For people with Pulmonary Hypertension (PH), managing the consumption of fluids is essential to prevent a serious condition called right ventricular failure. Effective fluid management in PH helps reduce pressure on the heart and lungs, alleviating symptoms and minimising complications. This involves monitoring fluid intake, using diuretics, and regular healthcare check-ups to adjust treatment. Let’s discuss the different aspects of fluid management in PH in more detail.

PH and the Struggling Right Ventricle

PH narrows the pulmonary arteries, making it like squeezing a hose. This forces the heart’s right ventricle to pump harder to push blood through the narrowed passage. Imagine the right ventricle struggling to lift weights during a workout. Now, add fluid retention to the mix. This extra fluid is like piling more weights on top of those the ventricle is already struggling with.

Fluid buildup is a red flag, a warning that PH is getting worse. Taking action to tackle this fluid buildup becomes critical to prevent the right ventricle from failing under the strain.

Fluid Retention (Oedema) in Pulmonary Hypertension

Fluid retention, also known as oedema (or edema), is a common issue for people with PH. It occurs when excess fluid builds up in various body tissues, particularly the ankles, legs, abdomen, and surrounding areas. This can happen for several reasons:

Increased Pulmonary Arterial Pressure: In PH, the pressure in the arteries that carry blood from the heart to the lungs is abnormally high. This puts extra strain on the heart, which can lead to fluid build-up.

Disease Progression: As PH progresses, fluid retention may become more likely.

Medication Side Effects: Some medications used to treat PH can have fluid retention as a side effect.

Signs and Symptoms:
– Swelling in the legs, ankles, or abdomen
– Shortness of breath
– Fatigue
– Unexplained weight gain

Managing Fluid Retention:

Managing fluid retention in PH requires a comprehensive approach. This may involve:

• Medication: Diuretics are often prescribed to help remove excess fluid from the body.
• Lifestyle Modifications: Reducing salt intake and wearing compression stockings can help reduce swelling.
• Close Monitoring: Regular check-ups with your healthcare team are essential to monitor fluid levels and adjust treatment plans as needed

What can we, patients, do?

1. Daily weight checks

Keep a weighing machine in your bedroom or near your bathroom, any place easily accessible daily. Check your weight daily and note it down in a book or on your phone. Watch out for rapid weight gains i.e. an immediate gain of 1-2 kgs overnight indicates fluid accumulation. If this happens, consult your doctor, immediately.

2. Check for swelling during your morning or evening routine

• While applying moisturiser or lotion on your body, take a moment to press gently on specific areas of your body. Focus on these areas: Ankles, shins, and the lower back (the bony area at the base of your spine). Look for indentation. Hold the pressure for a few seconds and then release. If the area remains indented for a minute or more, it could be a sign of swelling. 
• Look for any noticeable differences in size between your left and right legs or ankles.
• Tightness or discomfort in your clothes or shoes can also indicate swelling.
• If you notice any swelling, record the date, location, and severity (mild, moderate, etc.) to share with your doctor at your next appointment.
  By checking for swelling regularly and keeping track of any changes, you can help your doctor monitor your condition and adjust your treatment plan if needed.

3. Be mindful of all fluid consumption

Fluid comes from many sources. But what counts as fluid? Here are some key categories to consider:
– Beverages: This includes water, milk, tea, coffee, cold drinks, coconut water, fruit juices, milkshakes, lassi, chaas (buttermilk), alcohol, mocktails, cocktails and such.
– Foods: Many meal items contribute to fluid intake, including soups, stews, dals (sambar, rasam), curries, and kadhi.
– Fruits: Watermelon, oranges, grapes, and other fruits with high water content also add to your daily fluid intake.

4. Other dietary changes

Restrict salt intake, avoid caffeinated drinks, and avoid alcohol. For people with gluten sensitivity, wheat can irritate the gut and cause inflammation, triggering the body to retain fluids. Eating large meals at a time can also affect the functioning of the heart and hence, small nutrient-rich meals are advised. Read more about food moderation in PH by clicking here.

5. Conscious monitoring of urine output

Note the average number of times you have to pee. If there is a reduction in number and you are feeling abdominal fullness or pain, immediately notify the doctor and also make a note of it in your book. 

6. Compression stockings

These can be used if you are prone to leg swelling. They help in maintaining good blood flow through the legs, especially when the frequency of oedema is higher. One should use these as per the doctor’s advice.

7. Exercise

Staying active is important for managing fluid retention in PH, even if it’s just gentle movement. Walking is a great option, as it promotes healthy blood circulation and keeps your body moving, which helps prevent fluid build-up. If walking isn’t possible, don’t worry! Simple leg and hand movements while lying in bed can also be beneficial. Try gentle stretches, leg folds, and back movements to keep your body engaged. Additionally, consider exploring cardiopulmonary physiotherapy programs, as they can provide structured exercise routines and support tailored to managing PH and improving overall cardiovascular health. Keep in mind, that any movement is better than none!

Managing Fluid Restriction: A Practical Guide for PH Patients

The amount of fluid you need to drink depends on the severity of your PH. For moderate to severe cases, doctors typically recommend limiting your daily intake to around 1,500-2,000 milliliters (ml) per day.

To stay within your limit, it’s helpful to track your fluid intake throughout the day. Here are some easy methods:

• Measuring cup: Use a measuring cup for all your beverages, including water, juice, tea, and coffee.
• Designated cups and bowls: If using a measuring cup isn’t convenient, dedicate specific glasses, cups, and bowls for your daily fluids. Label them with your name and the volume they hold (e.g., “Water – 200ml,” “Tea/Coffee – 100ml”). This way, you can quickly calculate your intake by counting how many you use.
• Read food labels: Pay attention to the “water content” information on packaged foods.
• Choose wisely: Opt for lower-fluid content options when possible (e.g., baked potato vs. potato soup).

Making it Simple: An Example

Let’s say your doctor recommends 1,500ml per day. Here’s how to manage your intake:

• Beverages: 5 glasses of water or juice (200ml x 5 = 1,000ml)
• Hot Drinks: 2 cups of tea or coffee (100ml x 2 = 200ml)
• Soups and Dairy (optional): 3 bowls of soup, dal, or curd (100ml x 3 = 300ml)

This adds up to 1,500ml, keeping you within your limit.

The occasional extra serving of fruit is okay. However, exceeding your fluid limit by a significant amount (200-500ml) can worsen your symptoms.

Now, the Most Important Part: When to Make that Emergency Call to your Doctor?

It’s important to seek medical attention promptly if you’re experiencing fluid buildup that you can’t manage at home. Here are some red flags that warrant a doctor’s visit:

• Sudden or rapid weight gain: This could be a sign of significant fluid accumulation.
• Severe swelling: Especially in your ankles, feet, legs, or abdomen.
• Difficulty breathing: This can be a serious symptom and may indicate fluid buildup in your lungs.
• Sharp increase in shortness of breath when lying down: This can be a sign of worsening heart function.
• Chest pain or tightness: This could be a sign of fluid around the heart.
• Abdominal pain or discomfort: This can be a sign of fluid buildup in the abdomen (ascites).
• Decreased urine output: If you’re urinating less than usual, even when you’re drinking fluids, it could be a sign that your body isn’t getting rid of fluids properly.

Final Thoughts on Fluid Management in PH

PH presents many challenges, but taking control of your fluid intake puts you in the driver’s seat. By strategically monitoring what you drink and working with your doctor to manage fluid retention, you can significantly improve your heart health. This translates to real-life benefits: reduced symptoms, improved quality of life, and an overall sense of well-being. Effective fluid management in PH enables you to actively shape your health journey towards a better quality of life. But remember, consistency is key!

Disclaimer: This information is for educational purposes only and should NOT be considered medical advice. Always consult your doctor when you notice fluid retention.