These parameters are ideally written down in the diary provided by your treating cardiologist, but can also be noted in a personal booklet or sheet if no specific diary is available.
Weight
It is best to weigh yourself systematically at the same time, namely:
- In the morning when you get up.
- After visiting the toilet.
- Before getting dressed, eating or drinking.
In heart failure, the body may retain salt and fluid. In this case, diuretic medication will be prescribed. Normally a target weight is suggested by your cardiologist. This is your ‘ideal’ weight where the body is not retaining fluid and also not dehydrated. The goal is for your weight to fluctuate stably around this target weight. However, this target weight may change over time and should be regularly monitored and adjusted if necessary. The target weight can increase or decrease due to weight changes due to a changed diet (eating more or less) or other diseases, without there being too much or too little fluid in the body.
In addition, the aim should be to achieve a healthy weight , without obesity (body mass index, BMI > 30 kg/m²), but also avoiding underweight (BMI < 20 kg/m²).
How often do you have to weigh yourself ?
It is best to discuss this with your doctor.
- We prefer patients to weigh themselves every morning in the following circumstances:
- after a recent hospitalization for heart failure.
- if a higher dose of diuretics must be taken daily.
- in case of concomitant other illnesses (for example an infection/fever, vomiting, diarrhea, etc.)
- Sometimes weighing 3 times a week may be sufficient, for example if the condition has been stable for a longer time (months) and a lower dose of diuretic medication is required (e.g. furosemide 40 mg per day).
- Sometimes even weighing once a week may be sufficient, for example in a stable condition and if there is no need to take daily diuretic medication.
How to interpret changes in weight?
The weight will always fluctuate slightly day by day. Normal weight fluctuations are less than 1 to 2 kilograms, depending on your nutritional and fluid intake or toilet visits that day.
A change in weight of 2 kilograms or more is considered important, especially if there is a further increase in weight 2 or more days in a row. It is best to take contact with your doctor or heart failure nurse.
How to assess weight changes?
- Weight gain:
- When to consider worsening heart failure with fluid retention?
- An increasing weight 2 days in a row, more than 2 kg above the target weight.
- Increased shortness of breath.
- Swelling of the lower limbs.
Consult your doctor urgently: the diuretic medication may need to be increased (temporarily).Dynamic diuretic use: Sometimes your doctor will give you a schedule whereby the dose of diuretic medication must be adjusted according to weight. - Above a certain weight, a higher dose of diuretic medication must be temporarily taken or an additional diuretic medication must be taken for a few days until the weight has returned to the target weight. The therapy can then be reduced back to the basic schedule.
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- Below a certain weight, the dose of diuretic medication must be temporarily reduced until the weight is increased to the target weight. The therapy can then be increased back to the basic schedule.
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- When weight gain is more likely to be due to dietary mistakes (eating too much or unhealthy food) and/or less exercise?
- Rather slow weight gain over weeks.
- No increase in shortness of breath.
- No swelling of the lower extremities.
Diuretic medication should only be increased on the advice of your doctor after a clinical evaluation. If the weight gain is not the result of retaining too much fluid, the diuretic medication should not be increased, because unnecessarily increasing this medication can cause low blood pressure and a deterioration of kidney function. Weight loss should then be pursued through a healthier diet and more physical activity.
- Unintentional weight loss with normal eating habits :
- Unwanted weight loss despite a normal eating pattern:
- When to consider dehydration due to excessive fluid loss (for example due to too much diuretic medication, vomiting, diarrhea, etc.)?
- Weight loss after increasing diuretic medication or in case of vomiting, diarrhea, inability to eat or drink, etc … or very hot weather in the summer.
- Muscle cramps.
- Thirst and dry mouth.
- Low blood pressure.
Consult your doctor urgently: the diuretic medication may need to be temporarily reduced or stopped. Moreover, you may drink more water.
- When to think about other diseases?
- Unexplained weight loss without a recent change in medication and without certain other complaints.
- No muscle cramps.
- No increased thirst or dry mouth.
- Unchanged blood pressure.
Discuss this with your doctor.
