Heart Failure Book - Bronson Health
HeartHeart FailureBookInformation and Guidelines
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IntroductionThis book tells you about the disease called heart failure. We hope this information willhelp you know more about this disease. If there are words you do not know, pleasecheck the Words to Know section at the end of this booklet.Keep in mind that you are unique. Every health situation is different. If you havequestions, you should feel free to call your heart doctor or your family doctor.Table of ContentsHeart Failure Zones. . . . . . . . . . . . . . . . . . . . . . . 4General Guidelines for . . . . . . . . . . . . . . . . . . . . . 7Living with Heart FailureFollow-up Appointments and Care . . . . . . . . . . . . . .10Frequently Asked Questions (FAQS) . . . . . . . . . . . . .11Medicines. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Activity and Rehabilitation . . . . . . . . . . . . . . . . . . 17Diet Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . 28Words to Know. . . . . . . . . . . . . . . . . . . . . . . . . 323
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HEARTFAILUREACTIONPLANName:Date:Doctor’s Name:Phone:Emergency Contact:Phone:All Clear – This zone is my goal.Green ZoneDaysActions to takeMy symptoms are under control. I have: No shortness of breath. No weight gain. No increased swelling of feet, ankles, legs orstomach. No chest pain I gained 3 pounds in 1 day or more than 5pounds in 5 days. I am more short of breath. It is harder to breathelying down. I have more swelling of my feet, ankles, legsand stomach. I am more tired. I have less energy. I have a dry, hacking cough. I am feeling uneasy. I know something is notright. I am dizzy or light headed. I will call my doctor’s office today. I am struggling to breathe. I have pain, tightness or heaviness in my chest. I am confused or cannot think clearly. CAUTION – This zone is a warning.Yellow ZoneDaysActions to takeEmergency – Call 911Red ZoneDaysI will take all my medicines as prescribed.I will keep my doctor appointments.I will continue to do what I have been doingto manage my heart failure.Actions to takeI will call 911 for help right away.
Best Care for HeartFailure Keep your follow-up appointmentswith your doctor, cardiologist and theHeart Failure Clinic.Weigh yourself every morning. Reportweight gains to your doctor, cardiologistor the Heart Failure Clinic.Take your medicines as your doctor hasprescribed.Avoid NSAID medicines such asibuprofen (Motrin , Advil ) andnaproxen (Aleve ).Limit your sodium (salt) intake to 2,000mg a day.Limit your fluid intake to 48 to 64 ounces(oz.) daily.o This is also 1,500- 2,000 mL a day.This includes all drinks and foods thatare liquid at room temperature.Discuss end of life care and make a plan.Write your wishes down.Warning Signs forHeart FailureCall you doctor if you have one or more of thefollowing symptoms: Weight gain of 3 pounds in 1 day or 5pounds or more in 5 days. More short of breath than usual. New or increased foot or ankleswelling. It is harder to breathe when you laydown. You need to sleep in a chair at night. You have a dry, hacking cough. Tiredness that lasts more than one day. Feeling anxious or uneasy. Dizziness or lightheadedness.Call 911 if you have: Confusion or slurring of speech. Severe shortness of breath. Chest pain, tightness, heaviness ordiscomfort.6Tips for Healthy Livingwith Heart Failure Take your medicines as your doctor hasprescribed.Eat a heart healthy diet.Weigh yourself daily.Make your activity match what you areable to do. Start slow and work up to a 20to 30-minute exercise program.Talk with your doctor before starting anynew diets, medicines, vitamins or herbalsupplements.Keep an updated list of your medicineswith you. Include prescriptions, over thecounter medicines and vitamins or herbalsupplements. List drug names, how muchand how often you take it. Update this listevery time you go to the doctor, hospital oremergency room.If you smoke, quit. If you are readyto quit smoking, call (269) 341-7723.Get a flu shot every year and a pneumoniashot as indicated.
General Guidelines for Living with HeartFailureIn heart failure, your heart is not able to pump as much blood as needed throughyour body. When the heart cannot pump the blood through your body, you getextra fluid backed up in your lungs. This makes it difficult to breathe. Manypeople with heart failure also have swollen feet and legs. Sometimes peoplewith heart failure also get a bloated belly.There are many causes of heart failure. Sometimes it occurs after you have hada heart attack. Having high blood pressure can lead to heart failure. A buildupof cholesterol and fat in the arteries of the heart can lead to heart failure.Abnormal heart valves can lead to heart failure.Heart failure is a condition that will get worse over time. It is important foryou to follow your doctor’s advice about what to do to treat your heart failure.7
What you need to do: Take your medicines just as your doctor ordered. Weigh yourself every morning.o If you gain 3 pounds in 1 day or 5 pounds or more in 5 days callyour doctor. It is best for you to follow a 2000-milligram (low sodium), 1500-1200milliliter fluid restricted diet. Watch for these changes every day.o Shortness of breatho Weight gaino Increased swelling of feet, ankles, legs, and stomacho Chest paino Feeling more tired. No energyo Dry, hacking cougho Harder to breathe when lying downo Dizzy or lightheadedo Feeling uneasy – “you know something is not right” Check with your doctor about drinking alcohol. Maintain a healthy body weight, cholesterol, blood pressure level andblood sugar level to help keep your heart failure in control. Follow an exercise program to get regular physical activity. Not smoking is very important to your recovery and health. If yousmoke, PLEASE STOP. Information and support is available from yourdoctor, nurse, or Bronson HealthAnswers at (269) 341-7723.8
Problems to Report to the Cardiologist (HeartDoctor) or Your Family DoctorYellow Zone: CAUTION – This is a warning. Weight gain of 3 pounds in 1 day, ORWeight gain of 5 pounds or more in 5 daysMore shortness of breath than usualMore swelling of your feet, ankles, legs, or stomach than usualFeeling more tired – no energyDry, hacking coughHarder to breathe when lying downFeeling uneasy – “you know something is wrong”Feeling dizzy or lightheadedRed Zone: EMERGENCY - Go to the nearest emergency room orcall 911 if you have any of the following: Struggling to breath Pain, tightness, pressure or heaviness in the chest Confusion or can’t think clearly9
Follow-up Appointments and CareBefore you leave the hospital, an appointment will be made for you with yourcardiologist, family doctor or the Heart Failure Clinic. This appointment isimportant so your doctor can listen to your heart and lungs to be sure you aredoing okay.Please bring all of your medicine bottles, weight calendar and this heart failurebook with you every time you go to any doctor’s office.10
Frequently Asked QuestionsQ: Who do I call for my medicine?A: You will get orders for medicine before you leave the hospital. Take onlythe medicines listed on your discharge papers. Your heart doctor, yourfamily doctor or the Heart Failure Clinic staff can handle medicinequestions.Q: Am I going to die soon?A: Heart failure is a serious illness that can affect how long you live. This is achronic disease. It will never go away or be cured. Some people with heartfailure will die sooner than others. With proper medicines in the right dosesand careful management, you can live longer and feel better.Q: Why do I have heart failure?A: Heart failure usually starts when another problem makes the heart weak orstiff so it does not pump or fill normally. A common cause of heart failure isa heart attack. Other causes include high blood pressure, diabetes, lungdisease, problems with the heart valves, and infection of the heart muscle.Drinking too much alcohol for a long time can also cause heart failure.There can be a history of heart failure in some families. Sometimes theexact cause of heart failure is not known.Q: Will I have to take heart medicine forever?A: Yes. Research shows that heart failure medicines can help keep the heartfunction stable for a long time. Heart failure medicine can also help peoplelive longer, have fewer problems, breathe easier, have more energy, haveless swelling and stay out of the hospital. Different medicines help the heartin different ways. At times, your medicine may need to be adjusted to helpyour heart.Q: Should I get a flu shot or the pneumonia vaccine?A: The goal of heart failure treatment is to stay well. One way to do this is toavoid getting the flu or pneumonia. Get a flu shot every year. Ask yourdoctor if you should get pneumonia vaccine.11
Q: Can I drink alcohol?A: Alcohol can damage the cells of the heart and make it harder for the heart topump. In heart failure, the heart is already having trouble pumping. It isbetter to drink very little or not to drink any alcohol.Q: Do I have any movement limits?A: One of the most important ways that people with heart failure can keepfeeling good is to keep active. Research shows that activity includingexercise, work, and sex is healthy and safe for most people with heartfailure. The doctor may limit the amount of weight you can lift or the kindsof things you can do.Q: With whom will I make an appointment after I leave the hospital?A: An appointment needs to be made with your heart doctor, your family doctoror the Heart Failure Clinic. It is important for you to have an appointmentwithin a week of leaving the hospital. Your doctor or the doctor’s staff willcheck to make sure that you are getting better as expected.12
MedicinesThe following medicines are often ordered for patients who have heart failure. Eachsection has information about the medicine and side effects. It is important to learn yourmedicines and know why you are taking them.General Guidelines Always keep a complete list of your medicines with you. Include herbalsupplements, prescription and over-the-counter medicines. List drug name, dose(how much you take), and how often you take it. Update this list every time you goto the doctor, hospital or emergency room. Get all of your medicine from one pharmacy. This allows your pharmacist toreview all of your medicines. This helps prevent harmful drug interactions. It alsohelps your pharmacist answer any questions you have about your medicines. Tell your doctors about any changes in your medicines. This includes starting orstopping any medicines. Take your medicines as ordered by your doctor. If you miss a dose, do not doubleup on the next dose. Call your doctor if you have serious side effects from your medicines. If you have trouble paying for your medicines please call your doctor orpharmacist. Some medicines can make your heart failure worse. Talk to your doctor orpharmacist about medicines before you start taking them:o NSAIDS (ibuprofen (Motrin , Advil ), naproxen (Aleve )o New herbal or vitamin productsDiuretics (also known as “water pills”) In heart failure your body may keep too much fluid. Diuretics work byincreasing the amount of fluid that the body gets rid of. They do this byincreasing the amount of urine that your body makes. This increases thenumber of times you will have to go to the bathroom. You will need to have your potassium level checked when you are takingdiuretics. Most diuretics will take potassium from your body along with thefluid. Your doctor may give you a prescription for potassium tablets to takewith your diuretic.13
One common side effect is dizziness and lightheadedness, especially at thebeginning of therapy. Get up slowly when sitting or lying down to help withthis. Other side effects include:o Going to the bathroom a loto Thirsto Muscle crampso Sun sensitivity (you may get sunburned more easily) Diuretics include furosemide (Lasix ), bumetanide (Bumex ), torsemide(Demadex )ACE Inhibitors and ARBs These medicines treat high blood pressure and heart failure. They mayincrease survival after a heart attack. These medicines increase blood flow in the kidneys. This helps protect thekidneys especially for patients who have diabetes. One common side effect is dizziness and lightheadedness, especially at thebeginning of therapy. Get up slowly when sitting or lying down to help withthis. Other side effects include:o Headacheo Diarrheao Call your doctor or go to the emergency room right away if youhave: Swelling of the tongue, lips or nose Sudden trouble breathing or swallowing Rare side effects include kidney problems and more chance of infection.Call your doctor right away, if you are unable to pass urine or have a bigweight gain. Call your doctor or pharmacist if you have a constant dry cough while youare taking this medicine. You will need to have your potassium level checked when you are takingdiuretics. These medicines sometimes cause your body to keep too muchpotassium. Tell your doctor if you are taking extra potassium. You should NOT take these medicines if you are pregnant. If you arepregnant or plan to get pregnant while taking these medicines, you shouldcall your doctor. ACE Inhibitors include lisinopril (Zestril ), ramipril (Altace ), benazepril(Lotensin ), enalapril (Vasotec ), quinapril (Accupril ).14
ARBs include valsartan (Diovan ), olmesartan (Benicar ), losartan(Cozaar ), irbesartan (Avapro )Beta-Blockers Beta-blockers work by slowing your heart rate. This results in strongersqueezing of the heart muscle. These help prevent heart attacks - especiallyin patients who have had open-heart surgery. Beta-blockers help treat high blood pressure, heart failure, abnormalheartbeats and chest pain. Common side effects of beta-blockers include:o Running out of energy, especially at the beginning of therapyo Feeling drowsyo Shortness of breatho Diarrheao Swelling of hands or feeto Feeling dizzy or light-headed. Do not suddenly stop taking this medicine. Beta-Blockers include metoprolol (Lopressor , Toprol XL ), carvedilol(Coreg ), bisoprolol (Zebeta )Aldosterone Antagonists These medicines help improve quality of life and improve symptoms in somepatients with heart failure. Common side effects:o Headacheo Dizzinesso Tirednesso Diarrhea Call your doctor or pharmacist if you:o Develop a rasho Become confused. You will need to have your potassium level checked when you are takingdiuretics. These medicines sometimes cause your body to keep too muchpotassium. Tell your doctor if you are taking extra potassium. Aldosterone antagonists include spironolactone (Aldactone ), eplerenone(Inspra )15
Nitrates and hydralazine These medicines work by helping blood flow get through the heart. Theydecrease blood pressure and treat chest pain. One common side effect is dizziness and lightheadedness, especially at thebeginning of therapy. Get up slowly when sitting or lying down to help withthis. Other side effects include:o Headacheo Upset stomacho Chest paino Weakness Call your doctor or pharmacist if you have:o Shortness of breatho Chest paino Very bad headacheo Dizziness that does not go away For treating heart failure, these medicines come together in one pill calledBiDil .Digoxin (Lanoxin ) This medicine works by slowing the heart rate and helping blood flow to theheart. Common side effects:o Dizzinesso Headacheo Upset stomacho Diarrhea Call your doctor or pharmacist if you:o Have a very slow heart rateo Become confusedo Develop blurred visiono See yellow halos around lights16
Heart Failure Activity Guidelines from BronsonRehabilitation ServicesRegular Activity and Exercise: Improves your heart failure symptoms. Increases your energy and endurance. Improves your overall strength, balance and flexibility. Reduces stress, anxiety and tension.Making Your Exercise Safe for You: Talk to your doctor before starting any new exercise program. When resuming exercise, slowly increase back up to your normal work outlevels. Make sure you drink enough water to stay hydrated. Remember to followyour doctor’s fluid restriction guidelines. If you are unable to talk while exercising, you may be pushing yourself toohard. You should cool down at least 20 minutes after exercise before showering. It is important to protect your heart and keep it from working too hard.oooooDo not exercise while sick.Do not push yourself to “all out” effort during exercise.Do not climb stairs as part of the exercise.Do not walk for exercise outside if it is windy.Do not walk for exercise outside when it is very hot, very humid orvery cold.o Do not walk for exercise in areas with lots of hills.o Do not take a hot shower right after exercise. If you feel short of breath, very tired or have chest pain during or after youractivity, stop and rest until you feel better. Restart your activities at aslower pace.o If the symptoms are not relieved by rest or prescribed medicines, callyour doctor or 911.17
Perceived Exertion Scale (how much effort you think youare putting into your activity) Make your activity match what you are able to do. Start slow and work upto a 20 to 30 minute exercise program. You can use the PerceivedExertion Scale to help check if you are working at the right pace for you.Exertion is the amount of effort that you are using to do an activity.Perceived Exertion Scale00.512345-67-910Nothing at allJust noticeableVery lightLightModerateSomewhat heavyHeavyVery heavyVery, very heavy When you exercise, choose the number that best describes your level ofexertion on the 0-10 scale. Be sure to include your feeling of shortness of breath and overall fatigue. This will give you a good idea of the how hard you are working for youractivity. Use this information to speed up or slow down your activity to reachyour goal. When you start an exercise program, you may want to keep your level at 2-3,and then increase to a level of 3-4 for the rest of the exercise.18
Suggested Types of Exercise: Warm up: includes slow, gentle stretching to all muscles (5-10 minutes)While sitting:Pump ankles up and down.Raise knee up toward theceiling and alternate as ifmarching.Straighten out knees by extendinglegs and lowering them back tofloor.19
Alternate both arms reaching upoverhead and then slowly bring backdown to your lap.Shoulder shrugs: lifting shoulderstowards your ears and then rollshoulders in a circle.While standing:To stretch your calf muscles: holdonto the wall and place the leg tobe stretched behind you. Keep thatfoot flat and leg straight as youlunge forward onto the oppositeleg.20
To stretch your quadriceps: holdonto a chair and bend one kneebehind you while grasping yourankle. Repeat with other leg.To stretch your hamstrings:Sit on a surface large enough to putyour legs out straight in front of you.Keeping your low back straight, bendover and bring your chest as close toyour knees as you can until you feel asteady pull. Take a deep breath, relaxand try to get closer to your knees asyou let your air out of your lounges.Side reaches: reach one arm overheadand lean to the opposite side to stretchyour trunk. Repeat with the otherside.21
Shoulder stretch: Extend yourarms out in front of you whilelocking your fingers together andthen bring up over your head. Ifyou cannot lock your fingers, youcan hold the ends of a rolled uptowel. Cardiovascular exercises: any exercise designed to safely increase your heartrate which will allow you to strengthen your heart and lungs (10-20 minutes)o Walkingo Stationary bikeo Water aerobicso Low impact aerobics Cool down: slow, gentle stretching to allow your heart rate to come down afterexercise and allow your muscles to relax (5-10 minutes)o Repeat stretches from the warm up.o Cool down does not mean to sit down or to stop moving.Identification Card Carry an identification card with you at all times, especially when walking. Thecard below
a heart attack. Having high blood pressure can lead to heart failure. A buildup of cholesterol and fat in the arteries of the heart can lead to heart failure. Abnormal heart valves can lead to heart failure. Heart failure is a con
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1 See Heart Failure animation 2 See What is Heart Failure? pdf When you have heart failure, your heart doesn't pump as well as it should. As a result, some parts of your body may not get enough blood and oxygen. These problems may lead to the symptoms you feel. Heart failure is a chronic problem, meaning that it has no cure.
CARDIOVASCULAR ICD-10 Angina, unstable I20.0 Angina, prinzmetal (coronary spasm) I20.1 Stable Angina I20.8 Angina, pectoris, NEC/NOS I20.9 Left heart failure, unspecified I50.1 Systolic heart failure, chronic I50.22 Systolic heart failure, acute on chronic I50.23 Diastolic heart failure, chronic I50.32 Diastolic heart failure, acute on chronic I50.33 Systolic and diastolic heart failure .
your diagnosis of heart failure, also known as congestive heart failure or CHF. Heart failure is a serious condition that occurs when the heart muscle cannot pump enough blood through the heart to meet the body’s needs for blood and oxygen. However, many people with heart failure lead full, enjoyable lives when the condition is managed with
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