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1 Congestive Heart Failure Management WHAT IS CONGESTIVE HEART FAILURE? Congestive heart failure does not mean your heart is failing. Heart failure means that your heart is not pumping blood as well as it could be. As your heart s pumping action weakens, blood backs up into the vessels around the lungs. Fluid starts to build up and you may experience shortness of breath and/or swelling in your hands, legs and feet. This is why heart failure is called congestive heart failure. Heart failure is a serious illness, however, with medication and lifestyle changes, you can live a full life. CONTRIBUTING FACTORS THINGS TO DO TO HELP ME LIVE WITH HEART FAILURE Heart Attack, Coronary Artery Disease, Heart Valve Disease High Blood Pressure Weigh daily Monitor my blood pressure Eat a low sodium diet Watch my fluid/liquid restriction Avoid tobacco and alcohol Know when to call my doctor Always take my medication as ordered Exercise Diabetes Drinking too much Alcohol Infection/ Illness Irregular Heart Beat Lung Disease Eating too much salt

2 WHO TO CALL & WHEN WHEN SHOULD I CALL MY DOCTOR? Weight gain of 2 pounds in 1 day or 5 pounds in 5 days Shortness of breath that is worse or shortness of breath at rest New or worsening swelling in legs, feet, hands or abdomen Fatigue which keeps you from doing daily activities Bloating in your stomach, or feeling more full when eating Increased coughing Unable to lay flat or using more pillows than usual Feeling dizzy or lightheaded WHEN SHOULD I CALL 911? You have Chest discomfort or pain that lasts more than 15 minutes and is not relieved after taking Nitroglycerin You are unable to catch your breath You faint or pass out You experience a fast or irregular heartbeat CONTACT INFORMATION Cardiologist: Phone #: Emergency Contact: Please keep this along with your medication list on your refrigerator where it is easily accessible by emergency personnel. 2 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

3 WEIGH YOURSELF DAILY You should weigh yourself every day, at the same time, preferably in the morning, on the same scale, wearing only your underwear and after you have gone to the bathroom. Write down your weight each day and bring with you to your doctor s appointment. If you gain 2 pounds per day or 5 pounds in one week, please contact your doctor immediately. Do not wait until your next appointment. HELPFUL REMINDERS It is possible to gain fluid without noticing any swelling. Remember that scales weigh differently. 3 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

4 BLOOD PRESSURE Many people with heart failure often have other medical conditions as well, such as, high blood pressure (Hypertension). High blood pressure makes the heart work harder and can make you feel worse. It is extremely important to take your medicaion as directed by your provider caring for your heart failure. If you are unable to take your medication, talk with your provider. Do NOT stop taking the medication on your own as you can make your heart failure worse. The American Heart Association (2018) defines high blood pressure as 130/80 or higher. 4 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

5 LOW SALT DIET SODIUM MEASUREMENTS 1/4 teaspoon = 500 mg Sodium 1/2 teaspoon = 1000 mg Sodium 3/4 teaspoon = 1500 mg Sodium 1 teaspoon = 2000 mg Sodium Baking soda = 1259 mg Sodium It is not easy changing the way we eat or prepare our meals. It may take some time before you are accustomed to not adding salt to your food. People with heart failure need to cut down their salt intake to keep water from building up in your body. A low salt diet is 200 mg of Sodium (Salt), but your doctor may adjust this according to your symptoms. Learn to read labels. Remember: high salt foods are usually placed on the outer perimeters at your grocery store such as soups, lunch meat, chips, ketchup, etc. Check with your doctor before using a salt substitute as many substitutes contain high levels of Potassium which may interact with your medication. When preparing meals, NO MORE than 650 mg of salt per meal. Stop adding salt to food, this can cut salt down 30% or 1/3 teaspoon. Pick foods naturally low in salt such as, fresh fruits and vegetables, fresh meat, poultry, fish, canned fruits, plain frozen vegetables, dried beans, peas and rice. See a Dietician if you are having a difficult time managing your salt intake. TIPS FOR DINING OUT Do NOT add salt to your food. Avoid selecting foods that are cured or smoked. Order Salad dressing on the side and use sparingly. Avoid olives, pickles, bacon bits, cheese, mayo and cream-based or marinated salads. Choose an entree that is grilled, baked or broiled. Choose fresh fruit or angel food cake for dessert. 5 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

6 FLUID RESTRICTIONS FLUID MEASUREMENTS 1 quart = 4 cups = 32 ounces = 960 ml 1 pint = 2 cups = 16 ounces = 480ml 1cup = 8 ounces = 240 ml ITEMS THAT COUNT AS FLUIDS/LIQUIDS Water Popsicle Tea Non-dairy Creamer Alcohol Ice Cubes Jell-O Fruit Juice Coffee Milk Soup/Broth Vegetable Juice Ice Cream Cream Soft Drinks Sorbet/Sherbert HOW TO HELP CONTROL YOUR FLUID INTAKE Eat cold fruits and vegetables between meals Eat hard candies or chewing gum Rinse your mouth with Biotene Mouthwash Use small cups or glasses and take sips not gulps Measure allowed fluid and keep in refrigerator REMEMBER: 2 CUPS OF RETAINED FLUID = 1 POUND OF FLUID WEIGHT GAIN! 6 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

7 READING YOUR LABELS Start at the top and note the serving size, this describes how much food is in ONE serving. All the information on the rest of the label is based on serving size. The Servings per Container should be carefully viewed because it shows how much sodium (salt), fiber, protein, calories, etc. is in each serving. Look to see how many calories are in a single serving and the number of calories from fat. Eating less of total fat and sodium can help reduce your risk for heart disease and high blood pressure. Increase the amount of fiber you eat and try to lower your intake of sugars WHAT YOUR LABEL SAYS...AND WHAT IT MEANS LABEL CLAIM: Cholesterol Free Low Cholesterol Light or Lite Light in Sodium Fat Free Low Fat Calorie Free Low Calorie Sodium Free Very Low Sodium Low Sodium DEFINITION: Less than 2mg cholesterol and 2 gm or less saturated fat 20 mg or less cholesterol and 2 gm or less saturated fat 1/3 few calories or 50% less fat 50% less sodium Less than 1/2 gm of fat or less 3 gm of fat or less Less than 5 calories 40% or less Less than 5 mg sodium 35 mg or less sodium 140 mg or less sodium 7 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

8 MEDICATION MANAGEMENT The purpose of medication is to make you feel better and treat your heart failure. It is important you take all of your medication the way your doctor prescribed it. Do NOT stop taking your medication unless you are told to do so as this may make your heart failure worse. The following are types of medications that may be used to treat your heart failure. NAME OF MEDICATION: FUNCTION: Ace Inhibitors (lisinopril, enalapril, captopril, ramipril) Lower your blood pressure and decrease how hard your heart has to work Beta Blockers (Metoprolol, Atenolol, Nebivolol, Esmilol) Lower your blood pressure and slow your heart rate. This lessens how hard your heart has to work. Digoxin Helps your heart pump with more strength and helps the heart pump more blood to the rest of your body. *Diuretics (Water pills such as Lasix, spironolactone, torsemide or bumetanide) Rids your body of excess (too much) water which means your heart does not have to pump so hard. *Some diuretics (water pills) make you lose Potassium. Your doctor will provide you with Potassium supplements if needed, however, these levels must be checked regularly to avoid an irregular heartbeat. As with all medications, please tell your doctor immediately if you are feeling worse. 8 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

9 IMPORTANT FACTS ABOUT YOUR MEDICATION The medications your doctor prescribed cannot make your heart failure go away, but they can make you feel better and help you manage your disease. Below are some helpful tips regarding your medicine. HELPFUL TIPS Always take your medicine as prescribed. Keep all your medications in the original container (filling a weekly pill box is okay, however, do not put the rest of your medications in a different container). Try to learn your medications. What does it look like? What is the dose? Remember that from time to time the manufacturer changes. Please clarify any changes with your pharmacist. Do not run out of your medicine. Tell your pharmacist and doctor all of the medications you are taking, this includes all prescribed and non-prescribed medications such as vitamins and home remedies. Do not skip or increase your dose unless you are told to do so by your doctor. If you miss a dose, do NOT double up on your medications; instead, take your next dose when it is due. If you are unable to take your medications for any reasons, call your doctor or nurse immediately. Do NOT take any over-the-counter medications until you check with your doctor. Some of these medications may interfere with your prescribed medications and could worsen your heart failure. Try to get all of your medications from one pharmacy. This will decrease confusion for both you and the doctor when new medication is prescribed. 9 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

10 EXERCISE & HEART FAILURE It is important you continue to exercise regularly and continue your daily activities. Activities may include bicycling, walking, gardening, swimming, mild aerobics and more. Avoid activities in extreme heat or cold or when you are not feeling well. During extreme temperatures outside, it is best to remain indoors such as walking inside of a shopping mall or gym. If you experience any of the following symptoms during exercise: Increased shortness of breath Increased cough Chest pain or discomfort Light headedness or dizziness Fast or irregular heartbeat Extreme fatigue STOP AND REST! IF YOUR SYMPTOMS DO NOT GO AWAY, CALL 911. As with any activity, always check with your doctor before starting an exercise program. Taking short walks is always a good starting point. Ask your doctor if you qualify or would benefit from a Cardiac Rehab program. 10 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

11 HOW YOUR FAMILY CAN HELP Your family is a big part of your health care team. Your family can help you monitor and recognize signs and symptoms of heart failure. It is important for your family to understand your illness and know the medications you are taking. It is recommended that one family member accompany you to any appointments or classes. Please share any new information with them so they can assit you at any time. 11 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

12 REFERENCES American Heart Association. (2018). Understanding blood pressure readings. Retrieved March 06, 2018, from HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/ Understanding-Blood-Pressure-Readings_UCM_301764_Article. jsp#.wp7nqrmrab8 12 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

13 MY CARE TEAM My doctor is: Phone #: My cardiologist is: Phone #: Pharmacy: Phone #: Hospital: Cardiac Rehab: Dietician: Care Manager: Phone #: CHFM Copyright 2018 Trilogy Health Insurance, Inc.

14 BLOOD PRESSURE/PULSE RECORD NAME: DATE TIME BLOOD PRESSURE PULSE 14 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

15 MY MEDICATION RECORD NAME: PRESCRIPTION MEDICATION DOSE FREQUENCY LAST DOSE TAKEN 15 CHFM Copyright 2018 Trilogy Health Insurance, Inc.

16 QUESTIONS FOR YOUR DOCTOR Going to your doctor can be overwhelming at times and can make you nervous. You may forget what you want to ask and/or forget what your doctor tells you. Use this sheet to write down your questions. YOUR QUESTION 1. THE ANSWER YOUR QUESTION 2. THE ANSWER YOUR QUESTION 3. THE ANSWER 16 CHFM Copyright 2018 Trilogy Health Insurance, Inc.