Stay healthy and out of the hospital when living with heart failure

Stay healthy and out of the hospital when living with heart failure

Heart failure is a frightening diagnosis to be faced with. It is a chronic, generally progressive condition that is one of this country’s greatest healthcare burdens. Heart failure can be caused by several different conditions, and the treatment will vary considerably from patient to patient. The clinical pattern will also vary as it can be acute or chronic, or a combination of both. As frightening and debilitating the condition can be, there are ways to manage the disease that can allow for a full and active life. The information below is designed to help patients and their families understand some of the ways heart failure is treated and what can be done to keep the patient out of the hospital.


Do

Do know your diagnosis

There are several categories of heart failure. There is systolic heart failure (the pumping function of the heart is damaged), diastolic heart failure (the heart is stiff and doesn’t relax during filling), left heart failure (fluid builds up in the lungs initially and later can cause fluid to back up in the legs and abdomen), or right heart failure (fluid backs up in the legs and abdomen).

The patient should understand the cause of the heart failure. Coronary artery disease is a common culprit. Hypertension, diabetes, valvular heart disease, alcoholism are other common causes. Sometimes, the heart failure is idiopathic, which means we don’t know what caused the heart to fail. And of course, there are multiple other less common causes.

Do discuss possible interventional or surgical treatment options with your doctor

Once you understand the cause of the heart failure, some of these problems can be treated with surgical or catheter interventions. Coronary artery disease can be improved with stents or bypass surgery. Valvular heart disease can be corrected with valve replacement or repair. For patients with significant heart damage, ICD’s (implantable defibrillators) or Bi-V/ICD (bi-ventricular pacemaker and defibrillator) may be appropriate.

Do know your medications

Your doctor will prescribe several medications for heart failure. These medications usually include: Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II-receptor blockers (ARBs); Beta blockers; Diuretics; Vasodilators; Aldosterone inhibitors, and several other classes of drugs.

You may not understand the pharmacology of these medications, but you can improve the efficacy if you take them as prescribed. Keep a list of all your medications with you at all times. Your doctor may have a list of your medications as he/she thinks they were prescribed but that is not necessarily what you are actually taking.

Do work with your doctor

No one expects the patient to fully understand the medical issues surrounding heart failure. Feel free to ask a lot of questions — be an active participant. Use the internet to get information and be sure to keep a list of your medications with you at all time, the importance of this cannot be emphasized enough.

Know the symptoms and signs of heart failure so you can give a good update when you see the doctor. These signs/symptoms can include shortness of breath, swelling in the feet or abdomen, worsening fatigue or weakness, chest pain, decreased urine output, weight gain, and others.

Do monitor blood pressure

Monitoring the blood pressure at home will help the doctor to properly adjust medications to optimize care. The blood pressure in the office may not reflect the blood pressure at home. Very often, the blood pressure in the doctor’s office is higher than at home.

Do monitor daily weight

Managing heart failure is a matter of fluid balance. If the body starts to retain fluid, the weight will start to creep up. If this happens, the patient can alert the doctor who might increase the diuretic dose to get the extra fluid out before it reaches a critical state. On the other hand, if the patient is being treated with diuretics and is losing weight, monitoring daily weight can help determine if the patient is losing too much water and risks dehydration.

Do exercise

Physical activity is good for patients with heart failure. There are cardiac rehabilitation programs that can help a sedentary patient get started. Most times, however, patients can start gradually on their own. Also, there are more exercise options than walking. Arthritic problems often limit a patient’s options, but there will always be some way to get exercise. There are more and more programs offered for the elderly or disabled, such as chair yoga, modified pilates programs, balance programs, etc. — get creative.

Do get vaccinated

An annual flu shot is recommended. The pneumonia vaccine is recommended every five years.

Do stay positive

With treatment, people with heart failure now live very long, productive lives. Stay in touch with friends and family. Get out and do what you want to do. Listen to your body and rest if necessary — there is no reason not to go out and try to do what you love. Set goals. Life has not ended.


Don't

Do not eat salt

Excessive sodium (salt) intake will cause a patient to retain fluid. Most people today know to avoid adding salt to their food. However, most people do not realize that the vast majority of daily sodium intake is in the food they are eating. Breads, pastas, soups are some of the biggest culprits. Deli meats and processed foods are loaded with salt. Learn to read the food labels. Professional nutritional counseling is often helpful.

Do not smoke

This is a no-brainer. Do not smoke. Enough said.

Do not drink excessive alcohol

Alcohol in moderation is acceptable (up to four ounces a day - preferably red wine). However, excess alcohol can be cardiotoxic (poisonous to the heart).

Do not drink excessive amounts of fluid/water

We all have been told to drink a lot of water for good health. However, that does not apply to the patient with heart failure. Patients on diuretics should not drink extra water to compensate for the water they are losing with the diuretic. The extra water is the problem. Patients with heart failure should try to limit fluid intake — drink only when thirsty.


Summary
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Heart failure is a chronic medical condition and has become a major burden on our healthcare system resulting in multiple hospitalizations annually. Heart failure is also generally a progressive disease, so managing and treating it requires regular reassessments and adjustments in care. The good news is that the condition can usually be managed successfully on an outpatient basis. Many patients diagnosed with heart failure can expect to live a long and active life. Successful management of heart failure requires a team approach, and the patient is the center of this team. An educated, actively engaged patient is the best weapon in the fight to retard the natural progression of heart failure.


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Photo Credits: Day 73: Kerns family self portrait {about me} by Flickr: Loren Kerns; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Monica M. Reynolds, MDCardiologist

BS: Massachusetts Institute of Technoogy - AeroAstro Engineering MD: University of Pennsylvania Residency: Mount Sinai Hospital, NYC Cardiology Fellowship: Beth Israel Hospital, NYC ...

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