MAY 2019 OX465
Your guide to living with heart failure
Adult community services in Bexley and Greenwich
oxleas.nhs.uk This guide is intended to provide you with information about living with heart failure and help you to manage your condition at home. It contains charts for you to record information about your weight and medication and a section for your heart failure nurse to record notes from your appointments. Please bring it with you to appointments with your heart failure nurse.
What is heart failure? Heart failure can lead to symptoms of: Heart failure is a condition in which the heart is unable to • tiredness pump blood around the body effectively. It does not mean • breathlessness the heart is about to stop, but feet and ankle swelling rather, if left untreated, the • heart muscle would continue • ‘bloated’ feeling to weaken. It is one of the most reduced appetite. common heart problems in the • UK. There are various cases of If you have heart failure, you heart failure, including: may experience shortness of • a history of heart attacks breath, weakness, tiredness and swelling of the ankles. However • coronary artery disease some people experience very heart valve disease few symptoms and their • heart failure may have only • viral illness been discovered by a special heart scan known as an • excessive alcohol intake echocardiogram. • high blood pressure. 2 Sometimes a specific cause We run five heart failure clinics of the heart failure cannot be a week and visit patients in their found. own homes who are unable to attend a clinic. Although rarely completely curable, there are effective In the heart failure clinic and treatments for heart failure. A when you are visited at home range of medications can assist you will be seen by a nurse the heart, help to control and who specialises in the care and improve symptoms and increase treatment of people with heart life expectancy. Many of these failure. Each time you will be drugs need to be started at low examined and your weight, doses and increased slowly. pulse and blood pressure Once started most treatments recorded. From time to time need to be continued you may also need an ECG indefinitely. (electrocardiogram) and blood tests. Your Heart Failure Nursing Team Your nurse will make sure that Your Heart Failure Nursing Team you are prescribed the right is run by Oxleas NHS Foundation medication to work most Trust. Our goal is to support effectively for you. Everyone people to better manage reacts differently to medicine, their condition in their own so to ensure you are on the best home and avoid unnecessary dose for you, your nurse may hospital admissions and A&E adjust drug doses quite often at attendances. first. They may also talk to your GP about how the medication The team consists of: is working and discuss • a consultant cardiologist alternatives. • heart failure specialist nurses Your nurse will also explain (4 each in Bexley and the things you can do to keep Greenwich) yourself as well as possible and answer any questions you may • healthcare assistant to take have about your condition. bloods and perform ECGs • an administrator • input from a psychologist. 3 Monitoring your weight When weighing yourself, follow It is a good idea for people these guidelines. with heart failure to weigh Always use the same scales. themselves regularly, as this • gives an indication of how much • Always weigh yourself at the fluid the body is retaining. For same time of day. example, if your weight goes up by four pounds, you may be • Always weigh yourself retaining around three pints of wearing the same sort of fluid. The more fluid you retain, clothes/shoes. the more your ankles may swell • Always use the same units, and your breathing will feel ie pounds and ounces or worse (particularly when you lie kilograms. down, or try to do things). If your weight goes up by Weigh yourself every day. two to three pounds in one Most people find it easiest to day, make sure you weigh weigh themselves first thing in yourself the next day and if the morning, after going to the it is still raised, particularly if toilet, in their night-wear before you have noticed an increase breakfast. in breathlessness or ankle swelling, contact your doctor or You can record your weight on heart failure nurse for advice. the following pages if you want to. If your weight has increased very quickly it is likely to be due to fluid retention and it is likely that you will need to take an extra dose of your diuretic (water) tablets for a day or two. Your doctor or nurse will advise you about this.
4 Date Weight Date Weight Date Weight
5 Medication Important It is very important that you • Make sure you take your take your medication regularly, medications every day. as if you miss doses or muddle Always have a supply of your tablets up, your heart • medication so you never run failure may get worse and you out. may get more side effects. You need to devise a system • Bring all of your tablets (in that ensures that you take your their original containers) with medication as it is prescribed. you when you see the doctor You can use the form on page or nurse. 10 to help you organise when to • Keep taking the tablets unless take your tablets. Talk to your your doctor or nurse tells you pharmacist or nurse if you feel to stop. that you need extra help in coping with your tablets. • If you are bothered by side effects, please discuss this It is likely that you will be with your nurse or doctor. prescribed a combination of tablets (see the following pages • Do not take any ‘over the for the types of medication counter’ medicines without used) and your condition will checking with your doctor, be monitored closely as each nurse or pharmacist first. new tablet is introduced. The • For minor aches and pains, medications listed in this booklet such as a headache, you can are the most commonly used in take Paracetamol, up to eight the treatment of heart failure, tablets in 24 hours. but there are others that can be used if you are not able to take • Do not take any non-steroidal those listed. anti-inflammatory drugs (NSAIDs), including Nurofen, Brufen, Ibuprofen, Indomethacin, Diclofenac, Naproxen, Voltarol or Arthrotec.
6 Here are some of the most Diuretics (water tablets) common heart failure Name of drug: medications. Your nurse will ______write the name of the drugs you are taking into the relevant These help your body to get rid spaces below so you can read of excess fluid by making your about how they work and why kidneys lose extra water so you you are on them. pass urine more frequently. They help to reduce ankle ACE (Angiotensin Converting swelling and make you feel less Enzyme) inhibitors breathless. You should notice Name of drug: that you pass more urine after ______taking your tablets. These work by relaxing your It doesn’t matter what time blood vessels, making it easier of day you take the tablet, for your heart to pump blood although most people take it through them. The dose is first thing in the morning. always started very low and If you are worried about having increased over time. to find toilets when you are out When you are on an ACE shopping, on a car journey or inhibitor, your blood pressure will at a special occasion, it is OK need to be monitored and you to delay taking the tablet until will need regular blood tests to later in the day (but try not to monitor your kidney function. leave it out altogether). It is recommended that you do not Possible side effects include: dry take it later than 3pm as it may irritating cough; low blood continue to work into your bed pressure; and dizziness. time and lead to a disturbed Angiotensin-II receptor night’s sleep. antagonists Occasionally, diuretics may Name of drug: make you lose essential ______substances (called electrolytes) These have a similar effect as from your blood. You will need ACE inhibitors described above, to have blood tests to monitor but are less likely to cause a dry your electrolyte levels. cough as a side effect.
7 Digoxin Aldosterone Antagonists Current dose of Digoxin: Name of drug:
______This drug can help your heart These drugs reduce salt and beat more strongly and ensures water retention and may make that it doesn’t beat too fast. This the heart muscle less stiff. is especially important if you They are useful in controlling are in an irregular heart rhythm symptoms in people with such as atrial fibrillation. moderate to severe heart failure. Blood tests to Side effects include: nausea; loss measure the amount of of appetite; visual disturbances; potassium are required and diarrhoea. If this occurs occasionally. please see your doctor or nurse as soon as possible. Possible side effects include: enlargement of breast tissue Beta Blockers (men); painful or sensitive Name of drug: nipples; and impotence. ______Use the table to record the Beta blockers work by slowing details of your medication and down your heartbeat so your when you should take it. heart doesn’t work so hard. Some Angiotensin Receptor also relax your blood vessels, Neprilysin Inhibitor making it easier for the heart to pump blood through them. Name of drug: The dose is always started off at ______a low level and built up slowly These are new medications depending on how you feel, your which help improve the heart’s pulse and blood pressure. You ability to pump blood around will be closely monitored each the body. It blocks the body’s time the dose is increased. natural system which has a Possible side effects include: harmful effect on the heart. feeling tired; cold hands and feet; vivid dreams; and impotence. Contact lens wearers may notice dry eyes.
8 Bed Extra Medication AM Midday PM time Information
9 Dietary advice • Try to eat five portions of fruit Keep your weight under control. and vegetables per day (use Your heart has to work harder if fresh or frozen – avoid tinned you are overweight. The usual vegetables if possible as they advice to people who are trying contain a high level of salt – to lose weight is to increase the see below). amount of exercise that they are • Try to eat fewer biscuits, cakes doing and reduce the amount and sweet things. of calories (from excess sugar and fat) they are eating. When If your appetite is low, you are you have heart failure it can be troubled by nausea or vomiting, difficult to increase your exercise or you have recently been in levels, although it is important hospital, please talk to your to keep as active as your nurse or doctor about how to condition allows (this may vary increase your energy intake as from day to day). It is therefore this can be very important. particularly important that you Reduce your salt intake try to eat as healthy a diet as possible. If you eat too much salt (which contains sodium) it may affect • Try to eat less fat – chose lean the amount of fluid in your body, meat, fish and poultry. Avoid making you retain fluid. This fried foods and pastry. will make your ankles swell and breathing worse. Try to reduce • Dairy foods (milk, butter, the amount of salt you eat as cream and cheese) are an much as possible. important source of calcium. Use low fat versions Most foods contain low levels of (semi-skimmed milk, half salt naturally and this is usually fat cheese, low fat spreads) enough for our needs. Therefore as they contain the same do not add any salt to your food amount of calcium and other during the cooking process, or nutrients but less fat. at the table. There is hidden salt in items such as packet soups, • Eat more high fibre foods such stock cubes, sauce mixes, gravy as wholemeal bread, pasta granules, cheese, bacon and and cereals. smoked meats, crisps, salted
10 nuts and sausages. Also there One unit of alcohol is equivalent can be high levels in processed to: foods such as tinned vegetables, sauces and ‘ready meals’. It • half a pint of normal strength is better to avoid these items beer altogether, but if this is not a pub measure glass of wine possible, try to keep levels as • low as possible, and use less of • a pub measure of spirits. these items, eg: use half a stock Fluid intake cube or make your own stock and use less gravy. The more you drink, the more your heart has to work to It is alright to use vinegar, lemon eliminate fluid. On the other juice, garlic, pepper and other hand it is very important not to herbs to make your food more drink so little that you become interesting, especially if you dehydrated. It is recommended have lost some of your sense that you drink about two to of taste (a common problem in three pints (1.0-1.7 litres) of heart failure patients). fluid every day in total (tea, coffee, fruit juice, squash, low Do not use any ‘salt alternative’ calorie fizzy drinks, etc). In warm products such as Lo Salt, as they weather add a further pint (0.6 contain high levels of potassium, litres) unless you have been which can react with your given specific advice by your medication. doctor or nurse. If you find that Alcohol you have a dry mouth try using If you have been told not to refreshing mouthwashes or suck drink, don’t. frozen fruit juice ice cubes. If you have been told you can Exercise have alcohol, then keep your If your heart failure has made consumption to no more than you inactive, you may gradually three units per day if you are a feel weaker and less able to do man and two units per day if things. Try to keep as active as you are a woman. You should possible (what you feel able to have at least two alcohol free do may change from day to days a week. day). Many people with heart failure have said that they
11 feel better when they exercise Get immunised regularly. Whatever you do People with heart failure can (walking, swimming, cycling, quickly become very unwell with dancing, golf) you must always flu or pneumonia. Therefore be able to feel that you have we suggest you see your enough breath to be able to talk doctor to get the appropriate to someone while you are doing immunisations each autumn. it. If you feel that you are having difficulty talking, you must slow down a bit until you are able to hold a conversation. Please talk to your nurse about exercise levels specific to you. If you wish, you can be referred to an appropriate exercise class. Smoking Smoking can damage your heart and lungs. If you smoke we would advise you to stop now. You should also avoid passive smoking as much as possible. If you need help to stop please talk to your nurse who can refer you to a local stop smoking service.
12 Date Appointment notes Initials
13 Date Appointment notes (cont.) Initials
14 oxleas.nhs.uk facebook.com/oxleasNHS @oxleasNHS Friday from 8am to 6pm. We are available Monday to 0AY SE2 Abbey Wood Lodge Hill 151-153 Leigh Goldie Failure Team Nursing Heart address. following Our team is based at the us Contact
Tel: 01322 625751 Email: [email protected] provide. we services suggestions help us improve the Your complaints, comments and concerns Raising (not free from mobile phones) Tel: 9177159 0800 (freephone) Email: [email protected] (answerphone available) Monday to Friday 9am to 5pm our treatment and care. deal with any concerns about helps families patients, and carers a free, confidential whichservice we provide.services PALS is We welcome your views on the Your opinion matters usually discuss this with you first. to provide qualitycare. good We only share information in order onconduct confidentiality and All staff abidecode strict of by a Confidentiality Tel: 01322 625700 Kent DA2 7WG Dartford Pinewood Place Pinewood House Trust NHS Foundation Oxleas Please to speak of amember staff. weother can formats, arrange this. own language, large print, audio or If you’d like information in your Accessible information
MAY 2019 OX465