A guide to managing your illness and leading a healthier life

Transcription

1 A guide to managing your illness and leading a healthier life The Valley Hospital Heart and Vascular Institute 223 North Van Dien Avenue Ridgewood, NJ Resource: The Heart Failure Society of America, 10/13

2 each beat. A normal heart ejects 50 to 70 percent of the blood with each beat. EFs are typically monitored with an echocardiogram, MUGA scan or cardiac MRI. It is important to know how well your heart is functioning. Discuss your EF with your doctor. My EF is WHAT IS HEART FAILURE? Heart failure is a serious illness where the heart does not pump blood through the body as well as it should. Causes of Heart Failure Coronary artery disease High blood pressure Lung disease Diabetes Heart valve problems Excessive alcohol consumption Severe anemia Sometimes the exact cause is unknown Types of Heart Failure Left-sided HF results from the heart s inability to effectively pump blood to the rest of the body. Left-sided HF is commonly classified as one of two types: systolic or diastolic. Systolic HF occurs when there is a weakening of the ability of the heart to contract. Systolic HF can occur due to damage from a heart attack, infection, medication toxicities or damage that occurs to the heart valves. Diastolic HF, also known as heart failure with a preserved ejection fraction (EF), is the inability of the heart to adequately rest between beats. The heart muscle is stiffer in diastolic HF and, therefore, the ventricle does not appropriately fill with blood between beats. Right-sided HF occurs when the right side of the heart cannot pump blood effectively into the lungs. Right-sided HF usually occurs when there is lung or pulmonary vascular problems such as emphysema or pulmonary hypertension. What is My Heart Function? Heart function (pumping) is measured using a number called an ejection fraction (EF). The EF is the percentage of blood pumped out of the heart with 2 L I V I N G W I T H H E A R T FA IL UR E CARE MANAGEMENT With proper control of your heart failure, you can lead a normal active life. Be sure to: monitor and manage your symptoms daily. manage your fatigue. stay physically active. know when to call for help. maintain a healthy 2-gram sodium diet. take your medications. manage your feelings. stay up to date with your vaccinations (influenza and pneumonia) as patients with chronic illness are at high risk for these infections. quit smoking. Smoking causes coronary artery disease. For more information call The Valley Hospital Tobacco Education and Treatment Program at or call the toll free hotline at QUIT-NOW. T H E VA L L E Y H O S P I TA L 3

3 Monitor and Manage Your Symptoms Daily Once you know the symptoms of heart failure, learning the self-care needed to manage these symptoms is essential. Weigh yourself daily, first thing in the morning, after you go to the bathroom, and before breakfast. Weigh yourself using the same scale. Call the doctor if you have a weight gain of 2 or more pounds in one day or more than 4 pounds in one week. Check your body for swelling, also called edema, every day. You may see swelling in your legs or ankles or your shoes may feel tight. Your rings may feel tight with swelling in your arms and hands. Abdominal swelling may make your clothes feel tighter than normal. Call your doctor if you notice more swelling than normal. Chart your weight daily and call your doctor if you have a weight gain of 2 or more pounds in one day or more than 4 pounds in one week. DATE WEIGHT CHANGE Manage Your Fatigue It is important to manage your fatigue by: planning sleep and rest periods, alternating periods of activity with periods of rest, and asking family and friends for help with chores and errands. Call your doctor if fatigue increases or becomes overwhelming, or if you experience nausea and a decreased appetite. Stay Physically Active Research shows that exercise and work are healthy for those living with heart failure. Exercise will help you build activity tolerance, live healthier, and stay sexually active. Speak with your physician about exercise before starting. Ask: 1) How long and how often should I exercise? 2) Are there activities I should not do? Increase activity levels slowly. The goal for most people with heart failure is to accumulate at least 30 minutes of activity per day. You do not have to be active for 30 minutes in a row to benefit. For example, you can be active for three 10-minute blocks. Spend a few minutes warming up. This helps the heart get ready for exercise. Stretching should not be painful. Cooling down by slowly decreasing your activity level is a very important step in exercising because it helps your blood pressure and heart rate return to normal. Never stop exercising suddenly. There are times when it is important to refrain from exercise. Do not exercise if you have: a change in medication, increased shortness of breath, fever or infection, or chest pain. 4 THE VALLEY HOSPITAL 5

4 Watch the weather do not exercise or participate in outdoor activities when it is too cold, hot or humid. In poor weather, try indoor activities such as walking in a mall or doing household chores. Please remove and save this handy reference guide. Research shows that sex is healthy for those living with heart failure. Have sex when you are most rested. Avoid sex after eating a large meal. Use foreplay as a warm up for your heart. Do not have sex in positions where your arms are supporting your weight. Heart Failure Zones: Which zone are you in today? Know When to Call for Help Call 911 if you have: chest discomfort or pain lasting more than 15 minutes that is not relieved by nitroglycerin; severe shortness of breath that does not go away with rest; or feelings of fainting or passing out. Call your doctor immediately if you have: new onset of shortness of breath; sleep disturbances (needing extra pillows to sleep or sleeping sitting up due to difficulty breathing); fast, irregular heartbeats, palpitations, a racing heart or dizziness; or a cough with frothy or pink sputum. Primary Physician s name and number: Cardiologist s name and number: 6

5 Heart Failure Zones: Which zone are you in today? ZONE SIGNS AND SYMPTOMS WHAT TO DO GREEN ALL CLEAR No weight gain No increased swelling of feet, ankles, legs or stomach No increased shortness of breath No increased fatigue No chest pain Able to do usual activities without a problem Feel generally well Keep weighing yourself daily Take all your medications Avoid salt Avoid excessive fluid intake Keep up the good work! YELLOW WARNING CAUTION: Weight gain of 2 3 lbs. in 1 day, or 4 5 lbs. in 1 week Increased swelling of feet, ankles, legs or stomach Increased shortness of breath with less activity Increased fatigue Dry, hacking cough While sleeping, needing to add an extra pillow in order to breathe comfortably in bed, or needing to sleep sitting up in a chair Upon waking, had to sit on edge of bed to catch breath Just don t feel as well as you have Something is not right. THINK! Did you have more salt than you should have? If you did, really cut back and be careful. Did you forget to take your pills? If you did, get back on schedule. Did you drink more fluid than you should have? If you did, cut back on fluids. Call your doctor to report your symptoms. RED EMERGENCY STOP! Chest pain that is not relieved by nitroglycerin or rest Severe swelling Severe, persistent shortness of breath while sitting still Feeling faint or passing out Coughing up pink or frothy sputum Fast or irregular heartbeat that persists or makes you lightheaded Confused or can t think clearly CALL 911.

6 Maintain a Healthy 2-gram Sodium Diet Please remove and save this handy reference guide. Maintaining a healthy, low salt, 2-gram sodium diet is important for those living with heart failure. Lowering your intake of sodium helps to control high blood pressure and fluid buildup. Lowering your intake of fat and cholesterol is also important as these ingredients clog arteries and can worsen heart failure. Foods to Select Fresh meat, fish, and poultry Low-sodium cheeses such as Swiss, mozzarella, and parmesan Fresh or frozen plain vegetables Fresh, frozen, dried or canned fruit Regular or low-sodium bread Unsalted snacks Dry cereal Foods to Eliminate Processed and canned foods Salt used during cooking or added to prepared meals Snacks containing salt such as crackers, chips, pretzels, and popcorn Foods to Avoid Alcohol beer, wine, and liquor Tips for Healthy Eating Read food labels and look for low-sodium foods. Low-sodium foods have 140mg of sodium or less per serving. Buy fresh ingredients. When dining out, ask for low-salt dishes, baked and broiled foods, and all sauces and dressings served on the side. The Valley Hospital Heart and Vascular Institute 223 North Van Dien Avenue Ridgewood, NJ /13 THE VALLEY HOSPITAL 7

7 READING FOOD LABELS Products labeled light or lite must have 1/3 fewer calories or 1/2 the fat of the foods to which they are compared. Light can also mean that the salt has been reduced. Take Your Medications Another essential element to living with heart failure is taking all prescribed medication at the proper time. There are seven main types of medications often prescribed for patients with heart failure. ACE (angiotensin-converting enzyme) inhibitors work by relaxing blood vessels and lowering blood pressure. This improves blood flow and your heart is then able to pump more blood to the rest of your body without working harder. Examples include: benazepril (Lotensin ), enalapril (Vasotec ), lisinopril (Zestril ), quinapril (Accupril ), and ramipril (Altace ). Pay close attention to serving sizes. The sodium level tells how much salt, per serving is in the food. Look for products that have more fiber than sugar. Vitamins and minerals help your body function properly. Nutrition Facts Calories 80 % Daily Value* Total Fat 2g 3% Saturated Fat <1g 0% Trans Fat 0g Polyunsaturated Fat 1g Monounsaturated Fat <1g Cholesterol 0mg 0% Sodium 5mg 0% Total Carbohydrate 1g 9 6% Dietary Fiber <12g 48% Soluble Fiber 1g Insoluble Fiber 11g Sugars 7g Protein 7g Vitamin A 0% Vitamin C 0% Calcium 2% Iron 15% Thiamin 10% Phosphorus 10% Magnesium 20% Zinc 8% *Percent Daily Values are based on a 2000 calorie diet. The amount of calories a person needs depends on many factors, including exercise. Look for foods with lower levels of saturated fats. Calcium is important for both bones and teeth. Use this section as a guide for daily planning. Beta-blockers improve heart function, prevent heart attacks, and control blood pressure and heart rate by blocking certain stress hormones. Examples include: carvedilol (Coreg ), bisoprolol (Zebeta ), and metoprolol (Lopressor ). Digoxin may help lessen heart failure symptoms. Diuretics rid the body of extra fluid. Examples: furosemide (Lasix), torsemide (Demedex), and hydrochlorothiazide. Aldosterone antagonists block the stress hormone that tends to make heart failure worse and rids the body of extra salt. Examples: eplerenone (Inspra) and Spironolactone (Aldactone). ARBS (angiotensin receptor blockers) work by relaxing blood vessels and lowering blood pressure. They may be prescribed in place of ACE inhibitors. Examples: losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro). Isosorbide dinitrate and hydralazine (Isordil and Apresoline) work by opening blood vessels so it is easier for your heart to receive and pump blood. They also help restore the balance of nitric oxide needed by your heart and blood vessels. Medications to Avoid NSAIDS (non-steroidal anti-inflammatory medicines) such as ibuprofen, indomethacin, naproxen, and over-the-counter medications or herbal remedies should be avoided unless approved by your physician. Remember Even if you feel well, do not stop taking your medications without speaking with your physician! 8 THE VALLEY HOSPITAL 9

8 Manage Your Feelings Emotions such as depression and anxiety are common among patients living with heart failure. Signs of depression include: feeling down, blue or irritable; loss of interest in things you used to enjoy; sleeping all day; feeling worthless, hopeless or guilty; or thinking about death or suicide. Signs of anxiety include: worrying all the time; tension; fear; or feeling on edge, restless or shaky. If any of these symptoms last more than two weeks or stop you from leading an active, normal life, contact your doctor. Medical follow-up is extremely important! Even if you are feeling well after you are discharged, you must follow up with your physician/primary caregiver within 1 to 2 weeks of leaving the hospital. This is to ensure that you continue to feel well and recover. MEDICAL FOLLOW-UP THAT MAY BE NEEDED Medical follow-up is extremely important for all patients newly diagnosed with heart failure, especially if you recently have had a heart attack, with or without having subsequent cardiac bypass surgery or placement of cardiac stents. Your physician will need to re-evaluate the pumping function of your heart and your ejection fraction after a certain amount of time to see if you would benefit from other therapy. This other therapy may include special, small, implanted devices that can monitor and treat potentially dangerous heart rhythms, check cardiac fluid status, and potentially improve the pumping function of your heart. An ICD (implantable cardioverter defibrillator) is a device inserted into the body with lead wires similar to a pacemaker. It is used for certain patients with heart failure that may be at risk for having serious rhythm problems. It works by stopping harmful fast heart rhythms with pacing impulses or applying a shock to restore a normal rhythm. Another device is a special type of pacemaker that stimulates pumping of both lower chambers of the heart to provide what is called cardiac resynchronization therapy or CRT. In some patients with heart failure, conduction through the heart is slowed and the chambers of the heart contract out of synch with one another. CRT may improve the pumping function of the heart by making the lower chambers contract together or in synchrony. Your doctor will determine if any devices are needed to help treat your heart failure by re-evaluating the pumping function of your heart with an echocardiogram. You can discuss with your physician when you may need a future echocardiogram to evaluate the need for further therapy and/or devices, should it be required, for treatment of your heart failure. Prior to discharge you will be given information regarding Valley Home Care s Telemanagement Program. This program connects patients with a registered nurse at Valley Home Care by way of a portable system equipped with built-in devices that record blood pressure, heart beat, weight, blood oxygen levels, and blood glucose levels. This system can be programmed to remind patients to take their medications and/or report any troubling symptoms. This information is transmitted to a registered nurse every day for review, and physicians receive these reports as needed. This program is an important accompaniment to traditional home care visits and can improve your quality of life. For more information about Valley Home Care s Telemanagement Program, please call THE VALLEY HOSPITAL 11