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Compiled and reviewed by the Regional Cardiac Education Committee, clinical staff and physicians in Providence Health & Services’ Portland Service Area.
This book has been provided to you based on a review of your medical records. It contains helpful information and tips for those who are at risk of developing or who already have heart failure. We hope this book aids your comfort and healing by teaching you how to manage this condition. Your physician and cardiac team are available to assist if you need help or have questions about the appropriateness of this book for you.
Providence Health & Services and the manual’s author assume no responsibility or liability for personal or other injury, loss or damage that could result from the suggestions or information in this manual.
© 2010 Providence Health & Services. All rights reserved.
www.providence.org/heart
Living with Congestive
Heart Failure
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Questions for your doctor, nurse and other health care providers
Doctor: Phone:
Next appointment:
Questions:
1.
2.
3.
4.
5.
6.
7.
Don’t forget to ask
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This manual was put together specifically for you and your loved ones. It’s normal
to feel overwhelmed or anxious when you or a family member is diagnosed with
congestive heart failure. Heart failure is a chronic condition. In most cases, it will not
disappear. Without proper treatment this condition can worsen. However, we know
that with a treatment plan, including medications and lifestyle changes, patients have
a significant chance of improvement.
The doctors, nurses, dietitians and other health care professionals who provide you
with care all played a role in putting this heart failure guide together. Our goal is to
help you manage your heart failure so it interferes as little as possible with your daily
life. When it comes to living with heart failure, knowledge is power!
3
Introduction
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Medications:
• Yourjob:rightmedication,righttime,rightdose!(seepage5).
• Takeyourmedicationsataboutthesametimeeachday.
• Donotstoporskipdosesunlessyouconsultyourheartdoctor.
• Donottakeanysupplementsorover-the-countermedicineswithoutconsultingyour heart doctor or pharmacist FIRST.
• Askquestionsaboutanythingthatisunclear.
Diet:
• Donotaddsalttofoodsasyoucookoratthetable.
• ReadtheNutritionFactsfoodlabeltofindthesodiumcontentofafood.
• Learnwhichfoodsarehighinsodium(seepage27)andmakehealthier, low-sodiumchoices.
• Limitfluidintaketo2quartsaday(2quarts=8cups)orasinstructedby your physician.
Weight:
• Weighyourselfeveryday–atthesametimeofday.Usethesamescaleeachtime.Writeitdown(seepage6).
Call your doctor if you:
• Gainweight–3to5poundsinonetotwodays
• Havemoreswellingorshortnessofbreaththanusual
• Haveanupsetstomach,vomitingordiarrhea
• Feeldizzy,haveaheadacheorachangeinblood pressure from your normal readings
• Havemuscleachesorafever
• Runoutofamedication
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At home: living with congestive heart failure
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Medication list M
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Dat
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La
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Noo
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,sup
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Daily weight log for:
1. Make 12 copies of this blank chart so you have enough for one full year.
2. Weigh yourself every day and write it down.
• Weighyourselfeverymorningwhenyougetup.Dothisbeforeyoueatandaftergoing to the bathroom.
• Usethesamescale.(Placescaleonahardsurface–notonarug.)
• Wearthesameamountofclothingeachtimeyouweighyourself.
3.Callyourdoctorifyougainalotofweight–3to5poundsinonetotwodays. Yourdoctormayneedtoadjustyourmedications.
4.Bringthisdailyweightlogwhenyouvisityourdoctor’soffice.
Month/Year ______________________
Date Weight Date Weight Date Weight
1 12 23
2 13 24
3 14 25
4 15 26
5 16 27
6 17 28
7 18 29
8 19 30
9 20 31
10 21
11 22
Daily weight log
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Exercise log for:
Date/Time Activity (example: walking) Duration (minutes you exercised) Comments/Symptoms
Exercise log
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Part 1: Living with congestive heart failure
What is heart failure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 10
What causes heart failure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 10
How a healthy heart works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 11
What does heart failure feel like?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 12
How does my health care provider know I have heart failure? . . . . . . . . . . . . page 13
What is the treatment for heart failure?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 14
Whenitcomestosmoking–justsayno! . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 14
Part 2: Using medications to treat heart failure
Aspirin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 17
Diuretics(waterpills) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 17
Aldactone,eplerenone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page18
ACEinhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page18
AngiotensinIIreceptorblockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 19
Vasodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 20
Beta-blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 21
Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 22
Digitalis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 23
Heartfailuremedications:puttingitalltogether . . . . . . . . . . . . . . . . . . . . . . . page 23
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Table of contents
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Part 3: Eat right to feel right
Keeping track of sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 25
Say goodbye to salt!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page28
Reading food labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 29
Keepingtrackofliquids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 31
I’m thirsty! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 32
Watch the scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 33
Tips for dining out with confidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 34
Spice up your diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 37
Cookbooksandotherhelpfulbooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 39
Part 4: Exercising with heart failure
What are the best types of exercise to do? . . . . . . . . . . . . . . . . . . . . . . . . . . . page 40
ThinkF.I.T.:howmanydays,howhard,forhowlong? . . . . . . . . . . . . . . . . . . page 40
Whataboutstretching–doIhavetodothatalso? . . . . . . . . . . . . . . . . . . . . page 42
How will I know if I should stop exercising? . . . . . . . . . . . . . . . . . . . . . . . . . . page 44
Getmoving,keepmoving! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 44
Part 5: Finding comfort and support
Livingwithachronicillness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 45
Communityresources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 47
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Heart failure results when your heart loses its ability to pump enough blood through your body. In most cases, heart failure develops slowly, over a period of years. However, following a severe heart attack or a virus, heart failure can develop very quickly.Howseriousyourconditionisdependsonhowweakyourheartbecomes–inother words, how much pumping action your heart loses.
Heart failure is a chronic condition. In most cases it will not disappear and it can’t be cured. Taking the right medication at the right time, and paying attention to the foods you eat and how much fluid you drink every day, will help your heart continue to do itsjob.Inmostcases,thisleadstoimprovedheartfunction.
What causes heart failure?
The cause of heart failure can be one or more of the factors listed below, or sometimes the cause is unknown.
• Aheartattack
• Narrowingorcloggingoftheheartarteries
• Uncontrolledhighbloodpressure
• Diseasesoftheheartvalves
• Diseasesoftheheartmuscle
• Infectionoftheheartvalvesormuscles
• Defectsintheheartthatarepresentatbirth
• Irregularheartbeats
• Beingoverweight
• Havingdiabetes
• Anenlargedheartorafamilyhistoryofsuch
• Drinkingtoomuchalcohol
• Chroniclungorkidneydisease
• Pregnancy
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Part 1: Living with congestive heart failure
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How a healthy heart works
Yourheartisamuscle.Ithasfourchambers–twoontheleftsideandtwoontherightside. The upper chamber on each side, called the atrium, receives and collects blood. The lower chamber on each side, called the ventricle, pumps blood out of the heart. Fourvalvescontroltheflowofbloodwithintheheart.Thesevalvesactlikeone-waydoors. They allow blood to move forward, and they prevent it from backing up into the chamber it came from. The four heart chambers work together to pump blood through yourbody.Asittravelsaround,blooddeliversoxygenandnutrientstocells.
Animpairedordamagedheartpumpsbloodwithlessforce.Thiscausesbloodto flow more slowly around the body. It also causes blood to back up into the lungs and/or veins and other body tissues. Over time, your heart may stretch or increase insizeasitworksharderandhardertopumpthebloodaroundyourbody.Asit gets bigger, your heart also becomes weaker.
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Blood flow through a healthy heart
To the body
From the lungs
To the lungs
Left atrium
Left ventricle
Right ventricle
Right atrium
From the body
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Aweakenedheartcannotpumpbloodefficiently,soyourheartandlungsbecomebogged down with excess fluid. This makes it difficult for you to breathe, especially atnightwhenlyingdown.Also,you’llhavelessenergyortiremorequicklyaslessoxygen and nutrition are delivered to your muscles and other tissues.
Early signs of heart failure to watch for include:
• Fatigueorlackofenergy
• Shortnessofbreath
• Lossofappetiteornausea
• Swellingoffeet,ankles,legsorfingers
• Swellingoftheabdomenorfeelingbloated
• Progressiveweightgainfromthebodyholdingontoextrafluid(3to5pounds inonetotwodays)
• Havingtourinatemoreoftenduringthenight
• Needingmorepillowstosleep
Later signs of heart failure include:
• Feelingdizzyorforgetfulfromtoolittleoxygen-richbloodreachingthebrain
• Dark,strong-smellingurineornotbeingabletourinateasmuchasnormalfromkidneyproblemscausedbytoolittleoxygen-richbloodgettingto the kidneys
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How does my health care provider know I haveheart failure?
1. From problems that you report, such as being short of breath, feeling more tiredthanusualorfeelingasifyouhavetheflu(“wipedout”)
2. From heart tests,whichmayinclude:
• EKG/ECG to measure if there has been damage to your heart muscle and to evaluate any abnormal heart rhythm
• Chest X-ray to look for fluid buildup around your heart and lungs and to see if your heart is enlarged
• Echocardiogram to look at the heart valves and to determine how efficiently your heart is pumping
• Exercise stress test to see what your heart does when you exercise. It measuresyourbloodpressure,heartrateandECGwhileyouwalkonatreadmillor pedal a bike.
• Nuclear imaging scans to compare images of your heart at rest with images takenafteryourheartisstressed(bymedicineorbywalkingonatreadmill)
• Cardiac catheterization/angiogram, whichusescontrast(X-raydye)injectedthrough a catheter to take pictures of your heart and the blood vessels of your heart.(Thecatheterisputintoabloodvesselinyourarmorupperlegand guidedtoyourheart.)
3. From lab tests:
• BNP (B-type natriuretic peptide) blood test, which is used to diagnose heartfailureandmeasureitsseverity.Yourheart’spumpingchambersmakeextraBNP,ahormone,whentheycan’tpumpenoughbloodtomeetyourbody’sneeds.AhighBNPlevelmeansyouprobablyhaveheartfailure.ThehighertheBNPlevelatdiagnosis,theworseyourheartfailureislikelytobe.
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Step 1:Figuringoutthecause(ifpossible)
Step 2: Taking medications
Step 3:Changingyourlifestylehabits
• Avoidingsmoking
• Controllinghowmuchfluidandsodiumyouconsumeeveryday
• Balancingrestandexercise
When it comes to smoking – just say no!
Smoking reduces the amount of oxygen your blood can carry, raises your blood pressure and damages artery walls. In the event of a heart attack, a smoker also is more likely to die than a nonsmoker.
Avoidsecondhandsmoke,andifyoudosmoke,quit!Askyourdoctorforhelp,orusethe following information to get started.
ProvidenceResourceLine:503-574-6595
Providenceonlineresource:www.providence.org/stopsmoking
QuitNet:www.quitnet.com
Toll-freeQuitLine:Call1-877-270-STOP(7867)
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In more severe cases, other possible advanced treatments for heart failureinclude:
• Biventricular pacemaker, a new type of pacemaker made especially for people with heart failure who have a specific electrical abnormality of the heart seenontheEKG.Thisdevice“paces”orretimesthebeatofbothyourheart’sventricles(pumpingchambers),aprocesscalledcardiac resynchronization therapy (CRT).Gettingtherightandleftventricletobeatwithproper timing makes them pump blood more efficiently, which makes you feel better. NoteveryonewithheartfailurewillimprovewithCRT–yourdoctorwill discuss whether this pacemaker will help you.
• Implantable cardioverter defibrillator (ICD), a small mechanical device thatispermanentlyimplantedinsideyourbody(placedunderyourskinnearyourcollarbone)totreataseriousabnormalrhythm.Somepeoplewithheartfailuredeveloparapidabnormalheartbeatthatisdeadlyifnottreatedimmediately.Bydetecting this abnormal rhythm and delivering an electrical shock to the heart, an ICDrestorestheheart’snormalrhythm.
• Ventricular assist device (VAD), a mechanical device implanted during sur-gerythathelpsyourheartpumpblood.Partofthedeviceisplacedinyourheartandabdomen,andpartremainsoutsideyourbody.Youcarrytheoutsidepartofthe device on a belt around your waist or on a shoulder strap. If both pumping chambers(ventricles)ofyourheartarefailing,twoVADs(“heartpumps”)maybeused, one for each ventricle.
ApersonwithsevereheartfailureorsomeonewaitingforahearttransplantmaybenefitfromaVAD.Yourdoctorwilltalkwithyouaboutthisdevice.
• Heart transplant, an option in some cases when the heart is no longer workingwellenoughandthepersonisatriskofdying.Duringsurgery,the diseased heart is removed and replaced with a healthy human heart provided by adonor.Acomplexsetofrulesandguidelinesgovernshearttransplants.Yourhealth care team will discuss this with you.
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To manage heart failure, you may need to take several different types of medications every day.Yourjobistotaketherightdoseoftherightmedicationattherighttime.Bydoingthis, you will feel better and you won’t have to be admitted to the hospital as often. It can alsohelpyoulivelonger!Yournurse,pharmacistordoctorwillhelpyoudesignaschedule.
Right medication, right time, right amount
1.Keepawrittenrecordofallthemedicationsyoutake,includingover-the-countermedications,andalwayscarryitwithyou(seepage5).Ifyourdoctor,pharmacistor nurse changes the amount of a drug you take, be sure to change it on your medication list also.
2.Getorganized–buyaplasticpillboxatyourlocaldrugstore.
3.Getintoaroutine.Takeyourpillsatthesametimeeachday.Useanalarmortimer to help you remember.
4. If you will be away from home, take your pills with you so you don’t miss a dose.
5. Talk to your HEART doctor, nurse or pharmacist before you stop taking any medication. For example, perhaps you are having too many side effects, you can’t afford to pay for a medication, or your primary care doctor wants you to stop taking a medication. The medications you take are typically used to control high blood pressure. In your case, they are being used to treat heart failure, and different rules often apply, so check with your heart doctor first.
Watch your blood pressure!
The medications used to treat heart failure tend to lower blood pressure. To avoid becomingdizzythroughouttheday,sitorstandupSLOWLY.Youalsowillneedtomonitor your blood pressure every day. Yourhealthcareproviderorpharmacist can show you how to do this. Keep a written record and show it to your doctor at every visit.Anautomatedbloodpressurecuffmakesthejobeasy.Youcanbuyone at your local drugstore.
Part 2: Using medications to treat heart failure
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Aspirin
Common names:Ascriptin,Bufferin,Ecotrin
Purpose: lowers your chance of a heart attack or stroke; helps to stop blood clots from forming by preventing platelets in the blood from sticking together.
Side effect: bruising more easily
Reminders: • Takeabufferedorenteric-coatedproducttohelpprotectyourstomach.
• Ifyouhavehadableedingulcer,tellyourdoctorbeforestartingaspirintherapy.
Diuretics (water pills)
Common names: furosemide(Lasix),bumetanide(Bumex),hydrochlorothiazide(HCTZ) Purpose: to make you urinate more to help your body get rid of excess salt and water. This reduces the workload on the heart.
Side effects:legcramps,feelingdizzy,lightheadedorweak,lowerthannormalblood pressure, more trips to the bathroom.
Reminders: • Itisnotuncommontotaketwodifferentdiureticsatthesametime.
• Takeyourdiureticsasearlyinthedayaspossible(withbreakfast).Thiswillhelpcut down on trips to the bathroom at night. If you take a diuretic twice a day, take the second dose at 4 p.m.
• Weighyourselfeveryday.Ifyougain3to5poundsinonetotwodays,callyour doctor.
• IfyoutakeLasix,youmostlikelywillneedtotakeapotassiumsupplementalso.(Whenwatergoes,potassiumalsogoes.)
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Aldactone, eplerenone
Common names: spironolactone(Aldactone),eplerenone(INSPRA)
Purpose: a special type of diuretic; it’s used in heart failure to help slow the damage to heart tissue that occurs as the heart stretches or enlarges
Side effects:feelingtired,dizzy,lightheadedorweak,upsetstomach,headache,more trips to the bathroom
Reminders: • Ifyoutakespironolactone(Aldactone)oreplerenone(INSPRA),youshouldNOT
take a potassium supplement or use salt substitutes made with potassium unless yourdoctorgivesyoutheOK.Yourpotassiumbloodlevelsalsomayhavetobechecked once a month.
• Takeasearlyinthedayaspossible(withbreakfast).Thiswillhelpcutdownontrips to the bathroom at night. If you take this medication twice a day, take the second dose at 4 p.m.
• Weighyourselfeveryday.Ifyougain3to5poundsinoneto two days, call your doctor.
ACE inhibitors
Common names: captopril(Capoten),enalapril(Vasotec),lisinopril(Prinivil,Zestril) ramipril(Altace),trandolapril(Mavik)
Purpose: to open blood vessels so it’s easier for the heart to pump blood and to help slow stretching or enlarging of your heart
Side effects:excessivefatigue,drycough,feelinglightheadedordizzy,swellingoflips or throat
Reminders: • Togiveyourbodytimetoadjust,youwillstartbytakingasmalldose.Overtime,
you will build up to a larger dose.
• Avoiddirectsunlightorusesunscreen,asyouwillbemorelikelytoget sunburned when taking this medication.
• Yourdoctormayrequireyoutohaveregularbloodteststomonitoryourkidneys.Follow the schedule you are given.
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Angiotensin II receptor blockers (ARBs)
Common names:valsartan(Diovan),losartan(Cozaar),irbesartan(Avapro,Avalide)
Purpose: to slow the process of your heart enlarging, which happens with heart failure. This slowing helps to prevent your heart from getting weaker.(Thisdrugisoftengivenifyoucan’ttolerateanACEinhibitororabeta-blocker.)
Side effects:excessivefatigue,feelinglightheadedordizzy,swellingoflipsorthroat
Reminder: • Thismedicationmaymakeyourskinmoresensitivetothesunandcauseitto
burn.Usesunscreenwheninthesun.
Doctor’s orders: Take your medicine!
Studies show that people with heart failure who taketheirmedicationsasdirectedbytheirdoctor–especiallytheACEinhibitors,beta-blockersand angiotensinIIreceptorblockers(ARBs)–livelonger and need to be admitted to the hospital less often. Join the winning group! Take your medications at the right time and in the right amount.
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Vasodilators
Common names:nitroglycerin(Transderm-NitropatchorNitrospray),isosorbidemononitrate(Monoket,Imdur,ISMO),isosorbidedinitrate(Isordil), hydralazine(Apresoline),nesiritide(Natrecor)
Purpose: to relax or open blood vessels, which helps the heart pump blood through your body more easily
Side effects: feelinglightheadedordizzy,headaches(especiallywiththeNitro-patch),blurred vision, upset stomach
Reminders: • Checkyourbloodpressureeveryday.(Whenyoufirststartthismedication,check
yourbloodpressureatleastthreetimesaday.)Writeitdown.
• Takeatlunchtimeoratleastthreehoursapartfromtheothermedicationsyoutake for heart failure.
• Youmaybreaklong-acting(LA)orslow-release(SR)tabsinhalf;however,doNOTcrushthem.
• It’snormaltoneedmoreofthisdrugovertime;yourdoctorwillletyouknowwhen you need to take more.
• Nesiritide,aspecialtypeofvasodilator,isaman-madeformofB-typenatriureticpeptide, a naturally occurring hormone secreted by the heart as part of the body’s responsetoacuteheartfailure.Thismedicationisinjectedintoyourveinandmust be given over a period of hours in a hospital.
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Beta-blockers
Common names:carvedilol(Coreg),metoprolol(ToprolXL,Lopressor), bisoprolol(Zebeta)
Purpose: to slow your heart rate and to lessen the effects of hormones that make your heart enlarge. This causes your heart to need less oxygen.
Side effects:feelingdizzyorlightheaded,lackofenergy,shortnessofbreath,upsetstomach, impotence
Reminders: • Itisnormaltoexperiencemanysideeffectswhenyoufirststartthismedicine,
especially in the first five days. The amount you take will be increased very slowly togiveyourbodytimetoadjust.Trytostickwithit,asmostpeoplereportfeelingmuch better in a few weeks.
• Takewithfood.
• DONOTtakeover-the-countercoldmedicinesornasaldecongestants,suchasSudafed.
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Warfarin
Common name:Coumadin
Purpose: to reduce your chance of blood clots or stroke; thins the blood to help stop blood clots from forming and to keep clots from getting larger
Side effects: bruising, increased risk of bleeding
Reminders: • Howmuchwarfarinyoutakeisdeterminedbyabloodtestcalledprotime,orINR.
Whenyoustarttakingwarfarintherapy,youneedtohaveyourINRcheckedatleast twice a week.
• Asyourbloodlevelbecomesconstant,youmostlikelywillneedanINRonce a month.
• Takeyourwarfarinatthesametimeeachday.Ifyouforgettotakeadose,callyourdoctor.Donottaketwotabletsthenextdayto“catchup.”
• Remindallyourdoctorsthatyouaretakingwarfarinwhentheystartorstopanyof your other medications.
• Ifyouaresickandunabletoeatfortwodaysormore,oryouhavevomiting anddiarrheathatlast24to48hours,contactyourdoctor.Yourdosemayneedto be changed.
• FoodshighinvitaminK–broccoli,spinach,lettuce(exceptforiceberg),greencabbage,turnipgreens,collardgreens,Brusselssprouts,endive,parsleyandwatercress–mayinterferewithhowwarfarinworks.Youdonothavetostopeating these foods; however, keep eating the same amounts from day to day.
• Callyourdoctoraboutanyunusual bleeding, such as bruising for unknown reasons, unusual bleeding while brushing your teeth or shaving, or nosebleeds.
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Digitalis
Common names:digoxin(Digitek,Lanoxin) Purpose: to help your heart pump more strongly and to prevent or decrease irregular heartbeats
Side effects (from too much in your body): loss of appetite or upset stom-ach,flu-likesymptoms,unusualfatigueorweakness,diarrhea,confusion,changesinvision, headache, weight loss
Reminders: • Checkyourheartrateeveryday;callyourdoctorifitdropsbelow60.
• Takeitonanemptystomachandatleasttwohoursawayfromyourother medications.Bedtimeisbest.
• Antacidsinterferewiththismedicine,sotakeatleasttwohoursapart.
• Inkeepingwithyourdoctor’sorders,haveyourbloodtestedregularly to check the digoxin level in your body.
Heart failure medications: putting it all together
Here is a sample schedule you can follow to make sure you take the right medication at the right time. If your nurse or doctor puts together a different plan, follow that one.
Morning with breakfast Diuretic ACEinhibitorand/orbeta-blocker
LunchtimeVasodilator, if you take one
Late afternoon (4 p.m.)Diuretic–seconddoseifyoutaketwiceaday
DinnerACEinhibitorand/orbeta-blocker
BedtimeDigoxin
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Kidney disease and diabetes
If your physician has told you that you have kidney disease:
PleaseremembertheseadditionaldietaryguidelinesforyourkidneydiseasewhenreviewingthedietinformationinPart3ofthisbooklet.
1. Fruits, vegetables and other foods may have high levels of the mineral potassium.Potassiumintakemayneedtobemanagedforyourkidney function.Askyourphysicianorregistereddietitianifyouneedtoadjusttheamountofhigh-potassiumfoodsinyourdiet.Somehigh-potassiumfoodsare drybeans,potatoes,orangejuice,driedfruits,bananas,broccoliandavocados.
2. Follow the fluid limits set by your physician. In many cases, you may need to drink less fluid than the recommended amounts in this booklet due to your kidney function.
3. There are other foods that your doctor may want you to manage. The best way to learn about these foods is a visit with your doctor, who can refer you to a registereddietitianformoreindividualizedhelp.
If your physician has told you that you have diabetes:
PleaseremembertheseadditionaldietaryguidelinesforbloodsugarmanagementwhenreviewingthedietinformationinPart3ofthisbooklet.
Pleaseremembertheseadditionalguidelinestobettermanageyourbloodsugar.
1. Bemoderateineatingsweetenedfoodsandsugar.
2. Balancecarbohydrateintakewithmedicationandexercise.
3. Controllingfoodportionsizeshelpsmanagecarbohydrateintake.
4. Leancutsofmeat,chickenandfishhavelesssaturatedfat,soarebetterproteinchoices.
5. Choosefoodshighinfiber.Wholegrains,freshfruitsandvegetablesaregreatsources of dietary fiber and will help with blood sugar control.
To learn about foods and meal guides for kidney disease or diabetes, your doctor can referyoutoaregistereddietitianformoreindividualizedcare.
Part 3: Eat right to feel right
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With heart failure, your heart is no longer able to pump as strongly as it needs to. Asaresultfluidtendstobuildupinyourfeet,ankles,legs,handsandfingers.Fluidalso can build up in your heart and lungs, making you feel tired and short of breath.
Youmusthelpyourheartbywatchingtheamountofsalt(sodium)andfluidthatyouhaveeachday.Peoplewithheartfailuregenerallyfeelbetterandmostlikelyneedlessmedicationiftheyfollowtheseguidelines:*
Sodium: 2,000 to 3,000 milligrams a day
(1 teaspoon of table salt = 2,300 mg sodium)
Fluid: 2 quarts a day (eight 8-ounce cups)
*If your doctor gives you other limits for sodium and/or fluid, follow those guidelines.
Keeping track of sodium
Keep life simple! First, focus on eating less sodium. Once you have this habit firmly in place, you can work on other parts of your eating plan. Rather than counting milligrams of sodium at every meal, think of 2,000 to 3,000 milligrams as a budget youhavetospreadovertheentireday.Learnwhichfoodsarenaturallylowinsodium(eatmoreofthese)andwhichfoodsyouwillneedtoavoidorlimitbecausetheyaretoo high in sodium.
Sodiumcanbefoundinallfivefoodgroupsthatmakeupabalanced,healthydiet:
Breadsandcereals
Some vegetables
Meatandmeatalternatives(eggs,beans,soyfoods)
Milk, yogurt and cheese
Someofthesegroupscontainmanyhigh-sodiumfoods.Also,“extras”(fats,oilsandsweets),canbehighinsodium.Your job is to put your time and energy into choosing “green-light” foods, making smart choices from the “yellow-light” foods, and removing “red-light” foods from your daily eating plan. Usethechartthatfollowstoguideyourchoices.
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Green-light foods: Low in sodium, so enjoy on a regular basis.
Low-sodium Portion Sodium
Fruit:fresh,frozenorcanned 1cupor1serving 0-20mg
Vegetables:freshorfrozen 1⁄2 cup-1cup 5-30mg (nosauces)
Rice or pasta, cooked 1⁄2cup-1cup 10-30mg
Milk:skimorlow-fat 1cup 120mg
Yogurt 6-8ounces 90-190mg
Eggs 1 65mg
Chicken,whiteordarkmeat 3.5ounces 70-90mg (skinremoved)
Hamburger 3.5ounces 60-80mg (madewithlow-fatgroundbeef)
Porkloin 3.5ounces 70mg
Yellow-light foods: Proceed with caution. Check labels of similar items and choose the lowest sodium level for the same serving size.
Medium-sodium Portion Sodium
Bread 1slice 95-240mg
Bagel 1(31⁄2ounces) 250-370mg
Crackers 1ounce 120-300mg
Cereal 3⁄4cup 0-370mg
Peanutbutter 2tablespoons 5-220mg
Cheese,naturalorprocessed 1ounce 75-350mg
Frozenentrees Varies Choose650mg or less Limitoneperday
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Red-light foods: Avoid these items!
A few examples of high-sodium foods Portion Sodium
Cannedvegetables,regular 1⁄2 cup-1cup 350-1,100mg
TomatoorV-8juice,regular 6ounces 950mg
Cottagecheese 1cup 920mg
Ham 3.5 ounces 1,200 mg
Breads and cerealsBiscuitmixes Breadstuffingmixes Self-risingflourPancakes,pancakemixes Saltedbreadsticks,rolls CroissantsFlourtortillas,burritosize Frozenwaffles,pancakes Bisquickbakingmix
VegetablesCanned,regular Olives MostpicklesTomatojuice,regular V-8juice,regular SauerkrautPickledvegetables Cannedbeans:refried,baked
Meat: Avoid all smoked, canned, salt-cured, dried and kosher meat and fish!Cannedmeatorfish* Hotdogs MostTVdinnersFrozenbreadedfishormeat Liverwurst SausageBacon Cornedbeefhash CanadianbaconLunchmeats(bologna,salami,pastrami,etc.)
*Cannedtuna:Lookfor“verylowsodium”chunkwhitealbacoreinwater.
Milk, yogurt, cheeseCottagecheese Buttermilk Cheesespreads
Bakery, desserts, snacksCinnamonrolls,coffeecakes Pie Instantcakemixes*Instantpuddingmixes Doughnuts* Pretzels*Potatochipsandcornchips* Nuts,saltedordryroasted *Youcanfindlower-sodiumoptions.Readlabelsandcompare.
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Red-light foods: Avoid these items!
Sauces, condiments, graviesSalt:includingseasalt,rocksaltandkoshersalt Catsup Gravymixes SoysauceSteak sauce Tartar sauce Teriyaki sauce Hollandaisesauce Bouillon,broth Barbecuesauce Garlic,onion,celerysalts Seasonings Salsa*Spaghettisauce* Meattenderizer Bottledsaladdressings*Monosodiumglutamate(MSG)
*Youcanfindlower-sodiumoptions.Readlabelsandcompare. Convenience foodsInstantriceandpastamixes Instantpotatoes(augratin,scalloped,cheese)Dehydratedandcannedsoups PackagedmacaroniandcheeseRamennoodles Casserolemixes Ethnicfoods(Mexican,Italian,Chinese) Sportsdrinks Delifoods(potatoandmacaronisalads,etc.) Fastfood
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Say goodbye to salt! 1. Fresh is best! The more a food has been processed or made into a convenience item, the higher
the sodium content is likely to be.
2. Hide the salt shaker so you don’t use salt in cooking or at the table. Family members and friends can salt their own portions if needed.
3.Beawareofover-the-countermedications.Many,includingantacids,laxativesandcoughmedicines,containlargeamountsofsodium.Lookat the ingredient list or check with your doctor or pharmacist before taking these products.
4.Saynotobakingsoda.Don’tbrushyourteethwithitoruseitasanantacid–it’shighinsodium.
5.Checkwithyourdoctorbeforeusingasaltsubstitute.Noteveryonecanusesaltsubstitutesbecauseofthelargeamountofpotassiumtheycontain.(Ifyourdoctorgivesyouthego-ahead touseasaltsubstitute,donotcookwithit.)
6.ChecktheNutritionFactsonfoodlabelsforthesodiumcontentofthefoodsyoueat. Youalsocanbuyareferencebook(checkyourlocalbookstore)thatliststhesodiumcontent in hundreds of foods.
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Reading food labels
First: ChecktheNutritionFactslabelonfoodpackages.Findtheservingsizeandtheamount of sodium listed for that specific amount. If you choose to eat more or less thantheservingsizelisted,theamountofsodiumyoueatwillchangealso.
Keepinmindthat%DailyValueisbasedonagoalofconsuming2,400mgorlessofsodium each day. If your goal for the day is lower, the item will contribute more than thelisted%DailyValue.
Second: Checktheingredientslist.Avoidorlimitfoodsthatcontain:
• Salt
• Sodium
• Monosodiumglutamate(MSG)
• Sodium-containingadditives:sodiumbicarbonate(bakingsoda),bakingpowder,disodiumphosphate,sodiumalginate,sodiumbenzoate,sodiumnitrite,sodiumpropionate, sodium sulfite
Ruleofthumb:Ifsaltislistedasoneofthefirstfiveingredients,theitemistoohigh in sodium.
Third: On the front of a canned item, look for one of the best indications that it’s a low-sodiumfood:“NoSaltAdded.”
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Reading food labels
Canned Tuna
Heart smart
Heart unhealthy(too high in sodium)
Very Low Sodium Chunk White Albacore
(In Water)
Nutrition FactsServing Size 2 oz drainedServings Per Container 2.5
Amount Per Serving
Calories 70 Calories from Fat 10
% Daily Value*
Total Fat 1.0g 2%
Saturated Fat 0g 0%
Trans Fat 0g 0%
Cholesterol 25mg 8%
Sodium 35mg 1%
Total Carbohydrate 0g 0%
Dietary Fiber 0g 0%
Sugars 0g
Protein 15g 27%
Ingredients:Whitetuna, demineralizedwater.
Solid White Albacore(In Water)
Nutrition FactsServing Size 2 oz drainedServings Per Container 2.5
Amount Per Serving
Calories 70 Calories from Fat 10
% Daily Value*
Total Fat 1.0g 2%
Saturated Fat 0g 0%
Trans Fat 0g 0%
Cholesterol 25mg 8%
Sodium 250mg 10%
Total Carbohydrate 0g 0%
Dietary Fiber 0g 0%
Sugars 0g
Protein 15g 27%
Ingredients:Whitetuna,water, vegetable broth, salt, pyrophosphate
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Keeping track of liquids
Aimtodrink2 quarts (eight 8-ounce cups) of fluid a day.Anymoreandyoumakeyourheartworktoohard.(Ifyourdoctorrecommendsanotheramountoffluidperday,followthoseguidelines.)
Fluids include everything you drink and any item that melts at room temperature. Count these as part of your daily fluid intake:
Water Coffee,tea** Fruitorvegetablejuice,drinksMilk Soda,dietsoda Lemonade,icedteaBroth,soup Gelatin Icecream,frozenyogurtSherbet Popsicles IceAlcohol*
* Alcohol: Check with your doctor about drinking alcohol. For many medications, alcohol is not recommended. Limit: one drink a day for women, two drinks a day for men (one drink = 12 ounces of beer, 3.5 ounces of wine, 1.5 ounces of hard liquor).
** Coffee, tea: Limit yourself to one caffeinated cup (8 ounces) a day.
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The best way to know if you are getting too much or too little fluid is to keep track of yourfluidintakeforthreedays.Checkthesizeofyourglasses,cups,mugsandsoupbowls. Knowing how much each holds will make it easier to stay within your limit.
Helpful tips:
2quarts=eight8-ouncecups 8ounces=Icup 4ounces=1⁄2 cup 2tablespoons=1ounce 1icecube=1ounce 1adult-sizedgulp=1ounce
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I’m thirsty!
Chewsugarlessgum. Suck on a piece of sour hard candy.
Rinseyourmouthwithwater–don’tswallow.
Eatice-coldfruitsandvegetables.
Addlemonjuicetowaterandicecubes,it’sverythirst-quenching.
Avoideatinghigh-sodiumfoods.Moresaltmeansgreaterthirst.
Useyourfluidswisely–takeyourmedicationswithmealtimebeverages.
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Watch the scale
Partoftakingcareofyourselfistrackingyourweight.How much sodium you eat and the amount of fluid you drink greatly affect your weight and how hard your heart has to work.
Beawareofsignsthatyouareretainingfluid:
• You’remoreshortofbreathorneedtosleepproppeduponpillows.
• Yourbellyseemsmoreswollen,yourbeltseemstighteroryourclothesdon’tfitas well.
• Yourfeetandanklesbecomeswollen,yourshoesbecometightoryourshoelacesseem shorter than normal.
Your job is to:
1. Weigh yourself every day and write it down(onacalendarorusepage6).
• Usethesamescale.(Placescaleonahardsurface,notonarug.)
• Weighyourselfeverymorningwhenyougetup.Dothisbeforeyoueatandaftergoing to the bathroom.
• Wearthesameamountofclothingeachtimeyouweighyourself.
• Writeyourweightdown.
2. Call your doctor if you gain a lot of weight –3to5poundsinonetotwo days.Yourdoctormayneedtoadjustyourmedications.
3. As soon as you notice that you have any signs of increased swelling or holding on to fluid, follow these guidelines:
• Cutbackonsodium.Eat500mglessfortwodays(today andtomorrow).
• Cutbackontheliquidsyoudrink.Drink1to11⁄2 cups less fortwodays(todayandtomorrow).
• Ifyourweightdoesnotdropafteryouhavehadlesssaltand fluid for two days, call your doctor.
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Tips for dining out with confidence
Livingwithheartfailuredoesn’tmeanyoucan’teatoutafewtimesamonth.Eatingawayfromhome,however,doeshaveplentyofchallenges.Fastfood,suchaspizza,deluxe burgers and breakfast sandwiches, and most deli items, such as submarine sandwichesandpre-madesalads,containtoomuchsodium.Choosefamily-style restaurantswhereyouhavemoreoptionsandcanrequestthatfoodsbemade without added salt. No matter where you dine, always ask that condiments be served on the side.
Usethesetipsandrecommendationstostayoncourse:
Appetizers
Go for it
Fruitjuice
Fresh, canned fruit
Jell-O
Relish plate with raw veggies
Not recommended (too much sodium)
Vegetablejuice Fried vegetables, potato skins Nachos,chipsandsalsa
Soups
Relish plate with pickled items
Salads
Go for it
Fresh garden salad, dressing on the side
Sliced tomatoes
Fruit salad
Not recommended (too much sodium)
Gardensalad,dressingalreadyonit Coleslaw
Macaroni or potato saladCottagecheese
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Starchy sides
Go for it
Mashed, baked, boiled or steamed potatoes
Steamed rice
Boilednoodles
Not recommended (too much sodium)
Fried, scalloped or au gratin potatoesFrench fries Fried rice
Noodlesinacreamsauce
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Entrees
Go for it
Anyleanmeat,fishorpoultryroasted,baked,boiled or poached
Reminder:Asktohaveentreesprepared without salt.
Not recommended (too much sodium)
Fatty, fried or breaded meats Stews and casseroles
Vegetables
Go for it
Stewed, steamed or boiled
Not recommended (too much sodium)
Fried or breaded vegetables In a sauce or au gratin
With butter or cooked in egg yolk
Breads
Go for it
Hard or soft roll, breadsticks
Plainbreadortoast
Unsaltedcrackers,Melbatoast,matzos
Not recommended (too much sodium)
Butterroll,biscuit,croissant Sweet rolls, coffee cake
Salted crackers
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Beverages
Go for it
Fruitjuice
Skim,low-fatmilk
Soda, diet soda
Tea,coffee(limitto1cupadayifcaffeinated)
Not recommended (too much sodium)
Vegetablejuice
Alcohol,unlessallowedbyyourdoctor
Condiments (Limit to 2 tablespoons a day)
Go for it
Salad dressing, oil and vinegar
Reminder:Asktohaveallcondimentsservedonthe side.
Not recommended (too much sodium)
Mayonnaise-typedressing Gravy,cheesesauce
Baconbits
Olives, dill pickles
Desserts
Go for it
Fresh fruit
Angelfoodcake
Sherbet,Italianice,fruitsorbet,low-fatfrozenyogurt
Jell-O
Not recommended (too much sodium)
Pastries,cakes,pies
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Spice up your diet
Products to buy:
• Mrs.Dash
• Freshanddriedherbs:oregano,paprika,parsley,thyme,etc.
• Lemonsandlimes,lemonjuice,limejuice
• Pepper
• Vinegar
• Garlicandgarlicpowder
• Ginger
• Currypowder
• Freshonions,scallions,chives
• Freshhorseradish
Products to make:
Tomato sauceBuyfreshtomatoes.Mashthemandthenblendorfoodprocessuntiltheynolongerlookliketomatoes,butlikeliquid.Pourthroughastrainer.
To create a thicker tomato sauce, simmer the mixture over low heat until the desired thickness.
Spice blends: Combine all ingredients and mix well. Place in a shaker for use while cooking or at the table.
Chili powder2 tablespoons paprika 2 teaspoons oregano 11⁄4 teaspoon cumin 11⁄4 teaspoon garlic powder 3⁄4teaspoon groundredpepper(cayenne)3⁄4 teaspoon onion powder
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American favorite blend1 tablespoon garlic powder1 tablespoon paprika1 tablespoon dry mustard5 teaspoons onion powder1 teaspoon thyme1⁄2 teaspoon white pepper1⁄2 teaspoon celery seed
Source:NationalKidneyFoundation,www.kidney.org
Spicy seasoning3 tablespoons celery seed2 tablespoons crushed oregano1 tablespoon onion powder1 tablespoon crushed thyme11⁄2 teaspoon ground bay leaf11⁄2 teaspoon black pepper11⁄2 teaspoon ground cloves1 teaspoon garlic powder
Source:NationalKidneyFoundation,www.kidney.org
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Cookbooks and other helpful books
“American Heart Association Low-Salt Cookbook: A Complete Guide to Reducing Sodium and Fat in Your Diet”AmericanHeartAssociation, 800-242-8721,www.americanheart.org
“Get the Salt Out: 501 Simple Ways to Cut the Salt Out of Any Diet” by AnnLouiseGittleman. ThreeRiversPress,1996
“Eat Out, Eat Right! A Guide to Healthier Restaurant Eating” by HopeS.Warshaw.SurreyBooks,2003
“The Diabetes Food and Nutrition Bible: A Complete Guide to Planning, Shopping, Cooking and Eating”byHopeS.WarshawandRobynWebb. McGraw-Hill,2001
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Livingwithheartfailuredoesn’tmeanyouhavetositonthesidelines.Infact,youshouldkeepmovingasmuchaspossibleandkeepupwithactivitiesthatyouenjoy,like walking, swimming and gardening. If you haven’t been very active, it’s not too late to start. The more fit you and your heart are, the better you will feel.
Yourheartisjustlikeanyothermuscleinyourbody:tokeepitashealthyandstrongaspossible,youneedtoputittowork.Astrongheartisabletopumpblood(whichcarriesoxygen)throughyourbodymoreeasily.Atthesametime,yourbodyusesthisoxygenbetter.Asyoubecomefit,you’llhavemoreenergyandfeellessshortofbreath. This means that daily tasks, such as taking a shower and brushing your teeth, willseemeasier.You’llmostlikelyalsosleepbetter,handlestressbetter,andfinditeasier to reach and stay at a healthy weight.
What are the best types of exercise to do?
Thebestactivitiesforyourheartarethosethatuselargemusclegroups(thismeansyourlegs)andthatyoucando(orworkuptodoing)for30minutesatatime.Someexamplesarewalking,ridingastationarybikeandswimming.Evenlessintenseactivi-ties, such as strolling, gardening and housework, can bring benefits. It all adds up!
When it comes to exercise, think F.I.T. (Frequency, Intensity and Time)
Frequency: How many days per week do I need to exercise?
• Asmanydaysasyoucan–atleastfourdaysaweek;moreisevenbetter. The key is to find activities that you like to do and then do them on a regular schedule.Getmovingandkeepmoving.
Intensity: How easy or hard should it feel when I exercise?
• Youwanttoworkatamoderatepace–fairlylighttosomewhathard.Youshouldbeabletotalkatalltimeswhileexercising.Ifyou’rejustbeginninganexercise program, you will need to start at an easier pace.
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Part 4: Exercising with heart failure
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Time: How long should I exercise?
• Ifyou’vebeendoinglittleornoexercise,getstartedbydoingfiveminutesorless. Work your way up slowly, by adding one to two minutes to the total time each week. If possible, work up to exercising for 30 minutes at a time.
• Aimfor30minutesofactivityatonetime.Ifyoufeelgood,youcancertainlydomore.
• Somedays,youmaychoosetobreakyourexerciseupintosmallerbouts.Forexample, you could walk 10 minutes in the morning, 10 minutes at lunch and 10 minutes in the evening. It all counts!
Reminders:
• Everyonestartsatadifferentlevel–justfocusonwhatyoucando.
• It’sOKtotakearest.Forexample,youcanexerciseuntilyoufeeltiredorshortof breath, take a short rest, and then continue.
• Alwaysstartwithawarm-up.Thispreparesyourheart,musclesandjointsforactivity. For the first 10 to 15 minutes, exercise at a slower pace than normal. Afteryouwarmup,youcanpickupthepace.
• Alwaysendwithacool-down.Whenyou’renearingtheend,don’tstopwhatyouaredoingquicklyandstandstill.Thismaymakeyoufeeldizzyorlightheaded.Instead, cool down and give your heart a chance to recover by taking several minutes to slow your pace down before coming to a stop.
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What about stretching – do I have to do that?
Take a few minutes to do some gentle stretching movements after you exercise, whenyourmusclesarewarm.Youwillfeellessstiffandsorethenextday,andithelpstoprotectyourjointsandmusclesfromharm.
Follow the pictures for examples of some easy stretches to do. Hold each stretch for 15secondsorlonger.Alwaysstretchslowlyandsmoothly–donotbounceorjerk.It’sOKtofeelsometightness,butdonotstretchtothepointoffeelingpain.And,mostimportant of all, don’t forget to breathe as you stretch!
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Arm stretch
Gentlypullelbow (witharmbent)acrosschest toward opposite shoulder. Switch arms.
Shoulder stretch
With arms overhead, hold elbow of one arm with the hand of the otherarm.Gentlypullelbow behind head. Switch arms.
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Quadricep stretch
Stand with support, and pull lower leg toward buttocks, grasping pant leg or ankle. Keep upper leg and hip straight, knees together. Switch legs.
Modified quadricep stretch
If unable to hold ankle or pant leg, place leg on chair that is at or slightly above knee height.
Hamstring stretch
Extendoneleg.Keeping torso straight, lean forward, sliding hands down leg until a stretch is felt in back of thigh. Switch legs.
Calf stretch
Stand with hands support-ed on wall, elbows slightly bent, front knee bent, and back knee straight. Keep feet parallel and both heelsonthefloor.Leaninto wall by pushing hips forward. Switch legs.
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How will I know if I should stop exercising?
Listentoyourbody!Ifyoufeellightheadedordizzy,feelnauseous(sicktoyour stomach),havechestpain(angina),oraremoretiredorshortofbreaththanusualslow down immediately and then stop what you are doing! If you don’t feel better after resting for a few minutes, call your doctor.
Giveyourselfthebestchanceatfeelinggoodwhenyouexercise:
• Waitonetotwohoursaftermealsbeforeyouexercise.
• Wearcomfortableclothingandfootwear.
• Don’texerciseoutdoorsonhotdaysoronverycolddays.
• Avoidcoldorveryhotshowers,steamroomsandsaunasafterexercise.Choosemoderate temperatures only.
Get moving, keep moving!
1. Make exercise a priority. Write it on your daily schedulejustthewayyoudootherappointments.
2.Pickactivitiesyouenjoy.
3.Ifyouneedcompany,joinaclassorexercisewith a friend.
4.Planaheadforroadblocks—takingatrip, badweather,guestsintown—withaplanB. For example, walk indoors in a mall on cold, rainy days.
5.Keepanexerciselog(seepage7).Shareitwithyourdoctor.Beproudofallyoudo!
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Living with a chronic illness
It’s normal to feel sad, anxious, overwhelmed and even angry about having to live withheartfailure.Althoughthereiscurrentlynocureforcongestiveheartfailure,youdon’thavetostopenjoyinglife.Peoplelivingwithheartfailurewhotakechargeoftheir health and stay connected to their family and friends report feeling better. They have more energy, spend less time going to doctor appointments and, very often, can take less medication.
Reach out and connect with others to boost your own energy and strength. It’s a lot better for your heart than trying to go it alone.
Support people:Yourfamilyandfriends–thepeopleclosesttoyou–knowyouthe best. Talk to them about how you are feeling and come up with solutions to prob-lemstogether.Listenandtaketheirsuggestions.Yourlocalpastor,priestorrabbicanalsobehelpful.Beingpartofaspiritualcommunity,suchasalocalchurch,synagogueortemple,canbeabigboosttoyourdailywell-being.
Health care team:Yourdoctor,nursesandotherhealthcareproviders,suchas dietitians, exercise experts and pharmacists, are all trained to deliver the best care. Theywillworkwithyoutodesignatreatmentplanjustforyou.
Your spiritual center:Allofusarespiritualbeingswhetherwepracticeaparticularreligiousfaithornot.Exploreandconnectwiththepartsofyourselfandyourlifethatpersonally give you energy and strength. Having a deeper meaning and purpose in life helpsusmanageeverydaystressandenjoylifetoitsfullest.
Turning to a chaplain for care and support
While at the hospital, you can ask your nurse to contactProvidencePastoralandSpiritualCareServicesforyou.Achaplaincanbeagoodcompanionin times of illness, and he or she may help you find or rediscoveryourspiritualcenter.Providencechaplainsrespect the needs and wishes of people of all religious faiths and of people with no faith tradition.
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Part 5: Finding comfort and support
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Ready, set, breathe!
When you are feeling tired and short of breath, you can often feel better in a matter of minuteswithasimplerelaxationexercise.Giveitatry.Youwillbeamazedathowwellit works!
1.Sitdowninaquietplace.Closeyoureyes.
2.Allowallofyourmusclestorelaxforafewminutes.
3.Duringthistime,keepbreathing.Takeslow,deepbreathsinthroughyournoseand out through your mouth.
4.Letyourmindclear.
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Community resources
With the right medical care and lifestyle changes, your heart problem should not stop youfromenjoyingthingsyouliketodo.Theseresourcesmaybehelpful.
Yourhealthinsurancecompanymayhaveaprogramtomanagecongestiveheart failure.Besuretocheck.
Medicare
IfyouhavequestionsconcerningMedicare insurance,contact:
MedicareClaims,PartA 503-721-7007MedicareNorthwest1800S.W.FirstAve.,Suite380Portland,OR97201
NationalMedicareHotline 800-MEDICARE (633-4227)
Social Security Administration
ToinquireaboutSocialSecuritydisabilitybenefits,call:
SocialSecurityAdministration 800-772-1213
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Veterans Affairs
IfyouservedintheUnitedStatesarmedforces,youmaybeeligibleforbenefitsthroughtheDepartmentofVeteransAffairs.
OregonDepartmentofVeteransAffairs 800-633-6826www.odva.state.or.us
U.S.DepartmentofVeteransAffairs 800-827-1000
Medicaid
Healthassistanceforlow-incomepeople,contactSeniorsandPeoplewithDisabilities.
Forgeneralinformationortofindalocalareaagency 800-232-3020
MultnomahCounty Senioranddisabledhelpline 503-988-3646 DowntownPortland/westside 503-988-5460 SoutheastPortland 503-988-3660 NorthPortland:uptoage60 503-988-3429 ages60andolder 503-988-5470 Mid-county 503-988-5480 Gresham 503-988-3840
ClackamasCounty 503-655-8640
WashingtonCounty Hillsboro 503-640-3489 Beaverton 503-627-0362 Tigard 503-968-2312
Transportation
If you need help with a ride to doctors’ appointments, the grocery store or the pharmacy,pleasecall:
• RideConnection 503-528-1720
Application can take two to four weeks to process.
• TriMet(LIFT) 503-802-8200
Application can take three weeks to process.
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Meals and grocery delivery services
• Loaves&Fishes(theMeals-On-Wheelspeople) 503-736-6325
• StoretoDoor– 503-413-8223 (groceries,householdgoods,prescriptiondelivery)
Private caregivers and housekeepers
LookforprivatecaregiversintheYellowPages.TheyarelistedunderthecategoryHomeHealth Services. You must pay for these services yourself.
Prescription-drug assistance programs
Yourdoctor’sofficehasapplicationsfortheseprogramsandwillbeabletohelpyou.
Health, wellness and lifestyle resources
Providence Health & Services: • Heartfailureclinic 503-215-6672
• Heartfailureeducationclasses 503-574-6595 (ProvidencePortlandMedicalCenter)
• Onlinehearthealthinformation www.providence.org/heart
• ResourceLine 503-574-6595
• HeartWorks,supervisedexerciseprogram 503-215-8039
• CardiacRehabilitationCenter 503-216-1250
• HeartStrongCardiacPhysicalTherapy 503-216-5410
Cardiac support groups:
AdventistMedicalCenter 503-251-6260
AmericanHeartAssociation 503-233-0100 www.americanheart.org
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