Treatment

	Diet
	Fluid Limits
	Daily Weights
	Exercise
	Oxygen Therapy
	Medicines

Diet
Why a 2-gram sodium diet?

We must have some sodium for good health, but too much sodium makes the body hold fluid. Too much fluid causes edema or swelling. Edema can make the heart work harder. This can contribute to heart failure. People with heart failure should limit the sodium in their diet to no more than 2000 milligrams (2 grams) per day.

Table salt is a major source of sodium and must be eliminated. One teaspoon of salt equals 2,300 milligrams of sodium. If you eat just one teaspoon of salt you have eaten too much! Most foods contain various amounts of sodium. Processed or prepared foods often contain high amounts of sodium. You can limit your sodium intake by:

	Cooking without salt.
	Removing the salt shaker from the table.
	Using herbs and spices to season foods.
	Reading food labels for sodium content.
	Buying foods labeled low sodium or no salt added.
	Eating fresh or frozen vegetables.
	Eating fresh fish, poultry and meat.
	Making foods from “scratch” if you can.
	Not buying convenience (prepared) foods.
	Rinsing canned foods before cooking or eating them.
	Avoiding salted snack foods.
	Snacking on fresh fruits and vegetables.

You can still eat out if you watch what you eat. Be sure to:

	Choose the restaurant carefully.
	Avoid fast food, Oriental and buffet-type restaurants.
	Choose carefully from the menu.
	Make “special requests.” For example, ask that your food be prepared without added salt.
	Eat out less and watch your portions.

Reading Food Labels
Check the “nutrition facts” usually on the side or back of the package.

Look at the column called “% daily value.” It tells you at a glance whether a food is high or low in sodium, fat, fiber and calcium.

Look at the serving size. Remember to compare your serving size to the one on the label. For example, the label states that one cup contains 1,010 mg sodium. If you eat two cups, you will be getting too much sodium.

Look at the line titled “sodium.” Try to choose foods with 200 mg or less of sodium per serving. If you use a frozen dinner for a meal, choose one that contains less than 600 mg per serving.

Fluid limits
Besides lowering your salt (sodium) use, it is also important to lower your fluid intake. In heart failure, your main trouble is holding on to fluids. Your heart has to pump any fluids you drink. When you drink too many fluids, the heart must work harder. This extra fluid can cause swelling in your legs and shortness of breath because fluid builds up in your lungs. Lowering the fluids you take in will help your heart work with less effort. Here are some hints for decreasing your fluid:

	Do not drink more than 6 to 8 cups of fluids a day unless your doctor tells you differently.
	Anything that is liquid at room temperature is a fluid. This includes ice cubes, Jell-O and frozen desserts such as popsicles, sherbet and sorbets. All of these must be counted in your fluid intake for the day.
	Spread your liquid out over the day.
	Measure what you drink and record the amount of liquids each time you eat or drink.
	Eat only small amounts of melons because they are mostly fluid. Eat only 4 servings of fruit per day to avoid excess fluid intake. Drain liquid from all canned fruits.

You may notice a dry mouth. Try chewing gum or sucking on hard sugar-free candy, frozen lemon wedges or frozen orange sections.

To measure your fluids fill a half gallon juice bottle with water and keep it in your refrigerator.

When drinking anything, discard an equal amount from this bottle. When it is empty you should have no more to drink that day.

Daily weights
An increase in your weight is the first sign that fluid is building up in your body. By acting immediately to control your fluid buildup you will avoid increased stress to your heart. Call your doctor if you gain 2 to 3 pounds in two days or 5 pounds in a week.

Weigh yourself every morning after using the toilet. Do this before you eat breakfast.

Record your weight on the weight chart and watch for increases.

Exercise
Exercise is a must for people with heart failure. Benefits of exercise include:

	Lowering stress levels
	Increasing blood flow
	Helping you to do more
	Improving mental outlook
	Increasing a feeling of control

The best types of exercise for the patient with HF are:

	Walking
	Cycling
	Low impact aerobics
	Swimming
	Water aerobics

Gradually increase your exercise. Work with your doctor to plan the best exercise for you.

Oxygen therapy
Some patients need oxygen treatments as part of their heart failure care.

Flow rate is the amount of oxygen necessary for your treatment.

Your flow rate should be __________________.

Safety rules

	Never use oxygen near an open flame.
	Keep away from anything that can cause a spark.

When you are short of breath at night follow these three steps:

	Use your oxygen equipment
	Prop yourself up with pillows or sit up in a comfortable position
	If unable to get relief, call for help.

Be sure you know how to use your oxygen equipment.

Medicines
Different types of medicine are used in the treatment of heart failure. Each helps in a certain way. You may not need each type. Your doctor carefully chooses the medicines that are best for you. Often medicine and doses change during treatment.

ACE Inhibitors
These medicines are used often to treat heart failure. ACE inhibitors (angiotension converting enzyme inhibitors) widen the blood vessels so your heart does not have to work as hard. They help you to feel better. Because the medicines slow the progression of heart failure, patients may live longer.

The following medicines are ACE inhibitors:

Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
Quinapril (Accupril)
Ramipril (Altace)
Fosinopril (Monopril)

How to take this medicine:
Take this medicine at the same time every day. Make it a time you will remember.

Most common side effects:

	Lightheadedness. If you become lightheaded, let your doctor know. Your blood pressure may be too low. This can happen especially when you change position. An example would be when you stand up after lying down.
	Weakness, irregular heart beat or shortness of breath. Increased potassium may cause these symptoms. Let your doctor know if you have any of these.
	Swelling of the face, tongue, hands or feet. If you have this swelling, call your doctor immediately.
	Little urine output. If you have very little urine output, let your doctor know.

Diuretics
Diuretics (water pills) get rid of fluid that builds up in your lungs, lower extremities, and abdomen. With less fluid to pump, the heart works better. Sometimes you will need more than one diuretic to get rid of all the fluid.

The following medicines are diuretics:

Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demedex)
Metolazone (Zaroxolyn)
Spironolactone (Aldactone)
Hydrochlorothiazide (HydroDiuril)

How to take this medicine:
Take with meals to avoid stomach upset.

Take the last dose before 5 PM to avoid getting up at night to urinate.

Most common side effects:

	Irregular heart beat, muscle cramps, unusual tiredness or weakness. These may occur because of loss of potassium. Let your doctor know.
	Thirst and dry mouth. Use the techniques described with fluid restrictions to handle these symptoms.
	Skin rash. Contact your doctor if this occurs.
	Weakness and dizziness. Let your doctor know if you feel this way.

Digoxin (Lanoxin)
Digoxin increases the strength of your heart pump. It helps improve the symptoms of heart failure when used with other heart failure medicines. It also keeps the heartbeat slow and regular for patients who have atrial fibrillation.

How to take this medicine:
Wait two hours after taking antacids or fiber supplements.

Most common side effects:

	Nausea, vomiting or upset stomach
	Major loss of appetite
	Blurred vision
	Yellow, green or white halos around objects
	Weakness

Call your doctor if you have any of these side effects.

Drug interactions:
Some medicines can raise or lower the level of Digoxin in the blood. Most problems occur when there is too much Digoxin in the blood. Kidney failure, low potassium and older age can change the level of Digoxin in the blood. Your doctor will monitor your blood level of Digoxin as needed.

Beta blockers
Carvedilol (Coreg) is the beta blocker approved for use in people with heart failure. Coreg protects the heart from chemicals in the body that make the heart work harder. It helps keep your heart from getting weaker and can allow you to feel better over time.

Other beta blockers tht may be used by your doctor are Metoprolol (Lopressor), Atenalol and Toprol XL.

How to take this medicine:
Take this medicine every morning and evening at the same time. Always take it with food. Take your last dose at bedtime.

Most common side effects:

	Dizziness or lightheadedness
	Shortness of breath
	Swelling of feet and lower legs
	Slow heartbeat or heartbeat that “skips.”

Let your doctor know if you have these side effects.

Drug interactions:
Many other medicines can change the way your heart failure medicines work. Make sure your doctor and pharmacist know all the medicines you take, including over-the-counter medicine. Have all your prescriptions filled at one place so your pharmacist can look for medicines that could be dangerous if taken together.

Some medicines can raise the amount of Coreg in the blood. This can lead to side effects. These medicines include Cimetidine (Tagamet), Fluoxetine (Prozac), Paroxetine (Paxil), and Propafenone (Rythmol).

Heart failure medicines and potassium
Some diuretics remove potassium needed for muscle strength. You may need to eat food that contains potassium and/or take a potassium supplement. Foods rich in potassium include:

	Bananas, melons and oranges.
	Most fruit juices, including orange, pineapple and grapefruit. Do not drink tomato juice, because it contains too much sodium.
	Dried apricots, dates, prunes and raisins.
	Potatoes, spinach and sweet potatoes.
	Dried beans.
	Meat, fish and poultry.

Other commonly used medicines for heart failure
Angiotensin II receptor blockers: Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)
Some patients receive these instead of ACE inhibitors.

Vasodilators: Hydralazine (Apresoline)
These medicines have some of the same effects as ACE inhibitors. These help the blood vessels relax and help the heart pump better.

Nitrates: Isosorbide dinitrate (Isordil), Nitro-Dur patch
Often used in the evening to relieve symptoms of shortness of breath at night.

Amlodipine besylate: (Norvasc)
May be used for heart failure patients who have angina or high blood pressure.

Amiodarone hydrochloride: (Cordarone, Pacerarone)
Often used to control irregular heart beat.

Coumadin: (Warfarin)
Used in some patients to prevent blood clots and in patients with atrial fibrillation.

Tips on taking your medicine

1. Know the names, dose, actions, special instructions and common side effects of all the medicines you are taking. Keep your medicines handy. Bring them to all your doctor’s office visits.
2. Get your medicines at one pharmacy. The pharmacist will check your medicines to avoid possible interactions.
3. Take your medicines as ordered. Even when you are feeling better, continue to take them on schedule. Take medicines exactly as prescribed and do not stop taking them unless told to do so by your doctor.
4. It is best to take your medicines at the same time each day to make sure the same amount is in your body. If you have trouble figuring out a schedule, ask for help.
5. Keep your medicine in the original container, except for what you keep in your pill box. Do not remove labels from the original containers.
6. Ask your doctor before taking any over-the-counter medicines. This includes Dristan, Sudafed, Anacin, Advil, nonsteroid anti-inflammatory medicines and any other cold pills or pain relievers (even aspirin).
7. Medicines can become outdated and not work well. If they are more than several months old, ask your pharmacist or doctor if they are still effective and safe.
8. Do not give your medicines to anyone, even if that person seems to have the same symptoms as you.
9. It may take time for a medicine to begin to work and for your body to adjust to it. Sometimes you may have mild side effects during this period. Discuss them with your doctor. Sometimes another medicine can be prescribed. Always report anything unusual when taking a new medicine.
10. When you get a new medicine, ask your pharmacist to give you only a 1 to 2 week supply until you are sure your body will tolerate it. Your doctor may give you samples. Call your doctor to see if you should continue with that medicine.
11. Paying for medicine can be a problem. Many of the new drugs are expensive. However you cannot afford not to take them. Talk to your doctor about using less expensive medicines.
12. Warnings and instructions on prescription bottles help you take your medicine safely. They remind you when to take the medicine with food or of possible side effects. Usually you should follow these instructions. An exception to this is the warnings on bottles of potassium supplements. Sometimes they advise taking these “with plenty of water.” Since drinking extra fluid is not the best advice for most heart failure patients, be sure to check with your doctor for more specific instructions.
13. If you miss a dose of medicine, check with your doctor rather than take an extra dose. Certain heart failure medicines taken too close together can sometimes do more harm than good. Try not to miss doses.
14. Medicines help control your symptoms and should improve your quality of life. Follow the directions for your prescription carefully. Medicines only work if you use them correctly. Call your doctor, nurse or pharmacist if you have questions about how they work or if you notice side effects.