The purpose of this booklet is to help you and your family learn about heart failure and become active partners with your health care team. Share it with your family and other caregivers. It tells you how and why heart failure effects your body. It also tells how to respond to symptoms and what to expect from treatment. By working with your health care team and learning how to manage your condition, you may live longer and improve the quality of your life. The more you know the more you can get involved. Reading this booklet is a good step toward getting involved in managing your heart failure.
A Normal Heart
The human heart is a remarkable organ that continuously pumps blood that nourishes the body and removes waste products. About the size of a fist, this powerful muscle uses its own electrical system to pump blood. It pumps 5 to 6 quarts of blood a minute during rest, but more than 20 quarts a minute during exercise.
A normal heart adjusts itself to the changing demands of exercise and rest. As the body needs more nourishment and energy the heart responds. It beats faster and more forcefully, causing more blood to circulate through the body. Blood carries needed oxygen and nourishment to muscles and organs and then returns to the heart to begin the process again
What is Heart Failure?
Heart failure does not mean that your heart has stopped working. „Failure‰ means your heart is weak and its pumping power is reduced both during exercise and at rest. Although it still beats normally, your heart cannot pump as much blood with each beat. Your symptoms will depend on the cause of your heart failure and how long you have had it.
Heart failure is not a specific disease but a general way of describing a group of symptoms. These symptoms are caused by diseases that keep the heart from circulating enough blood to meet the body‚s needs.
Heart failure may occur suddenly, or it may develop gradually. For most people, heart failure is a chronic condition, which means it can be treated and managed, but not cured. If it is a complication of blocked coronary arteries or heart valve disease, surgery may help.
Effects of Heart Failure:
• strength of muscle contractions is reduced
• the heart chambers‚ ability to fill with blood is reduced, so there isless blood pumped out to the body
• the pumping chambers fill with too much blood and the heart is not strong enough to pump out all of the blood that goes into it
• the heart acts less as a pump, and more as a dam
Untreated, heart failure can put a strain on your entire body that can be fatal. Serious complications include pulmonary edema, and susceptibility to respiratory infections. Also, the liver, kidneys and brain can suffer damage. Treatment of heart failure and the underlying cause may allow you to resume your normal activities. If heart failure gets to a point it no longer responds to rest, diet, and medicine, then a heart transplant is necessary. Although heart transplants have been proven to be effective and have a high rate of success a shortage of donors limits this as a choice for treatment.
Causes of Heart Failure
The most common causes of heart failure are:
• coronary artery disease — narrowing of the arteries that supply blood to the hearts reduces. The heart‚s ability to pump decreases because the heart is not getting the oxygen and nutrients it needs.
• a previous heart attack — leaves less healthy heart muscle to do the work of a normal heart.
• diseased heart muscle (cardiomyopathy) — the heart muscle may be stretched or grown larger and weaker.
• chronic high blood pressure (hypertension) — because the heart muscle works harder it can become enlarged. After a while the enlarged muscle weakens.
• diseased heart valve(s) — fails to control normal blood flow through the heart
• congenital heart disease — refers to defects in the heart and its chambers that are present at birth.
Other causes of heart failure are alcohol abuse, drug abuse, overactive thyroid, and various heart valve problems. Sometimes the exact cause of heart failure is not found. This is called idiopathic heart failure. However, the actual cause is not as important as your heart‚s reduced pumping power and what can be done to manage it.
If high blood pressure is the cause of your heart failure be sure to follow your doctor‚s advice for controlling it. Have your blood pressure checked regularly.
Symptoms of Heart Failure
Your doctor may talk about right heart failure or left heart failure, depending on which side of your heart is most affected. Left side weakness leads to back up of blood in the lungs. Right side weakness leads to back up of blood in the veins. Because many of the symptoms of heart failure are caused by congestion of the tissues and lungs with fluid, it is often called congestive heart failure. You are likely to have both left side and right side symptoms. You may also lose your appetite, feel confused, and have a blueness to your skin.
Left Side or Right Side?
Left sided failure primarily causes respiratory symptoms. Symptoms of left-side heart failure:
• shortness of breath
• shortness of breath while lying down
• shortness of breath while sleeping
• fluid build-up in the lungs causing a cough and chest pain
Because it is hard to breathe lying down, you may need to sleep propped up with several pillows.
Right sided failure causes symptoms throughout the body. Symptoms of right-side heart failure:
• swelling of feet, ankles, and legs
• swelling of liver, abdominal pain
• build up of fluid in the abdomen
• frequent urination at night
Managing Your Heart Failure
To manage your heart failure, follow the instructions of your health care team. You may reduce your symptoms and improve how you feel by taking medicines as prescribed and changing how you live. Work with your health care team to make the right choices and set goals to keep life interesting. You can manage your heart failure with a program for each of the following:
• Daily Activities
• Family Support
Depending on your symptoms and diagnosis, your doctor may start treatment by prescribing one medicine and then adding others later. Sometimes, treatment begins with two or more medicines. Be sure to tell you doctor about other medicines you are taking including over the counter medicines such as aspirin, antacids, and cold medicine. Taking medicine every day is very important in treating heart failure. The benefits of medicine are lost or reduced if you do not take medicine as directed. Skipping doses or not refilling a prescription can cause serious problems.
It may take several days or weeks to find the right doses of medicine. Be patient as you and your doctor find the right amount of the right medicine and the right time for you to take it. Part of finding the right medicine is
finding a medicine that improves your symptoms but has the least side effects.
Ask your doctor to tell you about the side effects of the medicine you are taking. Ask for which side effects you should stop taking the medicine. Then be sure tell your doctor right away if you have any of these side effects.
Depending on how bad the side effects are your doctor may change your medicine or dose.
Common kinds of medicine, what it does and it’s common side effects:
An ACE inhibitor relaxes blood vessels and makes it easier for the heart to pump. It may take weeks for this medicine to work. Your doctor may also prescribe a diuretic and digitalis.
Side effects include
• skin rash
This medicine may cause an increase in your potassium level and effect how your kidneys work. You will need to watch these levels by having blood tests.
Diuretics remove excess fluid and sodium by making you urinate more often. This keeps fluid from collecting in your feet, ankles, legs, and abdomen. It is best to take in the morning so you do not disturb your sleep by getting up often to go to the bathroom. Skipping your medicine can cause swelling in your feet, ankles, legs, and abdomen. If you take diuretics regularly you can lose too much potassium and other important minerals. You will need to watch your these levels with blood tests.
You can replace potassium by:
• eating foods rich in potassium (bananas,apricots, oranges)
• taking a potassium supplement
Common side effects of diuretics are:
• leg cramps
• dizziness or light headedness
• accidental urine leakage
• skin rash
Digitalis strengthens each heart beat allowing more blood to be pumped and slows the heart rate. It may also improve your ability to exercise. Digitalis is safe for most people. If you get too much digitalis in your system your may have these side effects:
• nausea and loss of appetite
• mental confusion
• blurred or yellow-colored vision
• rapid, forceful heart beats
Blood pressure medicine lowers blood pressure. Your doctor may have you take blood pressure medicines if high blood pressure is a cause of your heart failure It is important to keep track of your medicine, especially if you take more than one or take medicine several times each day. Make a list of your medicines and the doses you take. Put this list it in a place that can easily be found. In case of an emergency this information could help your doctor help you.
Taking many medicines can be costly. Ask if there is a drug that costs less or if you can take a generic medicine. If cost is a problem, tell your health care provider; your health care team may be able to help you find assistance
with buying medicine.
Drug treatment is often so successful that you may feel like you can stop taking your medicine. Don‚t follow you doctor’s orders exactly!!
How heart failure affects you depends on how bad it is. Mild heart failure may have little effect on work or play. Severe heart failure may keep you from doing otherwise simple things. Ask your doctor to tell you and your family
which activities you should avoid. It is important to involve your family so they can offer you support.
Changing your eating habits and watching your sodium (salt) intake is another important part of managing heart failure. Sodium causes fluid to build up in your body. This extra fluid makes your heart work harder. To prevent fluid buildup you must limit the amount of sodium you eat. If you get too much fluid build up you may end up in the hospital.
Your doctor will tell you how much daily sodium you can have in your diet. You may be referred to someone who can help you with your diet and meal planning. You will have to learn new ways to prepare foods and modify your old favorite recipes.
You must learn how to find hidden sodium. The best way to find hidden sodium is by reading the nutrition facts on food labels for salt or sodium products. Changing what you eat can be complicated and confusing. You may have to learn to like foods seasoned in other ways and without sodium. If you have trouble changing your diet, ask your health care team for help.
You must also watch your weight. Rapid weight gain can mean you are holding fluid which can worsen your heart failure. Buy a good scale and weigh yourself each morning at the same time. Weigh after urinating and before eating breakfast. Record your weight each day. If you gain more than 5 pounds within a week or 3 pounds in one day, call you doctor right away. You may have other things to think about in your diet. For instance, you may
have to eat foods that are high in potassium if you are taking a diuretic. Also, your doctor may want you to eat foods that are low in fat and cholesterol.
Exercising regularly and according to your doctor‚s instructions will make your feel better. Before starting any exercise program ask your doctor to tell you ways you can exercise at home and how much exercise you can do. Ask if you can:
• ride a bike
• do low impact aerobics
Your doctor may ask you to start with a supervised exercise program at a rehabilitation center so you can be assisted in case of problems. You also may need to have an exercise stress test to see how much exercise is safe for you.
Your lifestyle and health habits are things you do that reduce or increase the chances of illness or injury. You will have to change your lifestyle and health habits to reduce your heart failure symptoms. Which of the following are
changes you can make to improve your quality of life:
• lose weight if you need to. Your heart will not have to work as hard if you are thin.
• stop smoking. Smoking narrows blood vessels and makes breathing harder.
• do not use alcohol or recreational drugs – these drugs could react with your medicine.
• don‚t overdo your exercise and put a sudden strain on your heart
• avoid contact with people who have colds or infections, get a flu and pneumonia shot
• reduce your stress. Stress can make your heart beat faster, cause you to lose sleep, and increase your blood pressure.
Changing your lifestyle doesn‚t happen overnight. Your family‚s concern, care and support can make a big difference in how successful you are in making these changes and living with heart failure.
Your family can be a great source of support and encouragement. As much as you can, include family members in all decisions that affect you. These include decisions about your lifestyle and your ability to earn a living for your
family. Support by family members can be important while you adjust and face emotional difficulties. Let your family know how they can help you. Things your family can do:
• keep track of medicines and watch for changes in you
• learn how to shop for and prepare heart healthy foods
• eat a heart healthy diet with you
• exercise with you
• help you learn more about heart failure
• join a support group with you
• lend and ear
• learn the symptoms of heart attack and your heart failure symptoms
• learn CPR
You family’s support can be very helpful while you are changing your lifestyle and health habits.
WATCHING AND RECORDING YOUR PROGRESS
Managing your heart failure requires keeping track of symptoms and monitoring how well you follow instructions from your health care team. Make sure you report all changes to your doctor.
Things you can do to manage your heart failure:
• monitor your general health
• report any changes in how you feel
• report changes in your symptoms
• take medicine as prescribed and report side effects
• follow you doctors orders for exercise and let your doctor know if you do not
• follow your prescribed diet, limit your sodium intake
• report any sudden weight changes to your doctor
Things your family can do:
• have emergency numbers handy
• help you monitor your condition
In case your family has to call the doctor they should be able to:
• tell the doctor you are being treated for heart failure
• describe any symptoms you are having
• describe what has already been tried to ease your symptoms
• tell the doctor the names and amounts of all medicines you take
In an emergency it is natural to assume that you would want whatever medical treatment is needed to save your life. However, you have the right to accept or refuse any treatment before an emergency happens. You can direct that you do not want emergency medical staff to restore your heartbeat or use machines to breathe for you.
Specific instructions for family members and others may be needed so they will know what you want in case of a medical emergency. Legal documents known as advanced directives tells others your wishes. This document spells out what lifesaving measures you want taken if you cannot think clearly or speak for yourself. Advance directives include:
• a living will – gives instructions to the medical team about using artificial life support
• a durable power of attorney for health care – names the person you want to make medical decisions for you
Usually, it is impossible to determine the chances of survival in an emergency situation or the outlook for recovery. After the initial emergency has passed, and depending on your condition, your advance directive may come into play if you are not able to express your wishes.
If you do not have advance directives, talk about your wishes for medical care and treatment with your family and health care team. Then prepare one. These decisions may be difficult to make. But, talking before an emergency happens can be much less stressful than when you are very sick. And your family will feel better knowing they respected your wishes.
WHEN TO CALL YOUR DOCTOR
• If you gain more than 3 pounds in 24 hours or more than 5 pounds in 7 days
• If you have serious side effects from your medicine
• If you have symptoms of a heart attack
• If you treatment does not seem to be working
• If you have severe breathlessness and your heart is pounding
• if you cough up pinkish sputum
Heart failure can be serious, but it doesn’t have to be deadly. Change to a heart healthy lifestyle of proper rest, diet, and exercise, then make a commitment to follow it – for life!