Happy Monday. As we settle into the first full week of 2026, I want to tackle a subject that is often dismissed or ignored: cognitive fatigue, or "heart failure brain fog."
When you have a heart Ejection Fraction (EF) of only 20%, the physical effort of moving is immense. But often, the mental effort of simply thinking is equally exhausting. This is believed to be due to reduced oxygen and blood flow to the brain, combined with chronic sleep disruption and the sheer mental load of managing complex medications.
The Mental Cost of Severe Illness
For the former traveler, a sharp, quick mind was essential for navigating new languages, calculating currency, and making split-second decisions. Now, I frequently find myself losing words, forgetting why I walked into the next room (my tiny housebound commute), or struggling to process complex information.
This isn't just frustrating; it can be dangerous when you're managing a life-critical illness:
Medication Errors: Brain fog increases the risk of forgetting a dose or taking the wrong pill, which is catastrophic when the medication balance is as delicate as mine.
Safety Risk: A moment of cognitive lapse can lead to a fall or an energy miscalculation, resulting in unnecessary strain on the heart.
My Strategies for Fighting the Fog
Since I can't fix the underlying cause (the 20% EF), I have to build systems to work around the fog. These are my simple, low-energy tools for mental support:
Externalizing Memory (The List is King): I rely entirely on external aids. Nothing is left to memory. All appointments, questions for the care team, and medication times are written down in a very large, brightly colored notebook or logged immediately into a digital reminder app.
The "One Thing" Rule: When the care team or a doctor gives instructions, I focus only on the one most important action item. If there are three points, I ask them to list them one by one, and I repeat them back. This uses maximum focus for minimal input.
No New Information After 5 PM: Just as I set physical boundaries for rest, I set cognitive boundaries. After 5 PM, I only engage in passive, familiar activities (reading an easy novel, watching a re-run). New learning or complex conversations are strictly banned to ensure my mind is rested for the night.
Accepting the Slowdown: The most difficult step is accepting that I am slower. I consciously slow down my speech and my process. I no longer beat myself up for needing to re-read instructions three times. Self-compassion is crucial; this is a symptom, not a personal failure.
If you are dealing with brain fog, know that it is a real symptom of heart failure. Be kind to your mind, build robust systems, and remember that your intelligence is still there—it just needs an organized and rested environment to surface.
What is one simple organizational tool or routine you use to help manage mental fatigue or brain fog in your daily life?
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