Living with Heart Failure

What is Heart Failure?

You might have felt frightened when your health care provider told you that you have heart failure. Although the term "heart failure" sounds frightening, it is a treatable condition. Heart failure does not mean your heart has stopped working. You can have heart failure without ever suffering from a heart attack. Having heart failure simply means that your heart does not work as well as it should. Your heart may be having difficulty pumping blood, either from being too weak or too stiff. As a result, your heart, organs and tissues cannot receive an adequate supply of blood, making it more difficult for you to do things that might have been easy in the past.

There are ways you and your health care provider can help your heart work more efficiently. Getting acquainted with how the heart works may help you understand how heart failure occurs and what you can do about it.

How the Heart Works

The heart is a muscle about the size of your fist. It is located on the left side of the chest, near the lower portion of the breastbone and partially under the ribs. The heart muscle has four chambers (called atria and ventricles) and four valves that pump blood through your body.

How Blood Flows Through the Heart

Blood enters the heart through the right atrium. This blood from the veins (venous blood) has already traveled through the body and delivered oxygen to the organs and tissues. By the time the blood reaches the heart again, it is loaded with carbon dioxide. The venous blood enters the right atrium. Then the blood passes into the right ventricle, which pumps the blood to the lungs. Carbon dioxide is transferred from the blood stream into the lungs (for you to exhale) and oxygen is picked up to be carried to your organs and tissues.

The oxygen-rich blood returns to the heart through the left atrium and then passes into the left ventricle. From the left side of the heart, blood is pumped through the main artery of the body (aorta) and circulated to all the arteries for use by the body.

Between the chambers of the heart are valves that open and close. These valves allow the chambers to fill and empty, helping the blood to flow in one direction.

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The Heart's Own Blood Supply

Just like any other organ, the heart needs to be nourished with oxygen. Coronary arteries are special blood vessels that supply oxygen-rich blood to the heart muscle. They branch from the aorta (the first artery to receive oxygen rich blood) and lie in grooves on the surface of the heart. There are three main arteries: The left coronary artery delivers blood to the left front portion of the heart, both front and back; and the circumflex coronary artery wraps around the left side of the heart to carry blood to the back portion of the heart. When these arteries become clogged (occluded) with a blood clot or fatty substances, the artery becomes narrowed or blocked. When this happens, the heart muscle cannot receive the amount of oxygen and nutrients it needs. Over time, the heart muscle starves and weakens, and cannot pump blood as well as it should.

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Heart Failure: Knowledge for Effective Self-Care

Heart failure is a progressive and chronic condition in which the heart's muscle is weakened and may no longer pump effectively. Heart failure can be caused by many reasons, including:

  • Blocked arteries in the heart
  • Heart attack
  • High blood pressure
  • Heart valve problems

Your heart function and type of heart failure can be measured by having an echocardiogram, which is a test that provides images of the heart.

When the heart muscle is weakened, the body compensates by working harder, which causes the heart walls to become thicker, and the heart becomes enlarged. This also causes stress hormones to be released, which cause the arteries to tighten (constrict). The tightened arteries make it even more difficult for the heart to pump. In addition, the stress hormones cause the kidneys to hold onto salt and water, which increases the amount of blood that must be pumped. It is important to take your medications regularly to block the actions of these hormones and to make it easier for your heart to pump.

The three types of heart failure are systolic heart failure, diastolic heart failure and valvular heart failure.

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Systolic Heart Failure

Systolic heart failure is diagnosed when the echocardiogram shows that not enough blood is being pumped by the heart. The amount of blood being pumped is called the ejection fraction. If this is less than 50 percent, it is weak and results in systolic heart failure. After an injury, the heart cannot pump the amount of blood the body needs. The blood backs up into the lungs, which causes shortness of breath, and/or backs up into other parts of the body which causes swelling in the legs. These symptoms can be controlled with medications and a low-sodium (salt) diet.

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Diastolic Heart Failure

Diastolic heart failure is diagnosed by an echocardiogram showing a stiff heart. In this case the heart cannot relax, so it cannot properly fill with blood to circulate to the body. This causes increased pressure and blood to back up in the lungs, liver, legs and other areas of the body, causing symptoms of swelling, shortness of breath, and the inability to tolerate activity. These symptoms also can be controlled with medications and a low-sodium (salt) diet.

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Valvular Heart Failure

Valvular heart failure is caused by either a backward flow of blood, a leaky valve in your heart, or a narrowing of the valve area through which blood can flow. These are both abnormalities of the heart valves. This may cause your heart muscle to weaken and pump less effectively, and/or can cause increased pressure in your lungs.

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The Importance of Medications

Following your heart failure diagnosis, you may have been prescribed many new medications. This can be very overwhelming at first but this booklet will help you understand and organize your medications so you can effectively manage this chronic illness.

It's important to always keep in mind that your medications play an important role in the treatment of heart failure. Research shows that heart failure medications can stabilize the function of your heart, slow down the progression of heart failure, and even improve heart function. It is important to understand that these medications take time to go into effect, and you might not notice a difference right away. Always stick to your medication plan unless you are instructed otherwise by your health care provider.

Following your prescribed medication plan can:

  • Help you live longer
  • Alleviate symptoms
  • Help you breathe easier
  • Give you more energy, allowing you to increase your activity level
  • Alleviate swelling in the legs or ankles
  • Reduce hospital readmissions

HEART FAILURE MEDICATIONS
Beta blockers are a class of drugs that block certain hormones that can put stress on your heart. These stress hormones can cause high blood pressure and/or a fast heart rate. Beta blockers slow your heart rate and widen (dilate) your arteries, which lowers your blood pressure. They allow a stiff heart more time to relax so it can properly fill with blood. Also, by widening your arteries, there is more blood flow to your kidneys. It is important to remember that beta blockers are beneficial to your heart even if you don't have a fast heart rate or high blood pressure because they decrease the hormones that can put stress on your heart.

ACE (Angiotension Converting Enzyme) inhibitors make it easier for your heart to pump by widening your blood vessels. ACE inhibitors limit the amount of stress hormones in your body. Stress hormones may cause tightening of your arteries, which increases your blood pressure and the workload of your heart. Like beta blockers, ACE inhibitors decrease the amount of stress hormones in your body that can worsen heart failure. The long-term effects of ACE inhibitors can slow the progression of heart failure and improve symptoms. ACE inhibitors can increase the amount of blood your heart pumps or ejection fraction over time. Please refer to your discharge medication list.

Angiotensin receptor blockers, also known as ARBs, are a medication for patients who cannot tolerate ACE inhibitors. Like ACE inhibitors, ARBs block certain stress hormones from tightening the arteries, thus decreasing the stress hormones which can negatively affect your heart.

Diuretics, often called "water pills," help your body get rid of extra fluid, so there is less fluid for your heart to pump. You should notice a decrease in swelling to your legs and feet and an improvement in your breathing. A diuretic will cause you to urinate more often and should be taken as advised by your health care provider. Most diuretics lower your potassium (an important electrolyte for your heart) so your health care provider might check your potassium levels with blood draws.

Digoxin is a class of medications that may be ordered to help your heart pump slower and more effectively. It is important to note that this drug may not be appropriate for all types of heart failure patients.

Aldosterone antagonists are a group of medications that block a hormone called aldosterone, which causes fluid retention and can make the symptoms of heart failure worse. Aldosterone antagonists are a type of diuretic that prevent your body from losing potassium. Your health care provider may order lab work when starting this medication.

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Fluid Restriction

In addition to taking medications to control heart failure, there are other lifestyle changes you can make. One of these changes is to reduce your fluid intake. We all need fluid every day to keep our bodies functioning properly. However in heart failure, extra fluid builds up in the body, which makes the heart work harder. Restricting fluid intake can help limit the build-up of fluid in your body. Your health care provider may recommend that your intake of fluid be limited to 1.5 to 2 liters, which equals 1,500 to 2,000 ml or six to eight cups of fluid per day. Count all fluids that you consume, including water, coffee, tea, juice, milk, soft drinks, ice cubes, soup and fluids. Also include the fluids in foods that become liquid at room temperature, such as Jell-O, sherbet, ice pops and ice cream.

WHAT CAN I DO ABOUT A DRY MOUTH?

  • Suck on hard, sugar-free candy, a lemon wedge, frozen orange sections, frozen grapes, or chew gum to moisten your mouth. Frequently brushing your teeth will also help moisten the mouth.
  • Prepare a measured amount of ice chips and flavor with lemon or lime juice, if desired. This still counts as fluid, but ice melts to about half its original amount so you will be more refreshed than drinking the same amount of beverage. (Example: 1 cup ice = ½ cup fluid).

KEEPING ON TRACK
If you are limited to 2,000 ml or 2 liters, use a 2-liter container to help you measure your fluid consumption. Before you drink anything, measure it and pour the same amount of fluid into the container. This will help you keep track of how much fluid you have left for the day. Be sure to use your fluid allowance evenly throughout the day and save enough fluid to take the medicines you need to take late in the day.

Click here for printable measurement conversions

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Sodium Restriction

Sodium restriction is another important lifestyle change for managing your heart failure. That means it will be easier to manage your heart failure symptoms by reducing the sodium in your diet. The recommended amount of sodium for heart failure patients is 2,000 milligrams daily. Heart failure patients should avoid adding table salt or sea salt to food or cooking. One teaspoon of salt has about 2,300 milligrams of sodium - more than you should get in a whole day! Try using fresh or dried herbs or spices to season your food, or experiment with a salt substitute.

Click here for a printable Sodium (Salt) Tracker

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Daily Weights

Keeping track of your weight is very important. A weight gain of as little as two to three pounds may be a signal that your medications may need to be adjusted and may be important enough that you need to call your physician's office. It is best to record your weight at the same time every day in the same state of dress or undress.

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The Heart's Electrical System

The heart has its own special electrical system that enables the heart to beat and pump. There are special cells in the heart that create electrical impulses. These electrical impulses begin in the right atrium (the heart's natural pacemaker) and spread through the entire muscle, causing it to contract. If the electrical system in your heart does not follow the normal pathway to generate a heart beat that causes the chambers to work together, the heart may not pump effectively. The regular contractions are what we know as heart beats. Sometimes heart failure is related to problems with the electrical system in the heart. As a result, you might have irregular beats or other abnormalities. If you have this, your health care provider will discuss it with you.

DEVICES for HEART FAILURE
Internal Cardiac Defibrillator (ICD)
Those with weakened heart muscles and a low ejection fraction may be at risk for lethal arrhythmias or abnormal heart rhythms. Because of this, your health care provider could recommend an internal cardiac defibrillator (ICD), which is inserted through a small incision in your upper chest. Similar to a pacemaker, the ICD protects you by pacing your heart back into a normal rhythm or delivering a shock to restore normal rhythm if a lethal rhythm abnormality occurs. Your health care provider can explain this device and procedure in more detail if necessary.

Bi-ventricular Pacemakers or Bi-ventricular ICD
If your heart shows signs of dysynchrony, meaning it doesn't beat effectively, your health care provider could recommend a bi-ventricular pacemaker or ICD. This means you would have pacemaker leads in both sides of your heart, which would help it beat in sync and more effectively while protecting you against potentially dangerous abnormal heart rhythms. Your health care provider will determine if you meet the criteria for this treatment based on your symptoms and by reviewing your electrocardiogram (EKG) and echocardiogram (ultrasound of the heart). This therapy has been shown in research to improve heart function, improve symptoms, and improve quality of life with heart failure.

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Living with Heart Failure

As mentioned earlier, heart failure is a progressive and chronic disease, but with proper treatment and lifestyle changes, many patients will experience a full and rewarding life. The guidelines in this book give you the tools to make necessary lifestyle changes and help you learn to live with heart failure. Following the instructions in this book and working closely with your health care provider are extremely important to your long-term health. Be sure to talk with your health care provider about other possible treatment options and how to manage your type of heart failure, as they may have other suggestions and treatment options.

The Choice is Yours

As with any health improvement or recovery program, the outcome depends a great deal on what you can do regularly. Here are some areas where you can make a difference in your health:

  • Become informed. Develop a good understanding of your condition and be certain that you know exactly what you need to do to take proper care of yourself at home. Ask your health care provider and the other members of your health care team specific questions. Our health care team's goals are to help you understand your condition and assist you in planning for future care and responsibilities.
  • Understand your prescriptions and treatment plan. Know the type, amount and frequency of your medication. Do not stop or change a medication unless you have consulted with your physician and have been directed to do so. Stop using tobacco if you use it and reduce any alcohol consumption to the least amount.
  • Manage your fluid intake.
  • Record your weight every day. Notify your health care professional if your weight increases by more than 2 pounds in 24 hours or if it increases by 3-4 pounds in 2 days. Use the following tracking document. Take the tool with you to your physician's appointments and share the information.

    Click here for a printable Daily Tracker
  • Monitor your blood pressure. Know your blood pressure. Keep a chart of your blood pressure. Notify your health care professional when your blood pressure changes significantly. Use the tracking document located in the back of this booklet. Take the tool with you to your physician's appointments and share the information.
    Click here for a printable Daily Tracker
  • Speak up. Follow your health care provider's orders and communicate. Speak up if you have any questions or changes in your condition. If you experience discomfort or an unusual symptom, contact your health care provider. Keep your scheduled appointments with your health care provider. Your health care provider wants to help you do as well as possible but needs to be informed how you are doing to provide quality care. Do not hesitate to call.

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    click here.

    Click here for a printable Heart Failure symptoms/side effects guide
  • Stay active. If you are able, and only on the advice of your health care provider, you should plan to exercise. It will be important for you to have set times during the day for exercise. Research has shown that exercise may decrease symptoms and improve your quality of life. Ask your health care provider if you are a candidate for cardiac rehabilitation.
  • Reach out. It is important for you to maintain your friendships and interests, as well as develop new ones. Changes in your lifestyle habits can lead to other positive changes in your health.

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Conclusion

Heart failure can be managed, but you must take control and play a very active role in the management of your condition. You can succeed with heart failure. With the right team in place, the right combination of medications and devices prescribed as needed, and with the right changes in lifestyle, many of today's patients with heart failure can enjoy healthier, happier and longer lives than ever before.

Click here for a printable Heart Failure Action Plan

For additional information, you can go to:
Heart Failure Society of America: www.hfsa.org
American Heart Association: www.americanheart.org

Click here for all of our printable tools for living with heart failure.

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