are my grandmas symptoms congestive heart failure

[triciabarth]

My 91 year old grandma has had cardiomegaly, hypertension, atrial fibrillation,left bundle branck block, mitral insufficiency-severe, LVEF 30-35% for several years.  Since 7-05, edema of legs and feet, especially after a lot of salt. She was on lasix 40 mg b.i.d., triamterene 35.5 mg every other day, potassium, toprol, ditiazem, coumadin, and synthroid. Her 9-08 cardiologist appt. summary stated she was well controlled, even the edema was better, since triamterene 4-07 was added.   In12-08, suddenly, after eating alot more salt and not taking any triamterene, she swelled up, including in the abdominal region for the 1st time, which even she noted, becamed fatigued, had a marked increase in shortness of breath and a raspy wheezing sound when she breathed which wasn't there before. Also, she wonders why she feels so full even though she's eating less. I assume the symptoms are from fluid builup in the peritineal cavity and possibly the lungs, consistent with CHF. Am I right?  An ECHO on 3-4 revealed essentially no change, the heart rhythym is the same, and chest x-ray 3-7 said lung fields appear clear. Her doctor increased the lasix to 60mg A.M and 40 mg P.M., and triamterene to daily.  Her potassium was low, and the potassium dosage was increased. Still, she has the same symptoms, and now the fatigue and shortness of breath is worse, and the abdominal swelling looks even worse, 3 new water blisters on legs from edema, but she ate more salt, and the doctor does not emphasize low salt, though I see her do so much worse when she eats it.  She hates going to the bathroom all the time and she' s now drinking less water to avoid that.  Shouldn't she be advised to keep sodium under 1500mg? Her Dr. said restricting her will affect her quality of life because she likes salty food and not to count mg.  I think her quality of life would be better if she had less fluid retention, and that low salt could help. What do you think?(her pulse runs in the 60,s and b.p. runs 120/70, though seeming to go lower lately). Thanks!

[Encephalomalcia]

I am not a doctor, but there are many in our family with CHF.  Right side heart failure produces swelling in the legs and ankles.  Left side heart failure produces swelling in the abdomen and fluid in the lungs.  Right side heart failure can lead to left side heart failure.  People with CHF need to limit their salt intake.  The more salt that she eats, the more she will swell and retain water.  This is hard on her kidneys and heart.  She should eat only fresh vegetables (not canned which contain a lot of salt).  Watch the soup, because most soups contain a lot of salt.  She should not eat any fast food and she should be avoiding processed foods.  Brown rice, organic fresh vegetables, salmon is all good for the heart.  Oatmeal is good to have in the mornings. When taking Lasix, she has to be careful not to get dehydrated.  Being dehydrated can be extremely dangerous especially in the elderly.  Signs of dehydrated is dry mouth, red lips, dry eyes, wrinkled skin.  You can push on her arms to see if the dent stays or not.  If the dent stays, she most likely is dehydrated.  Lasix takes potassium out of the body and potassium is important for the heart to beat.  Does she have blood work frequently to test the Coumadin?  When people get into their 90's, sometimes their blood does not clot as it should or as it did before.  The Coumadin should be watched very carefully.  My father is on Coumadin and he has his blood drawn every three months.  His doctor told him that once he reaches 80, he will most likely have to be taken off of Coumadin because blood doesn't clot as easily or is as thick at the age of 80.  Her pulse and blood pressure are good.  She needs to cut back on the salt otherwise she is just going to feel miserable and the symptoms will get worse.  You need to let her know this and explain so that she understands.  Too much salt is not good for anyone and there's a lot more salt in food then people think.  Once she starts reading labels, I am sure she will be shocked as to how much salt is in the foods that she is eating.  Hope she feels better after she has made some changes.  Take care.    

[Dr J Singh]

Hello,
The symptoms are definitely suggestive of CHF. As the body becomes overloaded with fluid from congestive heart failure, swelling (edema) of the ankles and legs or abdomen is noted.If left untreated it can cause fluids in lungs,shortness of breath,liver complications and serious cardiac conditions like cardiac arrhthymias,pulmonary edema,atrial fibrillation and heart failure etc which may be life threatening.

I would suggest an immediate medical intervention and investigations like ECG,echocardiography and blood tests.Either coax her or use force,she has to limit her intake of salt as it will cause worsening of symptoms.Excessive sodium intake may precipitate or exacerbate heart failure, thus a no added salt diet (60–100 mmol total daily intake) is recommended for patients with CHF.

I hope that helps.Take care and pls do keep me posted.