Surviving Congestive Heart Failure (CHF)

I should start with a definition by the American Heart Association (AHA):  “Heart failure can progress, so researchers have identified four stages of the disease — A, B, C and D. Health care professionals also classify heart failure when it has progressed to stages C and D. This classification measures a patient’s overall heart function and severity of symptoms”. There are further definitions based on classes ( I- IV). I encourage people to go to the AHA website to get more information, I have added the website to my resource page. 

I need to add that there is not just one kind of heart failure:

• Left-sided heart failure.
• Right-sided heart failure.
• High-output heart failure. This is a rare type of congestive heart failure.

As I mentioned in the previous post my father had a degree of heart failure after his heart attack. A portion of his heart was not contracting well from the damage to the muscle on the bottom left side of his heart and possibly some degree of failure on the right due to years of smoking.   He had been a heavy smoker for years, morbidly obese, with high cholesterol and high triglycerides. He was male and over 40. With 5 risk factors, it was no surprise he had a heart attack.  

After my father had his heart attack, I was told it put me into the next risk category for heart risk! I said, “Me…what did I do?” My doctor explained that you can inherit genes that can work together to predispose you to heart issues such as genes for hypertension or high cholesterol. 

Around Christmas, I received a call from my mother telling me that my father’s feet were really swollen. She was having a hard time describing just how swollen, so I told her to take her index finger and press down firmly for about 30 seconds, then I asked her to describe the indentation and how long it took to return to normal. It was deep and did not resolve. I then asked to speak to my father. While he said he was fine, he was clearly very short of breath (SOB). I told my mother he needed to go to the hospital for evaluation. She responded, “I just knew you were going to say that ”.  I explained it was inconvenient; however, he needed to go as his condition could get much worse.

As sometimes happens with parents getting advice from their children, she called her insurance and they confirmed he needed to go to the ER. He was in fact in a crisis stage and needed medications such as intravenous lasix to remove excess water from the body. 

As the heart weakens it loses its stretch, called the “Frank-Starling Law”. I explained to my mother and father that it is like taking a balloon and filling it with water. Too little stretch and it just hangs limp, too much stretch and it becomes rigid, just the right amount of stretch and it squirts with adequate force. It is a basic principle on how the heart works to generate enough systolic blood pressure; the first number when taking your blood pressure. The recoil of the heart is essential to give vital organs (brain, kidneys, liver, lungs…) enough blood pressure to keep them alive. Therefore, too much fluid can challenge the heart. If the heart can’t handle it, it will back up into the body and eventually to the lungs. I also told my mother to avoid excess salt, which she said she already was doing.

Just to be clear: Symptoms alone are not a diagnosis. There are many causes for foot swelling; however, because I knew my father and his health history, fluid overload would be a likely situation.  But he still needed to be “worked up” in an ER to be sure. He was treated and discharged home.  Hang on because it gets worse! 

Several months later,  my mother called and reported to me that my father was not doing very well and that he was physically unable to walk from the front door to the mailbox; which was not more than 30 feet away. She said he would get up, sit in his recliner and sleep all day. 

She told me that he had been diagnosed with sleep apnea.  I had witnessed signs of sleep apnea in him myself over the years. He refused to wear a CPAP (continuous positive airway pressure) at night to help keep his airway open to treat the problem. Despite my education, he refused to wear it, saying,  “I will be fine and I don’t need it”. I told him he would eventually hurt his heart and brain due to not breathing adequately when he sleeps. He was very stubborn and he never did use a CPAP machine.

My mother called his pulmonologist who felt that the sleep apnea was influencing his activity level. It was a valid point. However, I knew my father had sleep apnea for years and felt that this situation was unusually different for him. He was a contractor and had been very active his entire life. I could be wrong, but encouraged my parents to find a cardiologist to see if maybe something was going awry with his heart. He did have a heart attack 15 years prior and I knew his heart would certainly not be getting better.

Dad went into acute pulmonary edema which is fluid backing up from the heart in the lungs. I flew out to Florida to see what was actually going on. When I arrived, he had been discharged from the ICU and was on the medical floor. I asked if a cardiologist had evaluated him. They said no. I needed to use my not-so-subtle persuasion and they arranged for a cardiologist evaluation the next morning. My father reported to the nurses a chest pressure that evening and he was taken to the cardiac cath lab the next morning. This is where imaging is done of the vessels supplying the heart with blood and also looks at valve function. We were not there for more than 30 minutes when we were paged to meet the doctor. I was very worried as this is not typical.  

The cardiothoracic surgeon told us that his mitral valve, which is on the left side of the heart between the upper left chamber and lower “pump” chamber, was wide open allowing blood to flow backward. This situation could not generate adequate blood pressure for activities such as walking. The surgeon told my mother his likelihood of survival was maybe 2 years with a very poor quality of life. The surgical repair would be extremely difficult and risky. 

Dad decided on the surgery. He said he “wanted 10 more years”. 

Once the value was fixed, we still needed to deal with his congestive heart failure (CHF). Even though my mother insisted she had my father on a low-salt diet, I needed to make sure. 

That was all backstory, the following story will explain my point of this post. 

We started in the kitchen. “Mom, show me on an average day what you make for Dad’s meals”. Within minutes I already knew what the issue had been; excessively high salt.

I know this has been said many times, but everything starts and ends with our diets. 

I had a patient in the ICU that we could not get his heart failure under control. The doctors were frustrated when the sodium in his blood work and leg swelling (edema)  just would not resolve. One day after visitors left I saw a soda bottle at his bedside. Being the constant investigator (aka busy body), I asked if I could look at the label – sure enough loaded with salt! Once the education was provided he did well and was discharged to home. He never thought to look.

My mother, when reading the nutritional labels, was looking at the percentage for daily consumption but not at the milligrams it actually contained. He was getting more than 10,000mg a day! I explained that Dad’s heart could not handle excess fluid, which follows salt. It is a molecule that attracts and holds fluid in the vessels and eventually overwhelms a weak heart. In a weakened state, the heart can not handle the fluid and the muscle gets stretched beyond its ability to properly empty. That coupled with a bad value spelled disaster. 

I taught my mother and asked her to keep my father on a 1000 mg sodium/day diet, which is extremely difficult to do. I  bought her cookbooks and she checked every label finding the lowest sodium foods. Her local grocery store makes sodium-free bread and brine-free baked chicken breast instead of high-salt cold cuts. She needed to learn to avoid processed foods and she found it fairly easy after a while but it was a lifestyle change.

After his value replacement and diet change my father did well, he went on cruises with my mother and never went back to the hospital for congestive heart failure again. Dad got another 10 years like he wanted.  Mom was able to get off her antihypertensive medication; high blood pressure medication,  while eating the same lower-sodium diet as Dad.

I would say that it was a win-win situation. 

Something so small as changing your salt intake can for people with CHF dramatically improve your health. It often can be managed however it has to start with the diet and recommended medications from your primary physician.

Finally, I would not be a good nurse if I did not tell you what your risk factors are.

Risk Factors:

• Smoking
• High blood pressure
• Diabetes
• High cholesterol and triglyceride levels
• Lack of physical activity
• Overweight and obesity
• Family history of a heart attack before the age of 50.

Symptoms of a heart attack:

• Discomfort—tightness, squeezing, or aching in the chest, arms, neck, jaw or between the shoulder blades of the back
• Shortness of breath
• Nausea
• Feeling clammy or sweaty
• Fatigue
• The sense that something is terribly wrong

Warning signs of heart disease:

• Unusual tiredness, fatigue that does not go away.
• Trouble sleeping
• Shortness of breath
• Dizziness or lightheadedness, especially with exertion like going up stairs or happens without warning 
• Occasional passing chest pain or tightness
• Swelling in legs or ankles; overall fluid retention

I would love to hear your stories, questions and suggestions. Please feel free to comment and share your experiences as this blog is only intended to be one resource for surviving disease. With the right information I know people will not just live but thrive! 

My next post is near and dear to my heart, my baby sister has been diagnosed with Stage 4 Ovarian Cancer. She has agreed to share her story which started 14 months ago. This is an ongoing story that shows her determination to survive and her current ongoing journey.

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