CARDIOLOGY
Caring for Your Heart
The heart and science of medicine.
Key Points:
WHEN TO CALL YOUR HEALTHCARE PROVIDER:
After you are discharged from the hospital, it is important to notice if your
symptoms get worse and if so, call your healthcare provider.
These symptoms may include:
• New or increased shortness of breath
• Lightheadedness, dizziness, or fainting
• Weight gain of 3 pounds in one day or 5 pounds in a week
• Belly or Leg/Ankle swelling
• Unexplained side effects after taking medicine
Make a list of your questions and concerns so that you will remember
everything when you call your doctor.
WHAT TO BRING TO YOUR HEALTHCARE APPOINTMENTS:
• Weight chart or calendar
• All your medicines in their original containers
• A list of your questions and concerns
REMEMBER TO:
• Take your medicine as prescribed
• Eat less than 2,000mg of sodium (salt) a day and follow your fluid limits
• Record your weight daily
• Follow your healthcare providers instructions for activity
•Make sure you have an appointment within 1 or 2 weeks after
leaving the hospital.
• If you smoke, quit.
2
Vermont Quit Line:
New York Quit Line: 1 -866-NY QUITS, (697-8487) or
www.NYSMOKEFREE.com
1 -800-QUIT-NOW, (784-8669) or
www.802QUIT.org
3
NOTES
Table of Contents
What is Heart Failure?............................................................................. 6
What are the Causes of Heart Failure?............................................. 7
What is an Ejection Fraction (EF)?..................................................... 8
Signs and Symptoms of Heart Failure............................................... 9
Your Weight and Your Heart................................................................ 11
Check Your “Heart Failure Zone” Every Day................................. 12
Advance Care Planning.......................................................................... 13
Good Nutrition for Your Heart............................................................14
Grocery List................................................................................................16
Eating out....................................................................................................19
Fluid Intake Tips and Guidelines.......................................................20
Understanding Your Medications.......................................................21
Common Medications............................................................................22
Activity and Exercise............................................................................. 27
My Medications........................................................................................29
Exercise Log............................................................................................. 30
References for Heart Failure Patients:
American Heart Association: www.heart.org, www.HeartFailureMatters.org
Heart Failure Society of America: www.hfsa.org
4
American Association of Heart failure nurses: www.aahfn.org
5
What is Heart Failure?
•
Heart failure (HF) is when the heart cannot pump blood normally.
•
HF may cause you to feel weak, tired or dizzy.
•
HF may cause buildup of fluid in the body. This fluid can get into your
What are the Causes of Heart Failure?
Heart muscle damage of any type weakens the heart muscle and can lead
to heart failure. The most common causes of heart muscle damage:
lungs and make you short of breath. It can cause your legs, feet, and belly
to swell.
WHAT HAPPENS WITH HEART FAILURE?
When you have heart failure, your heart cannot pump enough blood to meet your body’s needs.
Here’s a summary of how heart failure can develop and progress.
• The heart muscle is weakened by conditions or diseases that damage your heart.
• The heart’s pumping action does not work as well.
• The body tries to make up for the heart’s reduced pumping action in these ways:
• Holds on to fluid to increase volume of blood.
• The heart beats faster.
•The heart enlarges. (Heart chambers stretch and get bigger, and the muscle mass may get
thicker.)
• For a time, these changes will help continue normal or near-normal heart function.
•Over time the heart muscle becomes tired and unable to pump the blood your body needs.
Heart failure symptoms – such as shortness of breath, cough, fatigue, and fluid buildup – may
begin or worsen.
•Atherosclerosis (coronary artery disease, CAD). When the arteries supplying blood to the
heart become clogged with plaque, it can cause a heart attack that damages your heart
muscle due to a lack of blood flow. Unlike normal heart muscle, damaged muscle tissue does
not contract so your heart may not pump as well.
• H
igh blood pressure (hypertension). Long-term, poorly controlled high blood pressure makes
your heart work harder to pump blood through your body. Over time, all that extra work can
cause the walls of the heart to become thick and/or wear out your heart, leading to heart failure.
•Heart valve problem. Heart valves control the direction of blood flow through your heart.
When they are damaged, they often do not open and close properly. This leads to backflow
of blood or limits the forward flow of blood. Congenital defects (defects present at birth) and
valve infections can cause heart valve problems that interfere with your heart’s ability to pump
blood normally.
•Alcohol Abuse. Chronic, excessive alcohol
intake can severely weaken the muscle
walls of the heart.
•Drugs. Illegal drugs such as cocaine or
amphetamines can damage the heart.
And rarely, some cancer treatments can
damage the heart.
•Other Causes:
•There are several forms of inherited heart
failure, it is important that you tell your
healthcare provider about any family
members that also have a diagnosis of
heart failure.
•Atrial Fibrillation or a fast heart rate can
weaken heart muscle.
•Heart failure can be caused by a viral
infection of the heart muscle.
There are many causes of heart failure,
but overall the treatment is generally
the same.
Poor Squeeze vs
Poor Relaxation:
For most patients with heart failure, the left
ventricle of the heart (also known as the
main pumping chamber) is affected.
• H
eart failure occurs because your heart
is not pumping well – you have “poor
squeeze.” Your healthcare provider
may call this systolic heart failure or
heart failure with reduced ejection
fraction (EF). (See page 8 for more
about EF)
• In other cases, the heart can still pump
normally – but the muscle walls have
become stiff, which prevents the heart
from fully relaxing and filling with
enough blood between contractions.
Your healthcare provider may call this
diastolic heart failure or heart failure
with preserved EF.
With both types of heart failure, your
heart cannot pump enough blood. This can
interfere with the function of other major
organs, and produce a range of symptoms
6
*Used with permission. © 2006-2016, Intermountain Healthcare
*Used with permission. © 2006-2016, Intermountain Healthcare
throughout your body.
7
What is an Ejection Fraction (EF)?:
Know These Signs:
Your EF is the percentage of blood that pumps out of the heart during
Noticing changes in your health is an important aspect of recognizing heart
each heart beat. It is also a measurement used to see how well your heart
failure (HF) issues. If you notice any of the symptoms listed on the next few
is functioning. A low EF is not always associated with symptoms. How you
pages, or if you find your symptoms are getting worse, be sure to let your
generally feel is a more important measure of how you are doing than your
healthcare provider know.
EF number.
Similar to blood pressure and cholesterol, your EF is an important health-related number.
A low EF can occur if your heart muscle has been damaged.
What does your EF number mean?
SHORTNESS OF BREATH:
People with HF may experience: Feeling out of breath; difficulty breathing
while lying flat.
This happens because: The heart can’t pump enough blood to meet the
body’s needs, which causes fluid to back up into the lungs.
•50-75% Heart’s pumping ability is Normal
•36-49% Heart’s pumping ability is Low (mild to moderate)
•35% -10% Heart’s pumping ability is Very Low (moderate to severe)
YOUR MOST RECENT EJECTION FRACTION (EF) IS:
NEED TO SLEEP UPRIGHT:
People with HF may experience: A need to prop themselves up to sleep; with
extra pillows or sleep in a chair because they have trouble breathing while flat.
This happens because: The heart can’t pump enough blood to meet the
body’s needs, which causes fluid to back up into the lungs.
PERSISTENT COUGHING OR WHEEZING:
People with HF may experience: Coughing that produces white or pink bloodtinged mucus.
This happens because: The heart can’t pump enough blood to meet the
body’s needs, which causes fluid to back up into the lungs.
SWELLING:
People with HF may experience: Rapid weight gain; swelling in the feet,
ankles, legs, and/or belly.
Congestive Heart
Failure?
This happens because: The heart can’t pump enough blood to meet the
body’s needs, which causes fluid to back up; kidneys are less able to dispose
of sodium and water, fluid collects in the in the legs or belly.
Your healthcare providers may refer
CONFUSION/CAN’T THINK CLEARLY:
People with HF may experience: Memory loss and feelings of confusion, a
caregiver may notice this first.
to your condition as “congestive heart
failure.” By adding the term “congestive,”
they’re referring to the buildup of fluid
This happens because: Changing levels of substances in the blood can cause
confusion.
(the congestion) that may occur with
heart failure. This can cause symptoms like
swelling and fluid weight gain as well as
8
shortness of breath, due to fluid in the lungs.
*Used with permission. © 2006-2016, Intermountain Healthcare
9
FATIGUE/TIREDNESS:
People with HF may experience: Feeling tired all the time and difficulty with
everyday activities.
This happens because: The heart can’t pump enough blood to meet the
body’s needs. Blood is then sent away from organs like muscles in limbs in
favor of vital organs like the heart and brain.
RAPID WEIGHT GAIN:
People with HF may experience: Three or more pounds of weight gain in one
day or five pounds in a week due to fluid retention.
This happens because: The heart can’t pump enough blood to meet the
body’s needs, which causes fluid to back up; kidneys are less able to dispose
of sodium and water, fluid collects in the in the legs or belly.
LACK OF APPETITE OR NAUSEA:
People with HF may experience: A feeling of being full or sick to their
stomach.
This happens because: The digestive system – the stomach and intestines –
receives less blood, causing problems with digestion.
A Family Affair
WHAT YOU CAN DO TO KEEP
FEELING GOOD AND STAY OUT OF
THE HOSPITAL:
Support from family and friends can go a long way
•Weigh yourself each day.
toward helping you manage your heart failure. It can
•Check your “Heart Failure Zone”
(see page 12) every day.
also help THEM – giving them a role to play and a sense
of control. They can help by:
•Keeping records and notes. Loved ones can help
you keep activity and weight records and write
questions to ask your healthcare provider.
• E
xercising with you. Having friends or family
exercise with you can help you stick to a schedule
and maintain an appropriate activity level.
• S
upporting you in heart-healthy eating. Loved
ones can help you eat properly by shopping for,
cooking, and eating low-sodium foods with you.
Have a frank discussion with your loved ones about how
•Take your medicines correctly
every day.
•Eat less than 2000 mg of salt/
sodium each day.
•Drink the right amount of fluids
(generally 2 quarts (64 oz) or less).
•Exercise regularly (at least 5 times
per week).
Your Weight and Your Heart
As you learned from the first section of this guide, heart failure causes fluid to
buildup in your body. This fluid shows up as extra weight on your scale.
Generally speaking, the more severe your heart failure, the more fluid can build up. An increase in
your weight could mean a worsening of your heart. For this reason, weighing yourself daily and
keeping a record will help you and your healthcare providers know if your heart failure is under
___
____________
____________
control.
Goal Weight__
__
Zone Indicator
(refer to cover)
Green Zone
that indicates
Mark the color
are in today
what zone you
Yellow Zone
WT:
HR:
BP:
WT:
HR:
BP:
When You are
Gaining…
WT:
HR:
BP:
WT:
HR:
BP:
WT:
HR:
BP:
WT:
HR:
BP:
these conditions:
HR:
BP:
BP:
WT:
HR:
BP:
WT:
HR:
BP:
BP:
diately
HR:
:
BP
BP:Weigh yourself when you are dry, not wet
3
from a shower
or bath.
WT:
WT:
HR:
BP:
WT:
HR:
BP:
BP:
morning – after urinating but before eating or
drinking.WT:
:
WT
HR:
WT:
HR:
BP:
:
An increase in: your weight
meansWT
either
of
WT:
HR:
WT
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itFrisi a digital scale.
WT:
WT:
HR:
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WT:
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scale every day and make sure
1Use the same
Sat
: Weigh yourself
at the same time every
2WT
HR:
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BP:
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WT:
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Thu
Wed
Tue
WT:
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WT:
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HR:
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HOW TO WEIGH YOURSELF EACH DAY
MO
Red Zone
Mon
Sun
____________
endation_____
Fluid Recomm
_
____________
__
n_
mmendatio
Sodium Reco
__
__
__
__________
Goals______
Daily Activity
__
NTH________
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u canno
Call 911 if yo
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althcare
• CaYou
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ll your he
• You are gaining weight in fat
Fat weight gain happens more slowly than
WT:
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: rite down
4 BPW
accurately – you want a detailed record
WT:
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of: your weight
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:
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idea. You should take your weight diary to
each appointment
and have your healthcare
WT:
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provider
review
it.
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BP:
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t reach your
healthcare pro
tely
vider immedia
WHEN SHOULD I CALL MY HEALTHCARE
PROVIDER ABOUT MY WEIGHT?
Call your healthcare provider if you see either of
these weight-gain warning signs:
fluid weight gain. Talk with your healthcare
You gain 3 or more pounds in one day.
provider to determine why you are gaining
You gain 5 pounds over your goal weight.
weight – and whether it warrants a change in
These signs could mean that your body is
retaining fluid, and may require a change in your
treatment plan. You should also call if you have
any questions about your goal weight, or any
other aspect of your treatment plan.
your treatment plan.
When You are
Losing…
A decrease in your weight may mean you are
dehydrated.
they can help you improve your health.
Consult with your healthcare providers
10
Another topic to discuss is your advance directive. An
to determine why you are losing weight
advance directive is a legal document that expresses
and whether it requires a change to your
your decisions for your healthcare. (See page 13 for
treatment plan.
more info)
*Used with permission. © 2006-2016, Intermountain Healthcare
11
Check Your “Heart Failure Zone” Every Day
Advance care planning
Heart failure can cause you to feel bad, have swelling and be short of breath.
Doing your daily checkup can help you catch these changes quickly so you
Heart failure is a serious chronic condition that can shorten a person’s life.
What is ahead of you can be uncertain and is different for everyone. Preparing for your health and
care choices before you are too sick is called advance care planning.
can take action to feel better and stay out of the hospital.
1
Each Day:
•
2
Weigh yourself
• Are you short of breath?
•
Do you have swelling?
Find which Heart Failure Zone you are in:
EVERY DAY
GOAL ZONE
WARNING ZONE
EMERGENCY
Heart Failure Zones
EVERY DAY
EVERY
DAY

Weigh yourself in the morning before breakfast, write down and compare to yesterday’s
weight.

Take your medicine as prescribed.

Check for swelling in your feet, ankles, legs and stomach.

Eat low-salt food.

Exercise and get enough rest.
GREEN ZONE—This is your goal!
GREEN
ZONE
Your symptoms are under control. You have:

Normal breathing.

No weight gain of more than 2 pounds. (it may change 1 or 2 pounds some days).

No swelling of your feet, ankles, legs or stomach.
CAUTION—This zone is a warning
Call your doctor’s office if:
YELLOW
ZONE
• Choosing health care agents.
• Deciding about treatment choices like CPR, whether to have surgery or pacemaker.

You have a weight gain of 3 pounds in 1 day or a weight gain of 5 pounds
or more in 1 week.

More shortness of breath.

More swelling of your feet, ankles, legs or stomach.

Feeling more tired. No energy.

Dry, hacking cough.

Dizziness.

Feeling uneasy, you know something is not right.
• Focus of this care is to improve quality of life for the patient and her/his family.

It is harder for you to breathe when lying down. You are needing to sleep
sitting up in a chair.
• It is about relieving and preventing physical and emotional symptoms.
EMERGENCY
RED
ZONE
ADVANCE CARE PLANNING INCLUDES:
• Doing an advance directive or living will.
Go to the emergency room or call 911 if you have any of the following:

Struggling to breathe. Shortness of breath even while sitting still.

Chest pain.

Confusion or can’t think clearly.
• Talking about and documenting your care goals.
PALLIATIVE CARE (PRONOUNCED PAL-LEE-UH-TIV) IS:
• Specialized care for people with serious illness like heart failure.
• Provided by specially trained doctors, nurses and other specialists.
• Clinicians skilled to assist with advance care planning.
Hospice is a care option for all of us when we no longer have years to live but months. The focus is
also on improving quality of life but the goal is comfort. Hospice care can take place in the home, a
hospice unit or a nursing home.
Ask your healthcare provider to guide you in how or who can help you with advance care planning.
12
13
YOUR HEART HEALTH TEAM #:
Good Nutrition for Your Heart
DAILY DIETARY SODIUM RESTRICTION
One salty meal may lead to a trip to the Emergency Room or
admission to the hospital. Eating salt (sodium) can make your
body retain too much water, which makes your heart work
harder. Too much salt (sodium) can cause shortness of breath
and swollen ankles. The average person in the US eats too
much salt, often taking in more than 4000 milligrams (mg) each
day. People with heart failure need to eat less salt, and should
limit their salt intake to less than 2000 milligrams (mg) or 2
grams (g) of salt each day.
READING A FOOD LABEL
1 Look at the serving size. Watch out: the Nutrition Facts label is for just one serving.
2 Look at the sodium per serving- focus on the mg per serving, and ignore the %, as the %
applies to a regular diet.
3 Choose foods with less than 140 mg of sodium most of the time. If it has more than 300 mg per
serving, put it back and look for a lower sodium alternative.
This food is a higher
sodium food, and is
NOT a good choice.
TIPS FOR EATING LESS SALT (SODIUM)
• Stop adding salt to your food. Take the salt shaker off the table and stove.
• Try herbs, spices, lemon and vinegars to season your foods– see page 18 for more details.
•Eat less processed foods (for example any food item in a box, wrapper or can); many contain
large amounts of salt (sodium). Most are available in regular (with salt) and reduced salt
(sodium) versions. Even the reduced salt (sodium) food items may have high salt (sodium)
content. Check the food labels to compare.
This food has 45 mg sodium in one serving, so it
is a good choice if you stick to one serving.
• Eat plenty of fruits and vegetables.
•Choose mainly fresh or frozen vegetables. When you choose canned vegetables, rinse off
with water and drain the vegetables before you eat them. Rinsing can remove some of the
added salt.
• Choose lean, fresh meats instead of high salt (sodium) cured meats, bacon, or sausage.
•Snack on low fat yogurt, unsalted air popped popcorn, unsalted pretzels and unsalted crackers,
and frozen juice bars.
•Try to focus on whole foods such as fruits, vegetables, beans, nuts, and whole grains. Farmer’s
markets and Community Supported Agriculture (CSA) shares from local farms are two ways to
get fresh produce that is often less expensive than the foods found in the supermarket.
•Realize that even foods that do not taste salty may still be high in salt (sodium) levels. Baking
powder, baking soda, MSG, soy sauce, bouillon cubes and preservatives added to foods also
contain sodium.
• Check the nutritional content labels on all of your food items.
To stay within your daily limit of 2000 mg sodium, aim for less than 600 MG sodium per meal.
This will leave you some wiggle room for snacks.
LABEL KEY WORDS
“Sodium Free”
Very Little Sodium (less than 5 mg per serving)
“Low Sodium”
140 mg sodium or less per serving
“Reduced sodium”
At least 25% reduction from the original product, may not
be a low sodium choice- check the numbers!
“Unsalted”, “Without Added Salt”, “No Salt Added”
When Light is Wrong
Don’t be fooled by “light” labels on foods. A “light,” or “lite” label may
refer to the amount of calories, fat or salt in the food. Many low-fat or fat14
free foods are actually quite high in salt! Check the label before buying.
No salt used during processing
Questions?
Call the DIET LINE: 802-847-DIET (3438)
Leave your name, phone number, and a brief nutrition question and a Registered Dietitian
will return your call.
15
Grocery List
Choose these
BREADS: Breads, pita, bagels, sandwich buns, dinner
rolls, and english muffins with less than 150 mg sodium
in a serving
Instead of
BREADS, CEREALS, SNACKS:
Breads, crackers and snacks with
more than 150 mg sodium in a
serving
CEREALS: Most dry cereals (check label), non-instant
hot cereals
PASTA: Whole wheat noodles, spaghetti, macaroni
RICE AND OTHER GRAINS: Brown rice, wild rice,
bulgur wheat, barley, quinoa
Fruit juice
Canned vegetables* or vegetable juice with less than
150 mg sodium in a serving
BEEF: Lean cuts of round, sirloin, flank, tenderloin,
cube steak, 90% lean ground beef
OILS: olive, canola, peanut are healthiest, but no oils
have sodium
Vegetables prepared in sauce,
pickled or brined vegetables;
sauerkraut, pickles
Vegetable oil spray, Molly McButter light sodium,
Regular vegetable juices or
canned soups
Margarines with less than 150 mg sodium in a serving
Any product in this group with
more than 150 mg sodium in a
serving
Butter Buds
Mayonnaise and salad dressing with less than 150 mg
sodium in a serving
Avocados
Butter, if saturated fat is not an issue.
Caviar, processed fish products
with more than 300 mg sodium in
a serving
Sausage, bacon, frankfurters,
regular luncheon meat with more
than 300 mg sodium in a serving
PORK: Tenderloin, leg (fresh), lean chops
Satisfy your “sweet tooth” with fruit. Choose treats
wisely. Sherbet, sorbet, Italian ice, low-fat frozen yogurt, popsicles
Commercial baked goods: pies,
cookies, pound cake, frosted cake,
with more than 150 mg sodium in
a serving
Fig bars, gingersnaps, graham crackers
Jelly beans, hard candy
Marshmallows, granola bars
Regular or sugar free Jell-O
Homemade cakes, cookies, pies and fruit crisps without added salt
VEAL: All trimmed cuts, chops and roasts
Venison or any game meat
DRIED PEAS AND BEANS: Split peas, black-eyed
peas, chick peas, kidney beans, lentils, soybeans.
Canned peas and beans with less than 150 mg sodium
in a serving
Salted nuts and seeds with more
than 150 mg sodium in a serving
UNSALTED NUTS AND SEEDS:
Almonds, cashews, hazelnuts, walnuts, peanuts,
peanut butter, pumpkin seeds, sunflower seeds
Frozen dinners with more than 650
mg sodium
Whole fresh eggs or egg whites
Other cheeses with less than 150 mg sodium in a
serving such as swiss cheese
All dairy has naturally occurring sodium, so don’t go
over 2-3 servings a day
Soups with less than 400 mg sodium in a serving (eg,
Campbell’s Healthy Request, Healthy Choice brand)
POULTRY: Without skin, ground chicken or turkey
breast
Cheese with more than 150 mg
sodium in a serving
Frozen yogurt
*Drain and rinse canned vegetables
FISH : All fish and shellfish (except fried), rinsed waterpacked canned tuna and salmon
MILK: skim, 1% milk or yogurt, low-fat buttermilk, lowfat evaporated or non-fat milk, or whole milk, yogurt
or ice cream if you need extra calories and saturated
fat is not an issue
Instead of
Low sodium fat free or 1% cottage cheese
PASTA AND RICE:
Prepared products with over 300
mg in a side dish serving
SNACKS: Whole grain crackers (eg, “hint of salt”
Triscuits, Ak Mak), matzo, bread sticks, rye krisp,
zwieback, rice cakes, low salt pretzels (eg, Snyder’s
unsalted mini’s), home popped popcorn or low salt
commercial brands
FRUITS AND VEGETABLES: Any fresh or frozen
fruits and vegetables
Choose these
Egg substitutes with more than 150
mg sodium in a serving
Puddings (count as a dairy serving)
Dark chocolate
BEVERAGES: Count as part of your fluid restriction.
Tea, coffee, herbal tea, unsweetened ice tea, seltzer,
mineral water
100% fruit and low sodium vegetable juice
Beverages with more than
150 mg sodium in a serving.
Be aware of beverages such
as Gatorade and low sodium
V8 that may have less than
150 in one serving but that
add up if you have multiple
servings
Frozen dinners with less than 650 mg sodium
16
17
Grocery List - Low Sodium Seasoning
Eating at home and eating out/ordering take out
Ways to add flavor to your food without having to add salt:
Food
Herb or Seasoning
SOUPS
Bay leaf, tarragon, marjoram, parsley, savory,
rosemary
BEEF
Garlic, bay leaf, thyme, green pepper, onion
powder, mushrooms, nutmeg, marjoram,
onion, cumin
POULTRY
Apples, pineapples, garlic, onion powder,
sage, thyme, basil, onion, ginger, cumin
PORK
Apples, pineapples, garlic, onion powder,
sage, thyme, basil, onion, ginger, cumin
EGGS
18
When you eat out
Don’t add salt to food when you cook or eat
Ask for foods cooked without salt
Make your own or choose low salt sauces,
salad dressing, breads and desserts
Choose grilled, baked, roasted, poached or
steamed foods
Cranberries, paprika, parsley, thyme, sage,
rosemary, garlic
LAMB
FISH
When you eat at home
(avoid items labeled fried, pan fried, crispy)
Avoid “instant” foods that come in a bag or
box
Avoid butter, cheese, sauces, and gravy
Rinse canned foods before cooking and
eating
Choose oil and vinegar or lemon juice as
salad dressing
Season food with herbs, vinegar, lemon juice
and seasoning without salt
Avoid or limit fast food
Avoid seasoned salts such as garlic salt and
onion salt
Avoid bacon, sausage, ham, hot dogs,
bologna, and other deli meats
(ie au gratin, scalloped, cheesy, creamy)
Lemon juice, onion powder, dry mustard,
green pepper, mushrooms, tomatoes,
Tabasco sauce, fresh onion, dill
Pepper, curry, dry mustard, onion powder,
paprika, parsley, tomato, oregano, tarragon,
fresh onion
BREAD
Caraway, oregano, poppy seed, rosemary,
thyme, cinnamon
VEGETABLES
Basil, garlic, chives, dill, tarragon, marjoram,
mint, parsley, pepper, thyme
SALADS
Basil, chives, tarragon, garlic, parsley,
vinaigrette dressings
19
Fluid Intake Tips and Guidelines
Understanding your Medications
Some people with heart failure hold fluid in their bodies, resulting in swelling. This may cause
swelling in your feet and legs. Even if you are thirsty, this does not mean your body needs fluid.
You may be taking a diuretic (water pill) to help your body get rid of fluid. Many healthcare provider
suggest that people with a heart condition limit fluid intake to 8 cups/day total, or 2 quarts per
day. Drinking an excessive volume of fluids may force your heart to work harder.
KEEPING TRACK OF YOUR MEDICINE
Use a pill box, medicine calendar, smartphone
or tablet app to help keep track of whether
you have taken your medicines. Set an alarm
to remind you to take your medicines. If you
are interested, the following are some popular
medication-tracking apps to check out:
Medisafe, Rxmind Me, Pillbox and Pillboxie.
Ask your healthcare provider if you should watch your fluids
To help you measure your fluid intake
1 cup =
8 ounces =
240 ml
4 cups =
32 ounces = 1 quart =
1000 ml =
1 liter
8 cups =
64 ounces=
2000 ml =
2 liters
1 ml = 1 cc
1 ounce = 30 ml
2 quarts =
Here are some examples of liquids and foods to include in your total fluid count:
Water
coffee and tea
Juice
milk
Ice cream or sherbet
Ice cubes- Account for half
volume of cup, i.e 16 oz of ice
Broth/Soup Jell-O
equals 8 oz of fluids Soda
Popsicles To keep track of your daily fluid intake, use an empty 2 liter bottle. Using the cup or glass you drank
from, fill it with water to the same amount you drank, and then pour into the 2 liter bottle. This will help
you gauge how much you are drinking over the course of the day, and when you have reached 2 liters.
THIRST QUENCHERS:
LIMIT ALCOHOL
Avoid salty foods: water goes where sodium is
Here are a couple of good reasons to limit your
alcohol intake:
Eat ice cold fruits and vegetables between meals
Nibble on lemon wedges
Freeze seedless grapes or blueberries
• H
elps limit your fluid intake to reduce the
strain on your heart.
Suck on sour hard candies or chew gum (sugar
free if diabetic)
• P
revents heart muscle damage that may be
caused by more-than-moderate alcohol use.
Rinse your mouth with water and don’t swallow;
or only take sips
According to the American Heart Association,
a woman should have no more than 1 drink
each day (a beer, glass of wine, or cocktail)
and men should have no more than 1 to 2
drinks each day. (Note: if alcohol caused
your heart failure, stay away from alcohol
completely.)
Add lemon juice to ice trays and freeze (use ½
lemon per tray of water)
Eat crushed ice instead of drinking water. Most
people find ice more satisfying than the same
amount of water. 1 cup crushed ice = ½ cup water
TAKE YOUR MEDICINES AS PRESCRIBED,
EVEN IF YOU FEEL BETTER.
Skipping one medicine may not seem like a big
deal, but it can make all the difference in your
treatment. Your medicines help your heart work
better and improve your heart function. It is
important to work closely with your healthcare
provider to make sure you are getting the best
and most appropriate medicines and doses for
you.
TALK TO YOUR HEALTHCARE PROVIDER
Make sure your healthcare provider is aware of
every prescription, over-the-counter medicine
and vitamin or supplement you’re taking, as well
as any allergies you may have. Ask questions
about your medicines. Learn what medicines
you are taking and why. Always ask your
healthcare provider or pharmacist before taking
any over-the-counter medications or vitamins/
supplements.
ALWAYS CARRY A LIST OF YOUR MEDICINES.
Keep a current list of your medications including
vitamins and supplements with you at all times.
(Use page 29 to get started). Show it to your
healthcare provider or dentist at each visit.
SIDE EFFECTS
Every drug has the potential to cause side
effects. However, many patients experience
none or minor side effects only. Feel free to
call your healthcare provider any time a side
effect becomes bothersome. Always call your
healthcare provider when a side effect becomes
severe. But remember to never stop taking a
medication without talking to your healthcare
provider first.
MISSED DOSE
If you miss a dose of medicine, take it as soon
as you remember. However, if several hours
have passed and it is almost time for your next
dose, skip the missed dose and go back to your
regular dosing schedule. Never double dose in
order to catch up.
MEDICATION STORAGE
Store your medications away from direct heat
or light. Do not store in a bathroom, near the
kitchen sink or in other damp places because
heat and moisture may cause the medicine to
break down. Keep your medications tightly
closed. Do not keep outdated medicine or
medicine that is no longer needed - and make
sure discarded medicine is out of reach of
children. Do not share your medicines with
others.
When you have a week of medications left, order more.
Use a humidifier or vaporizer at home
20
21
Medications to Avoid
Common Medications
Many different types of medications
are used to treat heart failure. Each
type does a different job.
ALWAYS ask your healthcare provider before you
take any new medicine.
COMMON ACEIs:
COMMON ARBs:
Benazepril (Lotensin®)
Fosinopril (Monopril ®)
Captopril (Capoten®)
Losartan (Cozaar®)
Enalapril (Vasotec®)
Olmesartan (Benicar®)
COMMON ALDOSTERONE ANTAGONISTS:
Spironolactone (Aldactone®)
Lisinopril (Prinivil®, Zestril®)
Candesartan (Atacand®)
Trandolapril (Mavek®)
Valsartan (Diovan®)
Quinapril (Accupril®)
Irbesartan (Avapro®)
Ramipril (Altace®)
Telmisartan (Micardis®)
Moexipril (Univasc®)
• Do not take any pills for pain except Tylenol
(acetaminophen). Do not take more than 4,000mg
daily.
Aldosterone Antagonists
•
Avoid all other over-the-counter anti-inflammatory
agents for pain, such as Ibuprofen (Advil®) or
Naproxen (Aleve®). They can cause you to gain fluid
and may decrease the effectiveness of your other
medications.
•
Avoid medications containing Aspirin such as
Excedrin®, BC Powder. It is OK to take a baby
aspirin (81mg) daily or other aspirin prescribed by
your doctor.
•
Do not take any herbal medications or dietary
supplements without approval of your healthcare
provider or pharmacist.
•
Do not take Alka-Seltzer® or any other fizzing or
effervescent medications. They contain a high
amount of sodium which can cause you to gain fluid
and strain your heart.
•
Avoid medications and herbal products that contain
®
Pseudoephedrine (Sudafed ), Ephedrine (ma
huang, Herbalife®) or Oxymetazoline (nasal sprays
such as Afrin and Dristan). These medications speed
up your heart rate and raise your blood pressure.
Eplerenone (Inspra®)
PREVENT FLUID BUILDUP AND LOSS OF
POTASSIUM
Works like a water pill (diuretics). Shown to help
patients live longer, feel better and spend less time
in the hospital.
IMPORTANT TO KNOW
• Your healthcare provider will need to check
labs on your kidneys (BUN and creatinine) and
potassium levels especially during the first few
weeks.
•May increase your potassium levels in your blood.
•Beware of potassium-containing salt substitutes.
They may further increase your potassium level
when using Aldosterone Antagonists. Always
check with your healthcare provider before using
a salt substitute.
MEDICATIONS TO AVOID:
Ibuprofen (Advil®, Motrin®)
Naproxen (Aleve®)
Ketoprofen (Orudis/KT®, Akron®)
Excedrin®
BC Powder®
Alka-Seltzer®
22
POTENTIAL SIDE EFFECTS
•Increased urine frequency
•Dry mouth, increased thirst
• Muscle weakness, cramps
• Upsets stomach, diarrhea
• Nausea
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
Pseudoephedrine (Sudafed®)
• Severe weakness, dizziness or muscle cramps
Ephedrine (ma huang, Herbalife®)
• Rash, hives or itching
xymetazoline (nasal sprays such
O
as Afrin® and Dristan®)
• With Spironolactone (Aldactone ®) only:
As a rule, AVOID any medications that speed up your
heart or contain sodium.
Angiotensin Converting Enzyme Inhibitors (ACEIs)
Angiotensin II Receptor Blockers (ARBs)
RELAXES BLOOD VESSELS AND DECREASES
BLOOD PRESSURE SO THE HEART CAN PUMP
BLOOD MORE EASILY.
ACE inhibitors and ARBs have been proven to help
you live longer, feel better and spend less time in
the hospital. They also reduce heart remodeling when your heart tries to get stronger by becoming
bigger. While this sounds like a good idea, a bigger
heart becomes weaker over time.
IMPORTANT TO KNOW
• Avoid sudden changes in position. Sit down
or lie down if you feel lightheaded.
• Take Captopril and Quinapril on an empty
stomach (one hour before meals or two
hours after meals if possible).
• May increase your potassium levels in your
blood.
• Beware of potassium-containing salt
substitutes. They may further increase your
potassium level when using ACEIs or ARBs.
Always check with your healthcare provider
before using a salt substitute.
• Your healthcare provider will need to check
labs on your kidneys (BUN and creatinine)
and potassium level from time to time.
POTENTIAL SIDE EFFECTS
• Dizziness/lightheadedness and fainting
early in therapy. Likely to occur when
standing up from a sitting or lying position.
• Skin rash (with or without itching), fever or
joint pain
• Persistent dry cough, impaired taste
perception
• Headache, fatigue or insomnia
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
• Chronic dry cough
• Severe weakness, dizziness, confusion
• Change in how much or how often you
urinate
• Numbness in hands, feet or lips
VERY RARELY, ACEIs OR ARBs CAN CAUSE A
CONDITION CALLED ANGIOEDEMA.
Angioedema is the rapid swelling (edema) of the
face, tongue, mouth or throat sometimes with
numbness or itchiness in these areas. Get immediate medical attention if you experience any of
these symptoms.
• ARBs are like ACEIs, sometimes they are
given when a patient cannot take an ACEI
due to side effects.
Men: b
reast tenderness or trouble obtaining
an erection.
Women: irregular menstrual cycle.
23
Angiotensin Receptor
Neprilysin Inhibitors (ARNI)
Beta Blockers
COMMON ARNI:
COMMON BETA BLOCKERS:
Metoprolol succinate (Toprol XL®)
Relaxes blood vessels and decreases blood
pressure so the heart can pump out blood more
easily.
Carvedilol (Coreg®)
Bisoprolol (Zebeta®)
IMPORTANT TO KNOW
SLOWS THE HEART RATE AND DECREASES
BLOOD PRESSURE.
Valsartan/Sacubitril (Entresto®)
• To lower the chance of feeling dizzy or
fainting, rise slowly over a few minutes when
sitting or lying down. Be careful climbing
stairs.
• Increases your potassium levels in your blood.
• Beware of potassium-containing salt
substitutes. They may further increase your
potassium level when using ARNIs. Always
check with your doctor before using a salt
substitute.
• Your healthcare provider will need to check
labs on your kidneys (BUN and creatinine) and
potassium level from time to time.
• Can take with or without food.
POTENTIAL SIDE EFFECTS
• Dizziness/lightheadedness
• Cough
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
• Severe dizziness or passing out
• Severe weakness or fatigue
• Cough that does not go away
Very rarely ARNIs can cause a condition called
angioedema.
Beta blockers help reduce the workload of your
heart and improve heart function to reduce
symptoms. Proven to increase the lifespan of
heart failure patients!
IMPORTANT TO KNOW
• May make you feel tired, weak, or dizzy when
first started. Your body usually adjusts to this
over the first couple weeks. If these symptoms
occur, sit or lie down.
• Always take Carvedilol (Coreg®) with food.
Food slows down the rate of absorption to
prolong therapeutic effects and reduces
side effects (lightheadedness when rising or
standing).
• May make you more sensitive to cold
temperatures.
• For men: May make it more difficult to obtain
an erection. Talk to your healthcare provider if
this occurs.
• Can mask signs of low blood sugar and alter
blood sugar levels if you have diabetes.
POTENTIAL SIDE EFFECTS
• Dizziness, lightheadedness, fainting - see
above.
• Drowsiness, fatigue
Angioedema is the rapid swelling (edema) of
• Stomach pain, diarrhea
the face, tongue, mouth or throat sometimes
CALL YOUR HEALTHCARE PROVIDER IF YOU
with numbness or itchiness in these areas. Get
immediate medical attention if you experience any EXPERIENCE:
of these symptoms.
• Large rash
• Worsening of asthma or COPD (Chronic
Obstructive Pulmonary Disease)
24
Digoxin (Lanoxin , Digitek®)
Diuretics
®
INCREASES THE STRENGTH WITH WHICH THE
HEART PUMPS.
Increases the amount of blood pumped with each
beat. May also be used to treat irregular heart
rhythms. Improves the ability to exercise and decreases time spent in the hospital.
IMPORTANT TO KNOW
• Your healthcare provider will check your blood
level in 2-3 weeks after digoxin is started or the
dose is changed.
POTENTIAL SIDE EFFECTS
• Loss of appetite
• Nausea
• Diarrhea
• Headache
• Extremely slow or irregular heartbeat
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
• Loss of appetite or unexpected weight loss
• Nausea or vomiting
• Confusion, mental disturbance
• Vision changes (blurred or bluish, yellow or
white vision)
• Dizziness or rapid heartbeat
COMMON DIURETICS (WATER PILL):
Furosemide (Lasix®)
Torsemide (Demadex®)
Bumetanide (Bumex®)
Metolazone (Zaroxolyn®)
DECREASES THE AMOUNT OF WATER IN THE
BODY BY INCREASING THE FLOW OF URINE.
Helps get rid of excess fluid that may collect in your
lungs or settle in your feet or legs. Less fluid makes
it easier for your heart to pump.
IMPORTANT TO KNOW
• Take it early enough in the day to avoid sleep
interruptions (trips to the bathroom).
• May be taken with food or milk.
• May make you thirsty. Limit yourself to the
fluid intake recommended by your healthcare
provider.
• Your healthcare provider will need to check
labs on your kidneys (BUN and creatinine) and
potassium levels from time to time.
• You may need to take a potassium supplement.
• May increase blood sugar levels if you have
diabetes.
POTENTIAL SIDE EFFECTS
• Increased urination (trips to the bathroom)
• Dizziness/lightheadedness when standing up
from sitting or lying down
• Stomach upset, nausea
• Low potassium or sodium
• Muscle weakness, cramps
• Limb heaviness
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
• Severe weakness, dizziness or leg cramps
• Hearing loss or ringing in the ears
• Worsening chest pain
• Vomiting
• Slow heartbeat
• Rash, hives or itching
25
Vasodilators
Mineral Supplements
COMMON MINERAL SUPPLEMENTS:
Potassium Chloride (K-Dur®, Klor-Con®,
K-Tab®, Slow-K®, Micro-K®)
COMMON VASODILATORS:
Hydralazine (Alpresoline®)
Isosorbide Mononitrate (Imdur®, ISMO®)
Isosorbide Dinitrate (Isordil®)
REPLACE POTASSIUM OR MAGNESIUM THAT
MAY BE LOST WITH DIURETICS (WATER PILLS).
Nitroglycerine Patches (Transderm-Nitro®)
Helps with muscle and heart contractions.
Hydralazine/Isosorbide Dinitrate (BiDil®)
IMPORTANT TO KNOW
• May cause stomach upset. Take after meals or
RELAXES BLOOD VESSELS, ALLOWING THEM
TO DILATE (WIDEN/OPEN).
Magnesium Oxide (Mag-Ox®, Uro-Mag®)
with food.
• Do not crush or chew K-Dur extended-release
®
tablets. But they can be split in half or allowed
to disintegrate in a small amount of liquid
(about 4 ounces) and consumed immediately.
• Extended-release capsules (Klor-Con®) can
be sprinkled onto a small amount of soft cool
food like applesauce and should be swallowed
immediately without chewing.
• Oral powder for liquids should be dissolved in
4 ounces of cold water or other beverage and
consumed after a meal.
• Beware of potassium-containing salt substitutes.
They may further increase your potassium level.
Always check with your healthcare provider
before using a salt substitute.
• If you notice blackish stools or other signs
of stomach or intestinal bleeding due to
medication irritation of the digestive tract’s
lining, call your healthcare provider.
POTENTIAL SIDE EFFECTS
•Stomach pain/gas
•Upset stomach or throwing up
•Diarrhea
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
•Bloody or black tarry stools
•Severe stomach pain
•Vomiting blood or vomit that looks like coffee
grounds
•Irregular or slow heart rate
•Nervousness or confusion
This decreases pressure and allows more blood to
flow through the vessels, reducing the workload of
the heart.
IMPORTANT TO KNOW
•Take hydralazine with or without food or
meals, but take it consistently, the same way
each time.
•Take first (or only) dose of oral nitrates first
thing in the morning after waking.
•Take extended-release nitrates, such as
Isosorbide Mononitrate CR (Imdur®), with a
glass of water.
•Headache often occurs during the first few
doses but it is usually not a problem after that.
POTENTIAL SIDE EFFECTS
•Drowsiness
•Headache
•Dizziness
•Flushing
•Blurred vision
•Dry mouth
CALL YOUR HEALTHCARE PROVIDER IF YOU
EXPERIENCE:
Activity and Exercise
Studies have shown that exercise has many benefits for people with heart
failure, it has been shown to make you feel better, have fewer hospital stays
and enjoy your life more.
ACTIVITY AND EXERCISE CAN HELP YOU:
• Improve the flow of your body’s blood, like fuel for your car
• Tone your muscles
• Strengthen your heart and body
• Control your weight
• Manage your stress
• Improve your mental health
• Raise your spirits and energy level
Ask your healthcare provider before starting an exercise program. Your healthcare provider can
help you to determine an exercise plan based on your interests and fitness level.
It is important to do low- level activity every day. An exercise program may include a variety of
activities such as:
•Severe tiredness
• Walking
•Large rash
• Low-impact mat and water aerobics
•Chest pain
• Swimming
• Cycling
Choose an activity that you enjoy. If you like the activity, you are more likely to continue doing it.
It may be more enjoyable if you involve friends or family in your activities
•Severe weakness, tiredness, lightheadedness,
fainting or passing out
26
•Shortness of breath or difficulty breathing
27
My Medications
Activity and Exercise
EXERCISE TIPS
It is important to get into a regular routine that includes activity that starts out slowly and then
increases gradually. Remember you may have better days than others, however continuing with
your routine will be beneficial.
If you are too short of breath to talk while you walk, slow down or stop and rest
NAME:
DATE OF BIRTH:
MEDICATION ALLERGIES
WHAT HAPPENS:
Avoid exercising outdoors when it is too cold, hot or humid, as this can stress the body and may
cause symptoms such as dizziness, shortness of breath, or even chest pain. Consider indoor
activities when the weather is poor, such as walking in a shopping mall.
Be sure to allow plenty of time for rest every day, especially after meals.
Avoid activities that cause you to strain
The goal is to start with a low intensity activity and increase the duration of the activity over time.
How often and how long you do the activity is most important, not intensity of the activity.
Engaging in different activities can also be of benefit (e.g. walking and exercise bike)
SAFETY ADVICE
START DATE
NAME OF
MEDICATION
DOSE (MG,
UNITS, PUFFS)
FREQUENCY OF
DOSE
TIME TO TAKE
PURPOSE
COMMENTS
Stop exercising immediately and call your healthcare provider if you experience:
• Pain or pressure in your chest area or neck, shoulder, or arm during or after exercising
• Shortness of breath at rest
• Sudden dizziness
• Unusual tiredness
• Different heartbeat feelings such as too fast, too slow
• Other new symptoms
Keep a record of your activities. Show your exercise log to your healthcare provider. Together you
can decide if your exercise routine is helping you improve your heart condition or if you need to
change level of activity.
IS IT OKAY TO HAVE SEX AGAIN?
People with heart failure often wonder whether - and when - they can safely resume sexual activity.
Once you are feeling back to normal, it is often okay to resume sexual activity. Discuss this topic
with your healthcare provider.
CARDIAC REHAB & YOU
Cardiac rehabilitation can help speed up your recovery and reduce your chances of future heart
problems. Whether you exercise at home or in a formal program, cardiac rehabilitation exercises are
designed to improve your quality of life after you’ve had a heart attack or another heart problem.
Medicare and Medicaid services pay for cardiac rehabilitation in certain cases. Ask your healthcare
provider if you qualify.
28
29
EXERCISE LOG
DATE
ENERGY LEVEL BEFORE
L
30
M
H
ACTIVITY/EXERCISE
ACTIVITY
DURATION
NOTES
ENERGY LEVEL AFTER
L
M
NOTES
H
31
FOR MORE INFORMATION
To find health information, or for convenient and secure
access to your medical record through MyHealth Online,
please visit UVMHealth.org/MedCenter
or call us at (802)847-0000.
CARDIOLOGY
111 Colchester Avenue
McClure, Level 5
Burlington, Vermont 05401
PHONE
(802) 847-2452
Heart Failure Clinic Phone (802) 847-4600
UVMHealth.org/MedCenter