Penn Medicine: A Stronger Pump CHF Guide
Contents
1. 38 m severe lung disease 38 m severe anemia 0000 00 00 39 m overactive thyroid 39 m abnormal heart rhythm 39 m over use of alcohol 39 Note Heart failure can also occur in adults who were born with a heart defect including some of those who had a surgical repair See page 40 and inside back cover coronary heart disease Coronary heart disease CHD is a buildup of cholesterol and fatty deposits in the arteries that supply Ways to prevent CHD the heart muscle with blood and oxygen As these arteries become clogged less blood reaches the Control blood heart muscle cholesterol levels Do not smoke Control blood pressure One or more heart attacks can Keep a healthy weight damage the heart muscle When large Exercise regularly areas of the heart are damaged the Control blood sugar heart does not pump like it should The for diabetes healthy areas of the heart work harder to Reduce stress levels try and pump all the blood that is needed Over time the heart chambers stretch dilate and the heart muscle gets larger hypertrophy This is called cardiac remodeling and can lead to heart failure Studies continue to find ways to slow or prevent this healthy muscle blockage Causes damage to heart large damaged 4 areas heart attack ne do not help pump remaining healthy muscle tries to do a2. leit heart failure When the left side of your heart does not pump out all the blood it gets fluid backs up into your lungs You may feel short of breath have trouble sleeping if you do not prop up on pillows m have a dry hacking cough m wake up feeling out of breath You may also feel swollen or bloated This is because your body is holding too much fluid This adds to your heart s workload Your weak heart has to pump all of this extra fluid along with the blood Why your body holds fluid A weak heart sends less blood to the kidneys The kidneys think the body doesnt have enough blood So instead of passing it out in the urine the kidneys keep this water and salt in the blood A sudden weight gain is one sign the kidneys are holding salt and water in your body To check for this weigh each morning after you urinate and before eating or getting dressed Write down your weight Each time you weigh make sure your scale is set on a hard surface not carpet and adjusted to zero When checking your weight think about how well you are eating If you are eating less and losing pounds you may not notice a gain from fluid a Ifyou gain 3 4 lbs in 1 to 2 days of normal eating or 2 lbs overnight it is more likely due to fluid rather than food Call your doctor for advice to Check get rid of this extra fluid before it Weight weakens your heart more Often you D Daily need more diuret
3. Low sodium foods what you CAN eat fruits and vegetables Y fresh or frozen check for sodium Y Y canned unsalted drinks Y fruit juices fresh or frozen canned low sodium or no salt added tomato and vegetable juice Y instant breakfast all flavors but eggnog limit to 1 cup day Y frozen concentrate or fresh lemonade dairy choices Y upto 3 cups a day of liquid or dry milk 1 or skim or homemade buttermilk using baking buttermilk powder Y no salt added cottage cheese Y ricotta part skim up to 4 cup a day Y upto 1 oz a day hard cheeses like unprocessed Swiss part skim Mozzarella Neufchatel or string Y soft margarine or mayonnaise up to 2 Tbsp a day non fat and low fat sour cream meats poultry fish amp meat substitutes Y fish fresh or frozen not breaded canned tuna and salmon unsalted or rinsed Y chicken or turkey not processed in salt solution Y lean cuts of beef veal pork lamb Y dried beans peas lentils not canned unless low sodium Y nuts or seeds unsalted dry roasted Y unsalted peanut butter up to 2 Tbsp a day Y tofu soybean curd breads cereals grains Y loaf bread and yeast rolls 3 slices day Y Y melba toast matzo crackers Y pita bread taco shells or corn tortillas Y cooked cereals avoid instant corn grits farina regular oatmeal oat bran cream of rice or wheat Y puffed rice or wheat shredded wheat or any cereal with 100
4. bridge to transplantation Research continues to find ways to help a damaged heart heal itself gene therapy and or stem cell injections m wrap or reshape heart chambers and m perfect a mechanical device that will fully support heart function Controlling symptoms and stress of a serious illness can be difficult If your doctor suggests palliative care you can get help with symptom management anxiety constipation diarrhea or nausea difficulty breathing sleeping or eating making difficult health decisions and finding community resources that can help you at home A palliative care team often includes a doctor nurse social worker and or chaplain All can consult with your primary heart failure doctor as needed 21 YOUR ROLE IN HEART FAILURE CONTROL 22 our role in heart failure control step 1 take your medicines exactly as prescribed Have a written schedule and a pill box or another way to remember your medicine Report any side effects to your doctor dizziness loss of appetite nausea or changes in mental or sexual function Do not stop taking any of your medicine on your own Take your diuretic in the morning to limit bathroom trips at night If you take a diuretic twice a day ask your doctor about spacing the second dose in the late afternoon Ifyou miss a dose dont take extra to make up for it But if you forget your diuretic in the morning take it later in the da
5. This book tells you about Heart failure How you may feel Heart failure testing Medical treatment Assist device VAD Heart transplant Your role in heart failure control In summary Causes of heart failure Congenital heart disease H PRITCHETT amp HULL ASSOCIATES INC STE 110 3440 OAKCLIFF RD NE ATLANTA GA 30340 3006 1 800 241 4925 2012 Edition Copyright 1980 1986 1992 1994 2000 2004 2007 2009 2011 by Pritchett amp Hull Associates Inc No part of this book may be photocopied reprinted or otherwise reproduced without written permission from Pritchett amp Hull Associates Inc This book can help you understand a guide for people heart failure and how to manage it with all types of If you still have questions after Heart Failure reading it ask your doctor If you just found out that you have heart failure you may feel scared and alone But youre not There are nearly 6 million Americans with this chronic disease by Julia Ann Purcell RN MN FAAN Barbara J Fletcher RN MN FAAN Make sure that you share this book with your loved ones The more you and your loved ones know about your heart failure the better you can manage it and the better your chances for living a longer fuller life This book offers guidelines that can help your heart become a more efficient pump The book is not designed to replace your doctor s advice or treatment eart f
6. salt make the body hold fluid eat less of them The average American takes in between 4 000 10 000 mg of sodium per day It s easy to see why since one teaspoon of table salt has about 2 300 mg of sodium Learn about packaged foods and certain spices that are high in sodium Some people with heart failure do well on 2 400 3 000 mg of sodium a day but most must limit sodium to less than 2 000 mg a day to control it Many people with heart failure have trouble with their body holding fluid Being very thirsty is also common because diuretics take away the extra fluid Even if you are thirsty DO NOT replace all the fluid that diuretics have helped your body get rid of Use small amounts of hard sugar free candy to help with a dry mouth Your doctor may tell you to have no more than 2 quarts 64 ounces of fluid per day or less in some cases This includes all beverages high moisture foods fruits Jell O ice cream and ice cubes see page 28 Following your doctor s advice about sodium and fluids can help you control heart failure and take lower doses of diuretics The 2010 Dietary Guidelines for Americans advise a daily sodium intake of 1 500 mg for all persons who are 51 and older all persons with hypertension diabetes or chronic kidney disease as well as all African Americans This sodium intake of 1 500 mg day less than teaspoon applies to about half of the U S population including children and the majority
7. 150 mg sodium limit to 1 cup day Y wheat germ Y popcorn no salt or fat added Y rice enriched white or brown or pasta cooking ingredients seasonings Y corn starch tapioca Y corn meal or flour not self rising Y fresh or dried herbs salt free herb seasonings Y lemons limes onions celery etc Y fresh garlic ginger or vinegar Y Louisiana type hot sauce 1 tsp day Y low sodium baking powder yeast onion or garlic powder Y tomato paste unsalted tomatoes unsalted tomato sauce Y water chestnuts Y carob powder cocoa powder Y low sodium salad dressings sweets Y flavored gelatins Y frozen juice bars fruit ice sorbet sherbet Y sugar honey molasses syrup Y jelly jams preserves apple butter Y graham and animal crackers fig bars ginger snaps Using homemade breads no self rising flour can reduce sodium intake further Read food labels Until you learn how to eat a low sodium diet add up the sodium content on all the foods and beverages you eat in a day Be sure it is less than your doctor has advised Tips to help you Buy products labeled low sodium sodium free or very low sodium Nutrition Facts At present a low sodium food Serving Size 1 hotdog link 57 grams Servings Per Container 8 label means 140 mg of sodium or less per serving size Amount Per Serving Calories 170 Calories from Fat 140 Daily Value Always figure the sodium Total Fat 16g 25 content
8. for the amount you pee Trans Fat Og plan to eat even if you see Cholesterol 45mg 15 healthy reduced sodium Sodium 480mg 20 is Total Carbohydrate lt ig 0 unsalted no salt added Pounce e a a or without added salt food TEF Vitamin C 20 Iron 6 labels Sometimes the food Calcium 6 label shows the sodium mg for Percent Daily Values are based on a 2 000 calorie diet Your daily values may be higher only a tny amount of food rather or lower depending on your calorie needs than a common serving size Calories 2000 2500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Spread out your sodium in healthy Sodium Lessthan 2 400mg_ _ 2 400mg Total Carbohydrate 300g 375g foods that are filling For example ERE 259 W choose a low sodium home cooked ne aie 1 g Protein 4 calories meat sandwich over a pickle since the sandwich will keep you feeling full the longest Studies show that 75 80 of our daily sodium intake comes from processed and restaurant foods When you eat out ask for help in choosing low sodium foods Almost all fast food is high in salt Dont buy convenience foods like prepared or skillet dinners deli food cold cuts hot dogs most frozen entrees or canned soups 27 TOULNO J 34 N1IiV LUVJH N 310 YNOA YOUR ROLE IN HEART FAILURE CONTROL High sodium foods what NOT to eat vegetables X salted canned vegetabl
9. new damage when there is severe narrowing in One or more arteries cardiac electrical devices Your doctor will let you know if your heart failure can be improved with a cardiac electrical device This could include a biventricular pacemaker to correct an electrical delay and or an ICD to help stop a life threatening heart rhythm Often heart failure patients need a device that works as both a pacemaker and an ICD Biventricular pacemaker crrT Some heart failure patients have an electrical delay in their heart muscle contractions This delay may mean the heart chambers do not beat when they should If you have this delay a biventricular pacemaker can correct it so the chambers can beat in normal sequence This may improve your heart failure symptoms and give you more energy Biventricular pacing is also known as cardiac resynchronization therapy CRT Internal Cardioverter Defibrillator ICD An ICD is used to stop life threatening heart rhythms The device can tell when these rhythms occur Within seconds it can deliver a shock and try to stop the rhythm Recent studies have shown that an ICD can help someone with heart failure who is at risk for a life threatening heart rhythm Most ICDs can also pace your heart to help keep a normal rhythm A few precautions are advised if you have a cardiac device Large electromagnetic fields must be avoided especially if you have an ICD More information is av
10. of a blood clot aspirin an anti platelet drug or a blood thinner like Coumadin warfarin or dabigatran Pradaxa Regular blood work protime INR is needed to regulate the dosage of Coumadin A drug anti arrhythmic may also be needed to prevent the rapid heart rate seen with atrial fibrillation 31 IOULNOD 34N1IiV LUVAH NI J1IOY YNOA n summary You have the most important role in managing your heart failure But having a partner who supports you and seeing a cardiologist or nurse practitioner who specializes in heart failure can also be helpful Write down what you are told for home care in the space provided Take your heart failure medicines exactly as prescribed Keep a medicine chart Note any directions on your first prescription bottle for a gradual dose increase How often Weigh daily Use the same scale clothing and weigh at the same time of day Keep a written record Call your doctor if you have rapid weight gain __2 3lbs overnightor ____ 3 4 lbs in 1 2 daysor __ siibsin__ days Limit fluid ___ 2 quarts day 64 oz or as your MD directs _____quarts day Limit salt intake ___ 1500 mg day __ 2000 mg day __ 2300 mg day Other diet advice Find the right balance in exercise and rest Ask your doctor about these Examples _ walking _ swimming __ bicycling _ treadmill or_ 32 Reduce demands on your heart by not smoking controlling high blood pressure or diabetes and m ge
11. substitutes or sodium free bouillon often high in NOTE Check with your doctor before using salt potassium substitutes or sodium free bouillon Most have a lot of potassium and in some people too much potassium can be dangerous Remember diuretics send extra body fluid out in the urine often washing out potassium at the same time Regular blood tests for potassium are needed to see if you need to eat more high potassium foods or if you should avoid those foods Do what your doctor tells you to keep your potassium within healthy levels 13 14 ACE inhibitors or ARBs ACE inhibitors Angiotensin converting enzyme ACE inhibitors are used to treat heart failure These drugs limit the amount of angiotensin a substance your body makes to tighten the arteries They offer long term benefits that help improve symptoms keep heart failure from Vasotec enalapril getting worse and prolong life Capoten captopril When you begin taking an ACE inhibitor you ma Prinivil 8 8 Pi y Zestril feel weak dizzy or have a cough that seems to hang on lisinopril Tell your doctor about any of these so a dosage or drug change can be made Non steroidal anti inflammatory drugs NSAIDs interfere Accupril with the benefits of ACE inhibitors and can worsen symptoms quinapril of heart failure by causing fluid retention Talk with your doctor pene before you take any NSAIDs even over the counter ones like Mo
12. up breathless at night frequent dry hacking cough most often when lying down loss of appetite or nausea You may also get tired from very little effort This happens when your blood flow is sluggish You may wake up feeling tired or get drowsy in the afternoon This is even more likely if you arent breathing well when you sleep Your family may notice snoring or louder snoring than before Many of these symptoms happen for other reasons too So your doctor will check your heart and lungs and if needed order a blood test and or a sleep study to help find out the cause BNP brain or b type natriuretic peptide or NT proBNP When the heart is pumping well blood goes from the veins to the right side of your heart and is pumped to your lungs for more oxygen Then the blood goes to the left side of your heart and is pumped out through the main artery aorta to your body If your heart failure is due to pumping weakness it may start in the right or left side of your heart but soon both left and right chambers are strained right heart failure When the right side of your heart has a pumping problem blood backs up in your veins You may not notice it since veins can stretch and hold the extra blood Days or maybe weeks later you may notice that your legs and ankles are swollen You may also feel sore or swollen in the upper right side of your belly And you may feel tired and not want to eat if
13. a heart valve is needed Other times a catheter procedure is done to help open a tight valve Heart muscle j weakens from the work of extra pumping severe lung disease blood from body Severe lung disease adds to the work of the heart If you have a chronic lung disease treatment for it is very important As your breathing improves it is easier for the heart to pump blood to your lungs and body pulmonary artery blood backs up right ventricle has trouble pumping blood into pies pulmonary artery deene severe anemia too few red blood cells Severe anemia means not having enough red blood cells to carry oxygen The heart tries to move the small number of red blood cells at a faster rate It can become very tired from this effort Taking iron tablets and getting more red blood cells may allow the heart to slow down and return ANEMIA to the normal pumping effort blood vessel overactive thyroid An overactive thyroid gland causes the body to work at a fast pace Over time the heart can thyroid have trouble keeping up Once the thyroid hormone is down to normal levels the heart is likely to pump at a normal speed abnormal heart rhythm An abnormal heart rhythm arrhythmia refers to the heart beating either too fast or too slow In either case the heart may not be able to pump enough blood for all of the body Sometimes strain or heart failure may occur over use of alcoh
14. ailable on the device maker s website and the Pritchett amp Hull booklet You Have a Pacemaker and or ICD All cardiac devices require regular follow up Often wireless technology and or phone lines allow you to send device readings from home to a secure internet server for your doctor or clinic to review Your doctor is notified right away of important changes Sometimes weight and blood pressure readings are also sent through the home monitoring system Your healthcare provider can see changes in your readings and may be able to adjust your medication before you have major symptoms or need a hospital stay 19 20 VAD ventricular assist device A ventricular assist device VAD refers to a small pump placed in the chest to boost blood flow from a lower heart chamber to a large body artery Newer VADS are smaller and often allow living at home with family support VAD patients often have more energy fewer medications and an improved quality of life A VAD implanted for long term use is called destination therapy All of today s VAD pumps have a drive line tubing that comes through the skin and connects to an outside VAD controller brains Cables from the controller lead to either battery or AC power During the day the batteries and VAD controller are placed in the pockets of a VAD vest worn over clothing At night the patient and family disconnect the battery cables and plug them into the AC powered VAD beds
15. ailure A healthy heart pumps out enough oxygen rich blood to feed all parts of the body When your heart can no longer do that you have heart failure Blood backs up into your lungs and other parts of your body This causes symptoms such as shortness of breath or swelling in the belly hands legs and feet Heart failure or congestive heart failure CHP can range from mild more common to severe There are many factors involved m the cause of your heart problem m the way heart pumping filling are affected how your body reacts to it m any extra demands on your heart like being overweight or having high blood pressure Most often your heart failure symptoms can be controlled with medicines diet and finding the right balance between rest and low level exercise With early detection and treatment there is a good chance you will lead a more normal life Your heart failure symptoms may come and go or in a few cases go away completely ow you may feel As heart failure gets worse you may notice some or all of these sudden weight gain 3 4 lbs in 1 to 2 days or 2 lbs overnight swelling of the legs and ankles swelling bloating making you feel full much earlier at meals or pain in the belly trouble sleeping unless propped up on 2 or more pillows may also be caused by problems other than heart failure shortness of breath may be all of the time with exertion or only when waking
16. amples of these aldosterone blocker diuretics Unlike most other diuretics aldosterone blocker diuretics are potassium sparing Taking a potassium sparing diuretic may mean taking fewer potassium supplements or none in some cases Blood tests to monitor potassium are needed especially after the first 7 days of taking a potassium sparing diuretic Blood tests also show if kidney function changes over time This can happen with heart failure causing you to need less potassium Some people with heart failure do not need any extra potassium They are told to avoid salt substitutes and sodium free bouillon Example Herb Ox or Wylers since both are high in potassium Males who get breast tenderness while taking an aldosterone blocker diuretic should tell their doctor Often a different potassium sparing diuretic can be used without this side effect High potassium foods dried fruits raisins prunes apricots dates fresh fruits bananas strawberries watermelon cantaloupe oranges grapefruit kiwi nectarines gt Oo 40 fresh vegetables avocados potatoes broccoli greens spinach peas tomatoes mushrooms dried vegetables beans peas fresh meats turkey fish beef fresh juices orange grapefruit canned juices grapefruit prune apricot NOTE Avoid canned juices like tomato and V 8 that contain salt Read all labels for salt sodium or sodium compounds or NaCl as salt is often written salt
17. blood against the high pressures in the aorta Tetralogy of Fallot TOF TOF refers to 4 heart defects The aorta opens to both of the lower heart chambers above a large hole called a ventricular septal defect or VSD underdeveloped pulmonary artery aorta hole between lower chambers VSD In addition there is narrowing under or at the pulmonary valve pulmonary stenosis and thickening enlargement of the right narrow openin lower chamber p J stenosis Single ventricle univentricular heart Single ventricle means there is one ventricle lower heart chamber instead of two separate chambers This means a large amount of blood is pumped into the lungs This can damage the blood vessels in the lungs and the heart valves can also be affected holes between chambers missing septum narrow pulmonary valve BEST HOSPITALS x OWS NATIONAL CARDIOLOGY amp HEART SURGERY a Hospital of the University of Pennsylvania Penn Presbyterian Medical Center Pennsylvania Hospital Penn Medicine 800 789 PENN PennMedicine org 31864 2500 4 12
18. d up 3 4 lb weight gain in 1 2 days or 2 Ibs overnight If you have fluid build up take action Call your doctor right away for advice to reduce your heart s workload If you have fluid build up often you may be told to take an extra diuretic tablet This weight chart shows one heart failure patient s success following his doctor s advice to take an extra Lasix for rapid weight gain example DATE WEIGHT DIURETIC TAKEN 11 6 152 Ibs 1 Lasix furosemide tablet 11 7 156 Ibs 2 Lasix furosemide tablets 11 8 151 Ibs 1 Lasix furosemide tablet Always follow your doctor s advice about diuretics Taking too much diuretic on your own can cause serious and even life threatening problems If you are urinating a lot but still holding fluid eat less salt Il 12 potassium supplements Aldactone spironolactone Inspra eplerenone potassium sparing diuretics Your body needs potassium Your heart needs normal blood potassium K for your heart rhythm Many diuretics cause a loss of potassium in the urine Often food alone can t replace the amount of potassium removed by the diuretic A blood test is used to see if potassium supplements are needed Most people who need supplements take them with their meals Some diuretics also block a stress hormone called aldosterone Blocking this hormone helps avoid heart failure getting more severe Spironolactone Aldactone and eplerenone Inspra are ex
19. eartbeat or dizziness may occur These side effects often stop and do not prevent long term use of a beta blocker carvedilol Beta and Alpha blocker Taking an ACE inhibitor or beta blocker improves heart failure over time i e months and years Studies show that people with a weak heart muscle ejection fraction lt 40 will live longer if they take an ACE inhibitor as well as a beta blocker Low doses are often used at first with slow increases every 2 to 4 weeks to get the most benefit with the least side effects 16 digoxin Digoxin Lanoxin may be helpful in some people with weak heart pumping If you still have symptoms after taking diuretics an ACE inhibitor or ARB and a beta blocker digoxin may be used Digoxin blocks an enzyme in the cardiac cells so the heart muscle may respond by pumping harder Digoxin can also be used for irregular heart rhythms such as atrial fibrillation Sometimes digoxin builds up too much in the body This can cause one or more of these loss of appetite distaste for food or a bad taste in the mouth ee e nausea or vomiting ne igoxin blue or yellow vision skipped heartbeats palpitations or rapid beating If any of these occur tell your doctor right away Too much digoxin can cause other heart rhythm problems Be sure to take it only as your doctor orders other drugs Some heart failure patients also need medicine to reduce the risk of b
20. ed it will most often appear enlarged on a chest x ray J y r mm enlarged Some things can also get into the heart heart muscle example iron amyloid body protein or a tumor A stretched heart does not pump as well as it should Itis like a rubber band that has lost its snap Restrictive and hypertrophic cardiomyopathy often begin by making it harder for the heart to fill A chest x ray may not show the problem Other tests may be needed to find out what is going on with the heart and how best to treat it Toxic agents include illicit drugs like cocaine methamphetamine as well as anthracycline Adriamycin or cyclophosphamide Cytoxan types of chemo ephedra for weight loss and Herceptin antibody for breast cancer 37 38 abnormal heart valves Abnormal heart valves are those that do not fully open or close during each heartbeat The problem can be present at birth or due to other causes like an infection with rheumatic fever Valve fails to close and some blood backs up in left atrium instead of going Normal heart valves act like doors out through aorta They open and close at the right time to move the blood forward and keep it from going backward Ifa valve doesn t open or close like it should the heart muscle has to pump harder If the work load becomes Normal valve keeps blood too great heart failure results Sometimes from backing up surgery to replace or repair
21. es X sauerkraut breads cereals grains starches X self rising flour and corn meal X prepared mixes Ex waffle pancake muffin cornbread and all frozen waffles X instant cooked cereals dairy products X buttermilk store bought X canned milk unless diluted and used as regular milk X egg substitute limit to 4 cup day X eggnog store bought X butter and any margarine with trans fat X certain cheese American and other processed cheese bleu cheese Parmesan feta and regular cottage cheese with more than 200 mg serving soups X bouillon all kinds X dry soup mixes X canned broth and soups with more than 350 mg serving drinks X athletic drinks such as Gatorade X canned tomato or vegetable juice unless unsalted sweets X prepared mixes or store bought pies 23 puddings cakes muffins etc meats and meat substitutes x x x x canned meats and fish sardines unrinsed tuna and salmon cured meats Ex dried beef bacon corned beef and any meat product processed with salt ham some chicken and pork all types sausage and hot dogs Ex beef pork chicken turkey Polish sausage hot dogs knockwurst rotisserie chicken sandwich meats bologna salami olive loaf etc regular peanut butter salted nuts cooking ingredients seasonings condiments snacks Note x x Kx KK X x x fermented miso and cooking wine pre seasoned mixes for tacos s
22. ght record These four types of drugs are common in treating heart failure l Diuretics cause you to pass more urine This helps reduce the amount of blood your heart has to pump Some diuretics also block aldosterone a stress hormone and save potassium ACE inhibitors and ARB s relax your blood vessels and make your heart s workload easier over time Beta or a beta and alpha blocker offer many long term benefits to make your heart s workload easier Digoxin may also be given to help control heart rate during atrial fibrillation or if symptoms of heart failure persist Other drugs may be needed to prevent clots This includes aspirin an anti platelet drug or a blood thinner Drugs to control heart rhythm beta blocker and or anti arrhythmic may also be needed 10 diuretics and potassium supplements Diuretics water pills help the kidneys make diuretics more urine and get rid of excess fluid Diuretics can also decrease fluid in the lungs and help you breathe more easily But at night you may need to go to the bathroom more When you lie down more blood goes to your kidneys which causes Lasix them to make more urine furosemide Demadex es torsemide Holding fluid is very common when your heart Bumex is weak Taking diuretics daily and limiting salt help bumetanide IL prevent this fluid build up n m i When you have heart failure weigh daily and watch for fluid buil
23. ic or another drug Always write down your weight and any diuretics taken in a notebook lined off like this Date Weight Diuretic Taken eart failure testing Your doctor will order a full 12 lead EKG and one or more of these tests to detect monitor and or choose the best treatment for you Often this leads to fewer heart failure symptoms as well as treatment to improve or get rid of your heart problem echocardiogram ECHO An echocardiogram is an ultrasound of your heart Sound waves sonography are moved over the heart to show problems with the heart muscle how well it pumps the condition of your heart valves and the sac around the heart A technician moves a hand held scanner over your chest taking pictures and recording them You may feel some pressure as the scanner is pressed against your chest Pictures can be made from several angles two or three dimensional ECHO Doppler imaging can also be added to show how the blood moves inside your heart and back and forth across your heart valves Echocardiograms also measure the ejection fraction EF an estimate of the heart s pumping strength A normal EF is 90 or more exercise test This test records your heartbeat and blood pressure at rest during exercise and just after exercise You may be asked to walk on a treadmill or ride a stationary bike As you exercise your workload is slowly increased to see how your heart respo
24. ide console The VAD patient or family member do the regular sterile pump batteries VAD tubing drive line VAD controller CONTINUOUS FLOW VAD dressing changes needed to prevent infection where the drive line tubing comes through the skin Although showers are OK swimming and tub bathing contact are not allowed with aVAD Prior to a shower plastic wrap like Glad Press N Seal is placed over the dressing The batteries and VAD controller go in a shower kit provided by the device company Many activities are fine for someone with a VAD as long as there is no tension on the drive line tubing Contact sports are not OK HeartMate II VAD made by Thoratec is only 3 inches long and weighs 10 ounces heart transplant Heart transplants replace a failing heart that can no longer meet the body s needs The stress of heart transplant surgery and the side effects of anti rejection medicine put a serious strain on certain body functions So the surgery is limited to those who have severe heart failure meet transplant criteria and otherwise have healthy body organs Costly medicines and life long medical follow up are needed to prevent the body from rejecting the new heart The need for heart transplants far exceeds the number of donor organs In some cases a ventricular assist device VAD can be used as temporary support for someone who isn t doing well enough to wait for a heart donor In this case the VAD is used as a
25. ll the pumping also known as coronary artery disease 35 or ischemic heart disease high blood pressure The left lower chamber ventricle of the heart pumps blood into the arteries which carry the blood to the body If pressure in the arteries is normal and they stretch easily there is no extra strain on the left chamber as it pumps If pressure in the arteries is high the heart has to pump harder to force out the blood into the arteries If blood pressure stays high for a long time the heart s left pumping chamber can become enlarged and weak Heart failure can be the result Do what your doctor says to keep 4 your blood pressure normal Have P it checked on a regular basis Good blood pressure control lowers the F risk of new heart failure by 50 K i h SN YS 2009 update of 2005 ACC AHA Adult Chronic Heart Failure Guidelines sec 4 1 1 1 A a Jj cardiomyopathy Cardiomyopathy is a general term for a disease of the heart muscle You may be told that your problem is idiopathic the cause is not known or your doctor may say you have dilated restrictive or hypertrophic cardiomyopathy Dilated cardiomyopathy is the most common and refers to the heart stretching or becoming larger Viruses the effects of alcohol or other toxic agents or sometimes pregnancy can cause this o7 Studies show that dilated cardiomyopathy tends to run in families If the heart becomes strain
26. lood clots to control rapid heart rates often a beta blocker or to prevent an abnormal heart rythm anti arrhythmic in hospital drugs IV medicine Sometimes intravenous IV drugs are used for short term relief of severe or sudden symptoms of heart failure IV diuretics can be given to help the kidneys quickly remove extra fluid Drugs to prevent blood clots example Heparin can also be given by IV in the hospital Blood tests are used to monitor the dose IV drugs like dobutamine and milrinone can make your heart beat stronger IV nesiritide Natrecor can make it easier for your heart to pump by relaxing your arteries and causing your kidneys to remove extra fluid These drugs are given through a small tube in your vein Often a pump controls how much medicine you get Blood pressure checks are often needed when you get these IV drugs Sometimes a procedure called ultrafiltration is used to remove the extra fluid when diuretics and other treatments arent working Ultrafiltration involves passing the blood through a special filter so excess salt and fluid can be removed 17 18 urgery for heart failure coronary artery bypass grait CABG Sometimes bypass surgery can improve blood flow to the heart when a fatty blockage or clot in a coronary artery is about to cause damage to a large section of the heart Although more blood flow doesn t help areas of old damage scar bypass surgery can help prevent
27. nds You may also be asked to breathe through a tube or mask to measure how much oxygen your body uses other tests are sometimes needed A cardiac catheterization may be done if narrowing in your heart arteries is suspected Ultrafast CT scans can detect build up of calcium in the heart arteries Multi slice cardiac CT scans take X ray pictures of the beating heart major blood vessels lungs and the sac around the heart Sometimes IV contrast is given and pictures are also made of the heart arteries Magnetic resonance imaging MRI is sometimes needed to find the reason for heart failure MRI offers more detail about the lower heart chambers In some cases an MRI is helpful to find out more about how well the heart pumps Nuclear scans can be used Sometimes a positive emission tomography PET scan or a thallium scan is needed to see if bypass surgery will help certain areas of the heart treatment overview These tests will help your doctor treat what s going on in your heart Each heartbeat involves a squeeze pumping and time for relaxation filling Although pumping problems are more common heart failure often includes some of both of these weak pumping systolic heart failure The ejection fraction EF is an estimate of the heart s pumping strength Normal strength is 50 or higher Less than 50 means weak heart pumping also called LVSD left ventricular systolic dysfunction poor filling diastolic hea
28. nopril fosinopril ibuprofen Advil Motrin Aleve and other arthritis medicines Angiotensin II receptor blockers ARBs or vasodilators are used to relax blood vessels when someone cannot take an ACE inhibitor Both help keep heart failure from getting worse If someone cant take an ACE inhibitor or an ARB vasodilators may be helpful Some ARBs are Some vasodilators are losartan Cozaar hydralazine Apresoline valsartan Diovan isosorbide Isordil candesartan Atacand m nitroglycerin Nitro Dur BiDil is a combination of these 2 drugs first proven helpful in African Americans with a weak heart and now in all races when heart failure doesn t respond to first line drugs You should not stop taking your ACE inhibitor ARB or vasodilator drugs without your doctor s advice no matter how good you feel beta and alpha blockers selective Beta and alpha blocker drugs block the beta blockers effect of certain nerve signals and hormones adrenaline and norepinephrine When these are blocked body arteries relax and your heartbeat slows down As the heart pumps more blood to your kidneys sodium and extra fluid are passed in the urine Heart failure symptoms are likely to improve after 2 to 3 months Zebeta bisoprolol Toprol metoprolol succinate When you first begin to use a beta blocker side effects such as holding fluid feeling more tired a slower h
29. of adults Hints to lower sodium in your diet Do not cook with salt or add salt to foods at the table Eat fresh vegetables or unsalted canned or frozen vegetables These have less sodium than most processed foods For example INSTEAD OF 1 cup of regular 1 cup of fresh canned peas cooked peas week q 400 mg of sodium 2 mg of sodium K Sodium content of foods from USDA Handbook 456 Season with fresh or dried herbs vegetables or no salt seasonings Bake broil boil steam roast or poach foods without salt When you eat out order foods cooked this way without breading butter or sauces Ask that no salt be added Avoid soups usually high in sodium Go easy on the salad dressing Most are high in salt Avoid eating out at restaurants that cause you to have a sudden weight gain the next day Make your own sauces salad dressings vegetable dishes and desserts when you can Some patients make their own bread to further lower sodium intake Buy low sodium tuna or salmon when possible If need be you can use water packed tuna or salmon if you break it up and soak it for 3 minutes in cold water Rinse drain and squeeze out the water Keep track of your sodium intake each day It may surprise you how fast it adds up Follow your doctor s advice to limit sodium and buy mostly low sodium foods see next page 29 TIOULNO 34N1IV LYUVAH NI 13108 UNOA YOUR ROLE IN HEART FAILURE CONTROL
30. ol Over use of alcohol can weaken the heart s pumping action If you stop drinking alcohol early enough the heart may return to its normal strength 39 AG ongenital heart disease Congenital heart disease refers to defects that you are born with Often they increase the work of your heart One or more surgeries to repair the defect s can help but may not offer a total correction Specialized medical care is needed especially if you have other health problems such as high blood pressure coronary heart disease lung disease etc Transposition of the great arteries TGA TGA occurs when the pulmonary artery comes out of the lower left chamber and the aorta comes out of the lower right chamber When the aorta and pulmonary artery are in the opposite position the body doesn t get the oxygen rich blood that it should The right heart recycles the same blood through the arteries and veins without a way to get more oxygen The left side of the heart recycles the same oxygen rich blood through the lungs For any of the oxygen rich blood to get into the aorta and out to the body there has to be one or more holes between the heart chambers and or a connecting blood vessel For years TGA was corrected by switching the top 2 heart chambers atria in a Mustard or Senning operation Adults who had either operation as a child can develop heart failure if the thinner right ventricle gets tired of pumping
31. paghetti chili etc coating mixes preseasoned convenience foods soy teriyaki or Asian fish sauce baking soda baking powder use low sodium type olives pickles dill sour sweet gherkins pretzels chips skins etc light salt seasoning salt sea salt meat tenderizer garlic salt monosodium glutamate MSG kosher salt celery salt onion salt lemon pepper Check the label Use less than 2 Tbsp a day of tomato sauce unless unsalted catsup chili sauce BBQ sauce mustard or salad dressings Even reduced sodium canned soups can be quite high in salt Check the label Follow your doctor s advice about limiting salt and fluid intake Some people with heart failure do well on 2 400 mg of sodium a day but most must limit daily sodium to less than 2 000 mg to avoid fluid buildup Foods with high liquid content also have to counted Your doctor may ask you to limit liquids to 2 quarts 64 oz a day This includes the foods in Column A all beverages even liquid with medicine and ice cubes Ice cubes usually melt to about half their size 4 oz ice 2 oz fluid Some patients also have to include foods in Column B Ask your doctor or nurse if foods in both Columns must be included column A column B FOOD LIQUID FOOD LIQUID Y2 cup ice cream or sherbet 2 OZ 15 grapes 1 oz 3 oz popsicle 2 OZ cup cherries or medium size lemon 2 OZ cup fruited Jell O 30z 9inch banana or cup pudding or custard 3 5 OZ medium
32. rt failure Stiff lower chambers do not relax for good filling and stretching If your heart failure is mostly poor filling your EF may be normal or even high Diastolic heart failure is common when you have high blood pressure but can also occur with other heart problems When your body doesn t get enough oxygen rich blood stress hormones and nerve signals tell the body arteries to tighten Tight arteries make it harder for your heart to pump Stress hormones also keep salt and water from going out in your urine This means fluid can build up in the tight blood vessels making even more work for the heart Extra salt and water in the body will cause thirst but drinking too much fluid will make things worse Medicines to relax tight arteries and remove any extra fluid will make it easier for your heart to fill and pump out the blood Most heart failure patients also need to eat less salt to avoid fluid buildup reduce swelling and breathe easier 2009 update to 2005 ACC AHA Adult Chronic Heart Failure Guidelines Sec 2 1 edical treatment For most the daily treatment of heart failure includes taking 3 or more medicines and keeping a weight record to watch for fluid buildup eating less salt and limiting fluids balancing low level exercise and rest reducing demands on your heart when you can Some patients also get a daily benefit from an implanted pacemaker or ICD see pages 18 19 take medicines and keep a daily wei
33. size peach 2 5 OZ 1 cup low sodium 7 oz cup applesauce canned broth based soup peaches pears or pineapple 3 oz 1 cup yogurt low sodium 6 oz cup fruit cocktail 3 5 OZ cream soup or can of nutritional supplement medium size pear 4 5 oz Medium size apple nectarine 4 oz orange 2 grapefruit or 1 cup watermelon 5 oz 1 cup strawberries Even if you are NOT told to restrict fluids avoid large amounts of high moisture foods 29 IOULNO 34N1IV LUVAH NI 1108 UNOA YOUR ROLE IN HEART FAILURE CONTROL Step 4 find the right balance in exercise and rest for you Rest throughout your day Put your feet up for a few minutes throughout your day Consider a nap after lunch After talking with your doctor begin walking or another exercise that you enjoy Gradual exercise training often lessens symptoms while increasing your energy and overall quality of life Walking on a treadmill bicycling and swimming allow you to use the large muscle groups Find an exercise that doesn t make you too tired or requires such effort that you cant talk while doing it Avoid lifting really heavy objects Step 5 reduce demands on your heart when you can Reduce high blood pressure Ask your doctor for your blood pressure goal and how to reach it Get rid of any excess body fat Find healthy ways to lose fat if needed and keep a normal body weight Bodies that are too large put more demand on the heart Control diabetes b
34. tting rid of excess weight Call your doctor if you have new onset or an increase in any of these symptoms Sudden weight gain Pain in belly 2 lbs overnight or 3 4 lbs abdomen in 1 2 days or bloating m Shortness of breath Chest pain pressure a Swelling of feet and or hands sm Constant cough Bleeding or bruising easily Dizziness fainting Keep appointments for blood tests and other follow up 2 Electrolytes sodium Na and potassium K 2 Protime PT with INR if on Coumadin warfarin 2 Thyroid blood level and eye liver and lung exams if on amiodarone to control heart rhythm 2 Other testing Q Next appointment Tell your doctor about any symptoms that are bothering you during daily activities or keeping you from doing things youd like to do 34 auses of heart failure If the cause of heart failure is known treatment can often be given for this heart problem This offers the best long term results Heart failure can be temporary if the cause can be reversed Having diabetes with or without heart disease or high blood pressure increases the risk of heart failure especially in women If your doctor has discussed any of these as a possible cause for your heart failure you may want to refer to that page and read the brief review m coronary heart disease 35 high blood pressure 36 m cardiomyopathy 37 abnormal heart valves
35. y keeping your blood sugar in the range your doctor suggests Ask if any of your diabetic drugs are likely to lead to fluid buildup Stop smoking All tobacco products tighten body arteries and make more work for your heart Talk to your doctor if you need help quitting If you snore or are sleepy throughout the day tell your doctor A sleep study may be needed to see if you have pauses in breathing apnea while sleeping Ask your doctor if you can have alcohol Since alcohol weakens the heart heart failure may improve if you stop drinking Reduce emotional stress You may feel depressed angry or anxious because you have heart failure Talk about your feelings with family friends or a professional Low level exercise meditation and or medicine may help Avoid temperature extremes The body works harder to keep a normal temperature when youre too hot or cold Reduce high cholesterol levels to prevent fatty buildup and damage to your arteries Stay away from people who have colds or flu Ask your doctor to keep you up to date with flu and pneumonia vaccines Avoid blood clots Regular walking and not wearing garters or hose with tight tops help improve blood flow in the legs Your doctor may also prescribe special compression stockings An irregular heart rhythm atrial fibrillation can occur along with heart failure adding to the risk of a blood clot Your doctor may ask you to take one of these to reduce the risk
36. y rather than waiting until the next morning Once you feel better don t stop any of your medicines Many of them work best together for a good long term effect on the heart and blood vessels Talk to your doctor before taking any herbs or other supplements Some may interfere with your medicines especially the blood thinner Coumadin warfarin or in a few cases Pradaxa dabigatran step 2 weigh daily and watch for rapid fluid buildup m When home always use the same scale Keep it adjusted to zero Use it on a hard surface not carpet each time When you travel make sure you have a good scale to weigh on Weigh yourself each morning Do this after urinating but before eating or getting dressed Keep a written record to take to your doctor Report any rapid weight gain to your doctor example 3 4 pounds in 1 2 days of normal eating or 2 pounds overnight If you have been eating the same amount of food a quick weight gain is often a sign that fluid is building up and causing more work for your heart Follow your doctor s advice about a sudden weight gain You may need more diuretic and or potassium supplements Do not take more without your doctor s advice Check the zero point on your scale each time you use it 23 sTOULNOD 34 N1IiV LUVAH NI 104 YNOA YOUR ROLE IN HEART FAILURE CONTROL 24 Step 3 eat less salt and limit fluid intake Since foods high in sodium
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