Congestive heart failure. Throughout the course of my career, it’s probably been one of most commonly misunderstood conditions my patients have lived with. It’s also an incredibly common reason for an occupational therapist to be consulted in the hospital. Why? Because when people don’t have a good understanding of their congestive heart failure (CHF for short), it’s very difficult to do a good job managing their heart failure (so they end up in the hospital!).

So, with that in mind, I wanted to share with you the education on congestive heart failure and volume overload that I’ve shared with so many patients. 

What is congestive heart failure?

Congestive heart failure, in the most basic terms, means that the heart is unable to keep up with its workload. The workload of the heart involves moving our blood to every nook and cranny of our bodies. When the heart is having a hard time keeping up, the blood gets backed up behind it. Depending on where the blood is backing up, the extra fluid that can make it hard to breathe or make parts of their body swollen. When the blood doesn’t circulate properly, it can also cause problems in other parts of the body that depend on getting good blood flow. 

What is volume overload?

Say you have a basement with a sump pump. The job of the sump pump is to prevent any water from collecting and flooding the basement by pumping it out. It does a great job, so long as it doesn’t have to pump more water than it is able to handle. But then, one day, someone takes a hose and turns it on in the basement. The basement floods, because the pump just can’t keep up with the workload. 

When we ask a heart with CHF to pump more blood, or pump that blood more quickly (often due to the demands of an activity, or because something is causing us to retain water – i.e. too much sodium) it’s unable to increase it’s pumping capacity to handle the higher workload. When the heart can’t keep up with the amount of blood it needs to pump, the blood backs up. Just like the basement, our system can essentially “flood.” So, in volume overload, the body ends up with more fluid than it can handle. This makes the heart work harder, and thus have even more fluid back-up. It also affects other systems in the body that manage fluid. 

When someone has volume overload (or CHF exacerbation), they may have a dry cough, swelling (particularly in the lower parts of the body), shortness of breath, fatigue, an increased heart rate, or weight gain (to name the most common symptoms). Weight gain is a frequently misunderstood sign of volume overload. Rapid, short term weight gain is due to water, not fat. You cannot gain pounds of fat or flesh in a few days time. This is due to an excess volume of fluid in the body, and needs to be addressed by your medical provider promptly. The amount of allowable weight gain can be different for different people, so make sure to talk with your or your loved one’s provider to understand individual guidelines. 

How can you prevent volume overload?

Managing CHF and preventing volume overload requires a multi-layered approach. Making sure to take medications as directed, following diet recommendations, and checking in with your symptoms are essential to management. 

Less frequently mentioned, but equally important, is managing the workload of the heart demanded by activity. Some activities place increased stress on the heart because they require the heart to pump more blood, more quickly. Activity management sometimes requires activity restriction, but more often, occupational therapists teach people how to modify their current activities and routine in ways that allow them to do what they want to do, feel good doing it, and not be exhausted at the end of the day. The goal is NEVER to take someone’s valued activities away, but rather make priorities, teach pacing and energy conservation skills, and help people to learn to listen to their own bodies before an overload or exacerbation occurs. 

My favorite tips for preventing activity related volume overload? Take breaks before becoming tired and organize activities to be energy efficient. Taking lots of little breaks throughout the day gives the heart many opportunities to catch up on its workload before it gets overwhelmed. Making sure you are performing activities in a way that reduces energy cost is also a great way to make sure someone can do what they want without the heart falling behind (one easy example: keep all the items for an activity in one place to avoid walking back and forth). 

How do I know if the person I am caring for is experiencing volume overload?

While I don’t advocate for self-diagnoses, I definitely encourage folks to listen to their bodies and monitor for small changes that can be early problem indicators. In the case of people with CHF, common early indicators include rapid weight gain, increased cough, increased swelling, increased shortness of breath or work of breathing, and increased fatigue. Because volume overload is a condition that essentially builds on itself, it’s important to catch warning signs early and communicate them to your loved one’s primary healthcare provider. The importance of early treatment cannot be overstated!

And while it is essential to note that CHF often requires multiple levels of functional and medical intervention to manage, it is (just as all conditions truly are) up to the person with the condition and the person or people caring for that individual to implement the treatment plan in real life. As I often tell my patients/clients – my job educating you is the easy part! It’s up to you to do the hard work that makes treatment effective. 

In closing, please do remember that this is essential information, but it’s not a substitute for treatment. If the person you are caring for (or maybe even you) have congestive heart failure and you need help, please reach out to their (or your) medical provider for support. 

Disclaimer: Consuming this content is not a substitute for health or medical advice, and does not constitute a therapeutic relationship. People should seek medical advice from a licensed health care provider if they feel they have a medical condition, impairment, disability, safety risk, or other needs related to health, wellness, and prevention. Neither the Author, nor any connected company or affiliation is providing medical advice or treatment of any kind in this document. No guarantees of specific results are promised or implied. Author/connected companies/affiliates are not liable for any injury or harm resulting from persons implementing tips, strategies, or information shared here.