Taking Control:

Of Your Heart FailureDawn Martinez, RN

Heart Failure Program Coordinator

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Table of Contents• What Is Congestive Heart Failure? 5• What Does Congestive Heart Failure Mean? 6• What Causes Heart Failure? 7• Managing Your Heart Failure At Home 8• Blood Pressure And Heart Failure 9• How To Weigh Yourself Every Day 10• Why Should I Weigh Every Day? 11• Fluid Control 12• Items That Count As Fluids, and Fluid Control Tips 13• Why Is A Low Sodium Diet Important? 14• Low Sodium Diet Tips 15• Common High Sodium Foods & Spices 16• Common Low Sodium Foods & Spices 17

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Table of Contents• Tips for Dining Out 18• More Diet Tips 19• Heart Failure Medicines 20• Types of Heart Failure Medication 21• Medication Tips 22• Activity Guidelines 23• How Much Is Too Much Activity? 24• Why Stop Smoking and Drinking? 25• Stress Management 26• How Can My Family Help Me? 27• When To Call My Doctor 28• When To Call 911 29• Questions For Your Healthcare Team 30• Resources 31• More Information 32

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What Is Congestive Heart Failure?

• Your heart has become too weak or too stiff to pump out enough blood to meet your body’s needs.

• It is not the same as a heart attack. Not all people with heart failure have had heart attacks. Heart attacks are due to blockages in the blood vessels that feed the heart.

• It does not mean your heart is “stopping.” You can live with heart failure for a long time, but it is a serious disease that can affect your quality of life and how long you live.

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What does Congestive Heart Failure Mean?

• When your heart doesn’t pump enough blood out to your body, fluid begins to build up in your blood vessels, especially the blood vessels to the lungs. This fluid leaks into the lungs, belly, and feet & legs. It causes you to feel short of breath, weak, and to have swelling in the legs, feet, and belly.

• Congestive Heart Failure, CHF, Heart Failure, and HF are all names for the same condition.

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What Causes Heart Failure?

• There are many conditions which may lead to heart failure. High Blood Pressure, High Pressure in the Lungs, Irregular Heart Beat, Coronary Artery Disease (blockages in the heart’s blood vessels), and Heart Valve Problems are very common causes.

• Smoking, Alcohol Abuse, Cocaine or other street drug use, some types of Heart Infections, and Diabetes can also lead to heart failure. Sometimes we cannot figure out why a person has gotten heart failure.

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Managing Your Heart Failure At HomeThere are several important ways that you

can help control your heart failure symptoms. These are things you can do in addition to taking all of your medications and following all of your doctor’s instructions!

Two of the most important ways you can help take care of yourself are:

Weigh yourself every day, and write it down.

Eat a low sodium (salt) diet.Other things you can do to control your

heart failure are: check your blood pressure, get enough exercise and rest, and stop drinking alcohol and smoking.

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Blood Pressure And Heart Failure

Many HF patients have high blood pressure too. High blood pressure makes your weak heart work even harder, and you may feel much worse as a result. You may have more problems and more symptoms.

It is important to take any medications your doctor prescribes for your blood pressure. Following a low salt diet will also lower your blood pressure.

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How To Weigh Yourself Every DayDoing “Daily Weights” is a bit more than just stepping on the scale

each day. It is important that you follow these tips to make your weight as accurate as possible:

Weigh in the morning, after using the bathroom but before breakfast.

Use the same scale every day. Make sure it is on a hard floor, not a rug or carpet.

Wear the same amount of clothing every time you weigh.Record your weight in your Heart Failure Log each day.If you are just getting home from the hospital, weigh on

your scale right away and record it. Your weight will probably be different than the hospital scale weight.

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Why Should I Weigh Every Day?

Your condition may change very quickly when you have CHF. One of the earliest signs of a change in your heart failure is weight gain. If you are weighing yourself each day, the scale will show the extra fluid you are carrying before you even begin having symptoms. This is an important step in keeping you out of the hospital by catching changes very early.

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Fluid ControlYour doctor may instruct you to drink only a certain amount of fluids each day,

so that the fluids don’t build up in your body and make your heart failure symptoms worse. Usually, the instructions will tell you to drink only a certain amount in liters or ML or CC. The ML and CC are the same thing, and a liter is 1000 ML.

1 quart = 4 cups = 32 ounces = 960 ML = approximately 1 Liter

1 pint = 2 cups = 16 ounces = 480 ML

1 cup = 8 ounces = 240 ML

1 ounce = 30 ML

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Items That Count As Fluids, & Fluid Control Tips

• All drinks: water, tea, milk, coffee, beer, wine, liquor, soda, punch, and juices, etc.

• Ice cubes, Ice cream, popsicles, sherbet, sorbet• Jello, gelatin salads• Cream and liquid non-dairy creamer• Soup, stock, broth~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~Lemon wedges, sour hard candies, and gum help moisten your

mouth.Mouthwash to refresh a dry mouth.Measure out your allowed fluid for the day, and stick to it.Use small cups and glasses—makes you feel as if you are having

more fluid if you have to refill your glass.Eat allowed fruits ice cold between meals to refresh dry mouth.

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Why Is A Low Sodium Diet Important?

• Sodium is an important chemical that our bodies need to function properly, but when there is too much sodium, or salt, in the body our kidneys hold on to extra fluid to dilute the salt or thin it out. Heart failure weakens the heart and it cannot handle this extra fluid, so you begin to have symptoms of fluid overload, like swelling and shortness of breath.

• A low sodium diet is about 2000mg (or 2 grams) daily. This is about one teaspoon of salt! Your body actually needs only about 1/8 teaspoon to function each day.

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Low Sodium Diet Tips

• It may be very difficult to change your eating habits, so don’t be discouraged if you make mistakes. Each day, take small steps toward the ideal low salt, low fat diet and you will reach your goal.

• The easiest salt tip: GET RID OF THE SALT SHAKER!

• Low salt and low fat do NOT equal no flavor!

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Common High Sodium Foods & Spices

• Packaged mixes: gravies, sauces, taco seasoning, marinades, mac-n-cheese, dinner kits (Hamburger Helper), instant potato mixes, etc.

• Season Salt, Garlic Salt, Lite Salt, any seasonings with “salt” in the name.• MSG, monosodium glutamate, Accent, meat tenderizer.• Soy Sauce (even the “lite” kind), Worcestershire, Teriyaki Sauce, etc.• Ketchup, Jarred Salsa, BBQ Sauce, Cocktail Sauce, Salad Dressings, Steak Sauce, Hot

Sauce.• Most spice mixes such as Cajun Seasoning, Poultry Seasoning, Steak Seasoning, etc.• Pickles, Relishes, Chutneys, Jarred Horseradish Sauce, Antipasti, Dips.• Canned Soups, Gravies, Broths, Tomato Sauces, Tomato Paste.• Canned and Jarred Vegetables, Canned Beans, Sauerkraut, etc.• Lunch or Deli Meats, Canned Meats/Fish, Yellow Cheeses, Velveeta or American Cheese,

Hot dogs, Sausages, Bacon, Bacon Bits, Imitation Seafood (Krab)• Most Frozen or Prepared Bread Products or Kits such as Instant Cereals/Grits, Frozen

Waffles, Corn Bread Mix, Dressing Mix, etc.• Salty snacks: Chips, Nuts, Pretzels, Saltines, etc.

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Common Low Sodium Foods & Spices

• Mrs. Dash Seasonings and Marinades• Pure Dried Spices such as Basil, Oregano, Italian Seasoning, Onion or Garlic Powder, Black

Pepper• Fresh Herbs and Garlic• Flavored Vinegars, Citrus Juices• Unsalted or “No Salt Added” Canned Soups, Broths, and Vegetables• Dried Beans, Grains, and Pastas• All Fresh or Frozen Vegetables and Fruits• All Fresh/Frozen Meats, Poultry, Seafood, Eggs and Egg Substitutes• White and Cream Cheeses, Ricotta, Cottage Cheese• Frozen Dinners with less than 600MG of Sodium each• Milk, Yogurt, Frozen Yogurt• Most Breads, Muffins, Rolls, etc.• Low Sodium Vegetable Juices, Tomato Sauces, etc.• Fresh, Refrigerated Salsa (From the Produce Section).

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Tips For Dining Out• Ask Questions! Your Waiter or Cook Can Explain

How Most Of The Dishes Are Prepared and Make Recommendations For Low Salt and Low Fat Dishes.

• Avoid Dishes with Gravies, Sauces, Soy Sauce, or MSG. Order Plain Foods such as Plain Baked Potato, Rice, Etc. Do Not Order Smoked or Cured Foods.

• Oil & Vinegar Dressing for Salads. Avoid Marinated Salads, Croutons, Creamy Dressings, Bacon Bits, Yellow Cheese, Olives, Pickles, and Antipasti.

• Get Grilled, Broiled, or Baked Entrees.

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More Diet Tips

• Watch your portion sizes. Most packaged meals contain more than one serving.• Read the Nutrition Labels. Look for Sodium Free (less than 5mg per serving),

Very Low Sodium (35mg or less per serving), or Low Sodium (140mg or less per serving), High Fiber (5gm or more per serving), Low Cholesterol (20mg or less per serving), Cholesterol Free (less than 2mg per serving), Low Fat (3gm or less per serving), and Fat Free (less than ½ gm per serving).

• Try to keep sodium, fat, and cholesterol less than 5% of the Daily Value per serving. Daily Value is based on 2000 calorie diet usually, sometimes 2500 calories.

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Heart Failure Medicines

Heart Failure medicines help your weak heart to work better and help relieve your symptoms. Sometimes you will also take medicines to control other health conditions which may make your heart failure worse. Depending on your particular needs, you may take very different medications from other heart failure patients.

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Types of Heart Failure Medication• ACE Inhibitors or ARBs: Work in the kidney system to lower the blood pressure

so the heart doesn’t have to work as hard.• Beta Blockers: Slow the heart rate while letting the heart pump better by

stopping some of the harmful chemicals that are produced during heart failure episodes. They also lower blood pressure. Sometimes you may feel worse when starting or changing the dose of beta blockers, but this effect is temporary.

• Digoxin: Helps the heart beat stronger. This helps your heart pump more blood out to the rest of the body.

• Isordil dinitrate and hydralazine decrease how hard the heart has to pump by lowering the blood pressure.

• Diuretics, or “water pills,” get rid of excess fluid in your body. This will help get rid of some of the swelling in your body and may help you breathe more easily. The heart doesn’t have to work as hard to pump blood to the body when the extra fluid is removed. Some diuretics cause you to lose potassium, so your doctor may prescribe a potassium supplement for you.

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Medication Tips• Take all your medication exactly as directed. Take them at the same times every

day. Using a pill organizer or writing times on the bottle lid may help you.• Always keep the medicines in the original bottle (except for the ones in the pill

organizer) and question your pharmacist if the pills change shape or color when you refill them.

• Do not run out of any medications. Make sure you have enough to last the whole trip if you are travelling. If you do run out of your medicine, call your doctor right away.

• Keep an up-to-date list of your medications with you at all times. Take your medicine bottles to all your doctor’s appointments, including any vitamins, herbs, or other supplements you take. Tell the doctor about any home remedies or over-the-counter medicines you take too.

• Don’t change the dose of medicine you are taking or skip any doses unless your doctor has instructed you to do so. If you miss a dose, don’t take it with the next dose!

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Activity Guidelines

• Group your activities with planned rest periods between them. A 30 minute rest period is usually enough. Don’t overdo it!

• Avoid activities in extreme temperatures.

• Do not perform heavy lifting.• Don’t start exercising unless your

doctor has said it is OK. Ask about a cardiac rehab program to help you increase your activity slowly.

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How Much Is Too Much Activity?

• If you are tired, stop and rest.• IMMEDIATELY STOP THE ACTIVITY IF:

– You have increased shortness of breath– Chest pressure or pain– Dizziness or feel faint– Palpitations or a racing heart– Unusual, severe weakness or tiredness– If the symptoms do not go away call your doctor or go to the

emergency room!

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Why Stop SmokingAnd Drinking?

Smoking causes the body’s blood vessels to tighten up. Your weak heart then has to work much harder to pump blood out to the body. Smoking causes damage to the lungs, which may make it harder for you to tolerate the symptoms of heart failure.

Drinking alcohol can lead to a weak heart muscle and worsen your HF symptoms even more. The extra fluid you drink with alcohol may make your swelling and shortness of breath worse. Alcohol damages the liver. The liver helps your body use the medications you must take. If your liver is damaged, your heart failure medicines may not work as well.

If you are having trouble stopping smoking, drinking, or using street drugs, talk to your doctor or nurse. There are many ways your healthcare team can help you quit!

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Stress Management• It is important to control stress in your daily life. Stress causes

chemical changes in your body which put a strain on your weakened heart.

• Many people use meditation, yoga, mindfulness activities, journaling, or guided imagery to relieve stress. Ask your nurse about these techniques or others that may help.

• If you feel overwhelmed by the stressors in your life, speaking with a counselor may also help.

• Sometimes people with serious chronic diseases like HF become depressed due to all the changes and issues associated with their diseases. If this occurs, your doctor may recommend medications or other types of treatment to help you deal effectively with these stressful issues.

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How Can My Family Help Me?• Heart Failure is a complicated disease which can be difficult to manage

alone. The many medications, diet and fluid restrictions, and all the other “rules” for taking care of yourself can become confusing, especially when you are very tired or your brain is feeling “fuzzy” from the HF.

• Your family can assist in many ways: by helping you organize your medications, going to doctor visits with you, and helping you shop for HF healthy foods. They can also watch for signs and symptoms that you may not be aware of, so that early treatment can keep you out of the hospital!

• Your family can help you when you are feeling overwhelmed or upset as well. Most HF patients go through periods where they are angry or sad or feel lost because of all the life changes their heart failure has caused. Talking to a trusted friend or family member, or another CHF patient can help with this stress.

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WHEN TO CALL MY DOCTOR• Weight gain of 2-3 pounds in 1 day or 5 pounds in less

than a week.• Worsening shortness of breath or when at rest.• New or worsening swelling of feet, legs, belly, or

hands.• Feeling full, hungry but unable to eat much, bloated

or tight.• New or worsening cough (wet or dry).• Needing more pillows than usual to sleep or unable to

breathe well when lying down, unable to sleep due to restlessness.

• Feel dizzy or lightheaded but have not passed out and do not have new or worsening irregular heartbeat.

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WHEN TO CALL 911• ANY CHEST PAIN OR PRESSURE THAT

DOESN’T GET BETTER AFTER FIFTEEN MINUTES OF REST OR AFTER TAKING PRESCRIBED DOSES OF NITROGYLCERIN

• SEVERE SHORTNESS OF BREATH, COUGHING UP FOAMY PINKISH OR WHITE SPUTUM

• FAST OR VERY IRREGULAR HEART BEAT THAT MAKES YOU FEEL WEAK OR DIZZY

• A FAINTING SPELL• SEVERE CONFUSION AND DIFFICULTY

THINKING

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Questions For Your Healthcare Team1. ____________________________________

Answer: _____________________________2. ____________________________________

Answer: _____________________________3. ____________________________________

Answer: _____________________________4. ____________________________________

Answer: _____________________________

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Resources

My Heart Failure Doctor: ___________________Phone: (___)___-____

Pharmacy: ______________________________ Phone: (___)___-____

My Primary Doctor: _______________________Phone: (___)___-____

Mainland Center Hospital: (409)938-5000Mainland Heart Failure Nurse: (409) 938-5159

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More Information

• American Heart Association:www.americanheart.org

• Freedom from Smoking: www.ffsonline.org• Heart Failure Society of

America: www.hfsa.org

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