Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. The heart's job is to supply blood to the rest of the body, so when it cannot work well, fluid is retained in organs and there is an insufficient blood supply.
The heart is like a pump trying to get water out of a flooded area, sending the water to other areas that need it. The retained fluid causes swelling in the legs, but some people might experience swelling in other areas such as the stomach or the liver. Some have too much water in their lungs, so they cannot breathe well. When organs do not get enough fluid, the hands and feet feel cold and the face looks pale. If the liver and kidneys don't get enough fluid, they can fail.
Therefore, in treating a patient with heart failure we must look at the root cause. More importantly, fluid levels must balance. Body fluid levels are partly due to the fluids and sodium we consume each day. Sodium makes the body retain more water.
A person with healthy kidneys and mild heart failure might not have to strictly control fluid consumption, but sodium consumption must be closely watched. Weighing themselves in the morning at the same time every day is a good way to monitor body fluid levels. A person's weight should not go up or down more than 500g a day. Any more than that, it means there is an imbalance of body fluids. One kilogramme of increased weight is a litre of water retained in the body.
Heart failure patients should also be careful with medication, including herbal meds. Most are older patients, and usually have other conditions such as joint pain, diabetes or neurological problems. Most medicine for joint pain adversely affects heart disease because it causes the body to retain more water and salt. Therefore, the heart disease medication is prevented from working well. It can also increase blood pressure, which could eventually lead to heart failure again.
In some areas, people still prefer "herbal" medicine which normally contains steroids. Steroids cause water and salt retention and can lead to heart failure as well. Some herbs interfere with the body's ability to flush out minerals. They can reduce potassium levels, which can affect the heart.
Chinese herbal medicine with ginseng also stimulates the heart and interferes with the medicine. Diabetes medicine could also affect the heart by increasing water retention, causing some parts to swell. A diabetic patient who has heart disease (which is quite common — diabetic patients usually have heart problems, sooner or later) should be extra careful with the heart's health.
Some migraine medicine, sleeping pills, medicine for Parkinson's disease, irritable bowel syndrome and prostate issues, and rheumatoid medicine might also affect the heart and coronary artery as well as blood pressure. If patients are not careful or do not alert the doctor when they are prescribing medicine, it could lead to heart problems.
A heart disease patient should have a list of every medicine and supplementary food and herbs being taken, and show it to their doctor. That way, if there is anything risky about the medication, the doctor can point it out and advise accordingly.
No medicine is perfect. Prevention is better than cure, and exercise is the best medicine.
Dr Nithi Mahanonda is a consultant cardiologist and interventionist at Perfect Heart Institute, Piyavate Hospital.
Visit his website at www.drnithi.com.