A Patient s Guide to Heart Failure

Transcription

1 A Patient s Guide to Heart Failure

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3 Introduction A diagnosis of heart failure sounds scary, but it doesn t have to be. With treatment and lifestyle changes, heart failure can be a manageable condition. Many people who are diagnosed with heart failure live long, normal lives. This booklet will explain what heart failure is, what symptoms to look for, types of treatments, how to change your diet to improve your health, and other lifestyle changes that give you a better quality of life. Table of Contents 2 Heart Failure (HF): What Is It? 4 Causes of Heart Failure and Risk Factors 5 Signs and Symptoms of Heart Failure 6 When to Seek Medical Advice 6 Medication and Treatment Options 7 Limit Intake of Sodium 8 Fluid Restrictions 9 Cooking the HF Way 10 Taking Care of Yourself ½1

4 Heart Failure (HF): What is it? Heart failure means your heart muscle has weakened and cannot pump blood efficiently throughout your body. This causes: Blood to pool in your legs, feet and ankles. Your kidneys to retain excess water and sodium. Fluid to back up into your lungs, leading to shortness of breath. This buildup of fluid is called heart failure. Heart failure can involve the left side, the right side, or both sides of your heart. Heart failure begins with the left side specifically, the left ventricle, which is your heart s main pumping chamber. Your physician may refer to your condition as left-sided or left ventricular heart failure. Right-sided heart failure can occur independently, or it can be a consequence of left ventricular heart failure. Type of Heart Failure Systolic Heart Failure Diastolic Heart Failure Idiopathic Dilated Cardiomyopathy What Occurs The left ventricle loses its ability to contract with energy. This means there is a pumping problem. The left ventricle loses its ability to relax or fill fully; or both. The heart becomes weakened without explanation. The distinction is important because the drug treatments for each type may be different. ½2

5 What is my ejection fraction? The ejection fraction (EF) is the percentage of blood that is pumped out with each heartbeat. This measures the heart s capacity and functioning ability. During each heartbeat, the heart contracts and relaxes. The ventricles (the heart s lower chambers) are the pumping chambers. In contraction (systole), the heart ejects blood from the ventricles. When the heart relaxes (diastole), the ventricles fill with blood. The heart never empties all of the blood from the ventricles, no matter how hard it beats. A normal ejection fraction in a person at rest is typically between 55 and 70 percent. If the heart muscle has been damaged by heart attack, heart muscle disease or heart valve problems, the ejection fraction may be below normal. Certain imaging tests are used to measure your ejection fraction such as an echocardiogram, cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT). Normal Heart Heart Failure Heart ½3

6 Causes of Heart Failure Heart failure often results from the stress of a heart attack, high blood pressure, or other forms of heart disease, including valve disorders. All of the behaviors that you probably associate with a heart attack or heart disease (such as smoking, being overweight, eating foods high in cholesterol and fat, and not exercising) also cause or contribute to heart failure. These underlying heart conditions typically develop slowly over many years. That is why it is important to control the risk factors that can lead to heart failure. Risk Factors There are many risk factors associated with heart failure. Some, like age or congenital heart defects, cannot be changed. But others can be influenced by the lifestyle choices you make. Age: Heart failure is more common in people older than 65. Congenital heart defects: Some people who develop heart failure were born with structural defects. Coronary artery disease: Narrowed arteries may limit your heart s supply of oxygen-rich blood, resulting in weakness. Excessive alcohol intake: This can damage the heart cells and lead to heart failure. Diabetes: Having diabetes increases your risk of high blood pressure and coronary artery disease. High blood pressure: Your heart works harder than it has to if your blood pressure is high. Heart attack: Damage to your heart from a heart attack may mean your heart can no longer pump as well as it should. Irregular heart beats: These abnormal rhythms can create extra work for your heart and weaken it. Kidney conditions: These can lead to high blood pressure and fluid retention, which can contribute to heart failure. Viruses: A viral infection may have damaged your heart muscle. Sleep Apnea: Improper breathing at night lowers blood oxygen levels and increases your risk for irregular heart rhythms. Smoking: Smoking damages your blood vessels, reduces the amount of oxygen in your blood and makes your heart beat faster. Valvular disease: Heart valves make sure blood flows in one direction through the heart. Disease may cause the valves to work improperly. ½4

7 During Hospitalization Sometimes symptoms of heart failure become severe enough for you to be hospitalized and monitored for a few days. During this time you may receive additional medications by mouth or through an intravenous line. The medications help your heart to pump better and to relieve your symptoms. While in the hospital, you may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need supplemental oxygen at home. Signs and Symptoms of Heart Failure Heart failure develops slowly over time. Understanding what signs and symptoms to look for will alert you that heart failure may be developing or progressing. Common symptoms of heart failure include: Swollen ankles, legs, and/or abdomen. These are all places where fluid may build up. Accumulated fluid may lead to swelling, which causes these body parts to seem puffy and larger than normal. Fatigue and weakness. Difficultly sleeping at night due to breathing problems. Persistent wheezing or cough with white or pink, blood-tinged phlegm. Fast heart rate or heavy heart beat. Your heart may feel like it is racing or pounding. Lack of appetite and/or nausea. You may not want to eat even when you should be hungry. You also may feel sick to your stomach. Rapid weight gain from fluid retention. When extra fluid builds up, it shows up on the scale as extra weight. So, you need to keep track of your weight each day. Increased urination at night. Difficulty concentrating or decreased alertness. Shortness of breath when you exert yourself or lie down. Built-up fluid in your lungs makes it harder to breathe, especially while lying down. This causes you to feel like you do not get enough air when you breathe, or you breathe heavily even when you are not doing anything tiring. ½5

8 When to Seek Medical Advice If you have a diagnosis of heart failure and any of these signs or symptoms suddenly become worse, or if you develop a new sign or symptom, it may indicate that known heart failure is either getting worse or not responding to treatment. Take action and quickly call your doctor or go to the nearest emergency room. If you have not been diagnosed with heart failure and are experiencing any of these symptoms, you should tell your doctor what you are experiencing. Call for chest pain, chest discomfort and/or extreme shortness of breath, fainting or persistent racing of your heart. Medication and Treatment Options Medications play a key role in the treatment of heart failure. They can also prevent the condition from getting worse. You should never adjust or stop taking your medications without first consulting with your physician. consider your specific condition and your personal health history to determine which is the best option for you. Medications that help treat heart failure include the following: ACE (Angiotensin-Converting Enzyme) inhibitors. Help lower your blood pressure and decrease your heart s workload. Angiotensin II Receptor Blockers (ARB). Help lower your blood pressure. Beta blockers. Keep your heart rate from increasing. Also, help lower your blood pressure. Diuretics (or water pills). Help the kidneys get rid of salt and water from the blood. They make you urinate more. This helps to lower high levels of fluid in people with heart failure. Aldosterone inhibitors. Block aldosterone. Aldosterone is a hormone in the body that causes the body to retain, or hold on to, sodium and water. Vasoactive agents. Widen or relax the walls of the blood vessels. ACE inhibitors, angiotensin II receptor blockers, nitroglycerin, and calcium channel blockers are all vasoactive drugs. Digoxin. Makes the heart pump more strongly. It may also help control certain types of irregular heartbeats. There are several types of medications that your doctor may prescribe to help treat heart failure. Your doctor will ½6

9 You will probably need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications as well, such as: Nitrates to help relieve chest pain. Statins to lower cholesterol. Blood-thinning medications to help prevent blood clots. Other treatments that may be appropriate for certain heart failure patients include the Implantable Cardioverter Defibrillator (ICD); Cardiac Resynchronization Therapy (CRT) or biventricular pacing; and the Ventricular Assist Device (VAD). Pneumococcal and Influenza Vaccines: Consult with your doctor to determine if you should be receiving these vaccines. Follow a Heart Failure Management Plan Your health care providers will work with you to create a plan to help you manage your heart failure. The key parts of this plan are diet, exercise, lifestyle changes, and medication. The pages that follow contain information on each of these topics. Follow this plan closely to feel better and stay healthy. Ask your health care provider to explain things that aren t clear to you. Always check with your doctor before you make any changes. Limit Intake of Sodium A low-sodium diet may help in managing both high blood pressure and congestive heart failure. Too much sodium in the diet can cause fluid buildup in those with congestive heart failure. Even if you are taking medication, it is still important to follow a low-sodium diet to help the medication work better. If you eat or drink too much sodium your symptoms can worsen. Sodium is a mineral found naturally in many foods. The most significant source of sodium in the diet is table salt, which is 40 percent sodium. Processed, convenience, take-out and preserved foods also contain a large amount of sodium. The American Heart Association recommends that heart failure patients consume no more than 2,000 mg (or 2.0 grams) of sodium a day this is less than 1 teaspoon. Use the food label information provided to you to help you decide what foods are best for you to eat and what you should avoid. ½7

10 Tips to Help Limit Sodium Intake at Home Cook cereals, rice and pasta without adding salt. In most recipes for baked goods, salt can be left out or decreased. Dairy foods have moderate amounts of sodium. Milk and yogurt are lower in sodium than most cheeses. Season vegetables with herbs, spices or lemon juice. Use convenience foods and deli meats sparingly buy the low-sodium, reduced-sodium or salt-free varieties. Read food labels carefully searching for high-sodium ingredients, such as salt, sodium chloride, monosodium glutamate, brine or broth. Tips to Help Limit Sodium Intake at Restaurants Here are some tips to help you limit or avoid sodium when you are dining outside of home: Order food that is fresh, broiled, baked, or grilled. Ask for mixed green salads or fruit as side dishes. Use olive oil and vinegar or low-fat vinaigrette dressings. Avoid fried, cured, smoked, processed, or convenience foods. Ask for dressings and sauces on the side. Ask your server if it is possible to omit butter and salt-based seasonings from your dish. Try to avoid eating fast food. Bring your own low-sodium, hearthealthy foods like fresh fruits, vegetables or yogurt when traveling. Fluid Restrictions Your fluids may need to be restricted. Your doctor or health care provider can talk with you about a specific amount for your individual needs. If you are on a fluid-restriction diet*, the following foods are considered fluids and will need to be measured: Water Juice Soup Coffee Milk Gravy Sherbet Soda Ice cream Tea Jello Any other beverages * Rule of thumb: Anything that is liquid at room temperature is a fluid. Tips for Controlling Thirst Avoid foods that are high in sodium. Use hard candies, such as sugar-free lemon drops, and chewing gum to moisten your mouth if appropriate. Try sliced lemon wedges to stimulate saliva and moisten a dry mouth. Water, lemonade or cranberry juice can be frozen into small popsicles in an ice cube tray. Also try sucking on frozen grapes. ½8

11 To avoid taking in too much fluid, use a favorite cup or glass and know how much it holds. Remember, 2 cups of retained fluid will equal 1 pound of fluid weight gain. Read Nutrition Labels Food packages have nutrition labels. The labels list how much sodium is in one serving. Note that the package may have more than one serving. The sodium content in one serving size might not be too much. However, if you eat the whole package, there might be too much sodium. Cooking the HF Way Here are some helpful tips to help you lower the amount of added fat and sodium in your diet. Meat, Poultry and Fish Sauces, Soups and Casseroles After making soups or sauces, cool them in the refrigerator. Then skim the fat from the top before heating it up to eat. Use 75 percent reduced-fat cheddar or reduced-sodium Swiss products for recipes requiring cheese. Seasonings and Condiments Try using carrots, onions, celery or garlic instead of seasonings or condiments. Avoid the use of salt pork or fatback to flavor vegetables and beans. Use Mrs. Dash (which is not a salt substitute) or Molly McButter. Use fresh, dried or powdered herbs to bring out the flavor of foods. Try using garlic, garlic powder, onion or onion powder instead of garlic salt and onion salt. Use no-added salt pickles, relishes, ketchup or mustard. Before cooking meat, poultry or fish: Trim the fat from the meat; remove skin and fat from poultry. Buy tuna or other canned fish packed in water (not oil) and rinse it in water before cooking. ½9

12 Taking Care of Yourself Place your Heart Zone Sheet in a prominent area for a daily reminder. The following pages contain information that will help you take care of yourself at home and live a healthy lifestyle. Try to incorporate these behaviors into your everyday life to promote good health. Keep Track of Your Symptoms It is important for you to keep track of your symptoms. Write down how you feel each day. Your record can help you know if your symptoms are getting worse or if you have experienced new ones. It can also help you decide if you need to call your doctor. Exercise Ask your doctor before you begin or change an exercise program. Always do what your doctor tells you and listen to your body. Only do what feels right to you. Ask your health care provider about cardiac rehabilitation. Exercise can: Help you lose weight or stay at a healthy weight. Help you get rid of stress and give you more energy. Help reduce heart failure symptoms. Lower cholesterol levels and blood pressure. Lead to better circulation. How to Exercise While exercise may be good for you, it is important that you take the correct approach to your exercise methods. The following tips can be helpful if you are exercising after a cardiac event: Walking is best. Start slowly. As you get stronger, over time, walk for longer amounts of time. Exercise at the same time each day so that it becomes a habit. Wear flat shoes and clothes that are comfortable. For information about St. Peter s Health Partners cardiac rehabilitation and wellness programs, ask your nurse. If you have heart failure, you must make every effort to keep your heart strong. Your heart is a muscle, and exercise can help make it stronger. There are many more reasons why exercise is good for you. ½10

13 Do not exercise if it s very hot or very cold outside, right after you eat, or if you do not feel well. Try new activities and ask friends or family to join you to make it more fun. Stay away from activities where you have to hold your breath or bear down, such as lifting weights. Don t Overdo It If you start having any of the following symptoms, slow down. If the symptoms don t go away, call 911 or the emergency response system in your area. Irregular heart rate (pulse) More shortness of breath (you can t finish a sentence, or you are short of breath after you stop exercising) More tired or weak than usual Dizzy or lightheaded Chest pain or tightness Pain in your jaw, neck, shoulders, or arms Nausea or vomiting Sex Most people with heart failure can continue sexual relations once symptoms are under control. There s no reason why heart patients can t resume usual sexual activity as soon as they feel ready to do so. However, if your condition is severe and you can t tolerate exercise, you may need to find less demanding ways to express love and affection. You could spend time hugging, kissing and touching. Energy Conservation Tips Conserving your energy will put less stress on your heart and help you to better disburse your energy throughout the day. Pull rather than lift. Sit while preparing food. Avoid frequent bending; work from waist level. If you have stairs, plan ahead to decrease amount of times you need to go up and down. Rest when you are tired. Avoid activity when it is very cold or hot and humid. Use home-delivery services when possible for groceries and pharmacy. Watch Your Weight Weight gain can be a sign that your body is holding on to fluids. This can lead to swelling. It may also be a sign that your heart failure is getting worse. Weigh yourself each morning after you have urinated, but before you eat breakfast. The importance is not your weight, but the change in weight from day to day. Notify your doctor if you experience a rapid weight gain of 2 or more pounds. Place scale on a flat, hard floor. Make sure the scale is set on zero. Keep the scale in one location. Avoid comparing your scale with other scales. ½11

14 Record your weight and symptoms daily. This information can help you to keep track of your symptoms each day. Quickly report a sudden weight gain of 2 to 3 pounds over two to three days, or 4 to 5 pounds in a week period. Prompt action may prevent re-hospitalization. The sooner you get treated, the less likely you are to end up in the hospital. Limit or Avoid Alcohol Alcohol makes it harder for the heart to work. Ask your doctor how much alcohol (if any) is safe for you. Stop Smoking Smoking hurts the lungs and the heart. It can also make heart failure worse. If you smoke, you should make the effort to quit now. Ask your doctor about smoking cessation products that may work best for you. Also, stay away from places where other people smoke so that you don t breathe in any second-hand smoke. Reduce Stress When you are anxious or upset, your heart beats faster. Stress may make your heart failure symptoms worse. Find ways to reduce stress in your life to give your heart a rest. You can t avoid all stress, but you should try to relax and avoid events that cause stress when you can. Talk to your doctor about how to manage stress. Here are some ideas: Try napping or putting your feet up when possible. Take up a quiet hobby, like light gardening or painting. Do things you enjoy like reading or spending time with friends. Write down how you feel. Putting your thoughts on paper can help you feel better. Go for a walk or get other exercise. Spend time with caring friends, family, or a support group. Learn to manage your time better. Don t take on too many things at once. If you can, avoid stressful settings, like rushing to appointments or sitting in heavy traffic. Meditate or do breathing exercises. ½12

15 Try this quick and easy breathing exercise to help reduce stress. Step 1: Sit in a comfortable chair and put your hands in your lap, or lie down. Close your eyes. Step 2: Think about being in a peaceful place, like walking barefoot in a meadow or lying on a beach. Hold that picture in your mind. Step 3: Breathe in slowly and deeply through your nose. Take the air into your belly. Breathe out slowly through your mouth. Step 4: Each time you breathe out, repeat a calming word or phrase like relax, let go. Step 5: Do this for 5 or 10 minutes. ½13

16 St. Peter s Hospital 315 South Manning Blvd. Albany, NY Samaritan Hospital 2215 Burdett Ave. Troy, NY Sunnyview Rehabilitation Hospital 1270 Belmont Ave. Schenectady, NY Eddy Visiting Nurse Association 433 River St. Troy, NY Albany Memorial Hospital 600 Northern Blvd. Albany, NY St. Mary s Hospital 1300 Massachusetts Ave. Troy, NY / H