PALOMAR POMERADO HEALTH SPECIALIZING IN YOU. Living Successfully with Heart Failure. HMJ1 12.07. Table of Contents. Welcome3 Contact Information4 Introduction 5 What is Heart Failure?6 What Causes Heart Failure?7 Other Questions to Ask8
SPECIALIZING IN YOU
Living Successfully with Heart Failure
Table of Contents
Welcome to Palomar Pomerado Health (PPH).
The mission of PPH is to heal, comfort, and promote health in the communities we serve. Our vision is that PPH will be the health system of choice for patients, physicians, and employees and be recognized nationally for the highest quality of clinical care and access to comprehensive services. Our goal is to provide you with excellent healthcare.
Our visiting policy is individualized and flexible based on the needs of our patients and family members.
The packet you are receiving has general information you may find helpful in dealing with your condition, or your loved one’s condition. Additional handouts will be given to you for any other risk factors that may be present. Handouts are available for medications you may be taking or will take at home. These handouts will be given to you when you are admitted and others may be added before you go home.
Your nurse or your primary healthcare provider can answer any questions you may have. We encourage you to write down your questions or comments on the “Notes” pages provided at the back of this booklet. Please use these pages to speak to your nurse or primary healthcare provider about anything regarding your hospital stay with PPH.
We want your experience to be as pleasant as possible. If we can help you with anything, please do not hesitate to ask. For any questions, comments, or concerns, please call the nurses’ station directly for immediate assistance.
Palomar Medical Center
All prefixes are: 1-760-739
Surgical, 8th Floor: 3840
Medical/Oncology, 7th Floor: 3740
Intermediate Care, 7th Floor: 3790
Telemetry, 6th Floor: 3640
Critical Care, 6th Floor: 3655
Orthopedic/Stroke, 5th Floor: 3540
All prefixes are: 1-858-613
4th floor: 4440
3rd floor: 4340
Critical Care/Intermediate Care,
2nd Floor: 4339
Please write down important contact information in the spaces below. You may want to share this information with family members and friends.
City: _______________ State: _____
Zip code: _________
Phone number: _________________________
Other doctors or nurses: ____________________________________________________________________________________________________________
Many people with heart failure lead normal, active lives. They do so because they have learned to take good care of themselves. This book is designed to help you learn to live successfully with heart failure. We want you to learn about your body, the disease, and methods of treatment. You can take control over heart failure by carefully following proper medication advice and healthy lifestyle changes. If you do so, you too may be able to lead an active and satisfying life!This booklet provides basic information on heart failure. It will help you:♦Understand your treatment plan♦ Learn how to actively work with your doctor or nurse so you can feel better♦ Learn how to overcome common stumbling blocks in following your treatment plan
What Is Heart Failure?
Many people misunderstand exactly what heart failure means. Heart failure does not mean that your heart has stopped or is about to stop. Heart failure is a serious illness in which the heart doesn’t pump blood through your body as well at it should. Your heart still beats, but it pumps less nutrient-and oxygen-rich blood to the rest of your body. Because of this, heart failure can make you feel tired or weak. Heart failure can also cause swelling and fluid buildup in your legs, feet, and even your lungs. Fluid backing up into the lungs is often referred to as “congestion,” which is why heart failure is sometimes called “congestive heart failure” or CHF.
What Causes Heart Failure?
WHAT CAUSES HEART FAILURE?
Heart failure usually occurs when another problem makes the heart weak or stiff so it doesn’t pump or fill normally. Coronary artery disease is a common cause of heart failure. Other causes include previous heart attack, high blood pressure, infection of the heart muscle, lung disease, and problems with the heart valves. Ask your primary healthcare provider what causes your heart failure. There may be special things you can do to care for yourself that are not included in this booklet.
The cause of my heart failure is: ___________________________________________________
Asking questions can help you talk about heart failure with your doctor or nurse. Talking with your healthcare providers will help to ensure you are receiving the best possible care. Your health is an active partnership between you and your doctor or nurse.
Do I have blockages in my coronary arteries?
Reason for asking this question: Coronary artery disease is a common cause of heart failure. With this disease, blockages in the coronary arteries decrease or cut off the blood supply to portions of the heart muscle. It can be possible to open the blockages and restore blood supply to the heart. This can improve heart function and reduce your symptoms. Knowing if your heart failure is a result of blocked coronary arteries can help your doctor plan the best treatment for you.
Is my blood pressure high?
Is my blood pressure under control?
Reason for asking this question: High blood pressure is a cause of heart failure and it can make heart failure worse. Reducing blood pressure to normal levels is a way to reduce strain on the heart. It is important to know whether your blood pressure is under control. Your doctor can help to make sure it is managed well.
Are my heart valves damaged?
Reason for asking this question: Heart valve damage is a cause of heart failure. Sometimes, valve damage can be repaired so that heart failure improves.
What is my heart function (ejection fraction or “EF”)?
Reason for asking this question: Heart function is commonly assessed by using a number call the ejection fraction. The ejection fraction is not a number of the amount of heart muscle that is still working rather it refers to the percentage of blood that is pumped out of the heart each time it beats.
A heart will not pump out all of the available blood with each beat. A normal heart pumps out, or ejects, about 50-65% of the blood inside. If the heart is damaged, the ejection fraction can fall below 40%. This is called systolic heart failure. You can have a normal ejection fraction and still have heart failure. This can be related to a condition called diastolic heart failure.
An echocardiogram is commonly used to evaluate heart function. The test can tell you and your doctor about your heart and heart valve function.
It is important to know your heart function because it can help to determine the severity of heart failure. It will also help to guide your care. Once your primary healthcare provider has evaluated your heart function, it is not necessary to keep testing it.
How Does it Feel to Have Heart Failure?
People with heart failure often have the
What Should Concern Me?
Just because symptoms are common does not mean you should ignore them! Call your primary healthcare provider for any of the following:
in a 7 days or less
Taking Care of Yourself
The treatment of heart failure typically involves several steps. The steps are listed here and explained more later in this booklet.
Weigh yourself daily
Take your medications exactly
Follow a low sodium diet
Avoid drinking excess fluids
Avoid alcohol consumption
Maintain a normal body weight
Get regular exercise
Know the warning signs of heart failure
Keep follow-up appointments
Make this plan a permanent part of your life
Weigh Yourself Daily
(preferably first thing in the morning)
Write your weight down every day for your records.
days OR 4 pounds in 7 days or less, call your primary
* “Daily Weights” sheets are provided at the back of this booklet for your convenience.
A sudden weight gain is one sign that you are retaining fluid.
Take Your Medications Exactly as Directed
Medications typically given for heart failure include:
Blood vessel dilatorscan be ACE inhibitors, beta blockers, or others. Blood vessel dilators make the blood vessels relax so it is easier for the heart to pump blood into vessels. Ask your nurse or pharmacist for detailed instructions on the medications you are given.
Type of Medications
ACE inhibitors work much like the other blood vessel
Common ACE inhibitors include Capoten (Captopril), Vasotec (Enalapril), Zestril (Lisinopril) and Altace (Ramipril). These drugs help to keep your heart failure from getting worse. Sometimes they even shrink an enlarged heart back to normal size. No matter how well you feel, do not stop taking this medication without your primary healthcare provider’s advice.
Beta blockersare other drugs that relax the blood vessels and also relax the heart, possibly lessening the stress which may play a part in the heart failure.
Common beta blockers include Carvedilol (Coreg) or Metoprolol (Toprol XL or Lopressor). They are used in stable patients and in combination with water pills and other blood vessel dilators.
• Some patients may initially gain weight, have swollen ankles, or shortness of breath.
NOTIFY your primary healthcare provider if this happens.
• Some patients feel slightly weak or dizzy at first; this effect usually goes away within a few days.
Other vasodilators include Norvasc, Isordil, Apresoline, Minipress, Sorbitrate, and others.
Type of Medications
Diuretics are water pills that help your kidneys produce
more urine. This results in less fluid for your heart to
pump. With less to pump, the heart does not need to
work so hard.
Commonly prescribed water pills include Furosemide
(Lasix), Bumex (Bumetanide), Zaroxolyn
(Metolazone), Hydrodiuril (HCTZ), and Diuril
(Chlorothiazide). Along with an increase in urination,
you may feel thirsty. Thirst and urination are normal
effects of diuretics. Do call your primary healthcare
provider if you are taking diuretics and experience:
• Dizziness• Severe weakness• Severe leg cramps
Potassium supplementation helps to control your heart
rhythm. Potassium is a mineral that your body needs.
Some water pills cause you to lose potassium (KCL)
along with urine. If this happens, you may need to take
extra potassium. It is often prescribed in tablet, liquid,
or powder form. The liquid or powder forms should be
mixed in 3 to 4 ounces of fruit juice or water to avoid
stomach upset. Liquid potassium is salty and bitter.
Do not let the taste keep you from taking this essential
Type of Medications
Aldactone or Spironolactone are aldosterone antagonists (hormone blockers). This medication may be started in a low dose and increased gradually. Blood potassium and creatinine (for kidney function) will be closely monitored the first few weeks of therapy and then on a regular basis after that. Your doctor may take you off all potassium supplements if you are on this medication. Digoxin (Lanoxin) is medicine that strengthen the heart muscle help assure that more blood is pumped with each beat. Digoxin, a commonly used heart strengthener, is usually taken once daily. Call your primary healthcare provider if you feel any of these possible side-effects: • Loss of appetite, distaste for food or bad taste in the mouth • Nausea or vomiting • Bluish or yellowish vision • Skipped heart beats, dizziness, palpitations, or rapid heart beating
It Helps to Eat Food High in Potassium and Low In Sodium
Dried fruits (raisins, prunes, apricots,
Fresh fruits (bananas, cantaloupe,
grapes, oranges, honeydew melon, fruit
Fresh vegetables (avocados, potatoes,
beets, greens, spinach, peas, tomatoes,
Dried vegetables (beans, peas)
Fish (flounder, halibut)
Fresh meats (turkey, beef)
Follow a Low Sodium Diet
A moderate 2 gram (2000 mg) per day diet restriction is essential Ask your primary healthcare provider how much sodium you can eat. Table salt contains 40% sodium and 60% chloride, so use it sparingly. One teaspoon of table salt contains about 2300 mg of sodium! Sodium is a naturally occurring ingredient in almost all foods. Fresh, unprocessed foods are naturally low in sodium. High amounts of sodium are found in many canned, pickled, convenience, packaged, processed and “fast” foods. Give yourself time to adjust to reduced sodium in your diet. Remember, salt is an acquired taste and it can be unlearned. Be patient and learn to enjoy new flavors in foods.
There are two basic types of salt substitutes, the “herb” type and “potassium chloride.” It is important to know the difference because some people should avoid the potassium chloride salt substitute (common brand names being NuSalt or NoSalt).
You should discuss use of potassium chloride (or KCl) as a salt substitute with yourprimary healthcare provider before using it. This compound may act as a strong drug for some people. On the other hand, herb seasonings can be enjoyed by almost everyone.
Herb Seasoning Suggestions
Curry, basil, bay leaf, dill, mustard, onion or garlic, mushrooms, sage, tarragon, thyme, grape, nutmeg, parsley, pepper.
Cloves, pineapple, paprika, sage, tumeric, oregano, cranberry.
Dill , curry, lemon rind and lemon juice, tomato, ground pepper, chervil.
Cloves, applesauce, caraway, rosemary, thyme, chives, basil, onion or garlic.
Paprika, tarragon, parsley, onion, jelly, curry, chervil, tomato, mushrooms.
Garlic or onion, basil, dill, green pepper, unsalted salad dressing, vinegar, tomato, mushroom, mint, mace.
Vanilla, extracts of other flavorings, mace, nutmeg, cinnamon, ginger, allspice.
Spice blend recipe
1 tsp chili powder2 tsp ground oregano
2 tsp black pepper1 T garlic powder
3 T paprika6 T onion powder
3 T poultry seasoning
Combine all ingredients and store in an air tight container.
Food GroupsSuggested Daily Servings
MILKLimit to 3 cups per day (1 cup = 8 oz.).
VEGETABLESUnlimited fresh, frozen, and low-sodium canned vegetables
BREADLimit to 5 servings per day (1 serving = 1 slice bread or 1 dinner roll). If you eat more than 5 servings per day, switch to “Low Sodium” bread. Avoid all quick breads such as biscuits, pancakes, waffles and corn bread; self-rising flours; stuffing mixes; regular bread crumbs; breads/rolls/crackers with salted tops.
PASTA/RICE/BEANS Unlimited. Avoid commercially prepared rice & pasta mixes.
CEREALSUnlimited unsalted cereals such as cooked
cereals (non-instant) and puffed wheat or rice.
FRUITUnlimited fresh, frozen or canned.
MEAT/POULTRY/6 oz. per day (1 egg = 1 oz. Meat)
MISCELLANEOUS:Crackers, popcorn, pretzels, nuts. Unsalted only, peanut butter, cheese, butter, margarine.
SOUPLow sodium only.
CARBONATED BEVERAGESLimit to no more than 50 mg.
sodium per day from this source.
DESSERTS Limit desserts (cake, cookies, pie, etc.) to 1 to 2 servings per day.
Guidelines for a 2 gram (2000 mg) Sodium Diet
Reading Food Labels
It is important that you read food labels to determine the sodium content of foods. Sodium content is expressed in milligrams (mg) per serving.
It may also be helpful to know that certain words used on labels must mean what they say as defined by the government:
“Sodium Free”negligible sodium (less than 5 mg per serving)
“Very Low Sodium”35 mg sodium or less per serving
“Low Sodium”140 mg sodium or less per serving
“Less Sodium”20% sodium reduction from the original product
“Reduced Sodium”at least 25% reduction from the original product
“Light in Sodium”50% sodium reduction from the original product
“Without Added Salt”no salt used during processing
“No Salt Added”
Always keep the serving size in mind when you inspect the label because all of the nutrient categories are based on this.
Serving Size 1/2 cup (114g)
Servings Per Container 4
Amount Per Serving
Calories 90 Calories from Fat 30
% Daily Value*
Total Fat 3g 5%
Saturated Fat 0g 0%
Cholesterol 0mg 0%
Sodium 300mg 13%
Total Carbohydrate 13g 4%
Dietary Fiber 3g 12%
Vitamin A 80% • Vitamin C 60%
Calcium 4% • Iron 4%
*Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:
Calories 2,000 2,500
Total Fat Less than 65g 80g
Sat Fat Less than 20g 25g
Cholesterol Less than 300mg 300mg
Sodium Less than 2,400mg 2,400mg
Total Carbohydrate 300g 375g
Fiber 25g 30g
Calories per gram:
Fat 9 • Carbohydrate 4 • Protein 4
Total kilocalories per serving
Total grams (g) fat per serving. Try to limit fat calories unless you have trouble gaining or maintaining your weight. Always try to limit saturated fat, especially if you need to lower your blood cholesterol level.
Total milligrams (mg) sodium per serving. This is salt! The chemical name for “salt” is “sodium chloride”. This label tells you that a 1/2 cup serving contains 300 mg of sodium. Remember to limit your daily total to no more than 2000 mg to 3000 mg.
Total grams (g) of carbohydrate per serving. Sub-categories identify the amount of added sugars and nutritionally important dietary fiber.
Total grams (g) protein per serving. Choose the lean sources of animal protein such as lean red meat, poultry, fish and fat-free or lowfat milk. Or, try vegetable protein sources such as beans, cereals and grains.
Avoid Drinking Too Much Fluid
Most people with heart failure can drink normal amounts of fluid. Do not restrict your fluids unless specifically told to do so by your primary healthcare provider. But, everyone with heart failure should avoid excess fluids; try around 48oz – 64oz or
1.5 – 2 liters a day.
Drink fluids at intervals throughout the day
Avoid drinking large amounts of fluid all at once
Limit Alcohol Consumption
As a general rule, you should not drink alcohol at all. It damages heart cells and can further weaken your already-weak muscles. Any alcohol use is strongly discouraged. Ask your primary healthcare provider what is right for you.
Stop Smoking Now
Smoking can make heart failure worse, so if you smoke, you should stop immediately.
Quitting takes hard work and a lot of effort, but you CAN quit smoking.
For counseling or to register for PPH Kick the HabitProgram, please call the Cancer Resource Center at (760) 739-3943 or (858) 613-4044.
Relapse Prevention for New Non-smokers
Think of yourself as a non-smoker.
Watch out for the top 3 triggers.
You can manage your weight when you quit.
You can manage stress when you quit.
If you “slip” (smoke or use tobacco products), do not let it turn into a relapse.
If you have a relapse, you can get back on track.
For more information, or to register for PPH Kick the Habit Program,
contact the PPH Cancer Resource Center
at 760.739.3943 or 858.613.4044.
Know Your Diabetes Risk
Get Regular Exercise
We used to believe that people with heart failure should rest, rest, rest. Now we know that regular exercise is essential! Even short periods of bed rest cause weakness. Research shows that you can exercise safely.
Remember to talk to your primary healthcare provider first before starting an exercise program.
Along with prescribed medication, exercise will:
Help you feel better – stronger and with less breathing trouble.
Help you to walk farther, work or shop with less fatigue and enjoy fun activities longer.
Help you sleep better at night.
Help maintain and/or improve your balance and help prevent falls.
Help you lose weight if needed.
Help you feel more positive and confident.
Help you relieve some stress.
Which type of exercise is the best?
The best exercise for your heart is “aerobic” exercise. Pick activities that are
continuous and have a smooth flow:
Riding a bicycle (stationary or regular)
Water exercise or walking in a pool
Plan to do different things in different settings so you have fun and stay interested!
How much exercise is enough?
Start off slowly. Increase the time and level of activity gradually. Remember that any time you spend a day or more in bed or in the hospital, you will be weaker than usual. Let your body be your guide.
How long should I exercise?
Start with 2-5 minutes of easy walking. Rest for 2-5 minutes.
Then do 2-5 minutes more of easy walking.
As you become stronger, gradually increase your walking time.
Keep your rest time at 1-2 minutes.
Keep doing this until your total exercise time is about 20 minutes. When you can walk for 20 minutes without stopping, slowly increase your walking time to 30-40 minutes.
If you start having trouble breathing or feel worn out, you have done too much. Stop, rest, and make sure to do less the next time.
You don’t have to do all of your activity at once either. For example, you can go on two short walks instead of one long one.
How often should I exercise?
Try to exercise 4-6 days each week if you feel well.
Make exercise a part of your daily routine, like daily weights and taking your medicines. The key is to get moving as many days as you can.
How hard should I exercise?
Keep your effort light and comfortable. You should be able to walk and talk
at the same time. If you have trouble breathing or feel worn out, you are
doing too much. Do not push yourself.
Listen to your body. Rest when you are tired, relax when you are under stress, and let your healthcare team know when you are not feeling well.
Choose activities that you enjoy. Exercise with a buddy if you can.
As you exercise, stay “slow and steady.” Avoid activities that require a quick burst of energy. Keep your effort light to moderate.
If you exercise shortly after taking your medicines, you may become dizzy or faint. A change in timing of exercise will often relieve this problem.
Avoid extreme heat or cold. If it is hot or humid out, move your workout indoors to a cooler time of the day. Walk in a shopping mall or follow an exercise video at home (pick an easy one).
Drink enough fluids to stay hydrated depending on your fluid allowance.
Any time of the day is fine for exercise. But wait at least two hours after a large meal. Also, do not exercise if you have not eaten for a long time. A light meal 1-2 hours before exercising is ideal.
If you get tired easily, walk on flat ground when possible.
Dirt or cinder walking tracks, grass playing fields, parks, nature trails, and golf courses are wonderful for walking. Wear loose fitting clothes and comfortable walking shoes. Running shoes may be easier on your feet.
Before you exercise, “warm up” for a few minutes by doing your activity at a slow pace. This will help blood flow to your muscles and ease you into the exercise. After the warm up, do some stretching. This will keep your muscles flexible and lower your risk of injury.
After you finish your exercise, ease into a “cool down” phase. Do this by repeating your warm up routine for a few minutes. Always allow some time after your activity to rest and relax.
Skip exercise any day that:
You are not feeling well.
You have had a weight gain over 2-3 pounds in 2-3 days or 4 pounds in 7 days or less. Be sure to call your primary healthcare provider if this happens.
You have unusual ankle swelling or bloating in your stomach.
You are having more trouble breathing, or are coughing or wheezing.
Stop exercising immediately if you feel any:
Pressure or pain in your chest, neck, arm, jaw or shoulder.
Dizziness, lightheadedness or nausea.
Unusual shortness of breath.
Heartbeat that feels unusual - too fast, too slow, or feeling like your heart is “skipping a beat.”
Any other symptom that causes you concern.
Call your healthcare provider for:
Shortness of breathing lasting 10 minutes or more.
Dizziness or lightheadedness.
Nausea, vomiting or cold sweat.
*Remember to speak with your primary healthcare provider first before
starting an exercise program.
Suggestions for Energy Conservation
Suggestions for Energy Conservation: Activities of Daily Living
holding arms overhead
Suggestions for Energy Conservation: Activities of Daily Living
instead of wringing
Suggestions for Energy Conservation: Activities of Daily Living
Suggestions for Energy Conservation: Activities of Daily Living
getting to the car
Note: "Suggestions for Energy Conservation" was written by Eileen Donovan, PT, Med. A physical therapist at the University of Texas M.D. Anderson Cancer Center. The publisher and author grant permission to photocopy these "Suggestions for Energy Conservation" so that they can be shared with patients.
Make This Plan a Permanent Part of Your Life
The attention you give to following your treatment plan will pay off for you! You can improve your ability to be active and your quality of life by following this treatment plan. We know that following a treatment plan can be difficult. If you are having trouble sticking to your treatment plan, please do not change anything. Talk with your nurse or primary healthcare provider for help!
The Hurdles People Often Experience Are:
Cost of medicines
Side-effects of medicines
Lack of time to exercise
Complexity of treatment
Difficulty following recommended diet
We can help and we want to help. Talk with your nurse or primary healthcare provider about these barriers and we can work out solutions together! We are here for you!