Dietary Sodium Management in Heart Failure: A Case of Recurrent Fluid Retention

Case at a Glance

A 68-year-old male with chronic heart failure demonstrates clear correlation between dietary sodium intake and fluid retention symptoms, with documented improvement during periods of dietary compliance and deterioration upon resumption of high-sodium foods.

Patient's Story

The patient, a 68-year-old male with established heart failure, presented with progressive bilateral lower extremity edema and weight gain. Family members noted significant dietary indiscretion, including regular consumption of processed meats, hot dogs, pickles, and other high-sodium foods. Despite initial resistance, the patient agreed to modify his diet after family intervention.

Initial Assessment

Patient presented with bilateral lower extremity edema, weight of 196 pounds, and reported dyspnea on exertion. Physical examination revealed pitting edema and signs of volume overload. Patient's baseline heart failure was being managed with standard medications, though family expressed concerns about medication optimization.

The Diagnostic Journey

A dietary intervention was implemented with elimination of high-sodium processed foods. Within 1-2 weeks of dietary modification, patient demonstrated remarkable improvement with weight loss from 196 to 179 pounds (17-pound reduction), resolution of lower extremity edema, and significant improvement in dyspnea on exertion. Patient acknowledged symptomatic improvement during this period.

Final Diagnosis

Chronic heart failure with acute exacerbation secondary to dietary sodium excess. The patient's clinical course demonstrated clear correlation between sodium intake and fluid retention status.

Treatment Plan

Primary intervention focused on dietary sodium restriction with elimination of processed meats, pickles, and high-sodium snack foods. Patient education regarding the relationship between sodium intake and heart failure symptoms was provided. Continuation of existing heart failure medications was maintained.

Outcome and Follow-up

Patient experienced significant clinical improvement during the period of dietary compliance. However, subsequent follow-up revealed recurrence of symptoms including unilateral lower extremity edema, pulmonary congestion, and dyspnea following resumption of previous high-sodium dietary habits. This pattern reinforced the direct relationship between dietary sodium intake and heart failure symptom control. Patient and family education regarding dietary compliance remains an ongoing challenge, with the patient demonstrating resistance to sustained lifestyle modifications despite clear clinical evidence of benefit.