People who have heart failure may have heard their health care providers tell them “we need to stop this vicious cycle.” Then they change or add specific medications and order a low salt diet.

What does this all mean? What is this “vicious cycle?” We will explain in this issue of the CHF corner.

To begin we need to start with the basics, technically called pathophysiology, the changes caused by a disease.

There are many causes of Heart Failure (HF), but no matter what the reason, the same series of events almost always takes place:

• When the heart is damaged, it pumps out less blood, which fires up the nervous system.
• Lower blood flow through the kidneys causes release of chemicals called renin and angiotensin II.
• Angiotensin II is a very strong vasoconstrictor. It causes the body to retain salt and water, which causes the body to produce a substance called aldosterone.
• The extra aldosterone makes the body retain salt and water even more, which leads to edema (swelling).

At first, these reactions by the body are actually a good thing. Retaining salt and water increases the pressure in the heart, allowing it to beat stronger. Epinephrine (adrenaline) levels increase which increases the heart rate. Again, this is good at first, since it helps the heart keep up with the body’s demand for blood.

Heart Failure begins when these responses continue to occur over any length of time. The heart is working much harder than it is designed to, and it begins to wear out, getting weaker. This is known as cardiac remodeling. You want to remodel your kitchen, but you definitely don’t want to remodel your heart.

This is the standard concept of HF’s vicious cycle. When you have HF you need to prevent this chain of events by taking specific heart failure medicines such as ACE Inhibitors (enalpapril, altace lisinopril), Beta Blockers (coreg, metoprolol, and toprol), Diuretics (lasix, bumex, and demadex), aldosterone inhibitors (inspra, spironalactone).

These medicines, along with a 2gm low salt diet and sometimes restricted fluid intake, will help to prevent the triggering of “the vicious cycle” preventing fluid retention and HF exacerbation.