THE HEART FAILURE MANUAL: Education, Management and Improvement

Transcription

1 THE HEART FAILURE MANUAL: Education, Management and Improvement

2 HEART FAILURE ZONES KNOW YOUR ZONE: GREEN, YELLOW OR RED EVERY DAY Weigh yourself daily and record at the same time, after going to the bathroom GREEN ZONE No Symptoms No shortness of breath No weight gain No swelling in your feet, hands or stomach No chest discomfort YELLOW ZONE Call the office Increased Symptoms Weight gain of more than 3 pounds in one day or 5 in one week Increased shortness of breath or chest pain Swelling in your feet, hands or stomach Fatigue, no energy Dizziness You have to sleep in a chair (cannot lay down due to shortness of breath) RED ZONE Call 911 Symptoms at Rest Cannot breathe Shortness of breath while sitting still Severe chest pain Confusion Fainting 1

3 WHEN TO CALL THE DOCTOR Emergency: If you have sudden, severe symptoms such as chest pain or severe shortness of breath, call 911 or go to the emergency department. Urgent: Please call the heart failure clinic (512) if you have: Weight gain 3 pounds in 1 day or 5 pounds in 1 week Increased or new swelling of feet, abdomen or hands Increased or new shortness of breath You are unable to lay flat at night or wake up in the middle of the night gasping for air Worsening cough New or worsening fatigue Heart Specialty Care and Transplant Center Heart Failure Clinic Seton Heart Institute Medical Center Seton Heart Institute Hays Seton Heart Institute Southwest Seton Heart Institute Williamson Seton Heart Institute Highland Lakes Your Primary Care Doctor 2

4 HEART FAILURE MANUAL Section 1 Heart Failure Basics 4 Section 2 Signs and Symptoms of Heart Failure 7 Section 3 Medications to Treat Heart Failure 8 Section 4 Lifestyle Management 20 Resources 25 Our goal at the is to turn your heart failure into Heart Success! 3

5 HEART FAILURE BASICS Heart Failure Facts If you are an American and over the age of 40, you have a 20% chance of developing heart failure. The number of people with heart failure continues to rise in the U.S. More than 5.1 million people in the U.S. have heart failure. Over the last several decades, more than half a million new cases of heart failure have been diagnosed every year. The mortality rate of people with heart failure over a span of five years is about 50%. Caucasian females have the lowest risk of developing heart failure and African-American males have the highest risk of developing heart failure. Despite these troubling facts, heart recovery is possible with proper medications, diet and exercise. Reference: Yancy, CW et al. (2013) ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), doi:doi: /j.jacc What Does the Heart Do? To put it simply, the heart is a pump. When it is healthy, it is around the size of your fist. Its job is to pump the blood that delivers oxygen and nutrients through the body. It does this by contracting and relaxing about times per minute. There are four chambers of the heart: the right atrium (A), right ventricle (C), left atrium (B) and left ventricle (D). The blood enters the heart through the right atrium then is pushed into the right ventricle. The right 4

6 ventricle then pushes the blood to the lungs, where blood is oxygenated. It then returns to the heart through the left atrium and is then pushed to the left ventricle. The left ventricle has the very important job of pushing the blood throughout the body. It is a very strong muscle and must work effectively for the body to get the important oxygen and nutrients which it needs. What is Heart Failure? Heart Failure is when your heart is damaged or weakened and is unable to pump blood through your body effectively. When the heart is unable to pump blood effectively through your body, blood that is exiting the heart slows down. Blood returning to the heart through your veins backs up and the body is unable to get rid of water and salt properly. This is the root cause of CHF or congestive heart failure symptoms. Fluid can back up into your lungs, extremities or abdomen causing what is sometimes referred to as congestion. Heart failure can include one side of the heart (left or right) or both sides of the heart (combined left and right heart failure). What is Left Sided Heart Failure? There are two types of left sided heart failure which include: (1) systolic heart failure and (2) diastolic heart failure. Some people have both systolic and diastolic heart failure. Systolic heart failure is when you have a weak heart and the heart muscle doesn t have the strength to contract /pump as it should. With this kind of heart failure, the left side of the heart cannot create enough force to pump the blood through your body and organs. People with this type of heart failure usually have an EF, or Ejection Fraction, of less than 40%. Diastolic heart failure is when the heart is stiff and it does not fill properly at rest leading to decreased function. If you have diastolic heart failure, your ejection fraction may be normal (or around 50-70%). Reference:Types of Heart Failure. (2015, April 6). Retrieved September 15, 2015, from 5

7 What is Right Sided Heart Failure? The right side of the heart pumps blood that is low in oxygen into the lungs to be replenished with a fresh supply of oxygen, which then sends out oxygen-rich blood to the rest of the body. When the right side of the heart isn t able to pump blood into the lungs properly, this is known as right sided heart failure. With right sided heart failure, the right side of the heart is not beating effectively causing blood to back up. This causes symptoms such as swelling in the legs, ankles, stomach and/or liver. Reference: Types of Heart Failure. (2015, April 6). Retrieved September 15, 2015, from Failure_UCM_306323_Article.jsp 6

8 SIGNS AND SYMPTOMS OF HEART FAILURE SIGNS: What you or your provider can see, hear, feel and touch; as well as test and lab results that aren t normal. Enlarged neck veins on your right side Abnormal sounds in your lungs Your liver is larger than normal and it is uncomfortable when your provider pushes on it Your heart sounds abnormal You have edema (swelling) where you shouldn t: Feet, legs, belly, face, or around the eyes Abnormal lab results Abnormal echocardiogram (ultrasound of your heart): Reduced percentage of blood (ejection fraction) that your heart can push out, because your heart is stiff, too big, too floppy, or your heart valves don t work the way they should SYMPTOMS: What you feel that isn t normal. Fatigue: You are very tired and can t do the simplest things you usually do without getting very tired Shortness of breath: not able to breathe comfortably Shortness of breath with exercise: Not able to breathe well with activity Puffiness or swelling, feeling bloated Chest pain Palpitations (you can feel your heart beating) You can t lie flat at night Not being able to breathe suddenly in the middle of the night, increasing how many pillows you use to sleep, or sleeping in an easy chair 7

9 MEDICATIONS TO TREAT HEART FAILURE NITRATE THERAPY Works by relaxing and widening the blood vessels, allowing blood to flow more easily. Given to treat chest pain. These medications lower blood pressure and help reduce how hard the heart has to work. COMMON NAMES Nitro sublingual (Nitrostat ) Nitro spray ( NitroMist, Nitrolingual ) Nitro paste (Nitro-Bid ) Isosorbide mononitrate (Imdur, Ismo ) Nitro patch (Nitro-Dur ) Isosorbide dinitrate (Isordil ) SIDE EFFECTS COMMENTS Low blood pressure Check your blood pressure at home daily. Dizziness or If you feel dizzy or feel like you are going to faint, call your lightheadedness doctor. Headache Check your blood pressure and notify your doctor. Flushing of the face and Tell your doctor at your next visit. neck HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by your doctor. For sublingual nitroglycerin: when you have chest pain, put one tablet under your tongue and let it dissolve. You may take one tablet every 5 minutes for a total of three times. If pain does not go away after three doses, call 911. If you are using a nitroglycerin patch, take the patch off 12 hours after you put it on. Wait for 12 hours before putting on another patch. Use a calendar, pill box, and/or medication list to help you take your medications at the correct time. If you are given sublingual nitroglycerin, keep at room temperature in the original glass container with lid on tight. Carry medication with you at all times. Do NOT use this medication if you are currently taking a medication for erectile dysfunction like Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), or Avanafil (Stendra) 8

10 VASODILATOR THERAPY Works by relaxing and widening the blood vessels, allowing blood to flow more easily. Helps reduce how hard the heart has to work. Decreases symptoms such as shortness of breath and swelling in people with a weak heart. Helps prevent chest pain. Helps extend life in people with a weak heart. COMMON NAMES Hydralazine (Apresoline ) Isosorbide dinitrate (Isordil ) Hydralazine/ Isosorbide dinitrate combination (BiDil ) SIDE EFFECTS COMMENTS Low blood pressure Check your blood pressure at home daily. Dizziness or Check your blood pressure. Tell your doctor. lightheadedness Headache Check your blood pressure. Tell your doctor. Flushing of the face and Tell your doctor. neck Upset stomach, loss of These medications should be taken with food to avoid upset appetite, diarrhea stomach. Fever Call your doctor. Joint pain or swelling Tell your doctor at your next visit. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. Check your blood pressure daily. Do NOT use medication if you are currently taking a medication for erectile dysfunction like Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), or Avanafil (Stendra) 9

11 ALDOSTERONE ANTAGONIST THERAPY Works by blocking a harmful stress hormone in the body. Decreases symptoms such as shortness of breath and swelling in people with a weak heart. Lowers blood pressure. Gets rid of extra water through the urine. Prolongs life in those with a weak heart. COMMON NAMES Spironolactone (Aldactone ) Eplerenone ( Inspra ) SIDE EFFECTS COMMENTS Growth in breasts (in Talk to your doctor. men) Breast pain or Talk to your doctor. tenderness (in men and women) High potassium levels Blood tests will be done frequently to monitor potassium levels. Frequent urination Talk to your doctor. Dehydration Call your doctor. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. Weigh yourself daily to prevent dehydration or fluid buildup. Try to avoid salt substitutes and foods high in potassium like beans and bananas, if your doctor has told you your potassium is high. Check your blood pressure regularly. 10

12 ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITOR Works by relaxing and widening the blood vessels, allowing blood to flow more easily. These medications lower blood pressure and help reduce how hard the heart has to work. Helps strengthen the heart s pumping ability in people with a weak heart. Decreases symptoms such as shortness of breath and swelling in people with a weak heart. Helps prevent heart attacks and strokes. Prolongs lifespan in those with a weak heart. Commonly used to treat high blood pressure and may be used to help the kidneys work better in people with diabetes. COMMON NAMES Lisinopril (Zestril, Prinivil ) Enalapril (Vasotec ) Benazepril (Lotensin ) Captopril (Capoten ) Ramipril (Altace ) Fosinopril (Monopril ) Perinopril (Aceon ) Quinapril (Accupril ) Moexipril (Univasc ) Trandolapril (Mavik ) SIDE EFFECTS COMMENTS Increased potassium Blood tests will be done frequently to monitor potassium level levels. dizziness or Check your blood pressure and notify your physician. lightheadedness Dry cough This is a common, non- life threatening reaction. Please notify Swelling of the mouth or throat Birth defects/fetal death if cough is persistent or bothersome. This symptom is called angioedema. Notify doctor immediately if your mouth swells. If you become short of breath or throat starts to itch or swell call 911. Take proper birth control measures; inform your doctor or nurse immediately if your become pregnant. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by your doctor. These medications may be taken with or without food. Do NOT take the medication and call 911 right away if you have swelling of the lips, tongue, face, and/or throat. Do NOT take if you are pregnant. 11

13 ANGIOTENSIN RECEPTOR BLOCKER (ARB) Has been shown to lower the risk of death for people who have heart failure. Has been shown to lower the risk of stroke and heart attack. Is a blood pressure lowering drug. Is used as an alternative to ACE- Inhibitor. Helps protect the kidneys if you have diabetes. Works in the kidneys to block hormones that cause high blood pressure. Can cause birth defects. COMMON NAMES Losartan (Cozaar ) Olmesartan (Benicar ) Valsartan (Diovan ) Azilsartan (Edarbi ) Candesartan (Atacand ) Telmisartan (Micardis ) Eprosartan (Teveten ) Irbesartan (Avapro ) SIDE EFFECTS COMMENTS Low blood pressure Check your blood pressure at home. Increased potassium Blood tests will be done frequently to monitor potassium level levels. Kidney problems Tested by blood tests; check how often to get tested. Birth defects/fetal Take proper birth control measures; inform your doctor or death nurse immediately if your become pregnant. Dizziness or Check your blood pressure and call your doctor. lightheadedness Angioedema- Swelling of the mouth or throat Stop taking this medication and notify your doctor immediately if your mouth starts to swell. If you become short of breath or your throat starts to swell or itch call 911. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Do NOT take if you are pregnant. Talk to your doctor if you are planning on becoming pregnant. 12

14 BETA BLOCKER THERAPY Works by relaxing the heart muscle and slowing down the heart rate. These medications lower blood pressure and help reduce how hard the heart has to work. Helps strengthen the heart s pumping ability in people with a weak heart. Decreases symptoms such as shortness of breath and swelling in people with a weak heart. Helps prevent heart attacks. Prolongs life in those with a weak heart. Reduces chest pain. COMMON NAMES Metoprolol (Lopressor, Toprol ) Carvedilol (Coreg ) Bisoprolol (Zebeta ) Nebivolol (Bystolic ) Atenolol (Tenormin ) Propranolol (Inderal ) SIDE EFFECTS COMMENTS Low blood pressure or Check your blood pressure and heart rate daily. heart rate Dizziness or Check your blood pressure and heart rate. Notify your doctor. lightheadedness Shortness of breath or May cause wheezing if you have asthma or COPD. Contact your bronchospasm doctor if this occurs. Tiredness This tends to go away after 1-2 weeks on the medication. Erectile dysfunction Please discuss with your doctor at your next scheduled visit. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Check your blood pressure and heart rate daily. This medication should be used with caution in patients with a history of asthma. 13

15 IVABRADINE (CORLANOR ) First medication approved for use to reduce hospital admissions from worsening heart failure. Works by slowing down your heart rate. Is used only if you have stable heart failure. Can be used in addition to beta blocker therapy or if you did not tolerate beta blocker therapy. Dose strength determined by resting heart rate and tolerability. SIDE EFFECTS COMMENTS Slow heart rate Check your heart rate (pulse) at home daily. Abnormal heart rhythm Phosphene (seeing stars) Can cause harm to an unborn baby during pregnancy (fetal toxicity) Notify your doctor or nurse immediately. May appear within 2 months of starting the medication and continue off and on. Let your doctor or nurse know if you experience vision problems. Take proper birth control measures; inform your doctor or nurse immediately if you become pregnant. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Check your blood pressure and heart rate daily. This medication should be used with caution in patients with a history of asthma. 14

16 SACUBITRIL/VALSARTAN (ENTRESTO ) Combination drug containing a neprilysin inhibitor (sacubitril) and an ARB (valsartan). Neprilysin inhibitor- Helps open up blood vessels and helps body get rid of extra fluid. ARB (Angiotensin Receptor Blocker) see ARB section. Prolongs life expectancy in those with a weak heart. SIDE EFFECTS COMMENTS Low blood pressure Check your blood pressure at home. Increased potassium Tested by blood tests; check how often to get tested. level Kidney problems Tested by blood tests; check how often to get tested. Swelling in lips or throat Occurs rarely, but if it does, seek medical attention immediately. Birth defects/fetal death Take proper birth control measures; inform your doctor or nurse immediately if you become pregnant. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Check your blood pressure and heart rate daily. Can be used instead of other ACE inhibitors or ARBs. Cannot be taken with ACE inhibitor or ARB. Take this medicine two times a day. Do NOT take this medication while pregnant. 15

17 LOOP DIURETICS Known as a water pill. Works to reduce congestion, shortness of breath, swelling and abdominal bloating by preventing the absorption of potassium and sodium in the kidneys. Therefore this drug makes you remove more water, potassium and sodium through your urine. COMMON NAMES Furosemide (Lasix ) Bumetanide (Bumex ) Torsemide (Demadex ) SIDE EFFECTS COMMENTS Dehydration If you have a dry mouth, have increased fatigue or weakness call your doctor. Dizziness or Check your blood pressure and notify your doctor. lightheadedness Low sodium Your blood will need to be monitored regularly. Please ask your (hyponatremia) doctor how frequently you need blood work. Eating more sodium will not cause an increase in sodium in your blood. Decreased potassium Your blood will need to be monitored regularly. You may need to (hypokalemia) take a potassium supplement. Muscle cramping Notify your doctor. Decreased magnesium You will need to have your blood checked regularly. You may (hypomagnesemia) need to take a magnesium supplement. Ear toxicity (damage) Please notify your doctor if you have hearing changes, ringing in Kidney damage your ears or vertigo (room spinning). Please check with your doctor about how often you need blood work to check your kidneys. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Can be given through an IV, muscular injection or by mouth. Do NOT take if you are pregnant. 16

18 THIAZIDE DIURETIC Known as a water pill. Prevents sodium absorption in the kidneys causing water and sodium removal through the urine. Not as strong of a diuretic compared to loop diuretics. Cause decrease in blood pressure. Decreases swelling in your extremities. COMMON NAMES Chlorthalidone Metolazone (Zaroxolyn ) Chlorothiazide (Diuril ) Indapamide (Lozol ) Hydrochlorothiazide Triamterene/Hydrochlorothiazide (Microzide, Esidrix ) (Maxzide, Dyazide ) SIDE EFFECTS COMMENTS Decreased Potassium Your blood will need to be monitored regularly. You may need to Levels take a potassium supplement. Dizziness or Check your blood pressure and notify your doctor. lightheadedness Low sodium (hyponatremia) Your blood will need to be monitored regularly. Please ask your doctor how frequently you need blood work. Eating more sodium will not cause an increase in sodium in your blood. Check your blood pressure regularly. Low blood pressure (hypotension) Decreased magnesium You will need to have your blood checked regularly. You may (hypomagnesemia) need to take a magnesium supplement. HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Is sometimes used in combination with a loop diuretic. If taken with a loop diuretic, thiazide should be taken 30 minutes to 1 hour prior to loop diuretic. Do NOT take if you are pregnant. 17

19 POTASSIUM SUPPLEMENT Some heart medications will remove potassium from your body; therefore you may need a potassium supplement. Potassium is an electrolyte in your body which is essential for normal function of the heart, digestive and muscular systems. Normal level of potassium is Common Names Potassium Chloride(Klor-Con, K-Dur ) SIDE EFFECTS COMMENTS Increased potassium Blood tests will be done frequently to monitor potassium levels. levels Heart rhythm changes If you are having palpitations, notify your physician. (arrhythmias) Nausea, vomiting Please notify your doctor. and/or diarrhea HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Do NOT take if you are pregnant. Potassium comes in different forms such as IV, pill, liquid and powder. 18

20 MAGNESIUM SUPPLEMENT Some heart medications will remove magnesium from your body; therefore you may need a magnesium supplement. Magnesium is a mineral in your body which is essential for normal function of the heart and brain. Normal level of magnesium is COMMON NAMES Magnesium Oxide SIDE EFFECTS COMMENTS Increased magnesium Blood tests will be done frequently to monitor magnesium levels. levels Diarrhea, nausea Please call your doctor if these symptoms occur. and/or vomiting HOW SHOULD I TAKE THIS MEDICATION? It is very important to take this medication as prescribed by the doctor. These medications may be taken with or without food. Call 911 right away if you have swelling of the lips, tongue, face, and/or throat. Do NOT take if you are pregnant. 19

21 LIFESTYLE MANAGEMENT DIET Salt (Sodium): If you have heart failure, you should take in no more than 2000 milligrams or 2 grams of sodium per day. Depending on your status, your doctor may want you to be on a low sodium and fluid restricted diet. Sodium has been shown to cause water retention, stops your water pill from working properly, elevate your blood pressure and can cause cramping at night. Even if your blood sodium level is low, you still need to watch your sodium intake. Many foods have hidden sodium and it is important to learn how to read labels. There is an example of a food label to the right. You can see that sodium content is listed as 300mg. One rule of thumb is to never add any salt to any food. Limit going out to eat at restaurants, as they load up salt in food for flavor. Some examples of foods that contain a lot of sodium include table salt, canned foods, fast foods, instant soups, cheese and cured meats. Examples: Ramen noodle soup has 875 mg of sodium Canned tomato soup has 480 mg of sodium Slice of pizza has around 640 mg of sodium Slice of white bread around 147 mg of sodium 20

22 Fluid: Depending on your health status, your doctor may put you on a fluid restriction. Usually fluid restriction is 2000 milliliters or 2 liters per day although it may be less. If you are on a fluid restricted diet remember that all liquids are included such as tea, juice, milk and ice. You can use a two liter bottle to measure, or you may use a measuring device. Each cup of fluid contains 240 milliliters of fluid. That means that if you are on a 2 liter fluid restriction you can take in about 8 cups of liquid per day. Some conversions to remember: 1 ounce = 30 milliliters 2 liters = 68 ounces 1 Cup= 8 ounces=240 milliliters 1.75 liters = 58 ounces 12 ounce=360 milliliters 1.5 liters = 51 ounces DASH Diet The DASH diet stands for Dietary Approaches to Stop Hypertension. It s a diet that focuses on unprocessed foods, increased fruit and vegetables, avoiding high saturated or trans-fat, and use of low fat dairy products. It has been scientifically studied and shown to reduce blood pressure, weight, and blood sugar. It encourages no more than 2,000 calories a day and 2,300 mg of salt a day. This diet has been recommended for people with heart failure. EXERCISE Staying active has been proven to improve cardiac function and overall wellbeing. Aerobic exercise is recommended, which is a type of exercise which uses the larger muscle groups. Examples of aerobic exercises include walking, running, bicycling and swimming. Be sure to warm up and cool down before and after exercising. Warm up should include slow-paced walking, bicycling or swimming, progressing into a faster pace, and finish with a cool down slow-paced walking, bicycling or swimming. Begin your exercise program, for example, with walking. 21

23 Do this three (3) times a day, 5-10 minutes at a time. When you can exercise for the full 10 minutes three times a day comfortably, and then advance to the next step. Progressing activity as tolerated is important. A good rule of thumb is to add five (5) minutes to your time once a week with a goal of minutes of exercise, three to five days per week. Your exercise intensity, or how hard you are working during exercise, should stay in a mild to moderate range. This means that you should exercise at an intensity at which your heart rate is elevated, but you can still talk. The Talk/Breath Test simply states: if you are breathing so hard during exercise that you are unable to talk at the same time, you are exercising above the moderate level and should slow down. Make sure to rest when feeling fatigued or short of breath and stop immediately with any chest discomfort. You may be eligible for cardiac rehab. Cardiac rehab is a program that offers an individualized and personalized treatment plan, including instruction on nutrition, stress management, self-care, and physical activity/exercise. If you participate in a cardiac rehab program, you will receive further guidelines about exercise. SMOKING CESSATION If you currently use tobacco, you should stop immediately. Chemicals in tobacco affect every part of your body. Smoking can cause inflammation and plaque build-up in your arteries. In addition, smoking can cause other diseases such as cancer or COPD, which can worsen your heart failure symptoms. There are several nicotine replacement agents out there to help, including gum and patch therapy. You should speak to your doctor about the best option for you. In regards to electronic cigarettes, there is no data to support its safety as a cigarette substitute. E- Cigarettes still give the body a steady dose of nicotine, therefore nicotine toxicity is a risk. There have also been documented findings of formaldehyde found in vapor formulations. Electronic cigarettes or vapor, are not FDA regulated, and therefore the government is not overseeing what exactly is 22

24 put into the vapor liquids. MONITORING & RECORDING DAILY WEIGHT, BLOOD PRESSURE & PULSE WEIGHT should be monitored and recorded first thing in the morning without clothes and after going to the bathroom. BLOOD PRESSURE should be monitored with an automated blood pressure cuff, which goes around the upper arm. Your blood pressure should be checked at the same time every day. Your PULSE will most likely be checked by your automated pressure cuff, but if yours does not, you can count your pulse by placing your index and middle finger on the thumb side of your wrist. Count the beat of your pulse for one minute. Your pulse should be checked at the same time every day. Be aware that many things may affect your blood pressure and pulse. Minimal changes are okay. If there are major changes, your provider should be contacted. COMPLIANCE Compliance is VITAL for your well-being. This includes taking your medications, following your heart failure diet, staying active and coming to your scheduled doctors appointments. If there is an issue that is restricting your compliance with any of these matters, please contact your doctor s office immediately so that the issue or issues restricting your ability to keep yourself as well as possible, may be resolved. Ways to ensure compliance include: filling a pill box weekly and notifying the office as soon as your prescription is low, keeping a food diary including sodium intake, and filling a measured container to measure fluid intake. SEXUAL ACTIVITY Heart failure is not a contraindication to sexual activity. The amount of increased work the heart does during sexual relations is the same as that needed to walk up two (2) flights of stairs or walk briskly. Libido and possibility of erection may be diminished based on your health status and your medications. Remind your 23

25 partner that your energy is decreased. If you start to have any chest discomfort or shortness of breath stop immediately. If symptoms do not resolve contact your doctor right away or call 911. Remember that you cannot take erectile dysfunction drugs such as Viagra or Levitra if you are taking nitroglycerin as it can have dangerous consequences such as fainting and low blood pressure. STRESS REDUCTION It is important to reduce your stress level. Try to pinpoint what your stress is coming from to find a solution. Avoid unnecessary stress. Ask for help and stay socially active. There are several ways to reduce stress. Some examples include: yoga, exercising, talking out your stressors, meditation and deep breathing. Try to avoid unhealthy coping mechanisms such as smoking, drinking, binge eating or sleeping too much, as these mechanisms can lead to more stress. ENGERY CONSERVATION Pace yourself. Alternate difficult tasks with easy ones and rest minutes between tasks/activities. Plan ahead to avoid rushing have a written plan and take time to organize your day. Break work/tasks into steps and then do away with the unnecessary steps. With any activity you are doing, you should be able to perform that activity and carry on a conversation comfortably. Ask for assistance from family and friends. Take time to recover, refocus and regenerate. Your attitude and emotions affect the way you react to the world around you. Avoid unnecessary worry, irritation or frustration when possible. VACCINATIONS Keep up to date with your vaccinations. Ask your doctor if you are a candidate for pneumococcal and influenza vaccinations. 24

26 ONLINES RESOURCES American Heart Association- Has several resources and information for you regarding your diagnosis. This website is a great resource for dietary advice and education. This website is a great source for information about heart failure. Heartfailure.org - Has information regarding your diagnosis. Smokefree.org - Has free resources to help you stop smoking. They also have a link for their free phone app. DASHdiet.org Gives in depth information about the DASH diet as well as sample recipes. - Website by the Heart Failure Society of America. This website contains several links to information about heart failure. 25

27 THE HEART FAILURE MANUAL: Education, Management, and Improvement NOTES 1301 W 38th Street, Suite 514 Austin, TX (512) Seton.net

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