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There are three components to keeping heart failure under control:
- Daily weights
- Diuretics
- Fluid restriction/salt restriction
Daily weights are critical for heart failure patients.
Weights should be done the first thing every morning on the same reliable home scale before eating or drinking anything. Establish a DRY WEIGHT with your physician.
Think of ALL WEIGHT GAIN as an INCREASE IN FLUID, not as getting fatter.
A weight gain of 2 pounds is significant. If you take diuretics on an as-needed basis, a weight gain of two pounds or more means it is time to take your diuretic (water pill). Diuretics include Lasix, Furosemide, Torsemide and Metolazone.
If your weight continues to go up the next day, it would be appropriate to call your cardiologist. There is a point that you will no longer respond to oral medications as fluid accumulates in the body. Getting to this point is very serious and generally results in prolonged hospitalization.
As an example:
Let’s say a patient has established a dry weight of 170 pounds.
- Day 1 – 169 lbs
- Day 2 – 170 lbs
- Day 3 – 172 lbs (take diuretic, improve fluid and salt restriction)
- Day 4 – 170 lbs
- Day 5 – 173 lbs (take diuretic)
- Day 6 – 177 lbs (call Cardiologist first thing in the morning to adjust medication)
(Please note that some patients require daily diuretics and cannot take diuretics on an “as needed” basis.)
Fluid restriction is critical in the management of heart failure.
Generally, fluid intake should be limited to 2 liters of fluid a day or less. This includes all fluid intake, not just water. A good way to visualize the amount of daily fluid is to think of a two-liter Coke bottle. You can even buy a two-liter Coke and pour it into several cups or glasses that you might drink from on a daily basis. This will give you an idea of how much you can take on a daily basis.
Salt restriction is also critical. Do not add salt to food OR eat salty foods. One common mistake is eating soup. Soup (even low salt soup) is invariably high in salt and should be avoided. Some heart failure patients are so sensitive to sodium that a single salty meal can put them in the hospital.
The American Heart Association publishes several cookbooks, which are a good resource to understand a low salt diet.
