McLaren Northern Michigan Living With Heart Failure: Resources to Improve Your Quality of Life by Mitchell Graphics

LIVING with Heart Failure

Resources to Improve Your Quality of Life

Living With Heart Failure You or your loved one has been given this booklet because you have Heart Failure. You are not alone. About 600,000 new cases of heart failure are diagnosed each year and it is the leading reason people 65 years of age and older end up in the hospital. Heart Failure is a serious life-long condition. But, by managing Heart Failure, people can live normal lives. Please read and learn from this booklet to improve the quality of your life!

What Causes Heart Failure? • I njury to the heart muscle from a heart attack or infection • B eing born with a certain type of heart problem • H igh blood pressure left untreated

• U nknown causes • A lcohol and drug abuse • V iral infections • H eart valve problems

TABLE OF CONTENTS What Is Heart Failure? �� 1 How Is It Diagnosed? ��2 What Can You Do If You Have Heart Failure? ��2 Heart Failure Action Plan ��3 Foods to Avoid �� 4 Reading Food Labels �� 6 Eating Out ��7 Daily Fluid Limit �� 8 Ejection Fraction �� 9 Medications ��10 Glossary & Web Resources ��12 Connecting Your Care with CardioSmart �� 13 Heart Healthy Living Wellness Group �� 13 Anatomy of the Heart ��Back Cover

WHAT IS HEART FAILURE?

How Does Heart Failure Affect the Rest of Your Body? Simply put, heart failure means that the pumping power of your heart cannot send out enough blood to meet the demands of your body. In order to keep up with your body’s needs, it needs to contract and expand so it can circulate blood. Reduced blood pumped by your heart can affect your lungs, your kidneys, your brain, your gastrointestinal (GI) tract, and other major organs. It can cause fatigue, confusion, weakness, shortness of breath, inability to lay flat, a dry cough, swelling in your legs, feet, abdomen, and chest pain.

Two Main Types of Heart Failure 1. Systolic Heart Failure means that your heart has trouble pumping blood and circulating it through your body. Systolic Heart Failure has a problem with the Squeeze. The muscle has thinned. It may cause your blood to back up into your lungs, commonly called fluid in the lungs. It may also cause your ankles, legs, and abdomen to swell.

Thin muscle doesn’t squeeze well.

Systolic heart failure is also called Heart Failure with reduced Ejection Fraction (HFrEF). Ejection fraction is the percent of blood pumped into your body with each heartbeat. When your ejection fraction is reduced, your heart is leaving blood in the chamber instead of pumping it into the body. 2. Diastolic Heart Failure means that the heart’s lower chambers (ventricles) have become too stiff to relax. They cannot Dilate (expand) to fill with enough blood. So even though the squeeze is good, there is less blood available in the chambers to pump into the body. This can result in the backup of fluid and other symptoms of heart failure.

Thick muscle doesn’t relax & fill well.

Diastolic Heart Failure is also call “Heart Failure with preserved Ejection Fraction” (HFpEF).

How is it Diagnosed? Heart Failure is detected after a review of your full medical history, an examination, and results from blood and/or cardiac tests. Many patients first learn they have heart failure after going to the emergency room or their doctor’s office with symptoms such as shortness of breath, fatigue, lightheadedness, or swelling in their legs, ankles, or feet. Blood and/or imaging tests are used to assess any damage to your heart and to check how well it pumps blood: • S imple blood test to see if your heart is under stress or blood tests to assess your kidney function, electrolytes, or thyroid function. • E KG • C hest x-ray • H eart Imaging – usually an Echocardiogram (ultrasound) • S tress Test • H eart catheterization Some of these may be repeated over time to see if your heart function is the same, better, or worse.

What Can You Do If You Have Heart Failure? • R ead this booklet to learn more about heart failure • F ollow the Action Plan • L earn Which Foods to Avoid • R ead Food Labels to Select Foods Lower in Salt (Sodium) • F ollow Guidelines When Eating Out • C alculate and Stay Within Your Daily Fluid Limit if Prescribed by Your Doctor • W eigh yourself daily and report a weight gain of more than 2 pounds overnight or more than 5 pounds in 1 week. • T ake your medication as prescribed. Know what each is for and potential side effects • K now Heart Failure terminology and web resources for more information • A ttend the Heart Healthy Living wellness group

Report problems with symptoms and problems as soon as they happen. If you have immediate questions or concerns, call your doctor during regular business hours or call 911 in an emergency.

HEART FAILURE ACTION PLAN If you have any questions about this plan, call the Heart Failure Clinic.

Pay Attention Use Caution

YELLOW ZONE

GREEN ZONE

Excellent! Keep up the Good Work!

You are in the GREEN ZONE if you have . . . • NO shortness of breath • NO swelling • NO weight gain • NO chest pain • Able to do all your daily activities You are feeling well!

• Continue taking your medications as ordered • Continue daily weights • Follow low-salt diet • Follow fluid restriction • Continue daily activities

You are in the YELLOW ZONE if you have any of the following . . .

The YELLOW ZONE means your symptoms are no longer in control and you should . . .

• Weight gain of 2 pounds or more in a day, or 5 pounds in a week

• Double check your intake of salt and fluids. Are you taking too much?

• Increased shortness of breath with activity

• Be aware that your medicines may need adjusting.

• Increase of swelling in ankles, legs, feet, or abdomen

• Do daily phone checks with your Heart Failure Nurse if feeling poorly and have one or more of the symptoms on the left.

• Frequent cough

You do not feel well.

WARNING!!

The GREEN ZONE means that your symptoms are under control and you should ...

• Keep all physician and blood draw appointments

• Sleep in a recliner or with more pillows

RED ZONE

Goal Weight: ��

Heart Failure Clinic: �� Nurse: ��

You are in the RED ZONE if you have any of the following . . .

The RED ZONE means you need to be evaluated right away!

• Unrelieved shortness of breath at rest

If you are in the RED ZONE, call your doctor or heart failure nurse immediately or

• Unrelieved chest pain, wheezing, or chest tightness at rest • Need to sit in a chair to sleep

*** CALL 911 if you can’t reach your doctor/nurse immediately!!

• Weight gain or loss of more than 5 pounds in 2 days • Experiencing confusion, dizziness, depression, or decreased appetite • Increased swelling in the lower body You need to get help now!

Heart Failure

FOODS TO AVOID With heart failure the heart has to work harder and is less efficient at delivering oxygen to the body. Blood can build up in different parts of the body, causing fluid accumulation in the lungs, arms, legs and gastrointestinal tract. Foods that you eat may worsen symptoms of heart failure, such as swollen feet, fatigue, shortness of breath, and weight gain. It’s important to avoid foods that are high in sodium and saturated fat.

SODIUM (salt) It is important to control and limit your sodium intake because it makes your heart work harder. You should limit your salt intake to 1,500 to 2,000 milligrams per day. Sodium is found in salt and is added to most processed foods, including fast food. Avoid using the salt shaker and replace it with spices, herbs and other seasonings. Check food labels to determine how much salt is in your food. If a serving has 140 milligrams of sodium or less, it is considered low in sodium. (See page 4)

SALT SUBSTITUTES Salt substitutes are not a healthful option for everyone. Many salt substitutes contain potassium chloride in place of sodium chloride. Potassium consumed in excess may be harmful for some people. If you have kidney problems or are on medication for your heart, kidneys, or liver, it is best to check with your physician before using salt substitutes in place of sodium.

SPORTS DRINKS (Gatorade, etc.) Your body needs a certain amount of electrolytes, particularly sodium, potassium, magnesium and calcium, which must be replenished after losing them through your sweat or urine. However, you can get too many electrolytes by drinking too many sports drinks. This can potentially be as harmful to your body as too few electrolytes. Do not drink any “sports” or “power” drinks without clearing it with your cardiologist.

PROCESSED FOODS Avoid processed foods that come in cans or boxes, such as canned soup, canned vegetables, and boxed mac and cheese. Salty snacks such as chips, nuts and pretzels should be avoided as well. These foods are high in sodium, which makes the body hold extra water.

MEATS AND WHOLE MILK Limit your intake of meats and whole milk that are high in saturated fat. Diets high in saturated fat are associated with high blood cholesterol and heart disease. By reducing your intake of whole milk and high-fat meats, such as red meat, sausage and bacon, you can lower your cholesterol. Lower your saturated fat intake to 10 percent of total calories. Avoid use of solid fats such as butter or lard when cooking and use oils instead.

ALCOHOL Alcohol can slow down your heart rate, making it more difficult for your heart to pump blood. Alcohol can also interact with your medications. It is especially important to avoid alcohol if your heart failure is alcohol-related. Talk with your health care team for specific recommendations regarding alcohol.

CHEESE Limit your intake of cheese. Most cheeses are high in sodium, and full-fat cheeses are high in saturated fat. One ounce of American cheese has up to 443 milligrams of sodium and 6 grams of saturated fat. Choose low-fat cheeses, and check the nutrition labels to find a lower-sodium option.

RECOMMENDATION Please consider modifying your food selections to those that are included in â&#x20AC;&#x153;The Mediterranean Dietâ&#x20AC;?. This is a heart healthy diet. It is based on widely-used foods and cooking styles from many countries around the Mediterranean Sea. The main pattern for the diet is more plant foods and monounsaturated fats, or good fats, like olive oil. It includes eating less red meat. You eat more grains, vegetables, legumes, nuts, and fruits. Fish, poultry, and moderate amounts of wine are also included. Ask your nurse for a handout on the Mediterranean Diet if you are interested. 5

READING FOOD LABELS

Food labels give important information that can help you choose low sodium foods. TIPS FOR READING LABELS SERVING SIZE: In this example one (1) cup is the serving size. The container holds two servings. Remember if you eat the double serving listed, you will double the salt, calories and fat. If you eat one half the serving size listed, the salt and calories should be halved. SALT is listed as “sodium” on the Nutrition Facts label. This food item has 470 mg of sodium in 1 cup serving. NOTE: Try to keep the sodium or salt in mg to 300 mg or less. % OF DAILY VALUE: Lists the Percentage Daily Value (% DV) in one serving of food based upon 2000 – 2500 calories consumed each day. • I gnore the % daily value and focus on the amount of mg sodium per serving • D ecreasing the total amount of sodium you consume to 2,000 milligrams (mg) per day is one of the most important ways to manage heart failure • A general rule to follow: — “Low sodium”=140 mg or less per serving — “No sodium”=less than 5 mg per serving

RECOMMENDATION • L imit sodium (salt) to 2,000 mg (2 grams) per day • B est to keep under 200300 mg of sodium (salt) per serving • T ry to avoid foods with more than 400 mg of potassium • R ead food labels carefully looking for salt, sodium, sodium chloride, monosodium glutamate (MSG), brine, broth, corned or pickled

t sp = teaspoon tbsp = tablespoon c = cup pt = pint oz = ounces lb = pounds sq = square min = minute(s) hr = hour

Heart Wise H E A R T FA I LU R E PAT I E N T

H E A R T FA I L U R E PAT I E N T

EATING OUT

HeartWise

Developed by the AAHFN Patient Education Committee

EATING OUT

Dining out allows for a relaxing break from daily responsibilities as well as fostering social time with family and friends. It’s also an opportunity to try new and different foods we normally wouldn’t prepare at home. Most restaurant foods have extra added salt & fat to enhance the taste. If you are trying to live a Heart Healthy lifestyle and are limiting or avoiding salt and fat, these suggestions are for you! It is possible to enjoy going out to eat without fear of becoming ill by following these recommendations:

If eating at a “chain” restaurant:

If eating at a finer restaurant:

Developed by1thediet.AAHFN Education Committee Ask that Patient no salt be added to your meal,

Go online to the restaurant’s website (for example: www.mcdonalds.com) and search for Nutrition Information. Here you will find food label information for specific items on the menu, such as fat in grams, sodium in milligrams. For those who do not have a computer, ask the restaurant manager for a written nutrition guide or nutrition information.

Tell the chef you are on a low-salt/low-fat

including vegetables. Despite no added salt, you will likely consume 700-1200mg of sodium at the meal depending upon bread, soup, gravy/ sauce and salad dressing consumption.

Order grilled, baked or broiled fresh meats Dining out allows for a relaxing break from daily responsibilities as well as fostering social time with family and and fresh vegetables with no salt added. This 2 includes the potato. Enjoy a little sour cream on Avoid or limit going to buffet-type restaurants. friends. It’ s also an opportunity to try new and different foods we normally at and home.hasMost your potato wouldn’t that is lowprepare in sodium less Most people find it difficult to limit portions 2 and/or the number of plates they eat, thinking fat than butter. restaurant foods havemyextra added salt. Remember, & fat to enhance the taste. If you are trying to live a Heart Healthy lifestyle “I need to get money’s worth” Similar to buffet-style restaurants, limit portions the more you eat, the more salt, calories and fat at the Avoidto orenjoy limit pickled-style 3 are consuming. and areyoulimiting or avoiding salt and fat, these suggestions are for you!salad It is bar. possible going out tooreat mayonnaise-based foods. Both choices have excess sodium and fat. Perhaps a tablespoon of Avoid or limit soups. Typically, one cup (8 without fear of becoming ill by following these recommendations: one or two would satisfy a craving!

ounces) of soup contains 900-1200mg sodium. Cream soups contain 15-20 grams of fat, while broth-based soups contain 1-3 grams.

Eat freshat salad before the main meal. Use limited If eating a of salad dressing (1 tablespoon=1004 amounts 150mg usually), or bring your own from home “chain” restaurant: in a sealed container. Avoid or limit salads

drenched in dressing or with lunchmeats and cheese that add salt and fat. Use half your normal amount of salad dressing and sprinkle the whole salad liberally with vinegar.

Limit bread consumption. One slice of bread has approximately 120mg of sodium, one hamburger bun contains 180-250mg sodium.

If eating at a finer restaurant:

Go online to the restaurant’s website (for Tell the chef you are on a low-salt/low-fat example: www.mcdonalds.com) and search for diet. Ask that no salt be added to your meal, Nutrition Information. Here you will find food including vegetables. Despite no added salt, you For more ideas on low sodium eating and other living with heart failure tips, check out label information for specific items on the menu, will likely consume 700-1200mg of sodium at http://aahfnpatienteducation.com/ such as fat in grams, sodium in milligrams. For the meal depending upon bread, soup, gravy/

Calculating Your Recommended

DAILY FLUID LIMIT

Your doctor has possibly recommended a limit to the daily amount of fluid you should drink. Here is a quick way to estimate how much you are drinking each 24 hour period. Fill your favorite cup/mug with water and empty it into a clear measuring cup to see how many ounces it holds. Multiply the number of ounces by 30 to get the total number of milliliters (ml). One typical 10 ounce coffee cup = 300 milliliters, so you could have roughly 6 Â˝ cups each day. When you drink/eat from different serving container sizes throughout the day, you will need to add the ml amounts together to stay within your limit.

RESTRICTION AMOUNT RECOMMENDED BY DOCTOR

1.5 L (Liter) = 1,500 milliliters (ml) â&#x20AC;˘ 2 L (Liter) = 2,000 milliliters (ml)

The limit includes all items that are liquid at room temperature.

Examples of common food and drink items and their fluid amounts. 8

________ %

Your EF is

20%

40%

60%

80%

www.RiseAboveHF.org

Nationally supported by:

It is also possible to have a diagnosis of heart failure with a seemingly normal (or preserved) ejection fraction of greater than or equal to 50%.

REDUCED Ejection Fraction ≤ 40% is pumped out during each contraction (Symptoms may become noticeable even during rest.)

BORDERLINE Ejection Fraction ≈ 41– 49% is pumped out during each contraction (Symptoms may become noticeable during activity.)

NORMAL Ejection Fraction ≈ 50–70% is pumped out during each contraction (Usually comfortable during activity)

How much blood is pumped out?

With the proper care and treatment, many patients are able to improve their ejection fraction and live a longer and healthier life. Talk with your healthcare provider about your options.

amount of blood in chamber

amount of blood pumped out

EJECTION FRACTION =

The fraction or percentage helps describe how well the heart is pumping blood to the body.

amount of blood pumped out.

to the

amount of blood in the heart

The Ejection Fraction compares the

HF and Your Ejection Fraction Explained

DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



Anticoagulants

Anti-arrhythmics

Angiotensin Receptor Neprilysin Inhibitors (ARNIs)

Angiotensin Receptor Blockers (ARBs)

AngiotensinConverting Enzyme Inhibitors (ACE Inhibitors)

Aldosterone Antagonists

CLASS

Warfarin (Coumadin)

Rivaroxaban (Xarelto)

Dabigatran (Pradaxa)

Apixaban (Eliquis)

Increase blood clotting time (reduce the risk of clot formation)

• Warfarin/(Coumadin): monitor INR

• Xarelto: must take with food, monitor creatinine.

• Pradaxa: monitor creatinine, store in original container and do not crush or open capsule.

• Bleeding & easy bruising

• Different depending on the medicine

Digoxin (Lanoxin)

Mexiletine (Mexitil)

• Slow heart rate (less than 50 bpm)

Corlanor (Ivabradine)

• Diarrhea, nausea (Digoxin)

• Reduce kidney function

• Low blood pressure

• Raise potassium (nausea, fatigue, muscle weakness)

• Dizziness

• Low blood pressure

• Raise potassium (nausea, fatigue, muscle weakness)

• Dizziness

• Low blood pressure

• Dry cough

• Raise potassium (nausea, fatigue, muscle weakness)

• Dizziness

• Cramping

• Breast tenderness

• Raise potassium (nausea, fatigue, muscle weakness)

SIDE EFFECTS (POTENTIAL)

• GI upset, dizziness (Mexitil)

Regulate heart rate or rhythm

Lower blood pressure (B/P)

Increase chemicals helpful to the heart

Reduce chemicals that are harmful to heart muscle

Lower blood pressure (B/P)

Reduce chemicals that are harmful to heart muscle

Lower blood pressure (B/P)

Reduce chemicals that are harmful to heart muscle

Lower blood pressure (B/P)

Reduce chemicals that are harmful to heart muscle

EFFECT/GOAL

Sotalol (Betapace)

Amiodarone (Cordarone)

Entresto (sacubitril and valsartan combination drug)

Valsartan (Diovan)

Olmesartan (Benicar)

Losartan (Cozaar)

Quinapril (Altace)

Lisinopril (Zestril, Prinivil)

Enalapril (Vasotec)

Spironolactone (Aldactone)

Eplerenone (Inspira)

MEDICATION

Medications Teaching: Name Purpose & Side Effects



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS



DATE/ INITIALS

Hydralazine (Apresoline)

Vasodilators

Hydralazine/Isosorbide (Bidil)

Isosorbide (Isordil/Imdur)

Potassium Chloride (MicroK, SlowK, K-Lyte, K-Lor, Klor-Con, K-Dur)

Ezetimibe (Zetia)

Simvastatin (Zocor)

Rosuvastatin (Crestor)

Pravastatin (Pravacol)

Atorvastatin (Lipitor)

Hydrochlorothiazide (HCTZ)

Relax veins and arteries

Lower blood pressure (B/P)

Reduce chemicals that are harmful to heart muscle

Maintain potassium levels as directed by your physician

Lower cholesterol/triglycerides

Reduce weight

Furosemide (Lasix) Metolazone (Zaroxolyn)

Torsemide (Demadex)

Increase urinary output

Bumetanide (Bumex)

Reduce angina (chest pain)

Increase blood flow to the heart (coronary arteries)

Diltiazem (Cardizem)

Nifedipine (Procardia)

Lower blood pressure (B/P)

Slow the heart rate

Lower blood pressure (B/P)

Reduce chemicals that are harmful to heart muscle

Increase blood clotting time (reduce the risk of clot formation)

Amlodipine (Norvasc)

& Toprol XL)

Metoprolol (Lopressor

Carvedilol (Coreg)

Ticagrelor (Brilinta)

Clopidogrel (Plavix) Prasugrel (Effient)

ASA (Aspirin)

Potassium Supplements

Drug Classes: • Statin • Intestinal cholesterol inhibitor

Lipid Lowering Agents

Diuretics

Calcium Channel Blockers

Beta Blockers

Anti-platelets

• Low blood pressure

• Headache

• Dizziness

• Stomach pain

• Diarrhea

• Nausea or vomiting

• Leg or muscle cramps and/or pain (statins)

• Can worsen kidney function

• Reduce potassium (can cause muscle cramps/ weakness)

• Dehydration

• Dizziness & dizziness when standing

• Edema (swelling) of legs or ankles

• Slow heart rate (less than 50 bpm)

• Low blood pressure

• Dizziness

• Worsens asthma/COPD

• Slow heart rate (less than 50 bpm)

• Low blood pressure

• Dizziness & weakness

• Dyspnea (Brilinta)

• Rash/itching (Plavix)

• Bleeding gums & Easy bruising

• GI upset (ASA)

WORDS

You May Hear or Read Atherosclerosis:

Coronary artery disease: Plaque:

Sodium:

The presence of plaque in the arteries throughout the body. Over time the plaque hardens and narrows the arteries. It is one of the leading causes of heart attack, stroke, and peripheral vascular disease. The buildup of plaque on the inside walls of the coronary arteries. These feed the heart muscles. Plaque is a white to yellow substance within the wall of an artery. It is composed of lipids (fat/cholesterol), smooth muscle cells, collagen, and in older persons, calcium. Salt.

Heart Failure Web

RESOURCES

The following web sites provide additional information and tools for living with heart failure. In most instances, heart failure information will be found on each organization’s main (“Home”) page. If you don’t find it there, type Heart Failure in the search box which is located on the top right side of the Home page. CardioSmart

www.cardiosmart.org

Heart Failure Online

www.heartfailure.org

Heart Failure Society of America Mediterranean Diet

www.hfsa.org www.oldwayspt.org

www.cardiosmart.org

CONNECTING YOUR CARE Sponsored by the American College of Cardiology

Join this FREE, easy-tonaviagte, interactive website to track your health and learn more about your condition.

• Manage your risk factors • Create a “Toolbox” with articles, quick fact sheets, or questions for your doctor • Create your personal “Dashboard to track your medical results: ✓ Blood Pressure ✓ Weight (BMI) ✓ Activity • Maintain a current medication list. Easy to add, edit, or delete medication changes. • Print your results or take your smartphone/tablet to your doctor’s office. Brag about your results! Most importantly ... Feel Better!

Heart Healthy Living WELLNESS GROUP A FREE community resource open to anyone interested in learning about all aspects of cardiovascular disease risk factors in a group setting. WHEN

4th Tuesday of Each Month 6 - 7 p.m. Call 800-248-6777 with questions.

WHERE

John and Marnie Demmer Wellness Pavilion and Dialysis Center (820 Arlington Avenue, Petoskey 49770 2nd Floor in the Thomas C. Mroczkowski Reading and Relaxation Room)

WHO

This group is designed for anyone interested in learning about prevention, treatment, and management of cardiovascular disease risk factors. 13

HEART PARTS

The Path of Circulation 1. VENAE CAVAE

6. LEFT ATRIUM

These two veins are the largest in the body; they carry de-oxygenated blood (blood without oxygen) to the right atrium of the heart.

The upper left chamber of the heart contracts and sends oxygenated blood through the mitral valve to the left ventricle.

2. RIGHT ATRIUM

A “flap” between the left atrium and the left ventricle that allows blood to flow in one direction only.

7. MITRAL VALVE

The upper right chamber of the heart squeezes de-oxygenated blood through the tricuspid valve to the right ventricle.

8. LEFT VENTRICLE

3. TRICUSPID VALVE

The lower left chamber of the heart pumps the oxygen-rich blood through the aortic valve into the aorta.

4. RIGHT VENTRICLE

A “flap” between the left ventricle and the aorta that allows blood to flow in one direction only.

A "flap" between the right atrium and the right ventricle that allows blood to flow in one direction only.

9. AORTIC VALVE

The lower right chamber of the heart contracts and sends the blood through the pulmonary artery.

10. AORTA

5. PULMONARY VESSELS

The largest artery in the body branches off into numerous smaller arteries that carry oxygenated blood to the rest of the body.

The pulmonary artery (5a) carries blood to the lungs where the blood loses carbon dioxide and picks up oxygen. The pulmonary vein (5b) carries oxygenated blood to the left atrium of the heart.

Heart Failure Clinic

231-487-5883 | mclaren.org/northern