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Ask Dr. K: Heart failure often manageable, at times unpredictable

DEAR DOCTOR K: My doctor says I have heart failure. Are there symptoms I should be looking out for that would indicate my condition is getting worse?

DEAR READER: The term “heart failure” is often misunderstood. People think it means their heart is going to suddenly stop pumping. When that happens, that’s not “heart failure”; it’s a cardiac arrest — and it’s fatal unless the heart can be restarted. In heart failure, the heart continues to pump, but it’s just not pumping as efficiently as it needs to.

The heart does just one thing, but that thing is of life-or-death importance: It pumps blood to every cell in the body. The blood carries sources of energy (like oxygen and sugar) to each cell, and it carries away from each cell its waste products. That needs to happen constantly, every second of your life.

When the circulation of the blood is not as efficient as it should be, a person develops symptoms. The most common are fatigue, shortness of breath and swelling in the legs.

The fatigue and shortness of breath are caused by lower-than-normal levels of oxygen and other sources of energy in the blood. The swelling in the legs comes from the buildup of fluid in the body. And that’s caused by a failure of the kidneys to make as much urine as they should, due to the poor circulation of blood through them. (I’ve put an illustration highlighting common symptoms of heart failure on my website, AskDoctorK.com.)

Heart failure is often a manageable condition. Taking medications, balancing exercise and rest, following a low-sodium diet and being careful about fluid intake can help keep it in check. But heart failure can be unpredictable. After a long stretch of being under control, it can flare up, and even require a hospital stay.

Sometimes these flare-ups come from out of the blue, caused by an infection or a medication. Most of the time, though, they creep up, announcing themselves with subtle changes, such as being more tired than usual or quickly gaining several pounds.

Call your doctor if you notice any of these warning signs of heart failure:

— Sudden weight gain (2 to 3 pounds in one day or 5 or more pounds in one week). The extra weight comes from the buildup of fluid, not from extra fat.

— Increased swelling in the feet or ankles.

— Swelling or pain in the abdomen.

— Shortness of breath at rest, or increased shortness of breath with exercise.

— Discomfort or trouble breathing when lying flat.

— Waking up at night feeling short of breath, and having to sit up to catch your breath.

— Increased fatigue.

Most important, stay in close communication with your doctor and health care team. Together you can catch changes in your condition early and help avoid complications.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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