01033 Understanding Heart Failure

Understanding Heart Failure

What is Heart Failure?

The term “Heart Failure” can be frightening. It doesn’t mean the heart has “failed” or stopped working. It means that the heart doesn’t pump enough blood throughout the body to meet the body’s needs.

How common is Heart Failure?

Almost 6 million Americans have Heart Failure, and more than 870,000 people are diagnosed with Heart Failure each year. Heart Failure is the leading cause of hospitalizations in people over age 65.

What are the causes of Heart Failure?

The most common cause of Heart Failure in this country is from blockages in the arteries (blood vessels that deliver blood to the heart muscle). The risk of Heart Failure is greater if you have diabetes, high blood pressure, or if you have had a heart attack in the past. In some cases, Heart Failure can occur from an infection, irregular heartbeat, obesity, or due to alcohol or drug use.  It can also occur in families due to genetic abnormalities. Sometimes we are not able to find the cause of the Heart Failure.

What are the signs of Heart Failure and when to call your nurse or doctor?

You should call your healthcare provider when you have any signs that your Heart Failure is getting worse. These include:

• Worsening shortness of breath or trouble breathing with movement
• Difficulty breathing when lying down and feeling the need to sleep in a chair or with multiple pillows in bed
• Worsening fatigue or no energy
• Increased swelling in your feet, ankles, legs, or stomach
• Heart racing, pounding, or palpitations
• Dry hacking cough worse when lying down
• Not wanting to eat, loss of appetite/filling up quickly, upset stomach or nausea/vomiting
• Dizziness, lightheadedness, confusion, difficulty concentrating or fainting
• Weight gain of 3 or more pounds in one day or 5 or more pounds in one week
• Chest pain that resolves quickly

What are the types of Heart Failure?

While there are many causes, the condition is usually broken down into two types:

¨  Heart Failure with reduced Ejection Fraction (HF-rEF)

• The bottom left chamber of the heart (left ventricle) is weakened and cannot pump enough blood to the body.

¨  Heart Failure with preserved Ejection Fraction (HF-pEF)

• The bottom chambers of the heart are stiffer than normal. The ventricles cannot relax properly and fill up all the way. Because there’s less blood in the ventricles, less blood is pumped out to the rest of the body when the heart contracts.

How is Heart Failure Treated?

The treatment of your Heart Failure will depend on the type of Heart Failure you have and in part what caused it.

• Medications: Medicines help strengthen and reduce stress on the heart, control blood pressure, prevent irregular heartbeats, and remove extra fluid from your body, and may help to prolong your life. 
• Get regular checkups with your doctor.
• Heart healthy lifestyle behaviors are part of every patient’s treatment plan. 
• Surgery or heart devices may be needed, such as pacemakers or defibrillators to regulate the heart rhythm.

Over the Counter Medications

Do not take ibuprofen, Advil®, Motrin®, Aleve®, or naproxen. These medications may lead to fluid build-up, stress on the kidneys, raise blood pressure, and cause bleeding. 

Aspirin is safe to take if prescribed by your medical providers.

Avoid decongestants in allergy medications as well as ephedrine, pseudoephedrine, and oxymetazoline in nasal sprays such as Afrin® and Dristan®. Medications marked as “HBP”, guaifenesin, Mucinex®, or those with dextromethorphan are safe, as well as saline nasal spray.

Changes in Diet:

Low salt (sodium) diet: Too much salt in the diet can cause water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet. It is recommended to limit your salt (sodium) to 2000mg a day. Avoid foods high in salt such as processed foods that come in a box or a can and food that you get at a restaurant or fast food. Read nutrition labels (look at the milligrams not at the percentage) and ask about salt content of restaurant foods. Many chain restaurants have their menus posted online with nutrition information. 

Fluid limitation: You may be asked to limit fluid intake to 64 ounces daily (eight 8-ounce cups a day). This is equal to about 2 Liters or 2 quarts. This includes anything that is liquid at room temperature such as: soups, ice cream, popsicles, Jell-o, smoothies, ice chips, and all drinks.  You may need to drink a little more fluid if you are exercising or outdoors and sweat a lot.

Limit or eliminate alcohol: Your doctor may recommend that you don’t drink alcohol if you have Heart Failure, since it can interact with your medication, weaken your heart muscle, and increase your risk of irregular heart rhythms.

Maintain a healthy weight. If you're overweight, your dietitian will help you work toward your ideal weight.

Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins.

Daily Weights:

You should weigh yourself every day. The best time to weigh yourself is first thing in the morning after you urinate and before you eat or drink. Do not weigh other times of the day. Tell your healthcare team if you gain more than 3 pounds in one day or 5 pounds in one week or less.

Stop Smoking:

One of the most important steps you can take if you are a tobacco user is to stop. Cigarette smoking, smokeless tobacco, and vaping make your heart pump faster, raise your blood pressure, and place more work on the heart. There are many ways to stop smoking and your healthcare team can discuss these options with you.

Exercise:

We recommend 150 minutes of exercise per week. You can start with at least 10 minutes every day.  Walk at a pace where you can “walk and talk.” Avoid getting so out of breath that you are unable to talk easily. If you get too out of breath before 10 minutes, stop and rest. Do this at least 3 times a week, increasing your exercise time gradually to a goal of 150 minutes per week. It is important to rest before and after exercising to conserve your energy. For example, don’t exercise right after grocery shopping.

Discuss with your health care team when it is safe for you to return to work and if you need to avoid driving. Talk to your provided to determine if cardiac rehab is right for you.

Sexual Activity:

It is safe for you to start sexual activity when you feel ready to do so. The energy used during sex is about the same as climbing 2 flights of stairs. If you can climb two flights of stairs without pain or feeling uncomfortable, it is OK to have sex. Be rested and don’t rush. If sex brings on chest pain or shortness of breath, stop and rest or wait until another time. Check with your doctor before using any drugs to improve sexual performance since some of these can cause irregular heartbeats and should not be taken if you take nitroglycerin or other nitrates.

The Future:

Heart Failure ranges from mild to severe. Some forms of Heart Failure, such as those due to problems with a heart valve, are reversible. If your doctor determines that your Heart Failure is reversible, they will discuss this option with you. 

Because many forms of Heart Failure are long term illnesses, you will be taking medicines the rest of your life. The best way for you to lead a full life is take your medicines as prescribed, reduce your risk factors (such as no smoking, limiting alcohol, controlling diabetes, high cholesterol and high blood pressure), exercise regularly, and weigh yourself every day. Visit your healthcare team regularly. If you choose not to take your medications or follow the advice to reduce your risk factors, your Heart Failure will likely get worse, you may need to be in the hospital more often and you will be more likely to die sooner.

Infections can make the heart work harder. If you have Heart Failure and an infection, the heart may not be able to work hard enough to meet the body’s need. For that reason, it is best to lower the risk of getting an infection by avoiding persons with colds or the flu. It is also important to get a yearly flu vaccine and to stay up-to-date with other vaccinations.

Family Involvement/Support:

Your family should know as much about your Heart Failure as you do, including when to call your healthcare team and the signs that your Heart Failure is getting worse. It is important for your family to be able to choose and prepare foods low in sodium. It is also important that they understand you need to take your medicines regularly. Heart Failure is a chronic long-term illness. Talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know your desires. A living will details the treatments you do or don’t want to prolong your life. It is a good idea to prepare a living will while you are well in case you aren’t able to make these decisions at a later time.

Resources to Learn More About Heart Failure

American Heart Association: http://heart.org

Heart Failure Society of America: https://hfsa.org/heart-failure-educational-modules

American Association of Heart Failure Nurses: https://www.aahfn.org/mpage/patient_tip_sheet

CardioSmart  https://www.cardiosmart.org/topics/heart-failure