decrease in serum potassium level increased the risk of death in this patient group.

“Hypokalemia, or low potassium, is common in heart-failure patients and is associated with poor outcomes, as is chronic kidney disease,” said C. Barrett Bowling, M.D., a fellow in the UAB Division of Gerontology, Geriatrics and Palliative Care. “But little is known about the prevalence and effect of hypokalemia in heart-failure patients who also have CKD.”

Bowling, a graduate of the UAB Internal Medicine residency program, said these findings indicate that in patients with heart failure and CKD the serum potassium levels should be monitored routinely and carefully maintained within a safe range.

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Other Guidelines For Taking Potassium And Magnesium

While taking potassium or magnesium, have your blood pressure checked regularly as advised by your doctor.

Keep all appointments with your doctor and the lab so that they can see how you’re responding to the supplements. Blood tests might be done to help monitor the level and decide on the dose.

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Potassium And Heart Health

The rhythmic contractions of the heart are controlled by periodic changes of the membrane potential, called action potentials, within the cells of the heart muscle . Potassium is both essential to generating a regular heartbeat and stabilizing the heart, helping to stave off potentially deadly cardiac arrhythmias.

Meeting your daily potassium requirement helps keep your heart working at its best. A healthy potassium blood level is between 3.5 and 5.0 milliequivalents per liter . Potassium levels that are too high or too low can cause or exacerbate heart failure.

Most of the potassium that you need will be consumed in your diet. Foods that are rich in potassium help manage your blood pressure by lessening the effects of sodium. Potassium does this through its ability to promote sodium excretion in urine and ease tension in your blood vessel walls.

Studies have shown that increasing potassium intake can reduce the risk of cardiovascular diseases, such as high blood pressure, heart disease, and stroke, but the mechanism responsible for this is unknown. Some researchers believe that potassium may prevent atherosclerosis, or hardening of the arteries, but more research is needed to support these claims.

The Relative Role Of Nka Vs K+ Channels In Induction Of Hypokalemia

Potassium may help to prevent heart disease

The pro-arrhythmic effects of hypokalemia have been linked to reduced outward K+ currents such as IK1, IKr, IKs, and Ito and recently to reduced NKA currents . Reduced outward K+ currents decrease the repolarization reserve, prolong the APD, and increase the risk of afterdepolarizations . Low extracellular K+ leads to hyperpolarization of the resting membrane potential, which paradoxically increases excitability of cardiomyocytes. This effect is ascribed to an increased number of available Na+ channels and the reduced ability of IK1 to generate outward current that protects against membrane depolarization .

Pezhouman, Singh, and coworkers observed in an elegant study that reduced NKA activity was necessary and sufficient to develop hypokalemia-induced ventricular arrhythmias. Reduced K+ channel conductance in itself caused only a modest increase in APD and no afterdepolarizations, but potentiated the pro-arrhythmic effect of NKA inhibition in this study . Comparably, we found that NKA inhibition was necessary and sufficient to increase Ca2+ levels in a factorial analysis where we compared the relative effect of lowering NKA activity vs. all other ion channels and transporters sensitive to K e + . Several lines of evidence suggest that Ca2+ overload caused by NKA inhibition is the main initiating event in hypokalemia-induced ventricular arrhythmias, as discussed in the next sections.

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The Real Enlightenment Of The Diamond Trial

By salvaging the DIAMOND trial, the investigators delivered real enlightenment. Specifically, the vast majority of patients with HFrEF and a history of hyperkalaemia will not experience recurrent hyperkalaemia in the absence of patiromer, even when challenged with doses of MRAs that are probably higher than those needed to reduce mortality. Importantly, the proportion of patients who tolerate MRAs without hyperkalaemia and without potassium binders will only increase in the future, since two foundational drugssacubitril/valsartan and sodiumglucose cotransporter 2 inhibitorsmitigate the risk of hyperkalaemia while having direct benefits on heart failure outcomes., These immensely reassuring findings mean that, if we truly seek to improve outcomes in clinical practice, we must assuage physicians exaggerated fears about the dangers of hyperkalaemia, since trial-based MRA dosing strategies currently represent an exceptionally cost-effective and well-tolerated way to slow the progression of HFrEF.

What Are The Consequences Of Hyperkalemia

When it develops, mild to moderate hyperkalemia up to 6.5 mmol/liter may cause no symptoms and no immediate problems, but it is associated with a high risk of developing serious heart rhythm disturbances. Severe hyperkalemia is a life-threatening medical emergency, requiring immediate attention and medical management. The consequences of hyperkalemia are also affected by other factors such as the presence of heart disease or other blood electrolyte abnormalities that can increase the risk of heart arrhythmias.

Hyperkalemia can be prevented by frequent monitoring of blood levels, avoiding of potassium rich foods and appropriate dosing of drugs that may lead to hyperkalemia. Often this may mean the use of low doses or stopping certain medication or not stopping. Referral to a dietician may be beneficial in helping to adapt diet in the individual patient.

Hyperkalemia is manageable and reversible directly lowering serum potassium. The type of intervention is determined by the severity of hyperkalemia and associated complications. Acute management for severe hyperkalemia is implemented in the hospital to monitor for complications and includes intravenous therapy and interventions to quickly reduce potassium levels. Occasionally, the rapid removal of potassium from the blood through hemodialysis is required. This is usually only required in patients with severely reduced or absent kidney function.

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Dietary Sources Of Potassium

Potassium is an essential nutrient that is naturally present in many foods and is present in all body tissues. Potassium levels are tightly regulated because it is required for normal cell function. This mineral helps to maintain the balance between intracellular fluid volume and transmembrane electrochemical gradients.

Although potassium supplements are available, most people can get the potassium they need from the food they eat and the fluids they drink. Potassium-rich foods include:

  • Tomatoes, tomato juice, and tomato sauce

How Does Hyperkalemia Affect The Body

Electrolyte Imbalances | Hyperkalemia (High Potassium)

Potassium is a mineral that is crucial for normal cell function in the body, including heart muscle cells. The body gets potassium through foods.

The right level of potassium is key. The kidneys are primarily responsible for maintaining the bodys total potassium content by balancing potassium intake with potassium excretion. If intake of potassium far outweighs the kidneys ability to remove it, or if kidney function decreases, there can be too much potassium and hyperkalemia may occur.

Potassium and sodium concentrations play a crucial role in electric signal functioning of the hearts middle thick muscle layer, known as the myocardium. An above normal level of potassium can interfere with proper electric signals in that muscle layer and lead to different types of heart arrhythmias.

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The Rales And Emphasis

The RALES trial studied patients with severe HFrEF not generally receiving beta-blockers, who were randomized to spironolactone 25mg/day or placebo for a mean of 24 months. In a pilot trial, doses from 12.5mg/day to 75mg/day had produced meaningful decreases in natriuretic peptides, with minimal incremental effect but more hyperkalaemia at doses > 25mg/day. Accordingly, 25mg/day was designated as the target dose for spironolactone in RALES, and it is the target dose in clinical practice., In RALES, 50mg/day could be prescribed if, after 8 weeks, patients experienced progression of heart failure without hyperkalaemia. However, up-titration did not occur in most patients the mean dose was 26mg/day. At this dose, spironolactone reduced all-cause mortality by 30% and hospitalizations for heart failure by 35%. A serum potassium concentration 5.5mmol/L was seen in 5.5% of the placebo group, in 13.5% taking 25mg/day, and in 41% taking 50mg daily. Serious hyperkalaemia was observed in 12% of patients.

For People With Heart Failure

There are some drugs that heart failure patients take that are associated with hyperkalemia. These are: diuretics, beta-blockers and angiotensin converting enzyme inhibitors . For patients with heart failure on these drugs, if any symptoms are experienced as above, you should tell your doctor to make sure that the symptoms are not related to hyperkalemia.

Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.

Last Reviewed: Oct 31, 2016

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Cellular Alterations In Heart Failure And Hypokalemia

Molecular remodeling and structural remodeling are hallmarks of HF . The remodeling is associated with increased risk of arrhythmias, and might potentiate the pro-arrhythmic effects of hypokalemia. However, there is a paucity of mechanistic data on hypokalemia in HF. Given the high prevalence of hypokalemia in HF patients, more studies are needed to clarify how the remodeling-associated HF influences the risk of hypokalemia-induced arrhythmias. Here, we discuss key alterations in HF that we consider relevant for the expected effect of hypokalemia in failing hearts.

Potassium Cuts Stroke Risks After Menopause

Prognostic role of serum sodium levels across different serum potassium ...

After menopause, women who get enough potassium in their daily diet have fewer strokes, according to a September 2014 study in Stroke from the American Heart Association. The lower stroke rate could be due to the heart-health benefits of a potassium-rich diet, like blood pressure control and heart rhythm stabilization. Looking at the diets of more than 90,000 women, researchers found that those who had the most potassium in their diets were 12 to 16 percent less likely to have a stroke, report Sylvia Wassertheil-Smoller, PhD, lead author of the study, and other researchers at the Albert Einstein College of Medicine in the Bronx, New York. The women included in the research were between 50 and 79 years old. Those who consumed the most dietary potassium were also 10 percent less likely to die over the 11 years of the study. Their potassium came from food sources rich in the mineral, rather than from supplements.

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Aspirations And Findings Of The Diamond Trial

The DIAMOND trial was designed to test this hypothesis. Patients with HFrEF and a serum potassium concentration > 5.0mmol/L or who had had a reduction in the dose or discontinuation of a reninangiotensin system inhibitor or MRA because of hyperkalaemia within 12 months entered a run-in period, during which they received spironolactone 50mg/day or eplerenone 50mg/day while taking other reninangiotensin system inhibitors at 50% of target dose and patiromer . The doses of eplerenone and spironolactone did not follow the expected 2:1 to 4:1 ratio. If patients had a serum potassium 4.0 and 5.0mmol/L at the end of the run-in period, they were randomized to continue patiromer or be switched to placebo and be followed for the trials duration. If hyperkalaemia was subsequently observed, investigators were asked to reduce the dose of the MRA, as was done in the RALES and EMPHASIS-HF trials. The original primary endpoint was cardiovascular death or hospitalization for heart failure, with a plan to treat 2388 patients for 2.5 years. When faced with slow event accrual, the investigators heroically salvaged the trial by refocusing it on changes in serum potassium concentration in 878 patients who had been followed for a median of 27 weeks.

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