Living with Heart Failure
What is Heart Failure?
Heart failure is not a disease, but a condition that occurs when your heart does not pump as well as it should. This does not mean that your heart has stopped working. Chronic heart failure, a type of heart failure that cannot be fixed, is a problem that you will have for the rest of your life. Although there is no cure for chronic heart failure, it can be managed successfully.
Causes of Heart Failure
All of us lose some blood-pumping ability in our hearts as we get older. If you have heart failure, however, other health problems have either damaged the heart or made it work too hard. If you have heart failure, chances are you have (or had) one or more of the following:
Past heart attack (myocardial infarction) – A part of the heart muscle dies and the remaining healthy muscle has to pump even harder to keep up.
High blood pressure (hypertension) – When pressure in the blood vessels is too high, the heart has to pump harder than normal. Over time, the heart chambers get larger and weaker.
Abnormal heart valves – When valves don’t open or close completely during each heartbeat, the heart muscle has to work harder to keep the blood moving in the proper direction.
Heart muscle disease (cardiomyopathy) or inflammation (myocarditis) – Heart muscle can be damaged by drug or alcohol abuse, viral infections or unknown reasons. With any heart muscle damage, the rest of the heart has to work harder.
Heart defects present at birth – If the heart doesn’t form correctly, the healthy parts have to work harder to make up for it.
Severe lung disease – When the lungs don’t work properly, the heart has to work harder to get oxygen-rich blood to the rest of the body.
Diabetes – If you have diabetes, you have up to eight times greater risk of having heart failure. The disease process in diabetes can damage the heart muscle. Good control of your glucose (sugar) level can decrease this risk.
Abnormal heart rhythms, too slow or too fast, can make heart failure worse.
Signs and Symptoms
Your heart pumps blood to all parts of your body—your feet, legs, hands, brain and muscles. Heart failure occurs when the heart cannot pump enough blood to keep up with the body’s needs. Congestion (buildup of fluid) can occur. Because of this, you may notice any of the following signs or symptoms:
- Swelling in the feet, ankles and/or legs
- Bloating (fluid in abdomen)
- Fluid in your lungs
- Shortness of breath with activity, or even at rest
- Difficulty breathing while lying flat
- Waking up with shortness of breath
- Tiredness and fatigue with the simplest activities
- Loss of appetite
- Weight gain over a short period of time
- Inability to concentrate
- Rapid heart rate, often irregular
- Dizziness or lightheadedness
- Decreased urination
- The need to urinate more often during the night
Types of Heart Failure
Heart failure can involve the heart’s left side, right side or both. It usually affects the left side first, causing shortness of breath. The term congestive heart failure often is used to describe everyone with heart failure. However, congestion (the buildup of fluid) is just one feature of the condition and does not apply to everyone.
Systolic heart failure occurs if the left side of the heart loses its ability to pump blood throughout the body. The normal heart pumps more than half of its blood out of the left side with each beat. The amount of blood that is pumped out is called the ejection fraction. A normal ejection fraction is greater than 50 percent. With systolic heart failure, the ejection fraction falls below 40 percent. The heart begins to receive more blood than it can pump out to the body. Over time, the heart gets bigger and stretches as it works harder to pump more blood.
Diastolic heart failure occurs when the heart wall becomes thick and stiff over time, and the heart has a problem relaxing. Because the muscle has become stiff, the heart cannot properly fill with blood. The ejection fraction is normal. However, the volume of blood received and pumped by the heart is less than normal. People with this type of heart failure also may have shortness of breath, swelling of the feet and other heart failure symptoms.
The New York Heart Association (NYHA) defines classes of heart failure, according to how it affects a person’s life. With medication and lifestyle changes, you may be able to improve your class level and your quality of life.
|Class||How You Feel|
|I||No symptoms and no limitation in ordinary physical activity.|
|II||Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.|
|III||Marked limitation of activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.|
|IV||Severe limitations. Symptoms present even at rest.|
Frequent Diagnostic Tests for Heart Failure
Your doctor makes the diagnosis of heart failure by evaluating your symptoms and doing a physical examination. Tests that may be performed include: electrocardiogram (ECG), chest x-ray, echocardiogram (echo), exercise stress test, multi-gated ventriculogram (MUGA scan) or cardiac catheterization (angiogram).
An ECG may show if you had a heart attack in the past or if the left ventricle is thick. It also shows any abnormal heartbeats.
A chest x-ray shows the outline and size of the heart. It also shows any congestion in your lungs.
An echocardiogram (echo) uses sound waves from outside the body to examine the heart’s size, shape, movement, valves, muscle and pumping ability. The echo will tell the doctor your ejection fraction.
An exercise stress test will look at your heart rhythm while you are exercising. This test may show changes in your heart’s electrical pattern when you are doing aerobic activity.
The MUGA scan will tell how much blood your heart pumps with each beat. This will let your doctor know the strength of your heart muscle.
A cardiac catheterization will allow your doctor to check for blockages in the arteries that supply blood to your heart muscle and check your heart’s pumping ability.
Treating Heart Failure
Heart failure caused by structural problems, such as a heart valve problem, may be cured. These defects can be fixed with surgery.
There is no cure for heart failure caused by damaged heart muscle. However, treatment can improve your quality of life and length of survival. This is accomplished through lifestyle changes (how you live and eat every day) and medication.
You can lessen the effects of heart failure by controlling your risk factors for heart disease:
- stop smoking or use of other tobacco products
- lose weight if needed
- avoid alcohol
- make dietary changes to reduce the amount of salt and fat you eat
- get regular exercise, but have a doctor monitor the amount and intensity of activity.
Several types of drugs have proven useful in the treatment of heart failure:
- Diuretics (water pills) help reduce the amount of fluid in the body and are useful for persons with fluid retention and high blood pressure.
- Digitalis increases the force of the heart’s contractions (pumping action), helping to improve circulation.
- Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) improve survival and may slow, or perhaps even prevent, the loss of heart pumping action. ACEinhibitors and ARBs lower the pressure inside the arteries and veins. As a result, the heart does not have to work as hard to pump the blood through the vessels.
- Beta blockers block the effects of harmful stress hormones (substances produced by your body that make heart failure worse and contribute to your symptoms).
- Aldosterone inhibitors prevent the retention of salt and fluid in the body. This may prevent your heart failurefrom getting worse.
Pacemakers and Defibrillators
Pacemakers and defibrillators are devices that are placed by the doctor to help your heart failure. The doctor puts the device just under your skin, near the collarbone. Insulated wires are threaded through blood vessels and connected to the device. The wires may be placed in one or both sides of the heart.
Internal cardioverter defibrillator (ICD) is a device used to reset the heart if it goes into an erratic or very fast rhythm. This is used to prevent sudden death. A jolt is felt when the ICD fires. If this happens, go to the emergency room.
Cardiac resynchronization (CRT)/biventricular pacemaker (BiV) may be used to treat certain types of heart failure. The doctor puts a special pacemaker just under your skin near the collarbone. The purpose of CRT is to let both sides of your heart beat together. You usually cannot feel the CRT electrical impulses.
Living with Heart Failure
Weigh Yourself Daily
Please do the following:
- Weigh yourself first thing in the morning after you urinate and before eating.
- Weigh yourself without clothes on.
- Use the same scale and place it on a hard surface.
- Write down your weight every day on a weight record.
- Call your doctor if your weight goes up by 2 to 3 pounds overnight, or if it goes up 5 pounds over a week.
- Bring your weight record with you to every doctor’s appointment.
- Take your medications as prescribed.
Maintain Daily Activities and Exercise
Depending on how bad your heart failure is, you may have difficulty with your daily activities. Always consult your doctor for suggestions on daily activity and exercise.
The benefits of regular exercise include:
- Strengthens muscles
- Helps you feel better emotionally
- Helps you sleep better
- Reduces stress and tension
- Helps you control hypertension (high blood pressure)
- Helps you control cholesterol
Suggestions for managing your daily activities:
- Pace yourself throughout activities – don’t rush.
- Space activities throughout the day, allowing for lots of rest periods.
Suggestions for exercise:
- Comfortable, easy exercise is recommended for most people who have heart failure. Studies show exercise may slow the progression of heart failure and decrease your symptoms.
- Regular exercise may help you feel better and become stronger so that you can enjoy your regular activities.
It can give you a more positive out look on life.
- Avoid outdoor exercise when it is too hot, too humid or too cold.
- Stop what you are doing if you have any of the following:
- Increased or unusual fatigue
- Increased shortness of breath
- Coughing after exertion
- Lightheadedness or dizziness
- Chest pain
You will need to make changes in the food you eat and limit the amount of sodium that you eat. The most common source of sodium is table salt. Too much sodium in your diet can cause your body to hold more fluid. This extra fluid makes it harder for your heart to pump. Your doctor will tell you how much sodium you are allowed. Usually the amount is 2,000 mg (2 grams) per day. 1 level teaspoon of salt = 2,400 mg of sodium.
Here are some ways to limit the amount of sodium in your diet:
- Read labels on the food you buy. Choose reduced-sodium foods.
- Limit the use of canned, ready-to-use and processed foods that are high in sodium such as bacon, sausage, cold cuts, frozen dinners, canned soups, chips and other salted snacks.
- Limit or avoid high-sodium condiments such as soy sauce, pickles, olives, BBQ sauce, mustard and ketchup.
- Use other seasoning such as pepper, garlic, onions, salt-free herb blends or herbal vinegar. Do no add salt at the table. This includes anything that says “salt” on the label such as garlic salt, seasoned salt or onion salt. See the diet section in your book for low-sodium seasoning ideas.
You may be asked to limit the amount of fluids you drink. The heart’s work is easier if it has less fluid to pump. Discuss with your doctor the amount of fluids that you should drink.
So…What Can You Eat?
A 2-gram sodium diet can include a wide variety of foods. Fresh meats, such as chicken, fish, lean beef, and fresh pork (such as pork chops or pork roast), should be limited to 6 ounces per day. Choose yogurt, graham crackers, fresh fruit and vegetables, unsalted pretzels or dry cereal such as Frosted Mini-Wheats.
Fresh, frozen and canned fruits are very low in sodium, as are fresh and frozen plain vegetables (avoid frozen vegetables in sauces or butter). Choose fresh potatoes or noodles cooked without added salt, instead of convenience mixes. Breads, cereals and baked goods can be included in the diet in moderate amounts. See the 2-gram sodium food list below for more details.
Choose carefully when eating out, as restaurant meals can be high in sodium. Avoid foods that contain salty ingredients, such as sandwiches with bacon or ham, or entrees that contain cheese or cheese sauce. Avoid soups in restaurants. Ask for salad dressing on the side, so you can control how much you use, or ask for oil and vinegar for your salad. If you’re not sure how a menu item is prepared, ask your server.
Remember, if you have diabetes and/or high cholesterol or coronary artery disease, you will need to limit fat, cholesterol, and/ or carbohydrates in your diet, in addition to limiting salt. Refer to the diet section of your book for help making low-fat, low-cholesterol food choices. Your dietitian also can help you make the right food choices. Taking the time to plan meals can take the guesswork out of eating a diet that has multiple restrictions.
Two-Gram Sodium Food List
|Soup||Homemade soups made without added salt and with allowed ingredients. Unsalted broth or bouillon. Low-sodium canned soups. Low-sodium cream soups made with allowed amount of milk.||Regular broth or bouillon. Regular canned or frozen soups or dry soup mixes. Any soup made with added salt or salty ingredients.|
|Meats and Meat Substitutes
1 oz. contains approximately 22 mg sodium. Limit meat and other substitutes to 6 ounces per day.
|Fresh beef, veal, pork, lamb, poultry, game, fresh or frozen unsalted plain fish (no breading or batter), unsalted canned salmon or canned tuna. Regular peanut butter limited to 1 tablespoon per day.
As desired: low-sodium cheese, dried beans and dried peas (prepared without salty ingredients – see “Avoid” list). Low-sodium peanut butter.
|Canned, dried, salted or smoked meats, such as bacon, ham, salt pork, sausage, hot dogs, metts, brats, chipped beef, corned beef, luncheon meats or Kosher meat. Regular canned salmon, tuna or sardines. Canned, dried, smoked or salted fish. Regular cottage cheese. Regular cheeses.
Low-fat or fat-free cheese (unless also low in sodium). Regular frozen dinners.
1 egg contains about 65 mg sodium.
|Limit eggs to 3 per week. Occasionally an additional egg may be substituted for 2 ounces of meat.||Eggs prepared with salt, salted meat or bacon fat.|
|Potatoes and Starches
½ cup provides about 5 mg sodium.
|Fresh white and sweet potatoes. Brown or white rice, macaroni, noodles, pasta prepared without added salt or high-sodium seasonings. Unsalted potato chips.||Frozen, instant, powdered or regular canned potatoes. Seasoned rice, pasta and potato side dishes (such as convenience macaroni and cheese mixes, etc.)|
½ cup serving of most fresh or frozen vegetables contains about 10 mg sodium. Vegetables naturally higher in sodium contain about 40 mg sodium per ½ cup serving.
|All fresh or frozen vegetables except those listed under “Avoid.” Lowsodium tomato juice. Low-sodium vegetable juices. Low-sodium or “no-salt-added” canned vegetables. “No-salt-added” tomato sauce, paste or puree.||Vegetables and vegetable juices canned with salt. Any vegetable prepared in brine, such as sauerkraut, pickles or hominy. Frozen succotash, lima beans and peas. Vegetables cooked with salty meat or salted fat. Regular canned tomato sauce, paste or puree.|
|Breads and Cereals
1 serving of regular bread contains about 150 mg sodium.
|White, whole wheat, whole grain, Italian, sourdough, French breads. Yeast rolls. Pita bread. Hamburger or sandwich buns. Crackers with “unsalted tops” or low-sodium crackers. Unsalted matzo. Unsalted or low-sodium pretzels.
All cereal except those listed under “Avoid.”
|Breads, crackers or rolls with salted tops. Quick breads made with regular baking powder, baking soda, salt or self-rising flour. Prepared baking mixes. Salted snack foods.
Quick-cooking or instant hot cereals.
1 tsp. of salted butter or margarine contains about 45 mg sodium.
1 tbsp. regular salad dressing provides between 100-200mg sodium.
-regular butter or margarine to no more than 5 tsp. per day.
-regular salad dressing to no more than 1 tbsp. per day.
One tbsp. of cream cheese can be substituted for 1 tsp. regular butter or margarine.
|Salted butter, margarine or regular salad dressings in excess of daily allowance. Bacon, salt pork, fat-free salad dressings (unless also low in sodium).|
One serving of fruit contains about 2 mg sodium.
|All fresh, frozen or canned.||None.|
1 cup provides about 120 mg sodium.
|Limit to 2 cups per day: Whole, 2%, 1%, skim milk. Reconstituted non-fat dry milk. Chocolate milk. Evaporated or condensed milk. Cocoa made with milk allowance. Yogurt. Soy milk.||Buttermilk. Malted milk. Milk mixes. Dutch processed chocolate. Regular cheeses. Cottage cheese.|
|Beverages||Coffee, tea (decaffeinated or regular). Regular non-carbonated beverages. Regular soft drinks. Sugar-free (diet) soft drinks sweetened with NutraSweet® or Splenda®. Salt-free club soda.||Commercially softened water (purified water is OK). Artificially sweetened beverages containing sodium. Club soda. Sports or “energy” drinks.|
|Desserts||Limit to one serving a day from the following list: regular cakes, cookies, gelatin, pie.
As desired: Fruit ice; sherbet; baked dessert prepared without added salt, baking powder or baking soda. Ice cream, pudding, custard should be used as part of milk allowance.
|Any regular dessert in excess of daily allowance.|
|Seasonings||Herbs, spices, pepper, sodium-free seasoning mixes such as Mrs. Dash. Fresh garlic and onion. Garlic and onion powders. Butter substitutes, such as Molly McButter.||Salt, “lite” salt, “Salt Sense,” seasoning salts such as celery salt, garlic salt and onion salt. Lemon pepper (unless sodium-free). Monosodium glutamate (MSG). Meat tenderizers. Cooking wines. Some flavored vinegars (check label).|
Your Heart Failure Management …
It Takes Teamwork
The daily management of your heart failure is like a team working to put a puzzle together. The pieces of the puzzle are: fluid balance, diet, activity and medications. Each player on the team has certain responsibilities to complete the puzzle, and you are the most important part of the team.
You have certain responsibilities:
- Weigh yourself daily (see weight log below).
- Eat healthy.
- Maintain daily activity and exercise.
- Take all medications as prescribed and report any side effects.
Your family can help by:
- Watching for swelling, shortness of breath, or changes in how you are feeling. They may be able to see changes before you do.
- Supporting you in your efforts to eat the right foods.
- Encouraging you to stay active.
- Knowing the medications you are taking, and reminding you to take them.
Your health care providers also are part of the team. As part of giving you the best possible care, they will give you the information you need to know.
When to Call Your Doctor
Please call your doctor if you have any of these symptoms commonly associated with heart failure. By treating these symptoms early, you can prevent or decrease your time in the hospital.
- Have more trouble breathing, especially if you’re lying down.
- Get more tired with simple activities.
- Gain more than 2 pounds in a day or 5 pounds in a week.
- Have more swelling than usual in your feet and ankles.
- Have decreased appetite or bloating in the abdomen.
- Cough at night or have a cough that won’t go away.
- Faint or have dizzy spells.
- Have tightness, pressure or pain in your chest.
- Have palpitations-abnormal heartbeats that are forceful, rapid, slow or irregular.
- Have trouble with your pills.
- Urinate less often.
The following Internet sources have good information about heart failure.
American Heart Association
Heart Failure Society of America
National Heart, Lung, and Blood Institute
This interactive Web site lets you put in your risk factors and treatment, then guides you in what to ask your doctor. Select “Treatment Profiler” on the left-hand side of the page, and follow the directions after that.
Weigh yourself daily at the same time. Download, print and record your weight.