Hi agin. I have a question about salt and, pacemakers and CHF.

I understand traditional no/low salt diets are are prescribed for many heart related issues.  However on all my bloodwork for at least the last decade I have had low sodium and low chloride. Realizing how imortant sodium is for body functions, wouldn't restricting salt be detrimental for me?





by ROBO Pop - 2021-05-27 21:28:45

Not all heart patients are crested equal. Your specific condition determines whether you should be on a low sodium diet or not. Many heart patients actually must take salt to maintain a safe blood pressure level as well ss other health criteria, while others must carefully limit their salt consumption to prevent fluid overload. Both can be deadly so it's important you talk to your doctor about your diet and salt consumption. 


by Julros - 2021-05-27 21:44:16

Electrolyte levels, including sodium and potassium are regulated by a balance between your pituitary gland, adrenal glands, and kidneys. Low sodium levels may be caused by medication as well, one culprit being thiazide diuretics. Generally speaking, low sodium is treated with a water restriction, and rarely, salt suppliment. Levels low enough to cause symptoms may need further evaluation, often by a kidney specialist. 

When you experience heart failure, increased sodium will increase blood volume and increase the work load of your heart. It can be a fine balance between keeping fluid low and maintaining an adequate blood pressure. You should speak with your doctor about what is your personal reccomended salt intake. Often patients are given a "one size fits all" diet recommendation without taking into consideration other factors. 


by simonsimon - 2021-05-27 23:03:26

Very interesting. I haven't gone on a low salt and I don't recall my doctors recommending it. Odd that just in the last week or so my BP readings are low. Not dangerously low but low for what it normally is for me.Time to run it by my cardiologist.

Low plasma sodium...

by crustyg - 2021-05-28 03:13:32

Salt and water balance is complicated, and there's a bit more to it than described above.

In general, a reduced sodium diet (compared to the usual Western-style diet) is good for CHF patients, as too much sodium causes expansion of blood volume=>increased RA filling=>increased LA pressure for the failing heart=>wet lungs so poor O2 pickup=>breathlessness.

The RA plays a big part in regulating sodium balance and a lot of heart conditions affect this (esp. AFlut/AFib). For many folk with CHF the balance is so fine that the *slight* sodium retaining effect of an over-the-counter pain medication like ibuprofen can precipitate HF (as reported by the patien't breathlessness).

There's a small epidemic of dilutional low-sodium in fitness types who over-drink water (used to be a major issue during half- and full-marathons).  Not everyone with a low plasma sodium needs salt. Some of them need less water.  There are specific conditions that make it difficult for the kidneys to excrete water and these *can* be quite dangerous to the brain. Heavy marketing of water bottles, reminder gadgets, social messaging have all increased water intake in a lot of folk.  A low plasma sodium caused by low body sodium makes it practically impossible to stand up, and is generally easy to diagnose by looking at the patient - sunken eyes, sagging skin, barely moist mucus membranes, obvious low BP.

Welcome back ROBO Pop!

How much salt ? A balancing act indeed

by Gemita - 2021-05-28 05:16:06

Simon, what a common but incredibly important question you raise and I sense this thread will be an important one for many of us.  It is for me because my husband has ongoing problems with low sodium due to his age and accumulating health conditions.  Sodium is of course an electrolyte and we all know how electrolyte imbalances can adversely and very quickly affect our bodies.  My husband has to have regular blood electrolyte levels checked to manage his many conditions and it is indeed a fine balancing act to keep these all under firm control, but the benefits are huge.  I hope your doctors are looking after all aspects of your health Simon, including your sodium levels.

What causes sodium levels to drop?  Many conditions can cause a loss of sodium/chloride and certainly not only heart related conditions which is why it is important to get an early diagnosis and treatment plan.  In my husband’s case, due to major bowel surgery years ago, he periodically suffers severe dehydration leading to worsening kidney function.  His sodium levels can suddenly drop and cause both physical and personality changes.  I know the signs now and have to get him into hospital quickly for intravenous fluids to prevent organ failure.  It can be a fine balancing act and become critical quickly if not well managed.

Hypochloremia occurs when there's a low level of chloride in your body. It can be caused by fluid loss through nausea or vomiting or by existing conditions, diseases, or medications.  In hyponatremia, the level of sodium in blood is too low.  A low sodium level has many causes, including consumption of too many fluids, decreased function of kidneys, liver, heart, and use of diuretics.  It is common in the elderly who are likely to have more difficult health conditions to manage and who are more likely to be on a variety of offending meds.  Many other conditions/illnesses from cancer to thyroid, pneumonia or urinary tract infections can cause dehydration/sodium loss too.

Hyponatremia treatments may include changing a medication that affects your sodium level, treating the underlying disease, changing the amount of water you drink or changing the amount of salt in your diet.

Crustyg your comment “The RA plays a big part in regulating sodium balance and a lot of heart conditions affect this (esp. AFlut/AFib)”  is one subject close to my heart.  It took me years to get to the bottom of why I was having to empty my bladder so many times during an episode of Flutter/AF, particularly when these episodes resulted in high heart rates.  I often question whether my body really knows what it is doing when in A-Fib or other fast atrial tachy arrhythmias.  I have read briefly about the “atrial natriuretic peptide hormone” in the atria kicking in and acting as a diuretic to lower the blood pressure and regulate the calcium and salt in the body during an atrial tachy arrhythmia but it can be a disruptive process.  I won't pretend I fully understand it or what the downside of all this might be.  For me I can most definitely suffer severe dehydration from sudden salt losses, leading to syncope when fluids are lost so rapidly through excessive urination.  It can be a fine balancing act to know how best to manage these symptoms when control of atrial tachy arrhythmias is not always effective.

I hope you stay safe Simon and thank you for raising this very common but important issue



by Blondpacer - 2021-05-28 08:00:41

I have Neurocardiogenic syncope and pacemaker for over 20 years and need salt in my diet because of low blood pressure. I just found thru research after taking a seizure medication for over 30 years that it depletes salt ! I cannot believe my neurologist didn't put this together with cardiologist from the beginning. But then again my neurologist is worthless. Electrolytes are also important. 


by simonsimon - 2021-05-28 12:45:40

Have been reading about electrolyte balance, is that a stand alone test I need to request or can I determine it from a CBC or basic metabolic blood test?

Request an Electrolyte Panel

by Gemita - 2021-05-28 12:50:35

Simon, perhaps you would care to read the following link.  I usually request an "Electrolyte Panel".

Good luck

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