heart failure english

7/26/2019 Heart Failure English

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WakeMed Health & Hospitals

Living with Heart Failure

A G U ID E F OR PAT IE N TS


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Table of Contents

What Is Heart Failure? ...................................3

What Causes Heart Failure?...........................4

Testing for HF ................................................5

Signs & Symptoms of HF ..............................6

Take Charge of Your HF ................................7

Weigh Yourself Each Day ............................7

Limit Salt/Sodium .......................................8

Reading Food Labels....................................9

Limit Fluids................................................12Lifestyle Changes.......................................14

Medication ................................................14

Exercise/Activity.........................................17

Other Treatment Options.............................18

Managing Your HF Using the Zones ...........19

Important Contacts.......................................20

My Medicines ...............................................22


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Living with Heart Failure

If you have been told you have heart failure (HF), you may feel anxious or scared. HF is

serious and there is no cure, but with proper medicine and careful management, manypeople leadnormal lives. Learning about your conditionand involving yourself in the

treatment can help you maintain a rich and productive life.

This book will help you understand heart failureand show you how to manage your

symptoms. If you have questions, please ask your nurse or doctor.The more you know, the

better equipped youwill be to manage your health.

Your WakeMed Heart Failure Team

What Is Heart Failure?

Heart failure, also known as congestiveheart failure (CHF) means your heart isnt

pumping enough blood to meet your bodys needs. It does not mean that your heart has

stopped oris about to stop.

Normal Heart

The heart has four chambers.The upper two chambers are the atria and the lower two are

the ventricles. These four chambers work together in powerful contractions or heartbeats

topump blood through yourbody. Valves (little doors in the heart) keep the blood flowing

in the right direction.

Right Atrium Left Atrium

Right Ventricle

LeftVentricle


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Heart wallsmay thicken

Heartdoesntpump well

4

The Heart with HF

Over time, the heart can no longer keep up with the normal demands placed on it to

pump blood to the body. The ventricles, lower chambers of the heart, may become stiff and

not fill adequately between the beats.

The heart muscle can also dilate (stretch) to the point where it is too weak to pump bloodefficiently. The term congestive heart failure comes from blood backing up into the

lungs, liver, abdomen and legs.

What Causes HF?HF usually develops after other conditions have damaged or weakened your heart. These

include:

Coronary Artery Disease: Coronary artery disease is the most common form of heart

disease. The arteries that supply blood to the heart become narrow from a buildup of fatand cholesterol. The narrowed arteries cause blood to move more slowly, leaving some

areas of your heart weak and without enough oxygen-rich blood. Your heart will not

function as well as it did before you had coronary artery disease.

Heart Attack:A heart attack occurs when the plaque formed by the fatty deposits in

the artery rupture. This causes a blood clot to form and block blood flow to an area of

the heart. As the heart heals, a scar forms and the hearts pumping ability is weakened.

High Blood Pressure: Blood pressure is the force your heart uses to pump blood to allparts of the body. If your blood pressure is too high, your heart has to work harder than

it should to pump blood throughout the body. The heart may become thicker enlarging

the heart or causing it to become too stiff or weak to effectively pump blood.

Heart Valve Problems:The valves are little doors in the heart that keep the blood

flowing in the proper direction through the heart. Leaky or damaged valves force the

heart to work harder. Over time, this extra work can weaken the heart.


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Congenital Heart Disease: Heart defects that are present at birth, if not corrected, can

cause the heart to work harder, leading to heart failure.

Cardiomyopathy: Heart muscle damage is called cardiomyopathy. There are many

causes of it. These causes include infections, alcohol abuse and the toxic effect of drugs

such as cocaine. In addition, diseases including lupus and thyroid problems can damage

heart muscle.

Abnormal Heart Rhythms: Heart arrhythmias such as atrial fibrillation can cause the

heart to beat too fast, creating extra work for your heart. Heartbeats that are too slow

may prevent your heart from getting blood out to the body and can also lead to HF.

Other Diseases: Chronic diseases such as diabetes, severe anemia, thyroid disorders and

lung disease (emphysema) can contribute to heart failure. Viruses can attack the heart.

Severe infections, allergic reactions, or blood clots in the lungs can contribute to HF.

Testing for HFTo diagnose your condition, your doctor will ask you about your medical history and

perform a physical examination. Many tests can be used to evaluate heart failure. Your

doctor may order several of these.

Blood Tests: Blood tests can show your doctor how well your kidney and thyroid

function. Your blood can also tell your doctor if you have diabetes and other diseases or

disorders that can affect the heart. A blood test to measure your brain natriuretic

peptide (BNP) can help in diagnosing HF.

Chest X-ray:X-ray images allow the doctor to see if there is fluid buildup in your lungs

or if the heart is enlarged.

Electrocardiogram (ECG):This test records the electrical activity of your heart. It can

reveal heart rhythm problems and damage to your heart from a heart attack.

Nuclear Stress Tests:A nuclear stress test measures blood flow to your heart at rest and

with activity.

Echocardiogram:The echo is an ultrasound image of your heart, used to check heartstructure and pumping function.

Multiple Gated Acquisition (MUGA) Scan:The MUGA scan produces a video image

of your beating heart. Your doctor will be able to see how well your heart pumps blood.


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Coughing

Pleural efflusion(excess fluid

around the lungs)

TirednessShortness of breath

Pulmonary edema(excess fluid in lungs)

Pumping action ofheart grow weaker

Swelling in abdomen(ascites)

Swelling in anklesand legs

6

Ejection FractionYour ejection fraction is measured during an echo, nuclear stress test, or MUGA. It is an

important measurement of how well your heart is pumping. It is also used to determine

the type of HF you have and the treatment that will work best for you. A normal ejection

fraction is 55-60 percent, meaning that over half of the blood that fills the ventricle is

pumped out with each heart beat.

Signs & Symptoms of HFYou may experience one, some or all of the following signs and symptoms of heart failure.


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Take Charge of Your HFYou dont have to go it alone! Your WakeMed Heart Failure Team

will help you create a plan to manage your HF. They will also be

available in the weeks, months and years ahead to help you make

changes to your plan if necessary. Your successful HF management

plan will include the following key parts:1. Weigh yourself each day

2. Limit salt/sodium

3. Limit your fluid intake

4. Lifestyle changes

5. Medication

6. Regular visits with your doctor or nurse7. Exercise/activity

How well you feel will directly depend on how well you follow your HF plan.

1. Weigh Yourself Each Day

This is one of the best ways to keep track of your HF. A sudden weight gain of 2 pounds

over night or 3 to 5 pounds in a week may be a sign that fluid is building up in your body

and your HF is getting worse.

Weigh yourself each morning, after you have urinated, but before breakfast.

Wear the same clothing.

Use the same scale. Scales should be placed on hard surface, not carpet.

Write your weight on a calendar.

Ask your doctor what you should do if you gain 2 pounds overnight or 3 to 5 pounds in

a week.

Maintain a healthy weight Extra pounds add more work for the heart.

HOW CAN I FEELMY BEST?

Stick to your heart failure

management plan by

watching your:

Weight

Sodium

Fluid intake

Medication compliance

Activity level

DO YOU KNOW?

Call your doctor if you suddenly gain 2 pounds

overnight or 3 to 5 pounds in a week.


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2. Limit Salt/Sodium

Eating food high in salt (also called sodium) can make your body retain

water. It increases your risk of heart failure, high blood pressure, kidney

disease and stroke. Always look at the amount of sodium in the product

and factor it into your total sodium for your meal. You should not have

more than 600 mg of sodium per meal and no more than 2,000 mg ofsodium per day.Thats about the same as 1 teaspoon of salt.

Your taste buds may need time to adjust to less salt. After a few weeks,

youll be amazed to discover some new flavors.

Ways to Decrease Salt/Sodium

Get rid of your salt shaker.

Cook without salt.

Flavor your food with spices, lemon, or vinegar instead of

using salt or high-sodium bottled dressings or marinades.

Use low-sodium recipes.

Buy sodium-free, low-sodium, no salt added or

reduced-sodium foods.

Look for unsalted varieties of popcorn, pretzels, potato chips

and crackers. Snack on fruit, fresh vegetables or unsalted nuts.

Be aware that processed foods, frozen dinners, canned soups,

and entrees with gravies or sauces may be high in sodium.

Avoid bacon, sausage, country ham, hot dogs and processed lunchmeats (bologna, ham,

turkey, chicken).

Use freshly cooked chicken breast, turkey, roast beef and fish for sandwiches and salads.

Eat fresh or frozen foods. If you have to eat canned or processed foods, rinse them

before you cook or eat them.

Be aware that fast food is high in sodium/salt.

If you eat a food that is high in sodium, balance it by eating lower sodium foods.

Look at the ingredients list for different types of sodium that may be added, such as

monosodium glutamate (MSG), sodium bicarbonate (baking soda), baking powder,

sodium nitrate, sodium benzoate, sodium hydroxide and sodium sulfate.

If you have heartburn or a headache, take medicines that do not have sodium

bicarbonate or sodium carbonate in them.

SALTSUBSTITUTES

Always check with

your doctor before

you use a salt

substitute. Many

salt substitutes

contain potassium

and are generally

not recommended

for people who

have HF.


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Reading Food Labels

Always check the serving size and servings per container.All the

Nutrition Facts information is based on the serving size. Remember:

This serving size on the food label may be different from what you

consider to be a serving size.

If you need to lose weight, check the number of calories per serving.

Label Lingo

When you read the Nutrition Facts on food and beverages, you may

notice some of the following terms. Here is what they mean:

Sodium free or salt free Fewer than 5 mg of sodium per serving

Very low sodium 35 mg or less of sodium per serving

Low sodium 140 mg or less of sodium per serving Low sodium meal 140 mg or less of sodium per 3 oz. (100 g)

Reduced sodium At least 25 percent less sodium than the regular

version

Light in sodium 50 percent less sodium than the regular version

Unsalted or no salt added No salt added to the product during

processing

When You Eat Out

Do order:

Food that is fresh and broiled, baked or grilled

Mixed green salads or fruit as side dishes

Avoid

Food that is fried, frozen or pre-made

French fries, potato salad, pasta salad Dips, potato or nacho chips, salsas, pizza or

soups

Dishes made with a lot of sauce

Fast food

Snacks from vending machines

Tips for Ordering

Ask the server if low salt/sodium or heart

healthy items are available.

Ask to have no salt or MSG, cheese or butter

added to your food.

Have dressing and sauces put on the side. Usejust a little of them on your food or dont use

them at all.


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Choosing Foods to Lower Your Sodium Intake

Limit Sodium to 2,000 mg/day

Food Group Choose More Often Choose Less Often

Sauces & Tabasco sauce, vinegar, BBQ sauce, salsa, Soy sauce,

Condiments tomato paste, fresh catsup, chili sauce, teriyaki sauce

herbs and spices, gravies, mustard,

Mrs. Dash. salad dressings,

tomato sauce, tomato

puree, mayonnaise,

Worcestershire sauce

Grains Flour, rice, pasta, noodles, Breads and rolls, most Can or jar spaghetti

whole grains, matzo, hot dry cereals, biscuits, sauce, instant pastacereals (except instant), muffins, pies, and rice mixes, instant

unsalted popcorn, doughnuts, cookies, hot cereals, pretzels,

Shredded Wheat pastries, pancakes, crackers, salted

waffles popcorn, snack chips

Vegetables Fruits, fresh vegetables, Canned vegetables, Pickled vegetables,

& Fruits most frozen vegetables frozen lima beans, olives, pickles,

frozen peas, sauerkraut, stewed

tomatoes, vegetables tomatoes

with seasoned sauces

Beverages Carbonated beverages, Milk, buttermilk Tomato juice, vegetable

coffee, tea, mineral waters juice

Fish, Poultry, Fresh meat without salt, Fresh shellfish, Bacon, ham, corned

Meat & beef & veal, lamb, peanut butter beef, lunchmeats,

Other Dishes poultry, pork, eggs, sausages, salami, canned

unsalted nuts & unsalted tuna, canned salmon,

peanut butter, Non-salt frozen breaded meats,

herbs and spices anchovies, sardines,

prepared entrees,

canned & packaged

soups, salted nuts

Milk Products Ricotta or Swiss cheese, Milk, buttermilk, Blue, cottage or parmesan

cream cheese, unsalted salted butter, ice cheeses, processed or

butter or margarine, yogurt cream, margarine, American cheeses;

custard, pudding cheddar cheese

LOW in Sodium

Below 100 mg/serving

MEDIUM Sodium

100-400 mg/serving

HIGH Sodium

Over 400mg/serving


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Sample Meal Plans

Breakfast Breakfast

medium banana 1 small orange

cup whole grain cereal dry, unsweetened cup oatmeal

1 slice whole wheat toast 1 slice whole wheat toast

1 cup skim milk 1 cup 1% milk 1 hard-boiled egg 1 scrambled egg

1 teaspoon soft tub margarine 1 teaspoon soft tub margarine

Lunch Lunch

1 cup low sodium bean soup Hamburger bun

2 slices whole grain bread 2-3 oz. grilled chicken breast

cup tuna Lettuce & tomato

Lettuce & tomato Carrot sticks1 tablespoon light mayonnaise 1 tablespoon light mayonnaise

Fresh apple, small 1 small pear

Dinner Dinner

2-3 ounce chicken breast 2-3 ounce pork roast

cup lima beans 1 small baked potato

1/3 cup brown rice 1 whole wheat dinner roll

cup steamed broccoli cup steamed green beans

2 teaspoons oil 1 tablespoon light margarine

cup pineapple cup light ice cream

5 vanilla wafers

Snack Snack

6 whole grain crackers (unsalted) 1 cup light yogurt

2 tablespoons natural peanut butter 1 cup strawberries


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3. Limit Fluids

Ask your doctor if you need to limit the amount of fluid that you drink. Some HF patients

need to limit the amount of fluid they drink to 1 - 2 quarts (6 8 cups or 1,500 2,000

ml) each day. A fluid is any food that is liquid at room temperature.

Fluid Restriction Guide

Ounces Cups ML

1 2 Tbsp 30 ml

4 12 cup 120 ml

8 1 cup 240 ml

32 4 cups 960 ml

(1 quart)

48 6 cups 1,440 ml

64 8 cups

(2 quarts 1,920 ml

or gallon)

Coffee

Water

Tea

Flavored water

Fruit juice

Fruit drinks

Hot chocolate

Kool Aid

Liquid medicine

Milk

Nectar

Soft drinks

Other items that count as fluid:

Crushed ice, cup = cup fluid

Fruited gelatin, cup = cup fluid

Ice cream, cup = cup fluid

Sherbet, cup = cup fluid

Popsicle, 2 halves = 1/3 cup fluid

Fruit ice, cup = cup fluid

Jell-O, cup = cup fluid

Frozen yogurt, cup = cup fluid

Milkshake, 1 cup = 1 cup fluid


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Stay on Track!

For at least a week, keep track of how much you drink.

Fill your favorite cup or glass with water. Pour that water

into a measuring cup to see how much the cup holds.

Using a 2-quart container or milk jug, pour 6 (or 8) cups

into the jug and stick a piece of masking tape at the water

line. Each time you drink something, pour the same

amount of water into the jug. When the fluid reaches the

tape line, you have had your fluids for the day.

Try to spread your fluid allowance evenly throughout the

day. Make sure you save enough fluid to take the

medicines you need late in the day.

If You Get Thirsty

Rinse your mouth with water. Spit it out dont swallow.

Add lemon juice to water or crushed ice.

Suck on lemon drops or tart hard candies. Use sugar-free candy or gum if you have

diabetes.

Suck on a lemon slice.

Put an ice cube in your mouth to melt or eat crushed ice. It takes longer to eat ice than

to drink water. You can count 12 cup of ice as just 1/4 cup of fluid.

Eat mandarin oranges, grapefruit sections or grapes.


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4. Lifestyle Changes

Stop Smoking: Smoking makes the heart work harder by increasing blood pressure,

heart rate and the force of each heartbeat. It can make HF worse. You should also avoid

second-hand smoke.

Limit or Avoid Alcohol: Excess alcohol damages heart muscle. Alcohol makes it harder

for the heart to work.

Stress: Stress increases your blood pressure and makes your heart work harder. It may

make your HF symptoms worse. The first step in controlling stress is to recognize it and

identify what causes it for you. It is not possible to get rid of all the stress in your life,

but you can take steps to reduce the amount of stress you feel.

5. Medication

Medication plays a key role in treating HF. Research has shown that people who take

medication as prescribed:

Live longer

Have fewer HF symptoms

Increase their activity level

Stay out of the hospital

Doctors usually treat HF with a combination of medications. You might take one or more

of these medications, depending on your symptoms: Angiotensin-converting enzyme (ACE) inhibitors:ACE inhibitors are drugs that

widen blood vessels to lower blood pressure, improve blood flow and decrease the

workload on the heart.

Antiotensin II Receptor Blockers (ARBs):These drugs have many of the same benefits

as ACE inhibitors and may be an alternative for people who cant tolerate them.

Beta Blockers: Slow your heart rate and lower blood pressure. These medicines also

reduce the risk of some abnormal heart rhythms. Beta blockers may reduce HFsymptoms and improve heart function.

Diuretics (Fluid or water pills): Help the kidneys rid the body of SALT (not fat) and

water. They make you urinate more often and help reduce swelling.

Aldosterone Inhibitors:Aldosterone is a hormone that causes your body to hold sodium

and water. These drugs act as diuretics and have other benefits in HF.

Vasoactive agents:These relax the walls of blood vessels and help lower blood pressure.


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Digoxin: Makes the heart pump more strongly and helps control irregular heartbeats.

Antiarrhythmic Drugs: Help prevent abnormal heart rhythms.

Non-prescription (over-the-counter) Medicines

Always tell your doctor and pharmacist about ALL of the medicines you take. Many over-

the-counter drugs, vitamins and herbal supplements can affect how well your prescriptionmedicines work.

Medications to Avoid

In particular, talk to your doctor or pharmacist before taking any of the medicines below:

Decongestants

Decongestants make the heart work harder.

Pseudoephedrine (Sudafed)

Phenylpropanolamine

Many cold and flu products, including some antihistamines, contain decongestants. Ask

your pharmacist if the product you want to take is acceptable.

Pain Relievers

Some pain relievers can cause fluid retention and kidney problems. These interact with

many drugs.

Ibuprofen - Advil, Motrin

Naproxen - Aleve, Orudis

Check with your doctor or pharmacist before using any

drugs for increased stomach acid. These include:

Tagamet/Cimetidine

Zantac, Pepcid, Axid

Safer Medications

Some over-the-counter medications are considered safer than others. Even though they

are, you still need to tell your doctor and pharmacist that you use these drugs. They

include:

Antihistamines

Chlor-Trimeton

Chlorpheniramine

Benadryl

NON-STERIORIADAL DRUGS

(NSAIDS Drugs that contain ibuprofen

or naproxen) Motrin, Aleve, Advil,

Daypro or Celebrex. If you take these

drugs for arthritis or other painful

conditions, talk to your doctor.


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Many cold and flu products, including some

antihistamines, contain decongestants. Ask your

pharmacist if the product you want to take is acceptable.

Pain Relievers

Acetominophen - Tylenol

Tips for Taking Medication

Take medication at the same time each day.

Do not change doses, skip doses or stop taking

medication without talking to your doctor.

Take only the medication your doctor tells you to

take.

Check with your pharmacist about foods that mayinteract with your medications.

Call your doctor if you experience side effects, such

as dizziness, increased weakness, increased fatigue,

muscle cramps, dry cough, nausea, poor appetite or

vision changes.

Keep medications in a cool, dry place away from

children. Make a chart and check off each dose as you take it

or place your medication in a pillbox with separate

containers for each day of the week.

Refill your prescriptions before you run out.

If you travel, carry enough medication to last on the trip and carry the

medication with you. Do not put it in your suitcase that you plan to

check. If you forget to take a dose, take it as soon as you remember. However, if

it is almost time for your next dose, skp the missed dose and go back to

your regular schedule. Do NOT take two doses to make up for the one

you missed. If you have questions or concerns, please talk to your doctor.

NON-HFMEDICATIONS

TO AVOID

Certain over-the-

counter drugs,prescriptions for non-

HF health conditions,

vitamins and herbal

remedies can interfere

with your HF

medications and

worsen your HF

symptoms. Always tellyour doctor about any

medications you plan

to take. In general, you

should avoid:

Non-steroidal drugs

(NSAIDS) Ibuprofen,

Naproxen, Ketaprofen

Heartburn/headache

medications containing

sodium bicarbonate or

sodium carbonate.


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6. Regular Appointments with Your Doctor

Make and keep your appointments with your doctor to maintain

your health.

7. Exercise/Activity

Activity including exercise, work and sex is healthy and safe for

most people with HF. People who exercise regularly:

Have more energy

Cope more easily with stress/Feel less tense

Increase resistance to fatigue

Look better

Burn off extra calories to help lose pounds or stay at ideal weightCheck with your doctor before beginning any exercise program.

Ask if a referral to the WakeMed Cardiac Rehab Program would

be right for you.

Exercise needs to be aerobic, meaning the body uses oxygen to

produce the energy needed for the activity. This can include

swimming, walking or bicycling. Choose an activity and set aside a

regular time each day to do it.

Be active for 30 minutes each day. You do not have to exercise 30

minutes at a time You could, for example break the exercise into

three 10-minute blocks. Begin exercise slowly and gradually increase

the time you spend doing the activity. Remember you should be able

to walk, talk and breathe, all at the same time! If you cant, you may

be working too hard and should slow down.

It is important to be active, but do not push yourself until you are

exhausted. Avoid exercising in extreme temperatures, such as very

hot or very cold weather. Do not exercise just after you eat or if you

do not feel well. Avoid activities where you have to hold your breath

or bear down such as lifting weights.

DONT OVERDO IT!

If you have any of these

symptoms, slow down. If th

symptoms dont go away, ca

911 or EMS for your area.

Irregular heart rate

More shortness of breath

(You cant talk or you are

short of breath after

resting)

More tired than usual

Dizzy or lightheaded

Chest pain or tightness

Pain in your jaw, neck,

shoulders or arms

Nausea or vomiting


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Other Treatment OptionsIf you have a heart rhythm problem, an implantable device to monitor and

correct your rhythm disorder may help you.

Implantable Devices

Pacemaker:These are primarily used to treat slow heart rates. Implantable Cardioverter Defibrillator (ICD): ICDs are used to treat

dangerous, fast rhythms in the lower chambers of the heart, which are called

ventricular tachycardia (VT) or ventricular fibrillation (VF).

Biventricular Pacemakers: In some HF patients, the lower chambers of the

heart beat in an uncoordinated way. Biventricular pacemakers coordinate this

beat.

Biventricular ICD:The biventricular ICD contains both a pacemaker tocoordinate the beating of the lower chambers of the heart and a defibrillator

to treat very fast rhythms, VT or VF.

If you have one of these devices, it is important that you continue to follow your

Heart Failure Action Plan.


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Managing your Heart Failure Using the Zones


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Important ContactsThese are the key people who are involved in your care. Remember,

if you have a medical emergency, always call 911 immediately for help.

The WakeMed Heart Failure Program

WakeMed Raleigh Campus

3000 New Bern Avenue

Raleigh, NC

919-350-5732

WakeMed Cary Hospital

1900 Kildaire Farm Road

Cary, NC

919-350-0875

My Primary Care Doctor

Doctors Name

Address/City/State/Zip

Phone/Fax

My Cardiologist

Cardiologists Name

Address/City/State/Zip

Phone/Fax


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My Emergency Contacts

Primary Contact

Name Relationship

Home Phone Work Phone

Cell Phone

Secondary Contact

Name Relationship

Home Phone Work Phone

Cell Phone


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My Medicines

Medicine Name Dose Time to Reason for

(How much to take) take medicine medicine


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My Medicines

Medicine Name Dose Time to Reason for

(How much to take) take medicine medicine


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WakeMed North Healthplex, Brier Creek Healthplex, Garner Healthplex,

Clayton Medical Park, Raleigh Medical Park, Zebulon/Wendell Outpatient

Rehabilitation, Wake Forest Road Outpatient Rehabilitation, Kerr Family YMCA

and Alexander Family YMCA are operated by WakeMed Raleigh Campus.

WakeMed Apex Healthplex, Kraft Family YMCA and

Cary Family YMCA are operated by WakeMed Cary Hospital.

WakeMed Health & Hospitalswww.wakemed.org

Raleigh Campus Cary Hospital

North Healthplex Apex Healthplex

Brier Creek Healthplex Garner Healthplex

Raleigh Medical Park Clayton Medical Park

WakeMed Outpatient Rehabilitation Facilities

Home Health WakeMed Physician Practices

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