Fluid retention: What it can mean for your heart

Fluid buildup indicates worsening heart failure. Learn how to spot it and treat it early.

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The buildup of excess fluid in your body can take a variety of forms from belly bloating and swollen ankles to nausea, persistent coughing and fatigue. You may be tempted initially to dismiss this hodgepodge of problems as having little to do with your heart. However, they all signal water retention, which can mean trouble for people with a history of heart failure.

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“Fluid buildup can quickly escalate into a life-threatening situation,” says Dr. Eldrin Lewis, a heart failure specialist at Harvard-affiliated Brigham and Women’s Hospital.

Heart failure may start with injury from a heart attack or develop as a result of damaged valves, infection or disease of the heart muscle cells. Many times, it is the product of years of toil against high blood pressure and clogged arteries. Regardless of what triggers the decline, heart failure culminates in a progressive weakening of your heart’s power to pump.

Consequently, blood circulates through your heart and body more slowly; your cells thirst for fresh oxygen and nutrients. To compensate for its weakened state, the heart undergoes a series of structural transformations. Other physical processes also come into play. When the kidneys detect the diminished blood flow, they activate hormones that prompt the body to retain fluid and sodium in an effort to boost the volume of blood in circulation.

What to look for

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The good news is that you can tell if you’re beginning to retain fluid merely by getting on the scale. “Weight change is the earliest sign of a problem with fluid balance. Most people will retain 8 to 15 pounds of excess fluid before they see leg and belly swelling. However, symptoms such as coughing and shortness of breath, loose stools, nausea and feeling full when without eating much may develop at the 5-to-7 pound mark” says Dr. Lewis. He instructs his patients to take action as soon as they notice their weight going up. “Don’t wait until you don’t feel well, you may have gained 5 or more pounds by then and could be well on your way to a serious problem.”

Daily weighing

The best method to monitor your weight is daily weighing. Your goal should be to keep your weight as close as possible to your “dry weight.” This is your regular weight when you are not retaining fluid. If you recently have been in the hospital or had your medicines adjusted, you may already know your dry weight. If not, your doctor or nurse can help you determine the right number. To get an accurate picture of your weight trends:

• Record your dry weight and compare you daily scale readings to this number, not the previous day’s scale weight. Write down your daily weights in a log or small notebook and bring this record to your doctor visits.
• Stick to a regular daily routine. Even small changes to your regular pattern can alter your weight by 2 pounds or more.
• Weigh yourself at the same time every day using the same scale. A good time is in the morning before you have had breakfast, but after you urinate (a full bladder can add as much as a pound). Weigh yourself without clothing or in underwear only.

Taking action against fluid retention

If you gain more than 2 pounds in a day or 4 pounds in a week, Dr. Eldrin advises taking these steps:

• Think about the foods you ate in the days before your weight gain and look for sources of extra sodium or fluid in your diet that you may be able to eliminate. (For example, did you eat out at a restaurant or indulge in a salty treat?)
• If your weight doesn’t return to normal in a day or two, call your doctor or nurse for advice. You may need to increase your diuretic medicine (water pills) or reconsider how much fluid you are drinking.

Image: Rostislav_Sedlacek/Getty Images

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