Self-Care Handbook - Learning to Live with Heart Failure
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Self-Care Handbook
Learning to Live with
Heart Failure
Write down important phone
numbers and keep them handy.
Health-care provider
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Pharmacist
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Home health-care agency
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Oxygen equipment supplier
Name ___________________________________________________________________
Phone Number ___________________________________________________________
An emergency contact
Name ___________________________________________________________________
Phone Number ___________________________________________________________
If you have heart failure, this
handbook is for you.
This handbook is designed to help you and your
CONTENTS
family understand and manage heart failure. There
What is heart failure ............... 2
are areas for you to track your medicines, diet,
weight, and exercise. Medicine .................................. 3
Family Members can be a wonderful source of Track your medicines ........4 & 5
support. Ask them to read this handbook with you.
They will be able to help you: Weight, blood pressure, and
stress........................................ 6
keep track of medicines
cook nutritious meals Track your weight ................... 7
stay active without overdoing it
High sodium foods ................. 8
prevent infections
get the support you need Low sodium foods .................. 9
Heart failure cannot be cured, but by understanding Sodium intake ........................10
it and following simple guidelines, you can lead a
full and active life. Other lifestyle changes .......... 11
Exercise ..................................12
Preventing swelling and
infection ..................................13
Support groups ......................14
What is heart failure?
Heart failure means that your body is not The healthy heart is strong enough to pump
pumping enough blood to meet your body’s blood out of the heart so it doesn’t back up into
needs. Heart failure does not mean that you are the lungs and veins.
about to die or that your heart has stopped. It
simply means that your heart is not working as The damaged heart causes slower blood flow to
well as it should. the body. It can also cause blood to back up into
the lungs and veins.
Heart failure can happen in different parts of
the heart. Sometimes the heart weakens and A traffic jam happens when you heart is not
is less able to pump blood out. This is called pumping properly. Blood from the lungs or from
“systolic” failure. Or sometimes the heart the rest of the body backs up, just as traffic can
cannot relax properly to fill with blood. This back up at rush hour.
is called “diastolic” failure. Some people have
both problems. To stop the traffic jam, the heart may enlarge its
chambers to let in more blood. It may enlarge
Heart failure also affects the kidneys’ ability to its muscle to beat with more force. These help
keep the heart working almost normally in the
get rid of sodium and water. The excess water early stages of heart failure. But these measures
can cause your feet, ankles and legs to swell.
cannot keep your heart working properly over
a long period of time - and can actually make
The terms “congestive heart failure” means that
matters worse.
your heart’s decreased ability to pump blood is
accompanied by excess fluid in the lungs.
Common symptoms of heart failure
Heart failure usually doesn’t occur suddenly. It
• shortness of breath
gradually worsens over time. Heart failure can
• waking up due to shortness of breath
be caused by:
• frequent cough or wheezing
• coronary artery disease
• bloating
• past heart attack
• swollen feet, legs and ankles
• high blood pressure
• the need to urinate more often during the
• lung disease
night
• heart valve disease or infection
• a sudden weight gain
• heart muscle disease
• nausea or loss of appetite
• heart defects present at birth
• fatigue or weakness
• heart damage from alcohol or drug abuse
• confusion or decreased alertness
• heart damage due to diabetes
• rapid or irregular heartbeat
• abnormal heart rhythms
• swollen neck veins
• thyroid disorders
If your symptoms change or worsen, contact
your health care provider.
2
Medicine is a key factor in
treating heart failure.
Medicine can help make it easier for your heart to pump, strengthen your
heartbeat and remove excess fluid from your body. It can also help improve
your overall quality of life when used as directed. Your health-care provider
may prescribe one or more types of medicine, such as:
ACE inhibitors & angiotensin II receptor Tips for managing your medicines
blockers (ARBs) Taken as prescribed, medicine can help you feel better.
Taken incorrectly, medicine can be useless or, even worse,
Purpose: To open up your arteries and lower harmful. Follow these guidelines for taking your medicine.
blood pressure.
Ask questions about your medicines, such as “What are they
Side effects: May include a cough, dizziness, loss for?” or “When should I take them?”
of taste, swelling, skin rash and high potassium
levels. Check the label before you take a medicine. Be sure you
are taking the right one and have the correct dose. Always
Beta blockers follow the directions.
Purpose: To block the effects of chemicals that Don’t take medicine in the dark - it’s easy to make a mistake
can make your heart work too hard. and take the wrong one.
Side effects: May include shortness of breath, Tell your health-care provider if you have other prescriptions
slow heartbeat, fatigue and low blood pressure. or take any over-the-counter medicines (even aspirin or
other pain relievers), nutritional supplements or herbal
Digitalis (digoxin) remedies. They could react with medicines he or she
prescribes.
Purpose: To make your heartbeat stronger and
more regular. Ask your health-care provider what you should do if you miss
a dose. Never take a larger dose the next time without his
Side effects: May include nausea and loss of or her permission.
appetite, blurred vision, mental confusion,
irregular heartbeat and headache. Report new side effects to your health-care provider. He or
she may adjust your dose, prescribe a different medicine
or make other changes.
Diuretics (water pills)
Purpose: To help your body get rid of excess Always carry a list of your medicines with you. This can help
fluid, making it easier for your heart to pump. health-care professionals in an emergency.
Side effects: May include leg cramps, dizziness, Keep track of your medicines - keeping a written record of
skin rash and low potassium levels. your medicines, including vitamins and over-the-counter
drugs, will also help you remember to take them on
schedule. The charts on the next two pages will give you a
Vasodilators good start.
Purpose: To open up your arteries and make it
easier for your heart to pump.
Even if you are feeling better, take your medicine as
Side effects: May include headache, low blood prescribed! Don’t stop taking a medicine without talking
pressure, dizziness, nasal congestion, flushing to your health-care provider first. Changing the size of
and irregular heartbeat. doses or skipping does can be dangerous.
Aldosterone blockers This handbook is not able to list all the risks, benefits, side effects, and special
Purpose: To block the effects of a hormone that precautions for each medication discussed. Patients (or guardians) should talk with
their health-care provider about risks, benefits, side effects and special precautions
can cause fluid buildup and high blood pressure. for each medication prior to use. Use medications only as prescribed or directed by
Side effects: May include headache, dizziness, your health-care provider.
enlarged breasts, irregular vaginal bleeding and
high potassium levels. 3
Track your medicines.
Start by “profiling” them. Complete the chart below. Doing so will help you become more familiar with your
medicines, why you take them and what the possible side effects are.
Medicine Name Color and shape Instructions/times to take Purpose Side effects
4
Now you’re ready to complete a medicine calendar or log.
Medicines &
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Instructions Hours Taken Hours Taken Hours Taken Hours Taken Hours Taken Hours Taken Hours Taken
5
Don’t be hard on your heart.
Your heart is under enough strain already. Help Practice stress-reducing techniques to calm
make your heart’s work easier by maintaining your mind and improve your overall health. Talk
a healthy weight, keeping your blood pressure to your health-care provider about meditation,
under control and reducing stress. visualization, massage, breathing techniques,
biofeedback, counseling, support groups
and stress management courses. Volunteer
Maintain a healthy weight. Being overweight
activities, hobbies, taking classes, and exercising
increases your chances of having high blood
may also help reduce stress.
pressure, diabetes, a heart attack and other
problems. Ask your health-care provider about
the best weight for you. If you need to lose
weight, he or she can help you make a diet and
exercise plan.
My current weight is ______________.
I should maintain a weight of ______________.
Weight also plays a role in monitoring your
health. In people with heart failure, weight gain
isn’t always just a sign of eating too much. It can
also be a sign that you’re retaining fluid from
eating too much sodium or that your condition is
getting worse. Use the chart to help keep track
of your weight regularly.
Maintain a healthy blood pressure. High blood
pressure can lead to increased risk of stroke,
heart attack and other health problems. Low
blood pressure may be a side effect of some
medicines. Ask your health-care provider what
your blood pressure should be and how you can
monitor it.
My current blood pressure is __________.
I should maintain a blood pressure of __________.
6
Are you gaining weight?
A sudden gain in weight may mean that your body is retaining fluid or that your
condition is worsening. As a result, tracking your weight is very important.
Week of: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Call your doctor if you gain ______ pounds or more in one day or ______ pounds or more in one week.
7Stay away from sodium.
Sodium makes the body retain fluid, making the heart work even harder. Salt
is a huge source of sodium. Reducing sodium will help decrease excess fluid
in your body. (Checking your weight will help you see if you’re retaining fluid.
See page 7)
Here are some popular foods and condiments that are very high in sodium. (Generally,
foods with 140 mg or more of sodium per serving are considered high in sodium.)
Check those that you eat.
424 Croissant Sodium content (in mg)
515 5 pretzels
616 Cheeseburger, fast food
662 Potato salad, 1/2 cup
739 Ham, 2 slices
821 Scalloped potatoes with butter, 1 cup
824 Tuna salad, 1 cup
833 1 dill pickle
850 Chicken noodle soup, 1 cup
902 Soy sauce, 1 Tbsp.
918 Cottage cheese, low-fat, 1 cup
1061 Macaroni and cheese, 1 cup
1114 Baked beans with franks, 1 cup
1203 Spaghetti with marinara sauce, 1 cup
Ask your health-care Note the foods you checked.
provider what your daily You may have to avoid these
limit for sodium should be. foods and foods like them.
But, there are delicious, low-
I should limit sodium to sodium foods you can eat.
_________ mg a day.
8Try eating a healthier diet.
Eating foods that are low in sodium will help you feel better.
Here are some foods that are relatively low in sodium. (Generally, foods with less than
140 mg of sodium per serving are considered low in sodium.)
Check those that you eat.
0Almonds, unsalted, 1 oz. Sodium content (in mg)Lower sodium intake.
Remove the salt shaker from your table. You The Percent Daily Value column can help you
will be less likely to use it. make low-sodium choices. It shows whether a
serving is high or low in sodium:
Use herbs and other seasonings instead of salt 20% Daily Value or more is high in sodium, while
to flavor food. Garlic, oregano, basil, curry, 5% or less is low.
lemon juice, rosemary, or parsley are great
substitutes. Avoid salted crackers. Snack on Be sure to note the serving size listed on the
fresh vegetables and fruits. Eat a variety of package. Although a package looks small, it may
fresh and frozen vegetables instead of canned contain more than one serving.
vegetables. Eat fresh fish, poultry, and meat
instead of canned or processed meats.
Be careful with salt substitutes and spices that Nutrition Facts
Serving Size 1 cup (228g)
taste salty. They may contain other forms of
Servings Per Container 2
salt that can be harmful. They may also contain
potassium, which can significantly change your Amount Per Serving
Calories 250 Calories from Fat 110
potassium level, especially if you take potassium
% Daily Value*
supplements. Ask your health-care provider
Total Fat 12g 18%
about safe substitutes. Saturated Fat 3g 15%
Trans Fat 1.5g
Check the sodium content of foods. It’s listed Cholesterol 30mg 10%
Sodium 470mg 20%
on the label. Many frozen dinners, packaged Total Carbohydrate 31g 10%
mixes, canned soups and condiments are high Dietary Fiber 0g 0%
in sodium. Many over-the-counter medicines Sugars 5g
contain sodium too. Ask your pharmacist about Protein 5g
the sodium content of medicines you take. Vitamin A 4%
Vitamin C 2%
Check out nutrition labels before purchasing Calcium 20%
Iron 4%
food. With the exception of fresh fruits, * Percent Daily Values are based on a 2,000 calorie diet.
vegetables, and meats, most foods have a Your Daily Values may be higher or lower depending on
your calorie needs:
nutrition label. Calories: 2,000 2,500
Total Fat Less than 65g 80g
Sat Fat Less than 20g 25g
The amount of sodium a product contains is Cholesterol
Sodium
Less than
Less than
300mg
2,400mg
300mg
2,400mg
listed on the label. Some products are also Total Carbohydrate
Dietary Fiber
300g
25g
375g
30g
labeled “sodium or salt free”, “reduced sodium”,
or “no-salt added.” Choose your foods by SOURCE: U.S. Food and Drug Administration/U.S.
Department of Health and Human Services.
comparing nutrition labels.
10Make other changes too!
If you smoke, quit. Smoking narrows blood Avoid alcohol. Alcohol can slow your heart rate
vessels, making it harder to breathe. This and worsen heart failure. It may also interact
increases your blood pressure and heart rate, with the medicines you take.
thus increasing your risk of developing other
heart and health problems. Don’t wait - quit Reduce caffeine intake. Caffeine increases your
now! heart rate and could cause irregular heartbeat.
Watch your fluid intake. Drinking too many Eat less fat and cholesterol. Diets high in fat and
liquids may force your heart to work harder. cholesterol can lead to more heart problems.
Therefore, your health-care provider may set a Eat more fruits and vegetables and talk to your
limit on the amount of fluids you can have. To health-care provider for specific guidelines.
keep your mouth from getting dry, suck on some
hard candy or use a humidifier. Ask before you drink grapefruit juice. It may
interact with some of your medicines.
11Should I exercise?
Studies have shown that exercise has many Involve friends or family in your activities
benefits for people with heart failure. you’ll be more likely to stick with your exercise
It can help: program.
• improve the flow of blood through your body
• strengthen your heart and body Don’t overdo it. Exercising and staying active
• tone your muscles are important. Keep in mind, though, that you
• increase your energy level won’t be able to do as much as you once did.
• manage stress Set realistic goals and take breaks periodically.
• raise your spirits
Stop exercising immediately and rest, no matter
Exercise does not mean you have to buy what you are doing, if you:
expensive equipment or join a health club. It can • feel tired
be as easy as walking regularly. Be sure to warm • have chest pain
up and cool down. • are very short of breath
See your health-care provider before starting Call your health-care provider if these symptoms
an exercise program. Your health-care provider don’t go away.
can help you develop an exercise plan based on
your level of fitness. Your program may include
a variety of aerobic activities such as walking,
swimming, cycling, or low impact aerobics.
Strength training may also be recommended.
Watch the weather. Try not to exercise outdoors
if it is too cold, hot or humid. It can interfere
with your circulation, make breathing more
difficult, or cause chest pain.
Ask questions about your exercise program.
• How often should I exercise?
• What kind of exercise should I do?
• Are there any activities I shouldn’t do?
• How long should I exercise?
• Do I need special equipment or clothes?
• Should I check my pulse?
12How to prevent swelling and
infections.
Swelling of the feet, ankles and legs, known Sadly, heart failure can make you more likely
as edema, is common in those with heart to get pneumonia and other illnesses. But,
failure. It is caused when excess fluid builds there are things you can do to reduce the
up in one part of the body. risk.
Stay healthy by:
In addition to consuming less salt and taking
certain medicines, there are several other 1. getting flu and pneumonia shots
(check with your health-care
steps you can take to help reduce swelling. provider)
2. washing your hands frequently
Elevate your legs: Lying down or sitting with 3. staying away from people who have
your legs raised will help drain the fluid respiratory infections or who are ill
away from your legs. However, this is only a
temporary measure because the fluid is just 4. avoiding large crowds
moving from one area to another.
Be sure to get plenty of rest. To increase your
Walk on a regular basis: Walking will help chances of staying healthy you should:
increase circulation and tone muscles. If you 1. Plan at least one rest period every
are bedridden, flex your leg muscles, move day.
your feet in circles and wiggle your toes to 2. Rest between periods of heavy
help circulation. activity. Alternate light and heavy
activities.
Wear special elastic stockings: These
3. Avoid working long days.
stockings can keep fluid from collecting
in your legs. In general, they should reach 4. Consider a short nap after lunch
above your knees because shorter ones may (long naps may make it difficult to
not eliminate swelling. They should be fitted sleep at night).
for you and adjusted as the swelling goes
down. Your health-care provider can help
When you rest, raise your legs to help keep
decide the proper type for you.
any swelling down.
13Support groups can help, also!
Talking to family and friends can help, but there is nothing like talking to
another person who has the same problems as you. So, ask your hospital,
health-care provider or area agency on aging about support groups close to
you, and join one!
You are not alone.
Support groups give you and your family an opportunity to talk about your
condition and any problems you’re having with others who suffer from heart
failure. Sharing common problems can give you more confidence and make
everyone feel better.
Help others.
If there isn’t a support group near you, start one. It could be a wonderful
source of comfort to others with heart failure. For more information, talk to
your health-care provider or contact:
The Mended Hearts, Inc.
www.mendedhearts.org
1-888-HEART-99
(1-888-432-7899).
You can also call the American Heart Association and ask for Mended Hearts.
Other sources of help
The American Heart Association The National Heart, Lung, and
www.americanheart.org Blood Institute Information Center
1-800-AHA-USA-1 www.nhlbi.nih.gov
(1-800-242-8721) 1-800-575-WELL
(1-800-575-9355)
1-301-592-8573
14Discharge Preparation Checklist
Before I leave the care facility, the following tasks should be completed:
፬ I have been involved in decisions about what will take place after I leave the
facility.
፬ I understand where I am going after I leave this facility and what will
happen to me once I arrive.
፬ I have the mane and phone number of a person I should contact if a
problem arises during my transfer.
፬ I understand what my medications are, how to obtain them and how to take
them.
፬ I understand the potential side effects of my medications and whom I
should call if I experience them.
፬ I understand what symptoms I need to watch out for and whom to call
should I notice them.
፬ I understand how to keep my health problems from becoming worse.
፬ My doctor or nurse has answered my most important questions prior to
leaving the facility.
፬ My family or someone close to me knows that I am coming home and what
I will need once I leave the facility.
፬ If I am going directly home, I have a scheduled follow-up appointment with
my doctor, and I have transportation to this appointment
This tool was developed by Dr. Eric Coleman, UCHSC, HCPR, with funding from the John A Hartford Foundation and the Robert Wood Johnson Foundation.
15SYMPTOMS: WHAT TO DO:
GO
♥ Breathing is easy Great Job!
♥ Weight is on target ♥ Keep taking your medicine
♥ Little or no swelling ♥ Keep watching your diet and
weight
♥ Keep exercising
Green - You feel well.
SYMPTOMS: WHAT TO DO:
♥ Hard to breathe with ♥ Call your doctor or nurse
activity or at night ♥ Change your medicine if
Caution ♥ Weight is up 3-5 pounds directed by your doctor.
♥ Swelling in ankles, legs, ♥ Other instructions:
or belly
♥ Chest feels heavy or
Yellow - You do tight, but gets better with
not feel well. rest
♥ Very tired
SYMPTOMS: WHAT TO DO:
♥ Hard to breathe even at ♥ Medical Alert - Get help NOW!
♥ Call 911 for emergency help
ALERT
rest
♥ Chest pain or chest feels ♥ Do not try to treat this yourself
very heavy or tight
♥ Sweating, weakness, or
fainting
RED - You need ♥ _______________________
♥ _______________________
medical help
NOW!
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