Features August 2019 Issue

Tricks for Managing Fatigue Caused by Heart Failure

It's a common problem with many possible causes. Don't despair. There are many things you can do to increase your energy.

Do you awaken in the morning feeling tired? Do you drag yourself through the day wondering if you'll ever have enough energy to feel good? Maybe you feel okay, but you can't walk very far without sitting to catch your breath.

Welcome to the world of heart-failure fatigue.

"Most of our patients are fatigued. It's the bane of their existence," says Cleveland Clinic heart failure specialist David Taylor, MD.

Know You Are Not Alone

Fatigue is a universal problem in heart failure. It affects patients with heart failure with preserved ejection fraction (HFpEF), but tends to be worse in those with heart failure with reduced ejection fraction (HFrEF). "These patients have lower cardiac output, which means not as much oxygen and blood are going to the brain and muscles," says Dr.Taylor.

That being said, there are other reasons why heart-failure patients may feel fatigued: The beta-blockers used to treat heart failure are a common cause. Deconditioning, depression, poor sleep and a poor diet can cause fatigue, as well. "All these issues must be addressed," he says.

Your Medication May Be at Fault

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Feeling exhausted is a common complaint among patients with heart failure. Fatigue tends to worsen as heart failure advances. Itís often caused by a decline in oxygen reaching the brain, due to a weakened heart muscle. But fatigue also can be brought on by the drugs used to treat heart failure, low blood iron levels, depression and poor-quality sleep. Identifying the source of fatigue is the first step in overcoming it.

The anti-adrenaline effect of beta-blockers-the very quality that makes them valuable for treating heart failure-can make patients feel tired.

According to Dr. Taylor, understanding why beta-blockers must be taken often makes it easier to deal with this side effect. "Once patients know the drug will improve their heart function, help them stay out of the hospital and live longer, most are willing to put up with a little fatigue," he says.

To test whether the drugs are at fault, Dr. Taylor often suggests cutting the morning dose in half. If the patient feels better in a day or two, the beta-blocker is to blame.

If he is able to wean the patient down or off the drug, and fatigue remains a problem, the beta-blocker is not to blame.

Look for Underlying Depression

Depression can be a reaction to the diagnosis of heart failure, but it can also be triggered by beta-blockers. "When this happens, we switch beta-blockers to see if we get improvement or treat the depression with antidepressants," says Dr.Taylor.

Your Iron Levels May Be Low

It is not uncommon for heart failure patients to develop anemia. Iron supplements or a drug that helps the body absorb iron can be used to restore blood iron levels and improve energy levels.

How Well Are You Sleeping?

If you feel exhausted after a bad night, imagine that every night is a bad night. Then you'll know how people with sleep apnea feel everyday.

Sleep apnea causes people to awaken hundreds of times a night, preventing them from getting deep, restorative sleep. Sleep apnea is common in heart failure. Once it is diagnosed, using a continuous positive airway pressure mask at night can restore a normal sleeping pattern and increase daytime energy.

As heart failure advances, some patients may not be able to breathe when they lie flat. This can interfere with normal sleep. Your heart-failure specialist can show you several sleeping positions that may make breathing and sleeping easier.

Your Heart Needs Exercise

Your instinct may be to "baby" a heart damaged by heart failure, but the opposite is true.

"Aerobic exercise strengthens all muscles in the body, including the heart," says Erik Van Iterson, PhD, MS, Program Director of Cardiac Rehabilitation at Cleveland Clinic. "A heart that pumps more strongly increases the delivery of oxygenated blood throughout the body, which your body needs to generate energy and battle fatigue. You can actually make yourself worse by doing nothing."

A cardiac rehabilitation program and guided exercise training therapy can put you on the right track, both physically and mentally. "All heart failure patients need cardiac rehab," he says.

If you were not raised in a culture that promoted exercise, you may find the concept intimidating. Dr. Van Iterson emphasizes that any exercise you do will be beneficial. "Exercise means different things to different people. There is no one-size-fits-all model to follow," he says.

Attending a cardiac rehab program enables you to be assessed for the type of exercise that will be safe based on your age, experience, overall condition and the condition of your heart. "You may never have thought that walking around your neighborhood would be beneficial, but if you are-for example-in your mid-70s, have heart failure and have never exercised before, it will be," says Dr. Van Iterson.

The goal is to move your body for a total of 30 to 60 minutes a day. You may need to ease into this goal by moving in shorter increments throughout the day, if that's all you can tolerate. "If you need a walking-assist device, that's fine," he says. "You will be able to tolerate more exercise over time."

Be patient and stay motivated. You won't feel better overnight. "It may take weeks or months of consistent exercise to feel the difference," says Dr. Van Iterson.

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When and What You Eat Matters

It's no secret that heart failure can steal your appetite. The food choices you make, as well as your eating habits, can affect your energy level and quality of life.

- Limit salt. "Unhealthy foods will worsen how you feel," says Julia Zumpano, RD, LD, a dietitian in the Department of Preventive Cardiology. "You want to follow a low-salt diet. Salt causes fluid retention, and your fatigue will worsen."

- Eliminate added sugar. If you are already restricting salt intake, make sure you are eating high-quality carbohydrates, such as whole grains. Eliminate added sugar in the form of sugar-sweetened beverages, jelly, syrup, candy, baked goods and desserts. "It's tempting to reach for sugary treats for the quick energy they provide, but in the long run, they will cause your blood sugar to drop and you'll feel more tired," Zumpano explains.

- Eat more fruits and veggies. Load up on whole fruits and vegetables. They contain fiber, which detoxifies the body and helps eliminate excess fluid.

- Give up foods that come in a box, bag or can. "Processed foods can make you feel run-down," she says.

- Eat healthy proteins. Although a protein-heavy diet is not advised for heart failure patients, consuming an adequate amount of high-quality protein is necessary, Zumpano says. "Minimize processed proteins, such as hot dogs and salami, since they harness inflammation and worsen fatigue. Instead, increase consumption of lean meat and eggs," she advises.

- Watch out for caffeine. Because caffeine causes dehydration, which leads to fatigue, watch the amount of caffeine you drink. Replace caffeinated beverages with plain water, flavored carbonated water or herbal teas.

- Eat early. Eat the majority of your calories in the daylight hours. "Set the bar early in the day. At least 75 percent of your nutritional needs should be met before dinner," she says.

- Get help, if necessary. If you don't have the energy to cook or need assistance following a healthy diet to combat heart failure and fatigue, consult a dietitian."We can help you identify foods that you enjoy, are easy to prepare and won't worsen your fatigue," says Zumpano.

Comments (1)

an excellent article. I follow your advise except for exercise which I cant do because of chronic fatigue syndrome.

Posted by: wizard | August 18, 2019 11:04 AM    Report this comment

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