Why Are Diuretics Used in Heart Failure?

Heart failure is the inability of the heart muscle to move a sufficient volume of blood to fuel normal activities. Diuretics eliminate pressure on a failing heart by reducing fluid accumulation.

The definition of heart failure means the heart is not pumping as it should to circulate oxygen-rich blood throughout the body.

Symptoms and signs of heart failure include the following:

• Shortness of breath
• Cough (may be chronic)
• Wheezing
• Swelling in the feet, ankles, legs, abdomen
• Weight gain
• Fatigue/tiredness
• Lightheadedness
• Exercise intolerance
• Palpitations
• Loss of appetite
• Nausea
• Confusion
• Problems thinking
• Chest pain (rare)

Symptoms usually worsen at night when lying flat and patients find that they may only be able to sleep sitting up.

Heart failure is caused by a weakened or thickened heart muscle.

Most people who develop heart failure have another heart condition, such as...

• Coronary artery disease
• High blood pressure (hypertension)
• Previous heart attack
• Abnormal heart valves
• Heart muscle disease (dilated cardiomyopathy, hypertrophic cardiomyopathy) or inflammation (myocarditis)
• Congenital heart disease (heart disease present at birth)
• Abnormal heart rhythm (arrhythmia or dysrhythmia)

Risk factors for heart failure include the following:

• Severe lung disease
• Diabetes
• Obesity
• Smoking
• Alcohol abuse
• Vitamin deficiencies
• Sleep apnea
• Heavy metal toxicity
• An unhealthy diet (including animal fat and salt)
• Sedentary lifestyle
• Severe anemia (low red blood cell count)
• Overactive thyroid (hyperthyroidism)

The diagnosis of heart failure starts with a physical exam which includes a doctor listening to the heart with a stethoscope.

The following tests help to diagnose heart failure:

• Blood tests
• Electrolytes such as sodium and potassium
• Albumin
• Creatinine
• Certain biomarkers including B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP)
• Chest X-ray
• Electrocardiograms (ECG or EKG)
• Echocardiography (echo)
• Exercise stress test
• Radionuclide ventriculography or multiple-gated acquisition scanning (MUGA)
• Cardiac catheterization
• Magnetic resonance imaging (MRI)

Treatment for heart failure includes lifestyle and diet changes, medications, and sometimes implanted devices. In severe cases, a heart transplant may be needed.

Lifestyle changes for heart failure include the following:

• Quitting smoking
• Losing weight
• Limiting liquid intake to reduce fluid buildup
• Limiting or avoiding alcohol
• Limiting or avoiding caffeine
• Eating a heart-healthy diet low in fat and sodium and high in fiber (plant-based diets may be helpful for heart patients)
• Exercising regularly
• Practicing stress reduction techniques such as mediation or yoga
• Controlling blood pressure
• Getting adequate rest
• Getting regular flu and pneumonia vaccinations

Medications used to treat heart failure and improve heart muscle function include

• beta-blockers,
• diuretics (water pills),
• angiotensin converting enzyme (ACE) inhibitors, and
• angiotensin receptor blockers (ARBs).

Diuretics (water pills) help the kidneys get rid of excess water and salt in the body, which makes it easier for the heart to pump. Diuretics are frequently used to treat swelling and water buildup caused by heart failure.

Complications of heart failure include

• heart valve problems,
• arrhythmias,
• kidney damage or failure, and
• liver damage.

Heart failure can be prevented and even reversed in some cases by many of the same lifestyle changes used to treat the condition:

• Taking medications as prescribed
• Quitting smoking
• Losing weight
• Avoiding or limiting alcohol
• Avoiding or limiting caffeine
• Eating a heart-healthy diet low in fat and sodium and high in fiber (plant-based diets may be helpful for heart patients)
• Exercising regularly
• Stress reduction techniques such as meditation or yoga
• Controlling blood pressure
• Getting adequate rest