Living with Heart Failure

Summary

This new edition of our “giveaway” video or DVD combines the self-management tools you've been teaching in your facility into an information-packed reference your patients can take home. Just like our other heart failure videos, this new home video shows actual people with heart failure, not actors. It reviews heart failure medications and how they work, how to restrict sodium in the diet to below 2000 mg/day, how to manage fluid intake, tips on reading food labels and dining out, the importance of developing a safe exercise program, working with the healthcare team, and coping with lifestyle changes and difficult emotions.

An accompanying pamphlet provides a written review of the questions and wrap-up activities at the end of each chapter.

Chapters include:

1. Understanding Heart Failure
2. Following Your Treatment Plan
3. Understanding Your Medications
4. Keys To Healthy Eating
5. Making Healthy Food Choices
6. Staying Active
7. Avoiding Tobacco & Alcohol
8. Handling Flare-ups
9. Coping With Heart Failure

Details

• Introduction
• Chapters:
  1. Understanding Heart Failure
  2. Following Your Treatment Plan
  3. Understanding Your Medications
  4. Keys To Healthy Eating
  5. Making Healthy Food Choices
  6. Staying Active
  7. Avoiding Tobacco & Alcohol
  8. Handling Flare-ups
  9. Coping With Heart Failure
• Conclusion

• Introduction
  • This program is designed to help you manage your heart failure. Whether you are having trouble controlling your symptoms… or are feeling a little frustrated about living with Heart Failure, it has something in it for you.
  • The program is broken down into the following chapters:
    1. Understanding Heart Failure
    2. Following Your Treatment Plan
    3. Understanding Your Medications
    4. Keys To Healthy Eating
    5. Making Healthy Food Choices
    6. Staying Active
    7. Avoiding Tobacco & Alcohol
    8. Handling Flare-ups
    9. Coping With Heart Failure
  • At the end of each chapter you will also find questions and suggestions that can help you manage your heart failure.
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• Chapters:
  1. Understanding Heart Failure
     • Taking the time to learn about heart failure, and why it makes you feel the way you do can help relieve many of your fears. It can also help you better understand the things you will need to do to control it.
     • The heart:
       • The heart pumps blood containing oxygen and nutrients throughout the body.
       • Our bodies need oxygen and nutrients to work.
       • Normally, the heart pumps enough blood to all parts of the body.
     • Heart Failure:
       • When you have heart failure, your heart is weakened, and pumps less blood.
       • Your body tries to improve blood flow by releasing chemicals called hormones:
         • These hormones gradually make your heart bigger, and beat faster.
         • These hormones also tighten your blood vessels.
       • Over time, these hormones weaken the heart more, and that makes it even harder for it to pump blood to the rest of your body.
       • Many symptoms occur because the body holds onto fluid when it does get enough blood.
         • This is called edema.
         • Fluid buildup in the lungs causes shortness of breath.
         • Fluid buildup in the feet, legs, hands, face and abdomen can lead to swelling, and loss of appetite.
       • Heart Failure can make you feel very tired because your muscles are not getting enough blood.
     • You cannot cure heart failure, but you can learn to control your symptoms.
     • Wrap-up questions:
       1. What symptoms do you have?
       2. Try writing down when your symptoms occur. Share this information with your doctor.
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  2. Following Your Treatment Plan
     • Successfully managing your heart failure starts with developing a treatment plan to get control of your symptoms.
     • To control your symptoms you will need to:
       • Meet with your healthcare team often.
       • Take your medications.
       • Eat right.
       • Stay active.
       • Avoid tobacco and alcohol.
       • Watch for flare-ups.
       • Cope with stress.
     • You need to work with your healthcare team to develop a plan that meets your specific needs:
       • Everyone's treatment plan is a little different.
       • Your healthcare team includes:
         • Your doctor
         • Dietitian
         • Nurse educator
         • Pharmacist
         • Exercise specialist
         • Counselor
         • You are the most important member of your healthcare team.
     • You need to get involved and commit to following your treatment plan.
     • Schedule regular check-ups with your healthcare team:
       • Your heart failure can change and your treatment plan may need to be adjusted.
       • Ask questions.
     • Your healthcare team may even recommend additional treatment options:
       • Some heart failure patients can benefit from a Biventricular Pacemaker, or an Implantable Cardioverter Defibrillator. Both are devices that can be placed in the body to help control some cases of heart failure.
     • Wrap-up Questions:
       1. Do you know the parts of your treatment plan?
       2. How often do you have a check-up?
       3. Write down questions you have to take to your next visit.
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  3. Understanding Your Medications
     • Medications are some of the most important tools you have to control your heart failure symptoms:
       • Some medications work by helping blood move more easily through your body.
       • Other medications help the body get rid of extra fluid that has built up.
       • You need to take your medications exactly as they have been prescribed or your heart failure will get worse.
     • Medications Classes:
       • ACE Inhibitors:
         • The most often prescribed medication to treat heart failure.
         • They include:
           • Captopril
           • Enalapril
           • Enazepril
           • Lisinopril
           • Ramipril
           • Fosinopril
         • Ace Inhibitors block the hormones that tighten your blood vessels so blood can pass through them more easily.
       • Angiotensin Receptor Blockers:
         • They include:
           • Losartan
           • Valsartan
           • Irbesartan
           • Candesartan
         • Angiotensin Receptor Blockers are similar to ACE Inhibitors, and may be recommended for people who cannot take ACE Inhibitors.
       • Beta Blockers:
         • They include:
           • Carvedilol
           • Metoprolol
         • Beta Blockers helps your heart pump more blood by block the hormones that enlarge the heart and make it beat.
       • Diuretics:
         • Furosemide is the most common diuretic.
         • Diuretics help your body get rid of extra fluid.
       • Aldosterone Blockers:
         • They include:
           • Spironalactone
           • Eplerenone
         • Aldosterone Blockers also block certain hormones that can weaken the heart.
     • Guidelines:
       1. Keep an updated list of your medications and carry it with you.
       2. Plan to get your medications filled early so you do not run out.
       3. Get all your prescriptions filled at one pharmacy, so they will have a complete list of your medications on file.
       4. Talk to your healthcare team before taking new medications, about allegories or bad reactions you've had to medications in the past, and about nutritional supplements of vitamins you are taking.
       5. If you are worried about the cost of your medication, talk to your healthcare team. You may qualify for a program that can help you buy them at a lower cost.
     • Side Effects:
       • As with all medications, there is a risk of side effects.
       • Possible side effects include:
         • Extreme tiredness
         • Nausea
         • Loss of appetite
         • Dizziness
         • Lightheadedness
         • Skin rash
         • Cough
       • Let your healthcare team know right away if you experience any side effects.
       • It takes time to find the right dosage, so you get the most out of your medications with the least amount of side effects.
     • Keeping track of your medications:
       • A checklist or calendar
       • A pill organizer
       • Post reminders
     • Wrap-up Questions:
       1. Make a list of all your medications. Do you know how each one works?
       2. Ask your healthcare team about possible side effects.
       3. How do you keep track of your medications?
       4. Talk to your doctor before taking any new medications.
       5. Write down when you need to have your prescriptions refilled.
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  4. Keys To Healthy Eating
     • Healthy eating is more important then ever when you have heart failure. If you want to feel healthier, you have to eat healthier.
     • Limit sodium, or salt in your diet.
       • Everyone with heart failure must.
       • Sodium causes fluid to buildup in the body.
         • Fluid build up makes heart failure symptoms worse.
         • The more sodium you eat, the more fluids build up, and the worse your symptoms will become.
       • Your sodium limit should be no more then 2,000 mgs per day.
       • Do not add salt to food.
         • Keep the salt shaker out of sight.
         • Low sodium cookbooks can show you how to fix a lot of delicious low salt meals.
         • Herbs are also a great way to add flavor to your food.
         • Salt substitutes may also be an option, but check with your healthcare team before using them.
       • Avoid foods high in sodium.
         • Avoid processed cheeses like cottage cheese, American cheese, or anything labeled processed cheese food.
         • Try natural cheese like Swiss, mozzarella, or cheddar in small amounts.
         • Avoid processed meats like bacon, sausage, hot dogs, ham, luncheon meats, and salami.
         • Try Chicken, turkey, beef, or pork.
         • Avoid Most dips, sauces, dressings, and soups.
         • Try plain yogurt, oil and vinegar, and lemon juice.
       • Many foods high in sodium have low or no sodium versions that are OK for you to have.
       • Try making a list of your favorite high sodium foods and low sodium substitutes.
     • Choose foods low in fat and cholesterol.
       • They can help reduce the risk of more heart damage.
       • These types of foods can also help you loose extra weight and that can make your heart's job a lot easier.
       • Foods low in fat and cholesterol include:
         • Lean cuts of chicken
         • Fresh fish
         • Fresh vegetables
       • Many dairy products also have low, and non-fat versions you can choose from as well.
     • Ask your healthcare team about potassium.
       • Some of the medications you have been prescribed may raise or lower your potassium level.
       • You may need to eat more or less foods high in potassium.
       • Foods high in potassium include:
         • Bananas
         • Oranges and orange juice
         • Tomatoes
         • Spinach
         • Potatoes
         • Milk and other dairy products
     • Limit Fluids.
       • Cutting back on sodium may not be enough to prevent fluid build-up.
       • You will need to keep track of all the fluids you drink each day.
       • Use a fluid intake jar.
       • Try sucking on hard candy or ice chips, or chewing gum when you are thirsty.
     • Wrap-up Questions:
       1. What is your daily sodium goal?
       2. What are you doing to cut back on sodium?
       3. Make a list of your favorite high sodium foods. Now try to find low sodium substitutes.
       4. Have you asked your healthcare team about other healthy food choices?
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  5. Making Healthy Food Choices
     • Everyday you find yourself in different situations, faced with many choices about what to eat. Here are some tips to help you make the choices that are right for you.
     • Watching your sodium limit is always your #1 priority.
       • Think about your sodium goal as the beginning balance in a checkbook.
         • After each meal subtract the amount of sodium you eat from that total.
         • When your balance reaches zero, no more sodium.
       • Spread your 2,000 mg out over the whole day.
         • Try not to eat any one thing with more than 300 mg of sodium.
         • An entire meal should have no more than 600 mg of sodium.
     • Meet with a registered dietitian.
     • Use the food label.
       • It's found on every canned, processed or packaged food and lists its ingredients.
       • Food labels list a product's sodium content.
       • The serving size helps you decide how much you can have based on the amount of sodium.
       • Food labels also list the fat and cholesterol content.
       • Always look at the food label.
     • Helpful shopping tips.
       • Choose frozen dinners carefully.
       • Fresh foods are always best because they tend to be naturally lower in salt.
       • Salad bars are full of high sodium traps.
       • Ask questions.
     • Dining Out.
       • Many restaurants today offer healthier choices.
       • Nutritional information about their dishes is sometimes listed right on the menu.
       • Choose heart healthy dishes carefully because many are lower in fat and cholesterol, but not sodium.
       • Don't be afraid to request your meal be prepared without sodium.
       • You can also limit sodium by controlling your portion size.
       • Ethnic dishes are usually quite high in sodium and should be prepared at home.
     • Wrap-up Questions:
       1. Have you met with a registered dietitian?
       2. Make a sodium checkbook. Subtract the amount of sodium you eat after each meal.
       3. Do you know how to read a food label?
       4. Do you know what to ask when dining out?
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  6. Staying Active
     • Physical activity is one of the best things for your heart failure, even if you may not always think so.
     • Physical activity and heart failure.
       • Heart Failure symptoms can make getting up and moving around difficult, but doing nothing at all can actually make you feel worse.
       • The less active you are, the weaker you become.
       • Your heart failure symptoms worsen.
       • That can make you want to do even less.
       • This starts a harmful cycle.
       • Staying active can help you break this cycle.
     • Benefits of exercise:
       • It helps you keep your strength up.
       • It can reduce your symptoms.
     • Increasing your activity level.
       • It is never too late to start increasing your activity level.
       • Talk to your healthcare team first.
         • They can help you figure out the right amount of activity for you.
         • They can help you develop a safe activity routine you can do at home.
         • They can also help you deal with other health concerns you may have such as: diabetes, arthritis, or joint replacements.
     • Physical Activity.
       • Some patients benefit from aerobic exercises
         • Examples include: stationary cycling, and swimming.
         • Walking is another great aerobic exercise that you can do indoors or outdoors.
         • Resistive exercises like hand and pulley weights can also be beneficial for some patients.
       • There are still plenty of things you can do around the house to stay active.
     • Increase your activity level gradually.
       • Do not overdo it.
       • Your goal should be to eventually work up to twenty minutes of uninterrupted activity.
     • Tips for exercising safely:
       • Always warm-up first.
       • Stretching for a few minutes will help get your body ready for exercise.
       • You are probably working at a good level if you can talk easily while exercising.
       • Except in an emergency, you should never suddenly stop exercising. Slow down first.
       • Vary your activities with each work out.
       • Exercise with others.
     • Monitoring yourself.
       • The perceived level of exertion scale.
         • The scale measures how hard you are working.
         • This scale goes from 0 to 10 with 0 representing no effort, and 10 representing extreme exhaustion.
         • Your goal should be between 3 and 5.
       • Signs you are working at a good level:
         • Increased heart rate and breathing.
         • You break a light sweat.
       • Signs you are overdoing it:
         • A very rapid heart rate
         • Severe shortness of breath
         • Chest pain
         • Extreme tiredness
         • Nausea
         • Dizziness
         • If these symptoms do not go away with rest, contact your healthcare team.
     • Places to exercise:
       • Cardiac Rehabilitation offers you a chance to learn how to exercise in a monitored setting, and talk with others who are also dealing with heart failure.
       • Local community center
       • Gym
       • Home
     • Wrap-Up Questions:
       1. What are you doing to stay active?
       2. Have you asked your healthcare team about an exercise program?
       3. Do you know how to tell if you are overdoing it?
       4. Make a list of physical activities you enjoy. Review it with your healthcare team.
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  7. Avoiding Tobacco & Alcohol
     • Avoiding tobacco is essential when you have heart failure because it can cause more heart damage.
     • Getting started:
       • Set a quit date.
       • Select a method to quit smoking.
     • There are many ways you can quit smoking:
       • Quit cold turkey.
       • Try gradually cutting back.
       • Nicotine patches and gum.
       • Your healthcare team may also recommend additional treatments.
     • Acknowledge the challenge of quitting smoking:
       • It's easy to become frustrated.
       • You may be tempted to give up on other parts of your treatment plan.
       • Don't get discouraged by setbacks.
       • Most people have to quit several times, and try several methods before they are successful.
     • Second hand smoke can be just as harmful, so try to avoid those situations whenever possible.
     • Alcohol
       • Effects of alcohol:
         • It can cause more heart damage, or make your symptoms worse.
         • It can also react badly with some of your heart failure medications.
       • Talk to your healthcare team about alcohol.
       • You will probably need to cut back on the alcohol you drink, or avoid it altogether.
     • Wrap-Up Questions:
       1. Have you developed a plan to quit smoking?
       2. Ask your healthcare how alcohol can affect your health.
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  8. Handling Flare-ups
     • No matter how well you follow your treatment plan, you may not always feel one hundred percent. Managing heart failure includes knowing what do when you feel this way, and how to tell when your symptoms are getting worse, or “flaring-up.”
     • Pace yourself.
       • Try doing everything you can to make things easier for yourself.
       • Break down tasks into smaller ones, so you can take breaks between them.
     • Flare-ups are sometimes unavoidable, but knowing what signs to look for can help you catch them early, and keep them from getting out of control.
       • Weigh yourself everyday.
         • Always weigh yourself:
           • In the morning.
           • After using the bathroom and before breakfast.
           • In the same amount of clothing.
           • On the same scale.
         • If you notice a weight gain of 2-4 lbs. in 1-3 days, call your healthcare team.
         • A rapid weight gain could mean fluid is building up.
       • Other signs to watch for:
         • Extreme shortness of breath or difficulty breathing
         • Trouble lying down or sleeping
         • Increased swelling in your hands, legs, feet, ankles, or abdomen
         • A loss of appetite or a full feeling
         • Extreme tiredness
         • Nausea
         • Skin rash
         • A dry cough
         • Dizziness
       • Try not to panic when symptoms appear.
         • Getting upset won't make your symptoms better, but could make them worse.
         • Stop whatever you are doing and rest.
       • Follow the instructions given to you by your healthcare team. Also, you should never be afraid to call your healthcare team, dial 911, or go to the hospital if you feel it is an emergency.
     • Wrap-Up Questions:
       1. Weigh yourself everyday. Keep a record of it.
       2. Do you know the signs of a flare-up?
       3. Write down your emergency contacts. Always keep a copy with you.
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  9. Coping With Heart Failure
     • While it's normal to become frustrated, or get upset from time to time when you have heart failure, you don't want to let these feelings overwhelm you.
     • Emotions and heart failure:
       • Stress Cycle:
         • When you get upset your body releases adrenaline, a chemical that makes your muscles tight, and makes your heart beat faster.
         • You begin breathing harder and faster, and that can make you short of breath and tired.
         • Feeling this way can upset you even more, starting the whole cycle over again.
       • Frustration and stress may also lead to:
         • A loss of appetite
         • Headaches
         • Tension in your back, shoulders, and neck
         • When you're upset, you may also return to unhealthy habits, like smoking, inactivity, and eating poorly.
       • All of these make it harder to manage your heart failure.
     • You can deal with stress by learning to deal with the situations that cause them:
       • Coping with lifestyle adjustments:
         • Ask your healthcare team for help.
         • Try writing down the pros and cons of making the change.
         • Keep track of your progress.
         • Reward yourself from time to time.
         • Take advantage of your support system of family and friends.
         • Don't get discouraged by setbacks.
       • Coping with relationships:
         • Sometimes dealing with heart failure can be just as hard for your family and friends as it is for you.
         • Situations that can lead to hurt feelings, anger, and arguments:
           • They may be just as upset or scared as you are.
           • They may react by being overly protective.
           • Sexual difficulties.
         • Talking about your heart failure can help both you and your loved ones feel a lot better.
         • Share your concerns about sex with each other. Your healthcare team may also be able to help.
         • Advanced Directives:
           • Instructions you can make now regarding the kind of medical care you wish to receive if there comes a time when you can no longer speak for yourself.
           • Express your wishes in writing and share them with your family and your healthcare team.
     • You can also reduce stress in your life by taking some time to relax.
     • Support options:
       • You and your family don't have to cope with heart failure alone.
       • Many hospitals and treatment centers offer heart failure support groups.
       • Ask your healthcare team about the support groups that are available in your area and how you can become involved.
       • Religious and other social groups can be comforting, too.
       • The internet can also be a great link to others living with heart failure.
     • Coping with depression:
       • Symptoms of depression:
         • Poor concentration
         • Sleeping too little or too much
         • Loss of appetite
         • Not caring about your appearance or things you used to care about
         • Contact your healthcare team if you develop any of these symptoms.
       • There are treatment options for depression and your health care team can help.
     • Wrap-Up Questions:
       1. What situations upset you the most? Are there things you can do to avoid them?
       2. Have you discussed Advanced Directives with your healthcare team?
       3. What are you doing to relax?
       4. Talk to your healthcare team about support groups.
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• Conclusion

  Living with heart failure can be challenging, but you have the tools you need to control your symptoms and feel better. Keep this home reference handy to review topics. With time, help from your healthcare team, family, and most importantly, your commitment, you can master these tools and live a full, rich life with heart failure.

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