He’s Knocking on My Door

Tag: Heart Failure

  • What Is HFpEF?

    What Is HFpEF?

    How Can I Have Heart Failure If My Heart Is Pumping Normally?

    That was one of my first questions after learning that I had heart failure with preserved ejection fraction, commonly called HFpEF.

    My echocardiogram showed that my ejection fraction was in the normal range. If my heart was still pumping normally, how could I possibly have heart failure?

    The answer is that ejection fraction tells only part of the story. HFpEF is not primarily a problem with how forcefully the heart squeezes. It is a problem with how well the heart relaxes and fills between beats.

    It is also important to distinguish a normal ejection fraction from a normal heartbeat. A person can have a preserved ejection fraction while also having an abnormal rhythm, valve disease, conduction problems, or other cardiac conditions, like me.

    What Does “Preserved Ejection Fraction” Mean?

    Ejection fraction measures the percentage of blood that the left ventricle pumps out with each contraction. In HFpEF, that percentage is generally 50% or higher.

    However, a normal percentage does not necessarily mean that the heart is moving a normal total amount of blood.

    Imagine a flexible balloon that expands easily and fills completely. Now imagine a thick, stiff balloon that can hold only a smaller amount. Both balloons might empty the same percentage of their contents, but the stiff balloon starts with less inside it.

    Something similar can happen with HFpEF. The heart may eject a normal percentage of the blood inside the ventricle, but because the ventricle cannot relax and fill properly, the total amount of blood pumped may still be insufficient—especially during physical activity.

    The National Heart, Lung, and Blood Institute describes HFpEF as a condition in which the left side of the heart becomes too stiff to relax fully between beats. That stiffness prevents it from filling with enough blood to meet the body’s needs efficiently.

    What Is a “Stiff Heart”?

    The heart works in two main phases:

    • During systole, the heart contracts and pushes blood forward.
    • During diastole, the heart relaxes so its chambers can refill.

    With HFpEF, the squeezing phase may remain relatively strong, but the relaxation phase is impaired. The left ventricle does not expand as easily as it should. More pressure is therefore required to push blood into it.

    This is why HFpEF was once commonly called diastolic heart failure.

    The problem may become more noticeable during exercise or other activity. The body needs more oxygen-rich blood, the heart rate increases, and the ventricle has less time to fill. A stiff heart may not be able to increase its output enough to meet that demand.

    This can contribute to symptoms such as mine:

    • Fatigue
    • Shortness of breath
    • Reduced exercise tolerance
    • Lightheadedness
    • Swelling
    • Rapid weight gain
    • Difficulty breathing while lying flat

    How Does Pressure Build Up?

    When the left ventricle cannot fill easily, pressure begins to rise inside it. That increased pressure can travel backward into the left atrium and then into the blood vessels in the lungs.

    As pressure rises in those vessels, fluid can move out of the bloodstream and into surrounding tissue. In the lungs, this congestion can cause shortness of breath, coughing, reduced oxygen levels, and difficulty breathing while lying down.

    Congestion can also affect the right side of the heart and the veins returning blood from the rest of the body. Fluid may then collect in several places, including:

    • Feet and ankles
    • Lower legs
    • Abdomen
    • Lungs
    • Tissues around internal organs

    Some people first notice tighter shoes, sock marks, swollen ankles, abdominal fullness, or an unexplained increase in weight. Others experience worsening shortness of breath before obvious swelling appears.

    How Is Excess Fluid Removed at Home?

    For many people with heart failure, fluid management begins at home. The exact plan should be developed with a cardiologist or other healthcare professional and may include:

    • Limiting sodium, mine is around 1200mg a day
    • Following a prescribed fluid limit, mine is 1.5 liters a day
    • Taking an oral diuretic, sometimes called a water pill
    • Monitoring weight, blood pressure, symptoms, and swelling daily
    • Contacting the healthcare team when warning signs appear

    Diuretics help the kidneys remove extra sodium and water through urination. This can reduce congestion and make it easier for the heart to work. It also make you having to use the washroom much more frequently.

    A person should not begin taking extra diuretic medication or change the dose unless their clinician has provided specific instructions for doing so. Too much diuretic can cause dehydration, low blood pressure, electrolyte abnormalities, or worsening kidney function. I’ve been in the hospital for this.

    What Happens If Home Treatment Does Not Work?

    If oral medication is not removing enough fluid—or symptoms are becoming severe—hospital treatment may be necessary.

    In the hospital, clinicians can give diuretics intravenously. IV medication enters the bloodstream directly and may work more quickly and reliably than oral medication.

    The healthcare team may also:

    • Measure urine output
    • Monitor daily weight
    • Check kidney function
    • Check sodium, potassium, and other electrolytes
    • Monitor blood pressure and oxygen levels
    • Adjust heart failure medications
    • Treat the condition that triggered the worsening congestion

    In uncommon, severe cases where medications are not effective, a specialized filtration procedure may be considered to remove excess fluid. Most episodes, however, are treated with carefully monitored IV diuretics.

    Why Daily Monitoring Matters

    Fluid can accumulate before it becomes obvious in the feet or ankles. For that reason, daily weight is one of the most useful early-warning tools for someone living with heart failure.

    Weight should generally be checked:

    • Every morning
    • After using the bathroom
    • Before eating or drinking
    • On the same scale
    • In similar clothing

    The American Heart Association advises contacting the healthcare team about a sudden gain of approximately 2–3 pounds in one day or 5 pounds in one week, because it may indicate fluid retention. These are general guidelines; each person should follow the limits established by their own healthcare team. These are the thresholds I have also established with my doctors.

    Blood pressure should also be recorded regularly, but there is no single blood-pressure threshold that applies to everyone with HFpEF. Both high and low blood pressure can create problems. The appropriate range depends on medications, kidney function, symptoms, and other medical conditions.

    A useful daily record can include:

    • Weight
    • Blood pressure
    • Heart rate
    • Swelling in the feet or legs
    • Shortness of breath
    • Ability to lie flat comfortably
    • Fatigue or lightheadedness
    • Diuretic use
    • Sodium and fluid intake, when directed

    The trend often matters more than a single number. A gradual weight increase, falling blood pressure accompanied by dizziness, or steadily worsening breathing deserves attention even when no individual reading appears extreme. I track these daily in an Excel spreadsheet. I will make a post and explain how and what I track.

    A Normal Ejection Fraction Does Not Mean a Normal Heart

    HFpEF can be confusing because the heart may still appear to squeeze normally on an echocardiogram. But the heart must do more than squeeze—it must also relax, fill, and respond when the body requires additional blood flow.

    A stiff ventricle cannot perform those jobs efficiently. Pressure rises, blood backs up, fluid accumulates, and symptoms develop. That is genuine heart failure, even when the ejection fraction remains preserved.

    Living with HFpEF means learning to notice small changes before they become emergencies. Daily monitoring, medication, sodium awareness, and communication with the healthcare team all play important roles in keeping fluid and symptoms under control.

    This article is based on personal experience and general educational information. It is not medical advice. Medication doses, fluid limits, sodium goals, and warning thresholds should be established with a qualified healthcare professional.

  • Low-Sodium Living: When “Temporary” Became a Way of Life

    Low-Sodium Living: When “Temporary” Became a Way of Life

    I learned that I had congestive heart failure in October 2025. At the time, I believed it was temporary—something I would deal with until my aortic valve was replaced. I assumed that after the procedure, I would recover and eventually return to normal.

    Boy, was I mistaken.

    I still live with heart failure, and I also have a left bundle branch block, or LBBB. What I thought would be a temporary change has become a new way of life. One of the biggest adjustments has been learning how to live with much less sodium.

    A difficult lesson

    I met with a nutritionist because I wanted practical guidance. I hoped she would teach me how to eat differently without giving up everything I enjoyed. I especially wanted help figuring out how I could occasionally eat at a restaurant and still make responsible choices.

    Unfortunately, the appointment felt more like a scare tactic than a useful lesson. The line I remember most was essentially, “You’ve eaten like crap for the last 25 years. Now it’s time to eat correctly for the rest of your life.”

    I understood the point, but I left without many realistic ideas for everyday life. I listened to what she said, but I also knew there was no way I was going to live on tofu for the rest of my life.

    What the appointment did accomplish was make me much more aware of how much sodium is hiding in packaged foods and restaurant meals. It isn’t only fast food. Sodium is everywhere, including in foods that do not necessarily taste salty.

    Changing how we shop and cook

    My wife and I have completely changed the way we grocery shop and prepare meals. We rarely buy prepackaged meals now and make most of our food from scratch. We look for no-salt-added products whenever possible, including broth, canned tomatoes, beans, seasonings, and other ingredients.

    Cooking from scratch takes more time and planning, but it gives us much more control over what goes into our food.

    Then there is barbecue.

    I am a huge barbecue guy, so giving up my usual rubs has been one of the harder changes. Many commercial rubs contain a surprising amount of sodium. I have found a few seasoning blends that work for pork shoulder and poultry, and I have experimented with making my own.

    They are okay—but I’ll be honest, they are not quite the same.

    Finding meals that work

    We eat far more salads than we used to. I like adding tomatoes, radishes, beans, onions, dried cranberries, and walnuts to make them more filling and interesting.

    Some of those foods may be higher in potassium or phosphorus, however. Because I also live with kidney disease, I have to consider more than sodium alone. What works for me may not be appropriate for someone else, so it is important to ask your doctor or dietitian what is suitable for you based on your conditions, medications, and laboratory results.

    Salad dressing presents another challenge. Many bottled dressings contain a considerable amount of sodium. We have found a few lower-sodium options, but I often make dressing at home.

    One option I use is a no-salt-added ranch seasoning mixed with mayonnaise and buttermilk. The mayonnaise and buttermilk still contribute some sodium, so it is not sodium-free, but it is considerably lower than many prepared dressings.

    It tastes different from the bottled ranch dressing I was accustomed to. Low-sodium food often takes some getting used to, but your expectations and taste buds can adjust over time.

    Learning as I go

    I am still learning how to make food enjoyable while protecting my heart and kidneys. Some changes have been relatively easy, while others—especially barbecue—still sting.

    Low-sodium living does not have to mean eating flavorless food or giving up everything you enjoy. It does require reading labels, planning ahead, experimenting, and accepting that some foods will never taste exactly the way they once did.

    Throughout this site, I will share foods, recipes, seasonings, and products that have helped me. These are personal experiences rather than medical recommendations, but I hope they make the adjustment a little easier for someone else.

    If you have found a low-sodium food, product, or cooking technique that works well for you, I would love to hear about it. I may be able to share your suggestion here so that others can benefit from it too.

  • Why I Created “He’s Knocking on My Door”

    Why I Created “He’s Knocking on My Door”

    There are moments when life gets your attention quietly. Then there are moments when it pounds on the door.

    For me, health problems did not arrive all at once. They accumulated over time—atrial fibrillation, a stroke, heart failure, severe aortic stenosis, kidney disease, diabetes, and a hip that has made simply walking difficult. Eventually, I underwent a transcatheter aortic valve replacement, or TAVR. I came through it with a new heart valve, but that was not the end of the story.

    I still live with fatigue, limitations, uncertainty, and days when my body refuses to cooperate with what my mind wants to do. Activities that once seemed ordinary can require planning, rest, and help from my family. I have had to learn that recovery is not always a straight line and that a successful medical procedure does not necessarily mean life immediately returns to normal.

    That is where the name “He’s Knocking on My Door” comes from.

    It reflects the feeling that mortality is no longer some distant idea. It has knocked loudly enough that I cannot pretend not to hear it. But this site is not intended to be about giving up or waiting for the worst. It is about answering that knock by choosing to live as fully and honestly as I can.

    Over the past year, I have lost more than 100 pounds. I have changed how I eat, greatly reduced sodium, tracked my weight and other health measurements, and learned how quickly an ordinary meal can affect someone living with heart failure. I am preparing to exercise again, rebuild strength, and hopefully regain some of the independence that illness and severe hip pain have taken away.

    None of this has been easy. I do not have a miracle formula, and I will not pretend that positive thinking makes serious medical problems disappear. What I do have is lived experience—the mistakes, fears, frustrations, small victories, and practical lessons that rarely fit into a short medical appointment.

    I created this blog to share that experience.

    I also want to be honest about how often I may be able to update it. I can only write on the days when I am feeling well enough. Fatigue, pain, appointments, and other health problems may sometimes keep me away longer than I planned. There may be gaps between posts, but that does not mean I have abandoned the site. It simply means I am taking care of myself and will return when I am able.

    Here, I plan to write about living with heart disease, recovering after TAVR, managing a low-sodium lifestyle, continuing weight loss, beginning exercise with physical limitations, and navigating the emotional side of chronic illness. I will also share low-sodium recipes, useful tools, questions worth asking doctors, and the everyday adjustments that have helped me.

    This is my personal journey, not medical advice. Every person’s health and treatment are different, and important decisions should be made with qualified healthcare professionals. But sometimes it helps to hear from someone who understands what it feels like to live between appointments, test results, symptoms, and uncertainty.

    If you are facing serious health problems—or helping someone you love through them—I hope this site reminds you that you are not alone.

    The knock at the door changed my life.

    What I do after answering it is still being written.