Congestive Heart Failure
The diagnosis of Heart Failure is done by a doctor or primary care provider.
Heart Failure
Heart failure is a condition in which the heart has trouble pumping blood. This means your heart does not pump blood efficiently for your body to work well. In some cases of heart failure, fluid may back up into your lungs or you may have swelling (edema) in your lower legs. Heart failure is usually a long-term (chronic) condition. It is important for you to take good care of yourself and follow your health care provider’s treatment plan.
Causes
Some health conditions can cause heart failure. Those health conditions include:
High blood pressure (hypertension). Hypertension causes the heart muscle to work harder than normal. When pressure in the blood vessels is high, the heart needs to pump (contract) with more force in order to circulate blood throughout the body. High blood pressure eventually causes the heart to become stiff and weak.
Coronary artery disease (CAD). CAD is the buildup of cholesterol and fat (plaque) in the arteries of the heart. The blockage in the arteries deprives the heart muscle of oxygen and blood. This can cause chest pain and may lead to a heart attack. High blood pressure can also contribute to CAD.
Abnormal heart valves. When the heart valves do not open and close properly, it can cause heart failure. This makes the heart muscle pump harder to keep blood flowing.
Heart muscle disease (cardiomyopathy or myocarditis). Heart muscle damage to the heart from a variety of causes. These can include drug or alcohol use, infections, or unknown reasons. These can cause a strain on the heart, leading it to fail.
Diabetes. Diabetes increases the risk of heart failure. High blood sugar contributes to high fat (lipid) levels in the blood. Diabetes can also cause slow damage to tiny blood vessels that carry important nutrients to the heart muscle. When the heart does not get enough oxygen and food, it can cause the heart to become weak and stiff. This leads to a heart that does not contract.
Other conditions can contribute to heart failure. These include abnormal heart rhythms, thyroid problems, and low blood counts (anemia).
Certain unhealthy behaviors can increase the risk of heart failure, including:
Being overweight
Smoking or chewing tobacco
Eating Foods high in fat and cholesterol
Abusing illicit drugs or alcohol
Lacking physical activity
Symptoms
Heart failure symptoms may vary can be hard to detect. Symptoms may include:
Shortness of breath with activity, such as climbing stairs.
Persistent cough
Swelling of the feet, ankles, legs, or abdomen
Unexplained weight loss
Difficulty breathing when lying flat (orthopnea).
Waking from sleep because of the need to sit up and get more air.
Rapid heartbeat
Fatigue and loss of energy
Feeling light-headed, dizzy, or close to fainting
Loss of appetite
Nausea
Increased urination during the night (nocturia).
Diagnosis
A diagnosis of heart failure is based on your history, symptoms, physical examination, and diagnostic tests. Diagnostic tests for heart failure may include:
Echocardiography
Electrocardiography
Chest X-ray
Blood tests
Exercise stress test
Cardiac angiography
Radionuclide scans
Treatment
Treatment is aimed at managing the symptoms of heart failure. Medications, behavioral changes, or surgical intervention may be necessary to treat heart failure.
Medicines to help treat heart failure may include:
Angiotensin-converting enzyme (ACE) inhibitors. This type of medicine blocks the effects of a blood protein called angiotensin-converting enzyme. Ace inhibitors relax (dilate) the blood vessels and help lower blood pressure.
Angiotensin receptor blockers (ARBs). This type of medicine blocks the actions of a blood protein called angiotensin. Angiotensin receptor blockers dilate the blood vessels and help lower blood pressure.
Water pills (diuretics). Diuretics cause the kidneys to remove salt and water from the blood. The extra fluid is removed through urination. This loss of extra fluid lowers the volume of blood the heart pumps.
Beta blockers. These medications prevent the heart from beating too fast and improve heart muscle strength.
Digitalis. This medication increases the force of the heartbeat.
Healthy behavior changes include:
Obtaining and maintaining a healthy weight.
Stop smoking or chewing tobacco.
Eating heart-healthy foods.
Limiting or avoiding alcohol
Stopping illicit drug use
Physical activity as directed by your doctor or primary care provider.
Surgical treatment for heart failure may include:
A procedure to open blocked arteries, repair damaged heart valves, or removed damaged heart muscle tissue.
A pacemaker to improve heart muscle function and control certain abnormal heart rhythms.
A left ventricular assist device (LVAD) to assist the pumping ability of the heart.
Home Care Instructions
Take medicines only as directed by your doctor or health care provider. Medicines are important in reducing the workload of your heart, slowing the progression of heart failure, and improving your symptoms.
Do not stop taking your medicine unless directed by your health care provider.
Do not skip any dose of medicine.
Refill your prescriptions before you run out of medicine. Your medicines are needed every day.
Engage in physical activity as directed by your primary health care provider. Moderate physical activity can benefit some. The elderly and people with severe heart failure should consult with their doctor or primary health care provider for physical activity recommendations.
Eat heart healthy foods. Food choices should be free of trans fats and low in saturated fat, cholesterol, and salt (sodium). Healthy choices include fresh or frozen fruits and vegetables, fish, lean meats, legumes
Fat-free or low dairy products, and whole grain or high fiber foods. Talk to a dietitian, your doctor, or primary health care provider to learn more about heart-healthy foods.
Limit sodium if directed by doctor or primary health care provider. Sodium restriction may reduce symptoms of heart failure in some people. Talk to a dietitian, your doctor or primary care provider, to learn more about heart healthy seasonings.
Use healthy cooking methods. Healthy cooking methods include roasting, grilling, boiling, broiling, baking, poaching, steaming, or stir frying. Talk to a dietitian about healthy cooking methods.
Limit fluids as directed by your doctor or primary care provider. Fluid restriction may reduce symptoms of heart failure in some people. • Weigh yourself every day. Daily weights are important in the early recognition of excess fluid. You should weigh yourself every morning after you urinate and before you eat breakfast. Wear the same amount of clothing each time you weigh yourself. Record your daily weight. Provide your doctor or primary care provider with your weight record.
Monitor and record your blood pressure as directed by your doctor or primary care provider.
Check your pulse as directed by your doctor or primary care provider.
Lose weight as directed by your doctor or primary care provider. Weight loss may reduce symptoms of heart failure in some people.
Stop smoking or chewing tobacco. Nicotine makes your heart work harder by causing your blood vessels to constrict. Do not use nicotine gum or patches before talking to your doctor or primary care provider.
Keep all follow-up visits as directed by your doctor or health care provider. This is very important.
Limit alcohol intake to no more than 1 drink per day for nonpregnant women and 2 drinks per day for men.
One drink equals 12 ounces of beer, 5 ounces of wine, or 1 ½ ounces of hard liquor. Drinking more that that is harmful to your heart. Tell your doctor or primary care provider if you drink several times a week. Talk with your doctor or primary care provider if you drink several times a week. Talk with your doctor or primary care provider about whether alcohol is safe for you. If your heart has already been damaged by alcohol or you have severe heart failure, drinking alcohol should be stopped completely.
Stop illicit drug use.
Stay up-to-date with immunizations. It is especially important to prevent respiratory infections through current pneumococcal and influenza immunizations.
Manage other health conditions such as hypertension, diabetes, thyroid disease, or abnormal heart rhythms as directed by your doctor or primary care provider.
Learn to manage stress.
Plan rest periods when fatigued.
Learn strategies to manage high temperatures. If the weather is extremely hot:
Avoid vigorous physical activity.
Use air conditioning or fans or seek a cooler location.
Wear loose fitting, light-wear, and light-colored clothing.
Avoid caffeine and alcohol.
Learn strategies to manage cold temperatures. If the weather is extremely cold:
Avoid vigorous physical activity.
Layer clothes
Wear mittens or gloves, a hat, and a scarf when going outside.
Avoid alcohol.
SEEK MEDICAL CARE IF:
If you have rapid weight gain.
You have increasing shortness of breath that is unusual for you (Call 911).
You are unable to participate in your usual physical activities.
You tire easily.
You cough more than normal, especially with physical activities.
You have any or more swelling in areas such as your hands, feet, ankles, or abdomen.
You are unable to sleep because it is hard to breathe.
You feel like your heart is beating fast (palpitations).
You become dizzy or light-headed upon standing up.
SEEK IMMEDIATE MEDICAL CARE IF:
You have difficulty breathing.
There is a change in mental status such as decreased alertness or difficulty with concentration.
You have a pain or discomfort in your chest.
You have an episode of fainting (syncope).
MAKE SURE YOU:
Understand these instructions.
Will watch your condition.
Will get help right away if you are not doing well or get worse.
TYPES OF HEART FAILURE
Blood is pumped from the body to the right side of the heart through the veins. The blood is then pumped to the lungs to pick up oxygen, and travels to the left side of the heart. The left side of the heart is then responsible for pumping the oxygen-rich blood back to the body through the arteries. Heart failure can occur
due to a pumping weakness that can start in your right or left side of the heart but can eventually lead to weakness or failure on both sides.
RIGHT-SIDED HEART FAILURE
When there is a pumping problem in the right side of the heart, blood backs up into veins, Initially, veins can stretch to hold the extra blood volume, but over time it will start pooling in the legs and ankles. You may notice in swelling these areas, as well as the upper right side of the abdomen.
LEFT-SIDED HEART FAILURE
When there is a pumping problem in the left side of the heart, blood backs up into the lungs. This will cause shortness of breath, trouble breathing when lying flat, and a dry hacking cough.
HEART HEALTH RECOMMENDATIONS
EAT PLENTY OF FRUITS, VEGETABLES, AND WHOLE GRAINS
Fruits, vegetables, and whole grains contain antioxidants photochemical, vitamins, and minerals. All of these will help you stay healthy and prevent disease. These foods are also rich in fiber, which helps your digestive tract stay healthy, and helps your cholesterol to stay under control.
Eat at least 5 servings of whole fruits and vegetables every day.
Choose fresh produce in a variety of colors for greatest health benefits.
Limit refined and processed foods such as white breads and crackers, white rice, sugar, and potato chips.
INCREASE YOUR PHYSICAL ACTIVITY
Being active will help with weight loss and reduce your risk of heart disease. If you are overweight, losing 10% of your body weight can lower your cholesterol and blood pressure. To get started, see your doctor or primary provider to set a goal and make exercise a priority each day. You can use a pedometer to measure your daily steps.
LIMIT BAD FATS (SATURATED FATS)
Saturated fats and trans-fatty acids are called “bad fats” because they can increase cholesterol, which can clog arteries. Trans-fatty acids are found in processed foods. It is best to avoid these fats, so always check the labels for trans
Fats. Saturated fats are found in animal products such as meat and dairy. Limit saturated fats to no more than 7% of your daily calorie intake. If you eat:
1200 calories a day, limit your intake to 9 grams of saturated fat.
1500 calories a day, limit your intake to 11.5 grams of saturated fat.
2000 calories a day, limit your intake to 15 grams of saturated fat.
EAT GOOD FATS: HEALTHY FAT TIPS
Omega-3 fatty acids help lower your LDL cholesterol and raise your good HDL cholesterol. Omega-3 fats are found in fish, flax seeds, walnuts, and other foods. Eat 2 servings offish or fish oil a week. If you have heart disease, then 1 gram is advised. If your cholesterol is high, then 2-4 grams daily is recommended. Replace butter, margarine, and shortening with oils such as olive and canola oil. These oils contain mono and polyunsaturated fats.
HEART HEALTH RECOMMENDATIONS
EAT PLENTY OF FRUITS, VEGETABLES, AND WHOLE GRAINS
Fruits, vegetables, and whole grains contain antioxidants photochemical, vitamins, and minerals. All of these will help you stay healthy and prevent.
FOOD SOURCES OF FATS
Fat Content in One Serving of Food
Omega-3 Fats Saturated Fats Trans Fat
Flaxseed (3.5g) Butter (7g) French Fries (8g)
Walnuts (2.3g) Cheese (6g) Doughnut (5g)
Salmon (2.1g) Ground Beef (4.5g) Cake (4.5g)
Trout (1.7 to 2g) Pork Loin (4g) Shortening (4g)
Soybeans (1.1g) Milk 2% (3g) Crackers (3g)
Fish Oil Supplement (1.1g) Doughnut (2.5g) Margarine (3g)
Chicken Breast (1.5g) Potato Chips (3g)
Candy Bar (3g)
LIMIT ADDED SUGARS AND SODIUM (SALT)
Reduce sodium to 1,500 mg daily to help lower your blood pressure. Remember to read food labels; sodium (salt) is high in processed foods such as frozen dinners or canned items.
Sugar products like candy, soda, and bakery items add a lot of calories and no nutrients to your diet. They can increase your triglycerides and lower your HDL, since your body turns extra sugar into fats.
HEART HEALTHY DIET
Daily sodium intake of 1500 mg is recommended for people with heart disease. Most foods contain some amount of sodium, including processed foods. Added salt is the main source of sodium in our diets.
Recommendations for a low salt diet:
Do not add salt when you prepare food.
Do not add salt to after it’s prepared.
Do not use salt substitutes.
Use herbs and spices for flavoring.
Reading food labels:
Labels that state “lite” or “light” may be misleading. These words only mean the product has less of a certain ingredient compared to the regular product. “Lite Salt” contains less sodium than regular table salt but is still high in sodium. In fact, it is not allowed on a sodium-restricted diet.
Other products to avoid:
Alkalizer tablets or powder such as seltzer or bicarbonate of soda (baking soda).
Cough medicines
Laxatives
Mineral waters
Pain relievers and sedatives
SPICES TO ADD TO YOUR FOOD
Herb Spice Add to...
Fennel Seed Bread, cookies, apples, pork, eggs, fish, beets, cabbage, cheese
Garlic Salads, soups, meat, poultry, bread butter
Ginger Fruit, vegetables, baked goods, meat, fish, poultry
Horseradish Meat, vegetables, butter, margarine
Lemon or Lime Juice Vegetables, fruit, baked goods, fish, tea
Mace Baked goods, fruit, vegetables, poultry
Mint Lamb, vegetables, carrots, cabbage, some desserts, sherbet, tea
Mustard Cheese, eggs, meat, vegetables, poultry
Nutmeg Baked goods, fruit, chicken, eggs, vegetables, winter squash
Onion Powder Meat, fish, poultry, soup, vegetables, eggs, bread, rice, salads
Oregano Pasta, eggs, cheese, onions, pork, lamb, fish, chicken, vegetables, salads
Paprika Meat, fish, poultry, eggs, cheese, vegetables
Pepper Meat, fish, poultry, eggs, vegetables
Poultry Seasoning Poultry, veal
Rosemary Lamb, poultry, meat, fish, vegetables eggs, bread
Sage Meat, fish, poultry, eggplant
Tarragon Meat, fish, poultry, vegetables
Thyme Meat, fish, poultry, vegetables
Vinegar Salads, cooked vegetables
COOKING WITHOUT SALT
Here are simple tips for added flavor:
Add lemon juice or vinegar to cooked vegetables.
Mix seasonings with unsalted butter, margarine, or oil to put on the food before serving.
Add whole spices at the beginning and add ground spices before the end of cooking.
SPICES/HERBS AS SALT SUBSTITUTES
Spice/Herb Add to...
Allspice Meat, fish, eggs, fruit, peas
Anise seed Sweet Breads, fruit, carrots
Basil Meat, fish, eggs, vegetables, rice, salads
Bay leaf Meat, fish, stews, beans
Caraway Bread, cottage cheese, meat, vegetables
Cardamon Baked foods, fruits, soups
Chili powder Meatloaf, chicken, cheese corn, eggplant, eggs
Chives Salads, cottage cheese, egg dishes
Cinnamon Baked goods, fruit, pork, lamb, chicken, carrots
Cloves Fruit, baked goods, fish, pot roast, green beans, beets, carrots
Coriander Pastry, cookies, meat, salads, cheese
Cumin Grains, beans, meatloaf fish, cheese, eggs, cabbage, fruit pie
Curry powder Meat, lentils, cottage cheese, poultry, vegetables, fish, salad bread
UNDERSTANDING FOOD LABELS
Word Meaning
Unsalted No salt added during process
Reduced sodium At least 75% less sodium than the food normally has
Low sodium 140 mg of sodium or less per serving
Very low sodium 35 mg of sodium
Sodium free Less than 5 mg of sodium per serving
FOODS TO EAT AND AVOID ON A LOW-SALT DIET
Beverages
Allowed: Mild (if allowed by MD), tea, coffee, fruit juices
Avoid: Vegetables juices that contain salt
Breads
Allowed: Bread and rolls prepared without salt, baking soda, unsalted crackers, Holland Rusk, and zwieback toast
Avoid: Bread rolls and breads that contain salt, baking powder, or baking soda; salted crackers and graham crackers
Cereals
Allowed: Unsalted cooked cereals, regular puffed wheat, puffed rice, shredded wheat, other low sodium dry cereals
Avoid: Any instant and quick cream of wheat, farina, hominy grits
Cheese
Allowed: Low sodium cheese, low sodium cottage cheese
Avoid: All other cheeses
Desserts (1 daily)
Allowed: Ice cream, sherbet, pudding, gelatin, low sodium baked goods
Avoid: Instant pudding and other desserts made with salt, baking powder, or baking soda
Fat
Allowed: Unsalted fats, butter, margarine, commercial salted salad dressings
Avoid: Regular butter and margarine, commercial salad dressings, mayonnaise, bacon drippings, and regular peanut butter
Meats, fish, poultry, eggs
Allowed: Fresh, or frozen meat, poultry, or fish without added salt or seasoning mixtures that contain sodium; fresh oysters, clams, and shrimp
Avoid: Meat, fish, or poultry with added salt or seasoning mixtures that contain sodium. Smoked and salt cured meats, such as ham, bacon, hot dogs, sausage, and cold cuts. Frozen fish with added salt, canned tuna, salmon, and other canned fish
Fruits
Allowed: Fresh, frozen, and canned fruits and fruit juices
Avoid: Dried fruits preserved with sodium. Limit to ½ cup per day
Milk
Allowed: Evaporated, skim, whole, 2%, chocolate, and cocoa made from a low-sodium mix
Avoid: Cultured buttermilk, malted and condensed milk mixes.
Other foods
Allowed: Sugar, syrup, jelly, jam, marmalade, maple syrup, honey, hard candy, spices, and herb included in this list; lemon juice, vinegar, unsalted nuts, cocoa powder, unsalted ketchup, and unsalted mustard
Avoid: Molasses, candy with added salt or sodium compounds, salt-based spices, pickles, relish, olives, salted nuts and popcorn, ketchup, mustard, prepared sauces and gravies, artificial sweeteners that contain sodium, and chewing
tobacco
Starches
Allowed: Fresh, frozen, and canned white or sweet potatoes without added salt or seasoning mixtures that contain sodium; rice, macaroni, spaghetti, and noodles
Avoid: Potato chips, corn chips with salt or added sodium compounds, salted shoestring potatoes, and frozen potato, products with salt or salt seasoning mixtures that contain salt.
Soups
Allowed: Low-sodium broth or soup made with allowed milk and vegetables
Avoid: All commercial broth soup, bouillon, or consommé (powdered, canned, or frozen)
Vegetables (no more than 1 serving a day of beets carrots, spinach, or celery)
Allowed: Fresh, frozen, or canned vegetables and vegetables juices without added salt or seasoning mixtures that contain sodium
Avoid: Canned vegetables and vegetable juices that are canned with salt, frozen peas and lima beans, tomato puree, sauerkraut, and tomato juice
FLUID RESTRICTION GUIDELINES
Your doctor has placed you on a fluid-restricted diet. It is recommended that you have 1500 ml of fluid in a 24-hour period. This is the equivalent to approximately 6 cups (240 ml each cup).
It is important that you know that some foods contain fluids. Thy may not seem like liquid, but you must count them as part of your fluid intake for the following reasons:
They are liquid at room temperature.
A liquid is the main ingredient in the food.
A food that naturally contains a lot of liquid.
Examples:
Cooked cereal
Custard
Gelatin (Jell-O)
Ice and ice chips
Milkshakes
Most fruits and some vegetables
Popsicles
Pudding
Sauces and gravies
Soup and broth
Yogurt
MEASURING FLUIDS
The amount of fluid you are allowed to have in a 24 period is measured in milliliters (ml). Please use this table to help you better understand measurements:
MEASURING FLUIDS
The amount of fluid you are allowed to have in a 24 period is measured in milliliters (ml). Please use this table to help you better understand measurements:
Volume in ml Equals Equals
15 ml 3 teaspoons 1 tablespoon
30 ml 1 fluid ounce 2 tablespoons
120 ml ½ cup 4 ounces
180 ml ¾ cup 6 ounces
240 ml 1 cup 8 ounces
500 ml 2 cups 16 ounces
960 ml 4 cups 32 ounces
1200 ml (1.2L) 5 cups 40 ounces
1500 ml (1.5L) 6 ¼ cups 50 ounces
2000ml (2L) 8 ¾ cups 67 ounces
TIPS FOR FLUID CONTROL
Use a measuring cup to measure the amount of fluid that your regular cups and glasses hold. This will help you plan and court your fluids for the day.
Be sure to include the liquid you will use for taking your medications, or for sips of water in between meals.
Keep a “liquid log” (do not guess or estimate).
Drain all fluids from the canned fruits and vegetables before you eat them, so the juices do not count towards your fluid allowance.
Avoid salty foods as they can make you thirstier.
Drink only when you’re thirsty.
If your mouth is dry, try:
Sucking on a lemon wedge, ice cubes, or hard candy.
Chewing gum
Rinsing your mouth with water but do not swallow the water. Here is a table to help you better understand foods that contain fluid:
Here is a table to help you better understand foods that contain fluid:
Cooked cereal, Jell-O, ice cream, pudding, sherbet, soup, yogurt ¼ cup (4 ounces) 120 ml (4 ounces)
Fruit ice chips 1 cup 120 ml (4 ounces)
Popsicle 1 count 90 ml (3 ounces)
Soda 12 ounces 360 ml (12 ounces)
Milkshake 16 ounces 480 ml (16 ounces)