Heart failure is a chronic condition in which your heart isn’t pumping the blood as well as it should. This disease is progressive, which means that it gets worse over time and the symptoms often make day-to-day functioning harder. However, even though heart failure can’t be cured, medication therapy can help ease the symptoms, slow the progression of the disease, and make you live longer.
What’s the relationship between fluid build-up and symptoms of heart failure?
If you’re going through heart failure, you might notice that you get out of breath more often, have trouble breathing, or you might have that annoying cough that won’t go away. And you’re not alone — heart failure makes breathing harder for 93 percent of patients. It might not be intuitive to think so at first, but fluid build-up is to blame for this and several other heart failure symptoms.
The heart's main job is to keep blood circulating, so it can deliver oxygen and nutrients to every cell and take away waste. The used-up blood goes to the right side of your heart that pumps it to the lungs to get saturated with oxygen. The left side of your heart receives that freshly-oxygenated blood from the lungs, and pumps it to the rest of the body. The blood from the lungs first fills the upper left chamber (atrium) and is then passed to the left ventricle, the heart’s main pumping chamber.
But since the left ventricle is working at limited capacity in heart failure, it’s getting more blood from the lungs than it can pump. That “extra” blood is not going anywhere but instead increases the pressure in the left atrium and the blood vessels of the lungs. Fluid tends to flow from areas of high pressure to the ones with lower pressure. So when it gets stuck in the blood vessels that are surrounding the air sacks of your lungs, where the pressure is normal, it moves there.
The second most common symptom of heart failure is swelling (edema) of other tissues, usually your feet, ankles, legs, and stomach. This happens to more than 70 percent of heart failure patients, and while it doesn’t directly disturb your everyday activities, edema makes the situation harder for the heart that’s already weakened. The problem is that all that extra fluid, both in the lungs and in other tissues, increases your blood pressure. When blood pressure is high, the heart needs to work extra hard — which might speed up the progression of heart failure and make your symptoms even worse.
So what are diuretics and how do they help with fluid build-up?
Any substance that causes excess formation of urine is considered a diuretic. They don’t all work in the same way, but the end result is the same: your kidneys start producing more urine, relieving your body of extra water that’s been held up.
Three classes of diuretics are frequently used for heart failure:
- Loop diuretics. They’re named so because they act on the part of the kidneys called Henle’s loop that keeps the level of ions higher in certain parts of kidneys. That forms a gradient that determines the movement of water. Loop diuretics interfere with this process and inhibit sodium, chloride, and potassium reabsorption. Ultimately, because they’re not reabsorbed, ions end up in your urine and take water with them.
- Thiazide diuretics. This class interferes with sodium transfer that results in water being retained in the urine. It also widens your blood vessels, but the mechanism by which it does it is still unknown.
- Potassium-sparing diuretics. As the name states, unlike many other diuretics, this type doesn’t lead to the loss of potassium.
What are some examples of diuretics used for heart failure?
Loop diuretics:
- torsemide (Demadex)
- furosemide (Lasix)
Thiazide type:
- chlorthalidone
- hydrochlorothiazide (Microzide)
Potassium-sparing diuretics:
- triamterene (Dyrenium)
- spironolactone (Aldactone)
How safe are diuretics and what are the side effects?
Diuretics are considered safe and are usually well-tolerated when taken as prescribed. However, some people can experience adverse reactions, including:
- Altered levels of potassium. Since diuretics interfere with the absorption of potassium and other ions, sometimes they can cause you to have too much potassium (with potassium-sparing diuretics) or too little (hypokalemia). Hypokalemia is dangerous because potassium plays an important role in the normal functioning of the heart.
- Headaches
- Dizziness
- Thirst
- Increased blood sugar
- Increased cholesterol
- Muscle cramps
- Skin rash
Some people might have an allergic reaction, which requires immediate medical attention.
Who shouldn’t take diuretics?
Sometimes diuretics can interfere with other health conditions and medications. If you have problems urinating, kidney or liver disease, or Addison’s disease, you need to have a talk with your physician because diuretics might be contraindicated for you. People with arrhythmia and those older than 65 might need careful monitoring during treatment with diuretics.
Are there things you need to be extra careful about if you are taking diuretics?
We often ingest substances with diuretic effects without even realizing it. For example, you might be drinking green or black tea, or use parsley while cooking. Since diuretics already decrease your blood pressure, it can be dangerous to lower it even more. This is why you need to be mindful of everything you’re consuming or ingesting, including herbs and herbal remedies.
Your thoughts on this