Afib and congestive heart failure

Hello - I write about my mother who is 90 yrs. old with afib and recently diagnosed with chf. She was on 10 mgs. of Lasix 2 x a day, but her edema and congestion in her lungs increased and she was very short of breath - especially at night and she had to sit in her recliner to get her breath back. She gained about 7 lbs. of water weight in a month. We saw her cardiologist and she had an echo done, as well as blood work, an ekg and a pacemaker check to see how her afib was doing. She has been in afib quite a bit lately, but the congestion seemed to be the real problem this time, so the cardio increased the Lasix from 10 mgs. 2 x a day to 20 mgs. 2 x a day for 3 days to see if this helped. She then went back to see him again after the increase for 3 days to see if she lost any weight and for him to check her general well-being. She only lost 2 pounds, and she was still quite full of fluid, so the doctor said she should stay on the 20 mg. protocol. Of course my mother objected because she has to use the bathroom so much on this dosage, so the doctor put her on a prn of 20 mgs. - to use the 20 mgs. for 3 days if she gets congested again. Well, it's been 4 days since we saw him, and I know she is back on her usual 10 mgs. 2 x a day. Her ankles are still very swollen, as well as her calves and feet and she is still breathing hard. I suggested she go on the 20 mgs. again for 3 days, but I know she won't do it. She still takes care of her own medications and is still of sound mind. She can ambulate okay with the use of a cane. Is there harm to her taking the 20 mgs. daily if the doctor recommends it? He is trying to make her comfortable and let her call her shots, but my mother will run rough-shod over him if he lets her. I think she should be on 20 mgs. now that she is formally diagnosed with chf, but I don't want to push it if it will affect her in other ways. Having to use the bathroom a lot seems like a small trade-off if the edema and congestion taper off. Just not sure what to do. I don't want her to suffer this congestion and limitations if she can keep the fluids down. Should I push this or leave it alone. Leaving it alone goes against my better judgement right now, but I don't want to be a nag.

17 Replies

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  • I think watching someone else suffer, especially a loved one, is often worse than our own suffering.

    You say your Mum is of sound mind and controls her own meds and she doesn't want to take more meds, for quite understandable reasons. Surely, therefore, it is entirely her decision? You can talk to her about it and I would also suggest listening to her about her concerns, rather than nagging her to do something to please you, rather than herself.

    Frailty is not for the faint-hearted.

  • Yes - I feel like I have to pick my battles with her. She is very anti-medication and was always conservative with what she takes, but I don't want her to be too conservative if it's going to affect her health so much. She is used to telling the doctors what she wants. Right now, I feel that her fluid retention is limiting her activity level, but so would being in the bathroom all day! Lol

  • I to have chf so sympathise with your mum I take 20mg of frusemide plus 32mg of candesartan plus and still have a problem had to go to ccu had 9lt of fluid removed lost 9kg in 2days they told me if fluid started to accumulate again they would take me in and do an iv infusion

  • Your mother needs to understand 2 things:

    1) she needs the bigger dose of lasix (or probably more for a week or two) and will obviously make more urine for a while to get rid of her excess fluid. Otherwise she will have to go into hospital.

    2) it's just as important not to drink too much water (or tea etc.) – the less she drinks, the less urine she will have to pass.

  • I so sympathise, my mother, who was incredibly stubborn and also, I realised later, a little confused because of her illness, refused essential treatment and died as a result. As she was well aware what would happen nobody could force her to have treatment and I couldn't persuade her. I know this is a heartbreaking situation but as long as your mother understands the consequences and that you don't want them to happen you shouldn't feel guilty though I'm sure you will. CDreamers advice is excellent so I hope it helps.

  • Just wondering if your Mum's cardio has a heart failure nurse you could ring for support? Am presuming the divided doses of lasix were for a reason? as usually one is encouraged to take diuretics early in the morning so that a reasonable night's sleep can be attained.

    Even 40 mg a day is a lowish dose where heart failure is concerned. I feel for you. Any advice I tried to gently give my mother always ended in tears ( usually mine) and Mum saying "To think it's come to this" me trying to tell her a course of action

  • It seems that the bathroom is the issue for your mum. Is there more to it than the reluctance to spend more time there. Us ladies can get "sensitive bladders" as we get older. If she walks with a cane she won't get to the bathroom as quickly as most people. Is it a fear of having an accident, of losing her dignity. If you think that might be the case then there are things which may help. Tena lady, pads on her bed, the timing of the dose, a temporary commode closer than the bathroom during the day and beside her bed at night. It doesn't have to be permanent. I can't see if you are male or female but even if you are female it might be she doesn't feel comfortable mentioning it to you. She may not want to tell anyone. Is there a nurse who could tactfully suggest some of these things and see how she reacts?

  • LindaD - I am her daughter. My mother has a lot of pride. She has incontenence problems and wears a "panty" all the time because of this. She is home most days, but I do take her out for lunch and shopping a few times a month. (Aside from her doctor appts). She likes to be able to "go out" at a moments notice and I believe she believes taking a greater dosage of lasix is going to inhibit her ability to enjoy our spontaneous outings. I know we are going to have to plan things accordingly if she takes the higher dose, - but not sure if she will go along with this. She will just lie to appease me. I feel as if I care more than she does. She was always one to keep up appearances - and hadn't changed her mindset even with the physiological changes in her health. She just tries to cover up more.

  • O dear, I can understand what a difficult situation you have. Is there anyone else who could talk things through with her? As Bagrat says it is very hard for parents to accept a change in roles, you cannot say the firm things that need to be said ie she will become too breathless to go out at all and may have to go to hospital in the end. Or maybe her consultant could be persuaded to remove the fluid as a 'starter' so she won't be so discouraged by the lack of effect of the medication? I gather you are American so I am not sure how the system works, here of course nothing would be considered unless she had complied with the doctor's instructions first. You could refuse to take her out of course but I can't see that happening!

    I hope it helps that we understand some of your difficulties.

  • It's a difficult situation for you. Keeping up appearances can make you determined to keep going and that's a good thing.but there is a time when we have to compromise and that's a difficult one. My mother in law wouldn't let us check her medication, she was determined to be independent. She ended up taking the wrong medication for 2 months and what was worse, not taking her thyroid tablets. But after a fracture she had to go in a care home for 24/7 care till it healed. She's still there 4 years later and does nothing for herself now. There is often no solution. I do sympathise with you. She's lucky that she has you.

  • My mother thinks a nursing home is a dirty word, so she fights to stay independent and I want to keep her that way too. For this reason, I just had a talk with her about taking the 20 mgs like the doctor wanted her to so she gets rid of the excess fluids in her body. We went for a short walk and she was so winded, she just wanted to go home. We got her scale out and I weighed her and I told her we have to do this a few times a week to see if she is losing the fluids accordingly. She says she never weighs herself because she is legally blind (and she is) and can't see the numbers on the scale, but we can't make excuses anymore. I guess the rest is up to her. I explained she has been on 10 mgs for over 5 yrs now, and now her body needs the 20 mgs in order to rid the fluids better. We will see what happens.

  • for the ignorant, what is chf?

  • Congestive heart failure. My mother has had AF for more than 25 yrs, but now just recently formally diagnosed with chf. I do suspect she has been on the cusp of it for at least 3 yrs now, but her former cardio denied it. I don't know how or why all of a sudden, she finally crossed the line, but a sudden weight gain was a clue. The weight gain was due to fluids, although my mother is attributing the weight gain to eating too much. (She always eats a well balanced diet). Lots of fruits and veggies, and little or no sugar. She should probably cut back on her fruits and veggies, but I know that will never happen! Pick my battles......

  • I'm sorry to hear of your mother's new diagnosis. For what it's worth I feel you need to start over with your mother's health evaluation perhaps with a new doctor (a cardiologist) from a different office basis and with new tests to see if some new/different/better responsive treatment based on current results and thinking can be found. If you have any questions during this new evaluation ask them at the time and don't leave the doctor's office until you understand.

  • Robroy- This doctor is her new cardio. He is also an EP. My mother loves him and he is the one who took her off the Tikosyn and the digoxin after over 5 yrs of being on those 2 drugs. My good news for the day is that my mother has agreed to take the 20 mgs of lasix, which is what she needs to do now - according to the new doctor's original orders! She is so uncomfortable now with all her excess fluid, I think she finally sees the light! This is such a relief to me and her doctor too. I phoned him today with the news.

    At almost 91 yrs old, we are really just managing the conditions. Invasive surgery and hard-core drugs (Amiodarone) are risky. We will see how she does now. Amiodarone may have to be on the table, but we see the cardio again in April and assess things then. TY!

  • Probably would not be approved by doctors but as a nurse long retired - could it be mooted that she takes the higher dose on days when you are not planning to go out. I know you said she likes impromptu trips but once settled on a higher dose the results on the waterworks are usually less dramatic!! If she feels better on the higher dose that is probably the only factor that will convince her to continue. I know several older friends who omit their "water pills" if having a day out. There are legion websites extolling the virtues of "natural diuretics" if you Google but difficult to know which, if any hold water( sorry for the pun)

    Best wishes Wendyb

  • Bagrat - We did an impromptu errand today and she did fine! She is now agreeable to taking the 20 mgs a day now - as per her doctor's original orders. I phoned the doctor today to tell him. She is very uncomfortable with her excess fluids enough now to comply with the doctor. I am so relieved. TY!

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