Stay Healthier Longer

Helping yourself remain as well as possible with CHF


Table of Contents

  1. What is CHF?
  2. Symptoms
  3. Weigh Daily
  4. Understanding Your Medications
  5. Fluid Management
  6. Other Things You Can Do To Improve Your Heart's Function
  7. The Future
You have been diagnosed with CHF (Congestive Heart Failure). Understanding CHF and what you can do to help yourself remain more active and with less problems as long as possible is our common goal. The things YOU can do to help keep yourself 'weller' longer include: Being aware of what is 'normal' for you in terms of your weight, Blood Pressure, heart rate, etc. is important.
Your ejection fraction is %. (Normal is 60-80%)
Your target weight is pounds.
A weight gain of 2 pounds or more in 2 days or 3 pounds in one week should be called to your doctor. If you are not eating for several days and your weight stays the same, this could tell us you are retaining fluids...call your doctor.
Your target blood pressure is .
Generally your BP should range from to .
Your target heart rate at rest is .
Digitalis(Lanoxin) and Beta Blockers can slow your heart rate. The low limit we would like for you is .
With exercise your heart rate will increase. An OK heart rate with exercise for you would be from to .

WHAT IS CONGESTIVE HEART FAILURE?

CHF is the most common reason for hospitalization of patients over the age of 65. CHF does not mean your heart has failed, or stopped. What it does mean is that the pumping function, or ability to squeeze blood out of your heart, is reduced from normal. No one squeezes all blood out of the heart with each heart beat. The amount of blood squeezed out with each heart beat is called the ejection fraction (ef). Normal ejection fraction is 60-80%, but yours is reduced. This reduction in pumping function contributes to your tiring more easily than the average person. Symptoms of heart failure can usually be controlled with medicines, rest, and diet.
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SYMPTOMS OF INCREASING HEART FAILURE

As heart failure worsens, when less blood is pumped with each heart beat, blood can 'pile up' in the heart and begin to back up and fluid leaks out of the blood vessels into the lungs and legs causing... Fatigue, in CHF, happens when blood flow to the cells of the body is too slow. Fatigue may also be caused by emotional stress or other physical problems. You may want to discuss this with your doctor. You may notice your body holding on to fluids. When less blood gets to the kidneys, the body thinks it doesn’t have enough blood. Water and salt are kept in the blood rather than passing them in urine, to increase the blood volume in your veins. Holding on to the extra fluids in the veins causes the heart to work harder, and can worsen heart failure. It is this fluid which causes your feet to swell, your waist band to tighten, and your lungs to build up fluid. Gravity will affect where the fluid builds up. If you are standing or sitting, it will accumulate in your feet (edema). If you are lying down at night, fluid tends to flow to the lungs making it harder to breathe.
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WEIGH DAILY

An early sign the kidneys are saving salt and water is a sudden weight gain. A guide to help us know how your body is handling the fluids that you are drinking is your weight. This is why we ask you to A weight gain of 2 or more pounds in 2 days should be reported to your doctor. A 3 pound weight gain in one week should also be reported. Stable weight when you have not been eating could hide fluid retention.
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UNDERSTANDING YOUR MEDICATIONS

Become familiar with the name, dose (mg's), color, size, why, and how often you take each medicine. Do NOT let your medications run out so that you will be without them for a day or two. Not taking medications as prescribed, even for a day or two while awaiting medications that have run out could make you seriously ill and require hospitalization. Please let the doctor’s office know ahead of time when pills are likely to run out. Many medications are affected by the acid in grapefruit juice so it is best not to take medicines with this. Four types of medicines are commonly used for Congestive Heart Failure. These include: ACE Inhibitors:
ACE Inhibitors (Angiotensin Converting Enzyme - Inhibitor) mostly decrease the blood pressure by widening or relaxing the blood vessels. Although often given to patients with high blood pressure these medicines when used for CHF are used primarily to reduce the work of the heart by making the size of the blood vessels bigger. This helps the heart in two ways. First, it is easier to pump blood through bigger, more relaxed blood vessels. Second, because the blood vessel size is bigger the blood returning to the heart to be pumped is reduced. Again, this decreases the work of the heart. ACE Inhibitors also help maintain kidney function. Know your target blood pressure. Taking ACE inhibitors will usually keep it on the very low side.
Examples of ACE Inhibitors are: With ACE Inhibitors you may sometimes experience dizziness when you get up. As you stand up, blood pools in the legs and doesn’t get to your brain quickly enough and you feel dizzy. To help this... get up slowly... first sit on the side of the bed/couch for a minute or two allowing time for your body to adjust, then get up slowly and hold on to something for a moment. If you have a new onset of dizziness, you should let your doctor know...even more important is dizziness when you are NOT getting up. Not all dizziness will be due to ACE Inhibitors. The doctor will decide.
A side effect sometimes seen with ACE Inhibitors is a cough that doesn’t bring anything up and may feel like a constant tickle in your throat. If you experience this let your doctor know at your next office visit. If you are unable to take ACE Inhibitors, often an Angiotensin II antagonist, such as Cozaar (losartan) or Avapro (ibesartan) will be used instead.
Diuretics
Diuretics or 'water pills' are often given to help the kidneys remove fluids from your body by increased urination. As the fluids are removed from the body, there is less blood volume for the heart to pump. With less blood volume to pump, the heart pumps more easily and ‘catches up’ on the fluids backed up into the tissues of the lungs and the legs. When your weight increases your doctor may increase your diuretic. You will notice that you pass more urine after taking your medicine, especially at night. When you are lying down the kidneys make more urine.
Diuretic examples include: Many combination drugs with a less potent diuretic HCTZ also exist.
If you are taking only one dose, take it in the morning, after breakfast. If you take more than one dose, take the last dose no later than 6pm to avoid loss of sleep... unless otherwise directed by your doctor.
Potassium is a mineral required by your body. You can lose large amounts of potassium as you pass extra urine with diuretics(water pills). Often extra potassium will be prescribed with a diuretic. Slow-release tablet should be taken with food to prevent stomach irritation, and, with adequate liquid to help them dissolve better. Do not crush potassium tablets. Foods high in potassium (such as bananas, strawberries, watermelon, oranges, dried fruits, potatoes, beets, greens, and tomatoes) can also be used to regulate potassium. Usually diet alone can’t give the amount needed for the heart failure patient.
You may experience dizziness with diuretics. As you pass water, volume of blood in the blood vessels is decreased and blood pressure comes down and may cause dizziness. Severe weakness and thirst can also be related to diuretic therapy. Potassium may be lost with the water passed. Low potassium can cause severe leg cramping or increasing irregular heart beats; Let your doctor know if you experience any of these symptoms, he may adjust your potassium dose, lower your diuretic dose, or change other medicines. Often, if your diuretic is adjusted, your potassium will be adjusted as well.
Beta Blockers
Beta Blockers make the heart beat slower and with less work. They can also make the blood vessels dilate or get bigger. They are also sometimes used to treat high blood pressure or chest pain.
Examples of beta blockers include: Blood vessels are made bigger by beta blockers which may lead to low blood pressure and dizziness. A slow pulse rate may also be caused by beta blockers. Again, this is why it is important to know your 'normal' blood pressure & pulse. Let your doctor know if you have new onset of these. In addition, beta blockers can contribute to fatigue, insomnia, nightmares, altered HDL cholesterol and triglycerides. Some are avoided in patients with COPD, diabetes, or peripheral vascular disease. If you have problems with these things, discuss them with your doctor at your next visit. Beta blockers are usually not discontinued suddenly, but are tapered off. A newer Beta Blocker type medication with additional properties is Coreg or carvedilol. In addition to beta blocker qualities, Coreg has the effect of preventing blood vessel constriction (or getting smaller) in the legs, so that the net effect is larger blood vessels in the legs. This makes the work of the heart even less than with a pure beta blocker. It is started very slowly and is gradually built up. It can occasionally cause fatigue initially, but this usually lessens with time. It has a similar effect on Blood Pressure to beta blockers. The long term benefits of Coreg are longevity and improved quality of life. Digoxin (Lanoxin) Digoxin, also called Lanoxin, is a form of digitalis. It makes the heart pump more blood with each beat by strengthening the heart muscle’s contraction. Also, it slows the heart rate so the heart does not need to work as hard. Knowing your normal pulse and learning to check your pulse for variances from your normal will help your doctor regulate this medicine.
If kidney function is reduced or if blood levels of digoxin rise, it can cause the following: Digoxin is also used to treat irregular and fast heart rhythms. If any of these things happen, tell your doctor so your dose can be adjusted. These do not necessarily indicate an allergy to the medicine.
Inotropic Infusions
When oral medications are no longer effective in controlling CHF symptoms. Intermittent medications through the veins, called inotropes may help the heart beat stronger.

REST

Your heart has little reserve capacity to pump more blood when there is an increase in activity or bodily functions that require more blood. So, things that do not tire others can quickly wear you out. Knowing this, you can adjust and plan your activities so you don’t try to do too much at one time. A full day of activities can make your tomorrow achey, very tired, and miserable! Listen to your body: if it feels tired, or you have chest pain, or any of the signs of worsening heart failure, you need rest!! Try planning rest periods into your day between activities so your heart muscle can regain its strength. Taking a nap after lunch (or at least not planning activities while your body is working to digest lunch!), or putting your feet up for a few minutes every couple of hours may be useful. A rested heart pumps more easily!

ACTIVITY

Avoid vigorous exercise or overexerting your heart. You don’t want to put sudden pumping demands on your heart. On the other hand regular, modest, daily activity of some sort, such as a 5-20 minute daily walk, bike ride, or water exercise, is essential to maintaining muscle tone. How far you walk and how much you do depends on your symptoms. If only 2 minutes of walking make you tired, start with 2 minutes, then gradually build up the time spent in an activity. The heart is a muscle and like any other body muscle will become stronger with exercise. Listen to your body.... if it tells you it’s tired ..... rest!

SALT & YOUR DIET

Too much salt in your diet will make your body hold fluid, and holding fluid makes your heart work harder to pump. Most people with heart failure are asked to eat less salt. Another word for salt is sodium. Look for sodium content of foods on the nutrition label.
Your doctor may suggest one of the following: It is sometimes difficult to tell if foods contain salt/sodium just by the 'taste' of the food. Some foods naturally taste salty and are usually High in sodium. But, other foods may not taste salty but have lots of sodium. Learning to recognize foods that are HIGH in sodium will be useful.
If you are only asked to 'cut down' on the amount of sodium that you eat a good rule of thumb is: Only 15% of sodium intake for the average American is consumed from table salt. On the other hand, 75% of sodium intake for the average American comes from processed or prepared foods. High Sodium foods include: Moderately High Sodium foods to watch include: LOW Sodium foods include: Basically fresh meats, fruits & vegetables will be without preservatives or flavorings which contain sodium.
Read all labels for salt or other names for salt like sodium, NaCl, brine.
Try seasoning with fresh or dried herbs, fresh garlic & onions, or garlic and onion powder, lemons or oranges; Mrs. Dash or Liquid Smoke are also low sodium. Avoid salt substitutes unless your doctor says it’s OK.

Non-prescription medications:
Some medicines used for other medical problems may interfere with Non-steroidal anti-inflammatory drugs(NSAIDS) e.g. Motrin/Advil/Nuprin (Ibuprofen), aspirin, Relafen, Aleve (naprosyn/naproxen), Tolectin, Ketoprofen (Orudis), Diclofenac (Voltaren), and other arthritis medicines can cause worsening of kidney function and/or fluid retention when taken with ACE Inhibitors. If you are taking a blood thinner, such as Coumadin, they may also cause increased blood thinning effects and cause your blood to be too thin, which can lead to bleeding problems. Tri-cyclic antidepressants such as Elavil (amitriptyline) also interfere with CHF medications. The moral is, make sure your doctor is aware of all over-the-counter and prescription medicines you are taking!
You should also know that many drugs that you purchase over-the-counter at the store may have a high sodium content. 'Fizzing' products such as Alka-Seltzer and Bromo-Seltzer are very high in sodium. Carefully check the labels for over-the-counter medicines that you purchase. Examples might be antacids or constipation medicines. Ask the pharmacist which choices are lowest in sodium when purchasing over-the-counter medicines.
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FLUID MANAGEMENT

When fluids become a problem and you are short of breath with minimal activities, often your doctor will request you restrict your fluid intake. Generally the recommendation is two (2) liters of fluid per day. This is approximately 8 cups of fluid per day. A simple way to keep track is to cut the top off a 2 Liter bottle and every time you drink something refill the glass with water and pour it into the 2 Liter bottle on the counter. When the 2 Liter bottle is full it is time to stop drinking fluids for the day. Fluids are considered anything which is fluid at room temperature e.g. Jello, ice cream, popsicles, coffee, tea, sodas, milk, juices, etc. If you have difficulty with thirst while restricting your fluids, sucking on ice chips or hard candies may be useful.
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OTHER THINGS YOU CAN DO TO IMPROVE YOUR HEART FUNCTION

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THE FUTURE

CHF is considered the 'cancer' of heart disease. It has a starting point and an end point. For many patients it will lead to death. However, comfort is easier to keep up with for heart failure patients. More than fifty percent of patients live well beyond five years and are able to adjust to the limits of CHF leading active lives, with only occasional bouts of severe difficulty. Understanding the signs and symptoms of CHF and letting your health care provider know when they are worse can help keep the difficult times as far apart as possible.
Diagnosis of heart failure can cause a wide range of feelings. It is helpful to talk about these feelings and life expectations with your family/support system and your health care team members. You may want to discuss plans with your family and medical team for how you want emergencies or deterioration handled in the future. Information on 'Living Wills' is available from your health care provider.
With CHF, it is not unusual to sometimes experience depression. This is easily treatable with non-addicting medicine that will not interfere with your other medications. If you find you are experiencing a depressed mood, loss of interest in activities, insomnia, motor agitation/tremors, feelings of worthlessness, or inability to concentrate, ask your health care provider about possible depression.
Contact your Health Care Provider if: The goal of your health care team is to help you stay as well as possible as long as possible. Your participation as the team leader informing us when you are experiencing any of the above problems as well as any of the other things discussed within this pamphlet are essential to your staying well as long as possible. If you have questions, write them down and discuss them at your next visit with your health care provider.
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