Management of Heart Failure

How is heart failure treated?

The goals of treatment are to help you feel better and live longer. Treatment may include the following:

• Heart medicines help regulate your heart rhythm, lower your blood pressure, and get rid of extra fluids.
• Cardiac rehabilitation is a program run by specialists who will help you safely strengthen your heart. The program includes exercise, relaxation, stress management and heart-healthy nutrition advice from a registered dietitian. Caregivers will also make sure your medications are helping to reduce your symptoms. In order to attend you will need an assessment and internal referral by a cardiac physician.
• Oxygen may help you breathe easier if your oxygen level is lower than normal. A CPAP machine may be used to keep your airway open while you sleep.
• Surgery can be done to implant a pacemaker in your chest to regulate your heart rhythm. Other types of surgery can open blocked heart vessels, replace a damaged heart valve or remove scar tissue.

Diet

The following dietary modifications will help to decrease some of the symptoms.

• Low sodium diet
• Fluid restriction
• Low fat and low cholesterol diet
• No alcohol

Low sodium diet

• Sodium acts like a sponge to hold extra water in the body, which makes the heart work harder. Cutting down on sodium is one of the most important parts of a treatment plan. Sodium is found in large amounts in salt (sodium chloride) and is added to most prepared and processed foods.
• The American Heart Association recommends that you reduce your sodium intake to 1,500 mg per day. One teaspoon of salt contains about 2,300 mg of sodium.

Here are some tips to lower the amount of sodium you eat:

• Avoid using salt at the table or in cooking. Remove the salt shaker. You'll be less likely use it.
• Experiment with new flavors. Use spices and herbs such as cardamon, cinnamon, saffron, turmeric, oregano and thyme, as well as other seasonings such as zaatar with no salt added to flavor foods.
• Eat fresh or frozen vegetables. Fresh or frozen vegetables are low in sodium. Do not add salt or high-sodium seasonings (such as soya sauce). Balsamic vinegar and lemon juice enhance the flavors and can be used in place of salt.
• Limit cheese.
• Eat fresh meats, chicken, and fish. Processed and smoked meats such as kebabs, turkey slices, luncheon meats and mortadella are all high in sodium.
• Use dried lentils and beans. These will have less sodium than the canned varieties.
• Snack on fresh fruits, vegetables and unsalted nuts. As opposed to salty snack foods such as chips or salted nuts.
• Learn to read labels. Read food labels when you shop. The amount of sodium in the product is listed on the label. By reading labels, you can find low-sodium foods you like that can take the place of high-sodium foods you used to eat. Remember your total sodium goal is 1,500 mg.
• Look for words on the packaging such as No Added Salt and Reduced Salt.

Fluid restrictions

When your heart is failing, your body retains fluid because your heart is not moving fluid around as efficiently as it should. Some fluid-related symptoms of heart failure include excessive swelling in the legs and feet, as well as unexplained weight gain. During heart failure, taking in excess fluids can make your heart work harder to pump that fluid around your body. This can increase the difficulty of breathing, causing shortness of breath as well as extreme fatigue. For this reason, people who are experiencing congestive heart failure or those who are especially prone to it may be placed on a fluid-restricted diet.

Other dietary advices:

• Trim the visible fat off meat and remove the skin from poultry before cooking.
• Eat fish at least twice per week, especially oily fish such as salmon, mackerel and tuna.
• Avoid too much red meat, aim for two servings per week.
• Eat low-fat milk, cheese, yogurt, laban and labneh.
• Eat wholegrain cereals and breads. Remember to check the sodium content on the label.
• Use small amounts of canola oil or olive oil instead of solid fats when cooking.

Eating out

Eating out is convenient, a nice break from cooking and a fun way to celebrate special occasions. Below are some tips for eating out without intaking too much sodium:

• Tell your server you are on a low-sodium diet and ask for suggestions that are low in salt and sodium.
• Order grilled, baked or broiled meat, chicken or fish without added salt, sauces, or gravies. Use lemon and pepper to add flavor.
• Select steamed rice, baked potatoes or plain noodles instead of mashed potatoes or fried rice.
• If the vegetables are not fresh or frozen, have a salad instead. Use oil and vinegar dressing or ask for the dressing on the side and use just a little bit.
• Avoid condiments high in sodium, such as pickles, relish and olives. Use just a small amount of ketchup, mustard or low-fat mayonnaise.

Maintain a healthy body weight

• This includes losing weight if you are overweight. Limit your total daily calories, follow a low-fat diet and exercise regularly to achieve or maintain your ideal body weight.
• A registered dietitian can give you tailored diet advice and help you achieve your ideal body weight. Ask your physician about a referral to see one of our dietitians.
• Weight gain is the first indicator that your body is holding onto fluid.
• Check your weight every morning after urination and before breakfast and record it.
• Report any sudden weight gain (two to three kilograms per week).

Exercise

Benefits of exercise

Regular exercise has many benefits. Exercise, especially aerobic exercise, can:

• Strengthen the heart and cardiovascular system
• Help increase energy levels so that you can do more activities without becoming tired or short of breath
• Improve muscle tone, strength and flexibility
• Strengthen bones
• Help reduce body fat and help you reach a healthy weight
• Help reduce stress, tension, anxiety and depression
• Improve sleep

Is there anything I shouldn't do?

You may be advised to avoid hard physical sports such as squash or weight-lifting. Vigorous activity may not be good for you.

In addition, avoid isometric exercises When you make a sudden, hard physical effort, your blood pressure goes up. You may become stiff and sore and will be getting into the over activity-rest cycle.

What type of activity is best?

• The activity should be regular, as it is much easier to get into the habit of doing something on a daily basis.
• The activity should suit your level of heart failure. Your level of heart failure can be confirmed with your physician.
• The activity should be a part of your daily routine so that you are more likely to remember to do it.

Cardiac rehabilitation therapists can help you set a realistic goal to work from as a baseline.

The ˜over activity-rest cycle'

• If you push yourself to a point of exhaustion on a regular basis, you may find that you're not balancing your activity and resting effectively. As a result, instead of getting fitter or maintaining your level of fitness, you decrease it.
• You may be in an over activity-rest cycle if you find that you have good and bad days of activity levels.
• The way to overcome this problem is to make an activity plan.
• If you want to increase your fitness, it helps to do it in a planned way and find a balance between doing too much and too little. Plan to do what you know you can achieve, rather than continuing because you feel you can. Learn to stick to your plan and stop when you have done what you planned. Your activity plan is also dependent on how well you are.

Tips On Activity

• Check with your physician, physical therapist and/or nurse that what you plan to do is safe.
• If possible, do your activities at the same time every day when you feel you have the most energy.
• Make sure you warm up first when doing any activity. For example, if you plan to go for a walk, do the first few minutes at a slow pace and then go a little bit faster. It is important to cool down towards the end of an activity or exercise.
• Start each activity at a level that's just right for you. If you are (or have been) unwell, go back to a lower level of activity until you feel better.
• Build up slowly and gently so it doesn't hurt. If activities hurt, you're not likely to keep them up. A gradual increase works better.
• Stop exercising if you feel any pain in your chest, neck, arms, jaw or shoulders.
• Stop exercising if you feel dizzy, light-headed or have any other symptoms that cause concern.
• Avoid extremely hot and cold showers or sauna baths after exercise.
• It's important to make sure you have regular rest periods, but resting all the time is not good for you. You need to plan both activity and rest if you want to keep fit and active.
• Not being active for a day or two can mean that you have to build up to previous levels of fitness again. Make sure you start at a level that you are comfortable with. This may mean going back a step or two.
• If you are ill or recovering from illness, for example with cold or flu, you may have to take it easy for a few days.
• If you are taking antibiotics, reduce your activity levels and discuss with a healthcare professional when it is safe to continue with activity. When you are well enough to start again, remember that you may not be able to start at the same point that you were before you became unwell. Build up your strength slowly.
• Think of different activities and vary them to keep yourself interested.
• Be careful if you are doing activities with other people, as they may go too fast for you. When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
• Wait at least 90 minutes after eating a meal before aerobic exercise.
• Keep an exercise record. This will allow you to see your progress.
• Avoid lifting and pushing heavy objects.
• Avoid push-ups, sit-ups and isometric exercises.
• High humidity may cause you to become fatigued more quickly and extreme temperatures can interfere with your circulation, make breathing difficult and possibly cause chest pain. Instead, try indoor activities such as walking in the mall. If you continue to have shortness of breath or chest pain, call your physician or nurse.
• Do not exercise if you are not feeling well or if you have a fever. Wait a few days after all your symptoms disappear before starting your exercise program, unless your physician, physical therapist and/or nurse give you other directions.
• If you are short of breath during any activity or have increased fatigue, slow down your activity level or rest. Keep your feet raised or elevated when resting. If you continue to have shortness of breath, call your physician or nurse. Changes may be made on your medications, diet or fluid restrictions.
• If you develop a rapid or irregular heartbeat or have palpitations, rest and try to calm yourself. Check your pulse after you rest for five to ten minutes. If your pulse is still above 120 to 150 beats per minute, call your physician or nurse for further instructions.
• Do not ignore pain. If you have chest pain or pain anywhere else in your body, do not continue the activity. If you perform an activity while you are in pain, you may cause stress or damage to your joints. Ask your physician or physical therapist for specific guidelines. Learn to read your body and know when you need to stop an activity.

Stress Management

• Unmanaged stress, especially stress-related anger and hostility, can affect your health. It may cause: high blood pressure, irregular heart rhythms and damage to your arteries, higher cholesterol levels and a weakened immune system.
• In times of stress, people often turn to harmful habits to reduce their stress, such as cigarette smoking, overeating, and use of drugs or alcohol. All of these factors put you at additional risk for heart disease and stroke.

Stress reduction

• Take time out each day to relax
• Exercise on most days
• Take care of your body
• Eat a healthy diet
• Get enough sleep
• Take control of your schedule. Prioritize what needs to be done each day
• Get answers to questions that may be worrying you, such as your health
• Learn relaxation exercises
• Control your stress at work
• Switch from caffeinated to decaffeinated coffee or herbal tea
• If you have a bad habit of smoking cigarettes or drinking alcohol, try to get help from your physician to get rid of such bad habits