Heart failure - fluids and diuretics

  • Definition
    • 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.

  • Alternative Names
    • HF - fluids and diuretics; CHF - ICD discharge; Cardiomyopathy - ICD discharge

  • 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
    • 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: Bumentanide (Bumex), furosemide (Lasix), and torasemide (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
      • 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.

      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, especially 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.
  • References
    • Januzi JL, Mann DL. Clinical assessment of heart failure. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 23.

      Mann DL. Management of patients with heart failure with reduced ejection fraction. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 25.

      Mant J, Al-Mohammad A, Swain S, Laramee P; Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute For Health and clinical excellence guideline. Ann Intern Med. 2011;155(4):252-259. PMID: 21844551

      Riegel B, Moser DK, Anker SD, et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141-1163. PMID: 19720935

      Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239. PMID: 23747642