One of the events contributing to our fun-filled summer was my husband’s congestive heart failure diagnosis, as if our daughter-in-law’s high risk pregnancy and my husband’s job loss weren’t enough. Since this is a public blog, I’m trying to think of a nice word to describe his emotions. I haven’t yet come up with one. Suffice to say, he was upset. I recalled Dr. Steve saying that the prognosis for congestive heart failure (CHF) patients in a grid-down situation was pretty grim. (Stockpiling medications and making lifestyle changes is essential.) Fortunately or not, we have a rule in our relationship: only one person can be down at a time. And since it was Aaron’s turn to be down, I had to suck it up and be cheerful. Which I did quite admirably, even if I say so myself.
To begin coverage of this topic, let’s see what The Ship’s Medicine Chest and Medical Aid at Sea has to say:
Congestive Heart Failure
Congestive heart failure occurs when the heart is unable to perform adequately its usual functions. This results in a lessened supply of blood to the tissues and congestion of the lungs. In acute failure, the heart muscle fails quickly and the lungs become congested rapidly. In chronic failure, the heart muscle fails gradually and the body has time to compensate. However, when compensation is no longer adequate, fluid will begin to accumulate in the lower parts of the body. Swelling most often appears in the legs and feet but it may occur in other parts of the body. Although, there are many underlying causes of congestive heart failure, the most common are chronic coronary, hypertensive, and arteriosclerotic heart disease.
The signs and symptoms of the disease depend on whether the onset of failure was sudden or gradual. Generally, a gradual loss of energy and a shortness of breath (dyspnea) occur upon exertion. In more acute cases, the patient may cough up frothy, bloodstained, or pink sputum. Later, shortness of breath may appear during periods of lesser activity, and the patient may need to sit up in bed, or sleep on several pillows at night to breathe more easily. Ankle swelling may occur due to the accumulation of fluid in the tissues and as failure progresses, the swelling may involve the hands, legs, and abdomen. The liver may become enlarged due to congestion which results in discomfort and tenderness. In more advanced cases, there may be a blueness of the skin (cyanosis), especially at the lips, ears, and fingernails.
Treatment
For acute failure, see acute myocardial infarction on p. 136. In severe cases of chronic failure, the patient should be placed on absolute bed rest in a sitting or semisitting position. Heavy meals should be avoided, and the food kept as salt-free as possible. Smoking should be prohibited. Medical advice by radio must be obtained. A patient with chronic heart failure should receive medications only upon medical advice.
This concludes the information from The Ship’s Medicine Chest.
(For the curious, of all the off-grid references I have here, only The Ship’s Medicine Chest and Armageddon Medicine contain information on CHF. All the others are completely silent on the topic.)
Signs and Symptoms
- Shortness of breath
- Fatigue
- Leg swelling
- Lung congestion
As Dr. Koelker notes, heart failure is most often a condition of the elderly caused by arteriosclerosis or atrial fibrillation.[1] But not always. There is such a thing as diabetic congestive heart failure, and with the skyrocketing numbers of diabetics, it’s becoming a lot more common.
Treatment
The most common treatments for CHF include the following medications:
- Furosemide, in doses of 10-160 mg per day (20-40 mg is most common) [2]
- Potassium chloride, 10-40 mEq, or increasing dietary consumption of potassium with bananas, citrus, or tomatoes.[3]
Remember, you are not stocking these medications to self-medicate. This is just to have on hand so that a doctor can treat your family. Using furosemide and potassium chloride without a doctor's supervision and monitoring is risky, particularly in CHF patients who may also have diminished kidney function.
Other drugs to consider:
- ACE-inhibitors
- Aspirin
- Beta-blockers
- Digoxin
- Lisinopril
- Statins
- Sublingual nitroglycerin
Diabetics may wish to consider building a supply of spironolactone. It has made a world of difference for my husband and is very inexpensive from the overseas pharmacies.
Alternative treatments
Prevention
Of course, preventing CHF in the first place would be the best course to follow. Lose weight, quit smoking, and exercise. My husband was advised that doing 40 pushups each day (presumably all together and not spaced throughout the day) would reverse his CHF completely. He’s now up to 6-7 at a time.
Links to related posts:
The Medicinal Uses of Hawthorn
The Medicinal Uses of Lemon Balm
The Medicinal Uses of Chocolate
Survival and Austere Medicine, 3rd Edition
[1] Cynthia Koelker, Armageddon Medicine, 2012, 364.
[2] Cynthia Koelker, Armageddon Medicine, 2012, 365.
[3] Cynthia Koelker, Armageddon Medicine, 2012, 365.
[4] Rebecca L. Johnson, et al., National Geographic Guide to Medicinal Herbs, 2010, 123.
[5] Steven Foster, et al., Western Medicinal Plants and Herbs, 2002, 295.
[6] F Abdellatif, et al., Minerals, essential oils, and biological properties of Melissa officinalis L., Plants (Basel), 26 May 2021, Vol 10 No 6, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229312/ (accessed 2 June 2023).
[7] David L Katz, et al., Cocoa and chocolate in human health and disease, Antioxidants & Redox Signaling, Vol 15 No 10, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696435/ (accessed 16 March 2023).
My husband and I also work out of the "only one of us at a time" can be in meltdown. We often lived far away from family. Having a child & no relatives, we honed this principle to an art! It especially helps in dealing with medical issues.
ReplyDeleteI sometimes wonder if the whole bit of being "up" when the other is melting down means I'm in denial or heartless. But I really do believe it's best to put on a brave face. Anyway, all is well here and with Aaron's health as well. For all who are dealing with CHF or may in the future, it does indeed appear as if spironolactone is life-preserving. Almost as much as insulin.
ReplyDeleteIf you're looking for other wellness preps, consider an accurate scale (daily weight fluctuations can help monitor CHF exacerbations), and have the equipment to be able to measure fluid in/out if suspicious. These are both things a doctor would want to use if attempting to help you manage meds.
ReplyDeleteAdditionally, for anyone that works on their feet, notices leg swelling, or has family members with varicose veins, stock up on compression stockings! Venous ulcers get nasty. CHF leg swelling can lead to pain and nasty infections that are nearly impossible to heal. Protect your legs and feet.