Ways to Reduce Swelling in Congestive Heart Failure

Approximately five million Americans have been diagnosed with congestive heart failure. This serious condition is the result of the heart's inability to pump blood throughout the body, causing a backup that seeps from blood vessels into other tissues. The water-logged cells cause a type of swelling called "edema," which usually pools in the ankles, feet and legs, as gravity pulls the blood down and the heart has trouble pumping it back up. About 90 percent of heart failure hospitalizations are related to this disconcerting water retention. Patients often feel bloated, in addition to suffering uncomfortable skin redness and tightness.

Diuretics

• Drugs called "diuretics" are often the first line of defense against congestive heart failure related swelling. These drugs encourage the kidneys to increase urine production, removing sodium, water and waste from the body. Doctors may prescribe an oral diuretic like furosemide (Lasix), torsemide (Demadex), butethamine (Bumex), ethacrynic acid (Edecrin), spironolactone (Aldactone) or digoxin (Lanoxin). If the patient is feeling really poorly, he or she may be admitted to the hospital and given Lasix intravenously instead. Patients are often hooked up to an oxygen mask and given morphine to reduce the anxiety caused by breathing difficulty associated with pulmonary edema and CHF.

  Diuretics are generally safe, but many patients report increased frequency of urination. They also may have too much or too little potassium in their blood. Some patients report low blood sodium levels, increased blood sugar, increased cholesterol, rashes, gout, impotence or breast enlargement in men and menstrual irregularities in women. In some instances, oral diuretics will not work for fluid around the abdomen. The extra fluid in the stomach region can block pill absorption, which is why IV Lasix is considered more effective.

Other Alternatives

• Other drugs commonly used to reduce swelling include: calcium channel blockers, ACE inhibitors and beta blockers. Calcium channel blockers work well in people with high blood pressure and coronary artery disease by reducing the narrowing of the blood vessels. However, some argue that long-term use of drugs like nifedipine and nondihydropyridines may increase mortality rates.

  ACE inhibitors (such as captopril or intravenous enalapril) block the contraction of blood vessels to allow better fluid circulation. These drugs are known for preventing early death in patients with hypertension and CHF, although some patients report side effects like drowsiness, cough, headache, low blood pressure and rashes.

  Beta-blockers (like Lopressor) block adrenaline, slow blood flow and relieve high blood pressure. For congestive heart failure patients, the beta blockers act as disease-modifying agents, which blocks hormones that progress the disease. Side effects include dizziness, fatigue, cold hands and feet, slowed heart rate, asthma and depression.

  Researchers are currently testing a new type of drug that blocks the hormone causing kidneys to retain water. In early trials, Vasopressin Receptor Antagonists (like Carvedilol) have demonstrated a two-thirds decrease in mortality in some patients. Researchers say this new drug may be just as effective as diuretics at helping patients get rid of excess water, while encouraging the body to retain the proper sodium and potassium levels.

How to Prevent Edema

• People who are interested in herbal remedies can try taking 400 milligrams of Coumarin, 250 milligrams of Selenium, or 2 grams of Hydroxyethylrtosides each day, which may help reduce swelling. However, not all patients with edema will require drug treatment. Often, lifestyle modifications -- like restricting sodium intake, elevating the legs, exercising moderately, quit smoking and restricting fluid intake to no more than 2 liters per day -- can be quite effective at reducing congestive heart failure swelling. In fact, when these lifestyle changes do not accompany drug treatment, there is very little progress.