Congestive Heart Failure
Welcome to the University of Wisconsin Hospital and Clinics
This booklet will help you learn
- About the heart and how it works.
- About heart failure and the tests and treatments used to manage it.
- How to work with your doctor and nurse so you can begin to live with heart failure and feel better.
Many people with heart failure lead normal, active lives. They do so because they have learned to take good care of themselves. You can take control of heart failure by learning how to follow your treatment plan.
Right now, your symptoms may limit you. You may feel discouraged about your treatment plan. You might even feel downcast about the name of the disease. If you follow the advice in this booklet, you will understand your heart condition, feel better, stay out of the hospital, and live longer.
What is Heart Failure?
Heart Failure means that your heart muscle is weakened. It is not pumping blood as it should. It does not mean that your heart has stopped or is about to stop. It just means that the pumping function of your heart is not working as well as it once did.
The heart muscle can become weak and less able to pump blood out to the body. This is called "systolic" failure. In another type of heart failure, the heart cannot relax the right way to fill with blood. This is called "diastolic" failure. Some people can have both problems. Both types lead to similar symptoms.
Heart failure also affects the kidneys. It makes it hard for the kidneys to get rid of sodium and water. The excess fluid can cause your feet, ankles, stomach, and legs to swell. The term "congestive heart failure" simply means that your body is holding onto this excess fluid.
What Causes Heart Failure?
Heart failure is caused by many things.
- High blood pressure
- Diabetes
- Heart attack
- Coronary artery disease
- Inactive lifestyle/obesity
- Alcohol or other drug abuse
- Tobacco use
- Heart valve problems
- Family or genetic trait
- Drugs that are toxic to heart muscle (ex: some chemotherapy)
- Arrhythmias
- Infections and diseases of the heart muscle (cardiomyopathy, viral myocarditis)
- Thyroid disease
- Age - the chance of heart failure increases after age 65
- Other unknown causes
What are the Symptoms of Heart Failure?
Some of the classic symptoms of heart failure are:
- Shortness of breath when at rest or with the least activity.
- Tiring easily with your normal routine or having little energy.
- A cough that does not go away or chest congestion.
- The need to sit up to breathe comfortably when sleeping.
- Swollen legs, feet, ankles, arms, and/or abdomen.
- Weight gain despite not feeling hungry.
- Feeling anxious or restless.
- Lack of hunger, feeling bloated when eating, or feeling full after taking just a few bites.
How is Heart Failure Diagnosed?
Your health care team includes doctors and nurse practitioners. They are able to detect heart failure. To do this they listen to your heart and lungs. They look for extra fluid at many places on your body, such as your neck, stomach and legs. Your health care team will ask you about any symptoms you are having. You may also have a chest x-ray, an EKG (electrocardiogram), or an ultrasound of your heart (echocardiogram).
Tests and Procedures for Heart Failure:
Your health care team may order:
- An electrocardiogram (EKG) to study the heart rate and rhythm. This can be useful in finding areas of damaged heart muscle or detecting abnormal heart rhythms that may lead to heart failure.
- An ultrasound of the heart (echocardiogram) to check the size of the heart. This also shows how well the muscle is contracting and relaxing and how well the valves are working.
- You may hear the words ejection fraction (EF). This is the percent of blood that the heart pumps out with each beat. A normal EF is 55-70%.
- A heart catheterization to see if you have any blocked blood vessels. During a catheterization, doctors may also measure pressures in the heart and lungs..
- Blood and urine tests to look for other causes of heart failure.
- A holter monitor to record your heart rate and rhythm. This is worn for 24-48 hours. It is used to see if there are any abnormalities with your heart rate or rhythm.
- A chest x-ray to show if the heart is enlarged or if there is fluid in or around your lungs.
Other tests your health care team has ordered:
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How is Heart Failure Treated?
Heart failure can be treated and managed. If you follow your medicine, diet, and lifestyle program, you may improve your symptoms and prevent your heart failure from getting worse. It depends on you!
Vital aspects of heart failure management that may help keep you healthy
- Take your medicines as prescribed by your health care team.
- Eat a 2000 mg sodium, heart-healthy diet.
- Limit your daily fluid intake to 2 L(liters) or 2 quarts.
- Get regular exercise.
- Before you start, you should talk to your health care team about an exercise program. Discuss the ways you can activity level.
- Change your habits
- Weigh yourself daily
- Quit smoking
- Limit or avoid alcohol
- Keep track of your symptoms
- Avoid stress
Weigh Yourself Every Day
You should check daily for signs that your heart failure is getting worse.
You should:
- Weigh yourself. Do this at the same time each day. Always wear the same amount of clothing. Go to the rest room before weighing yourself.
- Look for swelling. Look at your legs, belly, feet and ankles.
You can gain weight before swelling or other symptoms are noticed. Many people can hold 8 to 15 extra pounds of fluid before swelling is noticed.
Weighing yourself and looking for swelling may seem hard to do. Keep in mind, your active input in the treatment plan is vital to achieve better health and control of your heart failure
Fluid Allowance
Fluids are any item that is liquid at room temperature. Keeping track of what you drink will help manage your heart failure.
These are foods or liquids that you should count as part of your fluid intake:
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Don’t Forget: If it wiggles, jiggles or melts at room temperature, it is a fluid!
Fluid Measurements
1 cup = 8 ounces
1 quart = 32 ounces = 1 liter
2 cups = 1 pound of water weight
Regular consumption of alcohol, beer, and wine are not recommended for patients with heart failure. Alcohol can damage the heart muscle further.
Other Tips
- Limit what you drink (your fluid intake) as you are told to by your health care team.
- For most people the allowance is 2 liters a day.
- Diuretics (water pills) can cause dry mouth, as can other drugs. These items may help with dry mouth symptoms.
- Use sugar free candy or gum instead of fluids
- Frozen grapes
- Use a moistening mouth wash, such as Oasis™
- Measure all your dishes, mugs, bowls and glasses to see how much they hold and label them.
- Use a 2 liter pitcher or soda bottle to keep track of your fluid. Fill each item that you drink from with water. Pour this into your bottle. When you reach your limit, you have spent your allowance for the day.
Salt Allowance
The words sodium and salt mean the same thing. Keep in mind that it is common to see either term used.
Keeping track of your salt intake is a vital part of the treatment for heart failure. You will need to limit the salt in your diet to 2000 mg (milligrams) per day. One teaspoon of table salt is 2300 mg. Too much salt causes the body to hold onto fluid. Excess fluid makes your heart work harder. Fluid can back up into your lungs. This can make you short of breath. It is the extra fluid that causes swelling in the feet, ankles, legs and stomach.
Tip: Divide up your salt intake for the day. For example, you may wish to designate 400mg for breakfast, 700mg for lunch, 700mg for dinner, and 200mg for snacks.
Nutrition
You should talk to a dietitian. Plan to discuss how you can choose foods that you enjoy eating and that are low in salt. To avoid extra salt:
- Read food labels. Any words that have “sodium” in it count as salt (i.e., monosodium glutamate).
- Do not use salt at the table or in cooking.
- Try other seasonings and herbs to add flavor to your food..
Foods to Avoid
- Processed meats and cheeses such as bacon, luncheon meats, hot dogs, bratwurst, and cottage cheese
- Convenience foods (frozen dinners, etc.)
- Gravy mixes, instant rice and noodle products
- Canned soups, canned vegetables, canned tomato products
- Salty snacks (chips, nachos, etc.)
Keep in mind many processed foods have hidden salt! You must read the label carefully.
Dining Out
- Limit going to fast food restaurants. They often serve foods that are very high in salt. For example,
- Chef salad may contain as much as 1919mg
- Hotcakes with margarine and syrup 1190mg
- Butter burger bacon deluxe 1855mg
- Hamburger single plain 500mg
- If there are times you have to dine out at a fast food place, try a side salad with a plain burger.
- Ask for sauces and dressing on the side
- Basic Rules for Eating Out:
- Do not be afraid to ask the wait staff for a special order: "No Salt".
- Keep portions small
- Do not cheat. Too much salt can mean a trip to the hospital for some people.
Keep in mind that “special occasions” do not happen each week!
Medicines Used To Treat Systolic Heart Failure
ACE Inhibitors ((Angiotensin Converting Enzyme Inhibitors) are very helpful for people with heart failure. They work by blocking the harmful effects of stress hormones and open up your arteries and veins. This makes it easier for your heart to pump the blood out to the rest of your body. Side effects can include lightheadedness or feeling dizzy. When you make a change in posture, such as standing up from a seated position, brief lightheadedness is common. To improve this, try doing ankle pumps (move your feet back and forth about 10 times) before you stand up. Examples of ACE inhibitors may include: Lisinopril®, Enalapril®, or Captopril®.
Beta Blockers are very effective for people with heart failure. Beta blockers "block" the effects of harmful stress hormones in your body that can make your heart work too hard. Some common side effects include feeling tired or dizzy or wheezy. Tell your heart failure nurse or provider of the side effects right away. Examples of beta blockers may include: Carvedilol® or Metoprolol Succinate®.
Diuretics (water pill) work by helping your body get rid of excess fluid. Less fluid in your body can make breathing easier and help you feel more comfortable. Along with getting rid of fluid, your body will get rid of minerals such as potassium and magnesium. Common side effects can include leg cramps or feeling dizzy or weak. It is important to check and replace potassium and magnesium if the blood levels are too low. It is helpful to weigh yourself daily and review your weight log with your heart failure nurse or provider. Examples of diuretics may include: bumetenide (Bumex®), furosemide (Lasix®) or torsemide (Demadex®)
Aldosterone Antagonists block the effect of aldosterone. This is a substance in the body that can further weaken the heart and affect the blood vessels. Some side effects can include high potassium levels, breast soreness, and breast enlargement in men. Examples of aldosterone antagonists include: Spironolactone®, Eplereonone®.
Digoxin has been used used in the treatment of heart failure for many years. Digoxin can make your heartbeat stronger and more regular. However, it is not used in all patients with heart failure. Some side effects may include nausea, blurred or colored vision, or an irregular heartbeat.
Angiotensin II Receptor Blockers (ARBs) are used to reduce the impact of some harmful hormones that can worsen heart failure. ARBs are used less often than ACE inhibitors and are most commonly used in people who can not tolerate ACE inhibitors. Some common side effects of ARBs include dizziness and an elevation of the potassium level in the blood. Examples of ARBs may include Valsartan®, Candesartan®, or Losartan®.
A Combination of Hydralazine and Isosorbide Dinitrate is used to help relax blood vessels. This eases the work of the heart when it pumps blood to the body. Often, this combination is used in people with kidney problems, in place of ACE inhibitors or ARBs. These medicines may also be used in addition to ACE inhibitors or ARBs in some people. Some side effects include dizziness, nausea, and vomiting. Talk with your heart failure nurse or provider if you notice these side effects.
Do NOT stop taking your medicines without talking to your health care team first! It can be dangerous to change or skip doses!
Medicines to avoid
- Drugs that contain ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or other non-steroid anti-inflammatory drugs
- Drugs that contain pseudoephedrine (Sudafed®); found in many cough and cold drugs
- Medicines with sodium in them such as antacids
- Calcium channel blockers such as nifedepine and diltiazem
- Most antiarrhythmia medicines (used to treat irregular heart rhythms)
Herbal supplements to avoid
- Items that contain ephedra (ma-huang), ephedrine metabolites, Chinese herbs, or hawthorne (cratageus) products.
- Garlic, ginseng, gingko and coenzyme Q-10 may interact with blood thinners.
If you are taking any supplements or over-the-counter drugs, please discuss these with your health care team. They may interact with your prescribed drugs.
Beware of claims about the benefits of herbals that seem too good to be true. Never take them in place of your regular medicines.
Stop Smoking
If you smoke or chew tobacco, now is the time to stop. Smoking makes your blood vessels clamp down. This causes your heart to work harder and in turn, it can make a weak heart become weaker Ask your health care team about methods for helping people quit smoking.
Be aware that on average, it takes about 6 tries to quit smoking before a person can truly kick the habit – but it can be done!
Ask us about different medicines/patches/gum to help you quit!
The Wisconsin Tobacco Quit Line (1-800 QUIT NOW) provides free confidential help to quit smoking or chewing tobacco.
American Cancer Society: www.cancer.org/healthy/StayAwayfromTobacco/GuideNational Institute of Health: www.smokefree.gov
American Lung Association: www.lungusa.org/stop-smoking
Centers for Disease Control: www.cdc.gov/tobacco/quit-smoking
Your Heart Care
This is a group effort. Your active role in this is key to good management of your heart disease.
It is vital to find a health care team that you:
- Feel comfortable with.
- See on a routine basis.
- Can talk to when your symptoms change.
Exercise
Spend a few minutes warming-up before you begin exercising. Slowly increase your rate of exertion.
Aerobic exercise tones and strengthens all muscles. This lowers the work your heart has to do when you are active. This is the best type of exercise for your heart condition. It should be done 5 to 7 days per week. Examples of aerobic exercise include walking, swimming, or bicycling.
When your health care team tells you that it is okay, light strength training is encouraged. You can lift up to a limit of 30 pounds. This helps with muscle building and toning without a large amount of strain on the heart. While strength training is not an aerobic exercise and does not improve the function of the heart, it may help you do better in daily life.
- Wear clothing that you can move in.
- Wear shoes that fit and have good support.
- Wait one hour after a meal. Do not exercise on an empty or full stomach.
- Avoid strenuous activity when it is very cold or very warm. Also avoid muggy or dusty conditions.
- Always warm up and cool down.
- Do not hold your breath when walking or doing any form of activity. Breathe slowly and regularly.
- Pick a time of day that works best for your schedule. This should be a time of day when you have the most energy.
- Exercise can be done in small, more frequent periods of time during the day. This is as beneficial as exercising once a day for a longer period of time.
Warning Signs to Stop Exercise
Stop what you are doing if you feel:
- Chest pain or pressure in your arms, shoulders, neck or jaw.
- Sick to your stomach or begin vomiting.
- Lightheaded or dizzy.
- Short of breath which prevents you from completing a sentence or that does not get better when you slow down or stop what you are doing.
- Joint or muscle pain.
- A pulse that is irregular for you.
If you have any of these symptoms, stop and rest. If they do not go away, call 911.
Many people with heart failure continue to work and lead active lives. If you take an active part in the management of your heart condition, you can help control symptoms and improve your quality of life.
- Take the heart medicines prescribed by your health care provider.
- Follow fluid and low sodium guidelines.
- Exercise.
- Tell your health care provider about swelling or weight gain early.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 03/18/2011
Copyright © 03/18/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6087
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