Do you need a Lung transplant for Congestive Heart Failure?

Short answer -- no.

What you might need is a new health care team if you are being told that you can’t breathe because you need a lung transplant for Congestive Heart Failure (CHF). (Shams, et al., 2025) The real issue lies in restoring normal fluid balance, metabolic function, and energy flow in a heart that’s struggling—not replacing lungs that are merely collateral damage in a flood zone.

Breathing Struggles in CHF – Why It Feels Like Drowning

• Pulmonary edema fills the alveoli with fluid, preventing oxygen exchange.

• Orthopnea (shortness of breath when lying flat) and paroxysmal nocturnal dyspnea (waking up gasping for air) are classic CHF symptoms.

• Sympathetic overdrive (from the body’s stress response) worsens the sensation of breathlessness.

The problem is a metabolic crisis disrupting electrolytes the leads to abnormal heart function. The body needs fluid balance throughout the body to be working correctly again. Methylation cycle dysfunction is likely a problem along with mitochondrial and gut microbiome dysfunction.

Polyphenols may be too limited in the diet and salt restriction may be too excessive compared to providing adequate potassium and vitamin K2 — gut dysbiosis is likely with modern processed foods instead of resistant starches and zinc in the diet and/or excess copper may be present in combination with lack of zinc. We need healthy gut microbes to make vitamin K2 for us and butyrate and other short chain fatty acids to support the colon microbes and intestinal cells.

…many things may be lacking metabolically when Congestive Heart Failure is present, but it will feel like difficulty breathing primarily because the lungs become overfull of water along with the heart having an excess. Within the body’s cells acidity and intracellular calcium may be excessive. What won’t be likely to help though, is a lung transplant within a body that has dysfunctional fluid storage. Putting new lungs in a ‘vehicle’ that is ~ underwater, will just lead to the new lungs overfilling with water too.

In Congestive Heart Failure fluid and electrolytes are out of balance and the heart becomes overloaded with water, enlarged, and ‘breathing’ is difficult because heart circulation is labored. The lungs and heart have too much water and breathing is difficult because there is too much water in the lungs and heart. It is exhausting and likely frightening to try to breath — drowning in open air, struggling to catch a breath through an internal sea of excess fluid.

DeepSeek AI:

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Why a Lung Transplant Isn’t the Solution for CHF

1. CHF is a Heart Problem, Not a Lung Problem

   • In CHF, the heart’s inability to pump efficiently causes fluid to back up into the lungs (pulmonary edema), leading to shortness of breath, because the heart isn’t pumping efficiently. This is a circulatory issue, not irreversible lung damage 1 9.

   • Lung transplants are reserved for conditions like COPD or pulmonary fibrosis, where lung tissue is permanently destroyed, not for fluid overload from heart failure. CHF-related fluid overload can often be managed with diuretics, vasodilators, and lifestyle adjustments 5 12.

   • Better CHF management (diuretics, vasodilators, inotropes, or lifestyle interventions) can often resolve breathing difficulties without extreme surgical measures.

2. Fluid and Electrolyte Imbalance: The Core Issue

   • The "drowning" sensation in CHF stems from fluid retention, driven by:

     • Kidney dysfunction: Reduced blood flow triggers sodium/water retention 1.

     • Excessive salt restriction: Paradoxically, overly strict limits can activate the renin-angiotensin system, worsening fluid retention. Emerging research (e.g., the FRESH-UP trial) questions rigid fluid restrictions, showing no significant benefit in stable CHF patients 4 12.

     • Mitochondrial dysfunction: Impaired energy production weakens the heart’s pumping ability, exacerbating congestion 9.

     • Potassium & Magnesium are crucial—low levels can cause arrhythmias, irregular or a weak heart rate.

     • Vitamin K2 helps prevent vascular calcification, which can stiffen arteries and worsen CHF.

3. Metabolic Dysfunction—Methylation & Mitochondrial Dysfunction:

   • Methylation cycle disruption: Poor methylation (linked to MTHFR gene mutations) can worsen heart health by increasing homocysteine (a risk factor for cardiovascular disease). Elevated homocysteine (linked to B-vitamin deficiencies) can damage blood vessels and worsen CHF 9.

   • Mitochondrial dysfunction: Lack of magnesium or other nutrients may add to mitochondria dysfunction which reduces ATP production and energy availability leading to fatigue and further weakening of the heart muscle. CoQ10, D-ribose, and B vitamins (especially B1/thiamine) may help.

   • Polyphenol and potassium deficits: Low dietary polyphenols (e.g., berries, dark chocolate) and potassium imbalance (often due to excessive diuretics) may impair vascular and cellular health 5.

   • Gut dysbiosis & Resistant Starches: A disrupted microbiome increases inflammation, further stressing the heart and worsening CHF. Resistant starches feed beneficial gut bacteria, reducing endotoxin load from negative species. Resistant starches include raw fruits and vegetables and cooked-and-cooled starches like potato or pasta salad, rice, polenta, green bananas. 9

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What Can Help? Evidence-Based Strategies

1. Medical Interventions

   1. Diuretics (e.g., furosemide): Reduce fluid overload but require careful monitoring of potassium/magnesium 5 9.

   2. SGLT2 inhibitors (e.g., dapagliflozin): Originally for diabetes, these drugs now show promise in reducing CHF hospitalizations by improving metabolic efficiency 5 11.

   3. Vasodilators (like nitrates) to ease the heart’s workload.

2. Diet Adjustments

   1. Moderate, not extreme, sodium restriction (individualized based on lab work). Some patients benefit from slightly higher sodium to maintain blood volume. 12

   2. Adequate protein & polyphenols (berries, dark chocolate, green tea) to reduce oxidative stress.

   3. Potassium and vitamin K2: Critical for electrolyte balance and preventing vascular calcification 9.

   4. Zinc and selenium: Support immune function and thyroid health, which indirectly affect heart performance, (hypothyroidism can mimic/worsen CHF). 9

3. Lifestyle and Monitoring

   • Daily weight checks: A sudden gain of 2–3 lbs may signal fluid retention 1.

   • Pursed-lip breathing: Reduces breathlessness by slowing respiration and improving oxygen exchange, which may also help reduce feelings of panic. 9

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A Call to Action – Advocate for Better Care

• If a doctor suggests a lung transplant for CHF, seek a second opinion from a heart failure specialist.

• Demand thorough metabolic testing (homocysteine, magnesium, B vitamins, NT-proBNP).

• Consider functional medicine approaches alongside conventional treatment.

The Bottom Line

A lung transplant won’t fix a drowning heart. CHF demands a multidisciplinary approach—addressing fluid balance, metabolic support, and targeted medications—not organ replacement. If your team jumps to transplant talk without exploring these avenues, seek a second opinion from a heart failure specialist 7 9.

Key Resources:

1. Johns Hopkins CHF Guide 1 https://www.hopkinsmedicine.org/health/conditions-and-diseases/congestive-heart-failure-prevention-treatment-and-research

2. (4) https://rethinkingclinicaltrials.org/news/grand-rounds-may-2-2025-fluid-restriction-in-heart-failure-versus-liberal-fluid-uptake-the-fresh-up-study-roland-rj-van-kimmenade-md-phd/

3. (5) https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

4. (7) https://monument.health/team-based-approach-to-advanced-heart-failure-care-earns-national-recognition-for-monument-health-rapid-city-hospital/

5. (9) https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

6. (11) https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/joint-commission-online/sept-18-2024/performance-measure-changes-for-advanced-certification-in-heart-failure-for-2025/

• FRESH-UP Trial on Fluid Restriction 12 https://www.acc.org/About-ACC/Press-Releases/2025/03/30/12/24/Limiting-fluid-Intake-May-Not-be-Needed-for-Some-People-with-Heart-Failure

Final Thoughts:

Congestive Heart Failure is a complex metabolic crisis—not just a ‘fluid problem.’ Restoring balance requires more than draining the water; it demands nourishing the heart, mitochondria, and microbiome. A lung transplant won’t fix a drowning heart—but the right care just might.

• Sometimes we have to heal our own broken hearts by saying good-bye to loved ones who believe their body is like an automobile that is able to just get a new engine or transmission replacement whenever the old part wears out.

• Over-confidence and wishful thinking can only get you so far before feelings of drowning are too difficult to ignore.

What if it is the whole ocean* that needs to be ‘replaced’?

The ‘ocean’ = the body’s fluid and electrolytes are likely overly-acidic, excess phosphorus and calcium compared to magnesium, potassium, and other trace minerals and polyphenols.

Disclaimer: This information is being shared for educational purposes within the guidelines of Fair Use and is not intended to provide individual care guidance.

*I’m sad. This post is based on a true-life situation. People who think the body is like a Transformer Robot, do not understand health.

photo op

Crocheted critter and robot. Photo by Lizzi Sassman on Unsplash