Jan 27, 2010 8:59 PM
If you or a member of your family is among the 5 million Americans who suffer from heart failure, you may already know how important it is to take all prescribed medication. (This is not always easy because it can mean taking 15 to 20 drugs and working with multiple health-care professionals).
You already know the importance of cutting back on salt, staying physically active, not smoking, and if weight is an issue, losing the extra pounds.
But even if you or your family member is a model patient, you still need to watch for new or recurrent signs and symptoms of heart failure. And you need to alert the doctor at once if trouble seems to be brewing.
"Heart failure is a progressive condition," says Gregg C. Fonarow, MD, professor of medicine at UCLA David Geffen School of Medicine and director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles. "Patients may be stable for weeks or months or years and then have a worsening of symptoms. It can be very subtle. That's why there's a need for close follow-up."
Here are eight signs to watch out for. Call your doctor if you or a family member with heart failure experiences any of them.
Even in the absence of specific symptoms you can point to, experts say it's prudent to alert the doctor if you or a family member with heart failure begins to feel ill at ease.
"Heart failure is very heterogeneous, and it's different for each patient," says Clyde W. Yancy, MD, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas and president of the American Heart Association.
"You know what heart failure felt like before. If something isn't feeling right to you now, don't wait to see if it will pass. Call someone."
Feeling unusually tired or listless -- during exercise or while going about daily activities -- might be evidence that you or your family member's condition has taken a turn for the worse. "If you had been able to walk two blocks without becoming winded but now find you can now walk only one block, that can be worrisome," says Fonarow.
"You don't get a medal for bravery" for putting up with fatigue, Yancy adds. "Pick up the phone and call the doctor."
Breathing trouble is a leading cause of hospitalization for people affected by heart failure. The problem arises when a reduction in the heart's pumping efficiency causes fluid to accumulate in the lungs. This is called pulmonary edema.
Severe breathing trouble is a medical emergency, of course. It warrants an urgent call to 911. But even mild "air hunger" should be reported to the doctor, especially if it occurs at rest or with minimal exertion.
In certain cases, people with heart failure have trouble sleeping because they find it hard to breathe when lying down (a condition known as orthopnea). "Some patients can sleep only if they prop themselves up with a pillow or two," says Yancy. "If you see that you are going to three pillows, that should prompt a call to your doctor in the morning."
Putting on pounds may be evidence that the body is retaining fluids. This suggests a decline in the heart's pumping action. Gaining 3 or more pounds in a single day or 5 or more pounds in a week means it's time to alert the doctor.
Since weight gain is such a reliable indicator of potential trouble, doctors urge heart failure patients to weigh themselves every day. Use the same scale at the same time each day, while wearing little or no clothing.
For example, you or your family member might hop on the scale first thing in the morning. Keep a written record of these daily weigh-ins. This can help the doctor assess any problems.
In addition to weight gain and shortness of breath, fluid retention can cause swelling in the lower extremities. This can be apparent when shoes feel tight or socks leave indentations in your ankles. But swelling can also affect other parts of the body.
"Most people know to look for swelling in the ankles," Yancy says. "But edema can also affect the thighs, buttocks, hands, and even the scrotum or vulva."
People who develop fluid retention in the abdomen (a condition known as ascites) may experience nausea or a loss of appetite or feel uncomfortably bloated. Or they may simply notice that clothes that used to fit now feel tight. In any case, the doctor should be alerted.
Heart rhythm disturbances known as arrhythmias are more common among people with heart failure. Some arrhythmias are benign, but others can raise the risk for stroke, heart attack, or even sudden death.
For this reason, it's best to alert the doctor to any new or recurring change in heart rhythm. Similarly, let the doctor know if it feels like your heart is racing or throbbing.
Some arrhythmias stem from a potassium deficiency caused by the diuretics used to treat heart failure. In such cases, a medication adjustment or potassium supplements may be all that's required.
Severe arrhythmias sometimes cause a loss of consciousness; so can extremely low blood pressure. No matter what the suspected cause, any heart failure patient who faints or blacks out should seek urgent medical attention.
"A significant decrease in blood pressure without a change in medication can be a sign that the heart muscle is not functioning as well," says Fonarow. An increase in blood pressure might suggest that medication needs to be adjusted. In either case, it's important to alert the doctor.
The sooner potentially worrisome symptoms are reported to the doctor, the better the outcome is likely to be. "The best way to get out of trouble is to avoid trouble to begin with," Yancy says.