What Do You Mean I Have Heart Failure? Objectives 4/26/2017. What Do You Mean There is Something Wrong with my Heart?

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1 What Do You Mean I Have Heart Failure? Heather Mosley APRN,NP-C Bryan Heart Improvement Program Lincoln, NE Objectives To better understand the 2 different types of heart failure. To understand why you take the medications you do. To empower you to be able to identify signs and symptoms of an acute exacerbation of heart failure To empower you to know what to do when an exacerbation arises Help you to identify foods that would be good choices and those that will not What Do You Mean There is Something Wrong with my Heart? Weak Heart Stiff heart Systolic Dysfunction Diastolic Dysfunction Water in my lungs Fluid around my heart Congestive Heart Failure CHF ALL EQUAL HEART FAILURE If you belong to the Bryan Heart Improvement Program, YOU HAVE HEART FAILURE! 1

2 Types of Heart Failure What Can I Do To Help My Heart? #1 Know your medications!! KNOW YOUR MEDICATIONS Bring them to every appointment At least a CURRENT list (include vitamins) Know what they are for Heart, blood pressure, blood thinner, etc Know when you should take them With food, without food, etc Unless you are specifically asked to fast before your appointment, take your medications as usual before each visit 2

3 Beta Blockers Carvedilol (Coreg) Bisoprolol (Zetia) Metoprolol Succinate (Toprol) Nebivolol (Bystolic) What do they do? Slows down my heart rate Lowers my blood pressure and It can even improve my pump function!! BUT.. They can also make you tired! Angiotensin Converting Enzyme (ACE Inhibitor) Lisinopril Benazapril Captopril What do they do? Lowers blood pressure Can help improve heart strength Protects my kidneys BUT.. It makes me cough Angiotension Receptor Blocker (ARB) Valsartan (Diovan) Losartan (Cozaar) Irbesartan (Avapro) Olmesartan (Edarbi) What do they do for me? Lowers blood pressure Protects the kidneys Improves pump function Psstt..and no cough!! 3

4 Angiotensin Receptor Neprilysin Inhibitor (ARNI) Combination of Sacubitril/Valsartan There is only One: Entresto Used IN ADDITION to your current heart failure medications There are special instructions when you start Entresto. What does this do for me? Lowers blood pressure Decreases mortality Decreases hospital admissions Shown to improve symptoms of fatigue and shortness of breath Shown to improve ejection fraction in some patients Diuretics AKA: The Water Pill Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex) Metolazone (The Power Pee Pill) Aldosterone Antagonist Aldosterone antagonists are drugs that block harmful effects on the heart and blood vessels caused by the hormone aldosterone. Spironolactone (aldactone) Eplerenone (Inspra) Amiloride (Midamor) #1-LESS or NO Potassium Supplement Decreases Blood Pressure Works as a wimpy water pill 4

5 What Can I Do To Help My Heart? #1-Know your medications #2- Limit your fluid intake What goes in must come out! Fluid Restriction 1500ml per day=48 ounces per day 6 8 ounce glasses of fluid per day Anything pourable ie. Milk, Juice, Water, Soda, Tea, etc DON T DRIVE YOURSELF CRAZY!! 5

6 But my other Doctor says I need to drink lots of water.it s good for my kidneys! Not with heart failure.. Too much water results in swelling, shortness of breath, cough, dizziness, confusion because a weak pump can t handle more fluid What Can I Do To Help My Heart? #1-Know your medications #2- Limit your fluid intake #3 Limit your Sodium Intake Sodium Restrictions 1500mg of sodium per day 1tsp of table salt contains 2325mg of sodium No More Salt Shaker Read Your Labels Salt = Sodium (THEY ARE THE SAME THING) Hidden Salt Cottage Cheese 1 cup of cottage cheese = mg of sodium. What s the big deal?? 6

7 Where there is Salt.There is water! What Can I use??? Reduced Sodium When you see "reduced sodium" on a food label, you may think you're being served up a lot less salt. However, this FDA-regulated term means that a food has only 25% less sodium than the original product. Better labels to look for are: "low sodium" ( 140 mg of sodium or less per serving) "very low sodium" (35 mg of sodium or less). 7

8 Lower Sodium Options Use lower-sodium options like pita bread, whole grain mustard instead of pickles, fresh veggies, Swiss cheese (it contains a fraction of the sodium of provolone), and low-sodium deli turkey or better yet pieces of freshly carved turkey. I ll eat Chicken!! It s healthy.. right? Raw chicken breasts harbor a secret: they're often injected with a high-sodium flavoring solution to perk up the taste. To avoid it, buy chicken with the words "non-enhanced" on the label, avoid brands that list salt on the ingredients label, or go for an organic variety. Try the brand called Smart Chicken. Which of the following would NOT be a good snack for someone watching their sodium intake? A. A cup of cottage cheese with some fresh fruit B. An apple with peanut butter C. Trail Mix D. Fresh vegetables with dip 0% 0% 0% 0% A cup of An apple cottage with peanut cheese with butter some fresh fruit Trail Mix Fresh vegetables with dip 8

9 Answer A. A cup of cottage cheese with some fresh fruit THIS IS HARD.. WE GET IT!! 9

10 What Can I Do To Help My Heart? #1-Know your medications #2- Limit your fluid intake #3-Limit your sodium intake #4-Weigh yourself EVERY DAY! Daily Weights Be Consistent Once a day is plenty How much weight is too much? 3 pounds for 2 consecutive days 5 pounds in any given week When do I call? Above weight increase Worsening symptoms 10

11 It s the best.for now We now know that your weight changes just days before you become sick enough to be hospitalized..this is why you must call!! NEW TECHNOLOGY Cardiomems Lets us see changes almost 30 days before your weight actually changes Currently implanting Cardiomems Heart Failure System How much weight gain in 1 week is too much, therefore I should call BHIP! A. 2 pounds in any given week B. 5 pounds in any given week C. 7 pounds in any given week D. Any weight gain is too much I ll just call. 0% 0% 0% 0% 2 pounds in any given week 5 pounds in any given week 7 pounds in any given week Any weight gain is too much I ll just call. 11

12 Answer B. 5 pounds in any given week What Can I Do To Help My Heart? #1-Know your medications #2- Limit your fluid intake #3-Limit your sodium intake #4-Weigh yourself every day #5- Exercise Exercise 30 minutes most days of the week Walking Stairs instead of the elevator Resistance bands Chair exercises Ask if you qualify for cardiac rehab! 12

13 Symptoms to Watch out for What symptoms may I experience when I have too much fluid on board? A. Swelling in the legs or abdomen B. Cough, especially when you lay down C. Loss of appetite D. Confusion or memory loss E. Dizziness F. All of the above 0% 0% 0% 0% 0% 0% 13

14 Answer F. All of the above Scary Facts about Heart Failure Heart Failure is a progressive disease that contributes to approximately 287,000 deaths a year. About half of people who develop heart failure die within 5 years of diagnosis. HELP ME HELP YOU!! Tell me how you feel. Tell me what s different.. Tell me what you miss doing.. If there was one thing you could change about how you feel, what would it be? Tell me when you have had enough. 14

15 Don t Come to Appointments when QUESTIONS 15

16 YOUR Bryan Heart Improvement Providers Dr. John Steuter Dr. Matt Baker Heather Mosley, APRN Starrlet Klute, APRN 16