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Home , Heart, Heart failure

WHAT TO EXPECT: LIVING WITH FAILURE KEY POINTS TABLE OF CONTENTS WHEN TO CALL THE DOCTOR REMEMBER TO: After you are discharged from the , it is •• Take your as prescribed Key Points...... 1 THE HEART AND HOW IT WORKS...... 9 important to notice any worsening of •• Record your weight daily symptoms and call your doctor. These symptoms may The Right Side...... 9 • Eat less salt and foods with less than 140 mg of include: • per serving WHAT IS HEART FAILURE...... 3 The Left Side...... 9 •• New or increased •• Limit fluid intake to eight, eight ounces glasses per •• Light-headedness, , or fainting day (2 quarts), or as recommended by your doctor •• Weight gain of 2-3 pounds over two days, or 4-5 •• Follow cardiac rehab’s (if seen by them) or your CAUSES OF HEART FAILURE...... 11 pounds over one week doctor’s instructions for activity SYMPTOMS OF HEART FAILURE...... 4 •• Abdominal bloating or swelling in legs or ankles •• Ask your doctor about a cardiac rehab program near you •• Unexplained side effects after taking medicine Make a list of your questions and concerns so that you •• Make sure you have an appointment with your HEART FAILURE SELF-MANAGEMENT COMMON CONGESTIVE HEART FAILURE will remember everything when you call your doctor. doctor within 1 week of leaving the hospital as ...... 14 possible SKILLS...... 4 •• If you smoke, contact UPMC Referral Services Daily Weights...... 5 WHAT TO BRING TO YOUR at 1-800-533-8762 or PA Quit Line at Low Sodium Eating ...... 5 DOCTOR VISITS: 1-800-QUIT-NOW (1-800-784-8669) for infor- NOTES...... 16 mation on stop smoking classes •• Weight chart or calendar Taking Your ...... 7 •• All your in their original containers •• A list of your questions and concerns DAILY WEIGHT CHART...... 17 EXERCISING AND ACTIVITY...... 8 Ways to Save Energy...... 8

1 2 WHAT IS HEART FAILURE SYMPTOMS OF HEART FAILURE (HF)

Heart failure (HF) is sometimes called congestive heart failure (CHF). It affects 5 SYMPTOMS OF HEART FAILURE WHAT CAN I DO ABOUT IT? MAY INCLUDE: million Americans, with 550,000 new cases diagnosed each year. It is the most •• Weigh yourself daily (first thing in the morning before you eat, and after you urinate) •• common cause of hospitalization in people over 65. • Eat less salt (sodium) •• Shortness of breath • •• Pace your activities (if you get tired – rest) The heart is a pump. Heart failure occurs when the heart is not working as well as it •• Sudden weight gain • (talk to your doctor about going to a •• Dry, hacking , which may occur more of- • should. This booklet is designed to help you understand heart failure, know the signs ten while lying down and might stop after sitting cardiac rehab program near your home) and symptoms, do what you can to prevent it, and when to seek treatment. upright •• Take your medications as prescribed and go to all follow-up appointments with your doctor •• Swelling in the legs and ankles or lower belly (ab- domen) There is much to learn about how to manage your DOES THIS MEAN MY HEART IS heart condition, and it’s hard to remember everything. •• Loss of appetite STOPPING? This book is yours to keep at home. Take your time as If you experience these symptoms and notice a Many people hear the phrase “heart failure” and Some parts of your treatment plan are medicine, you read through each section, and ask your doctor or sudden increase in body weight you might be holding mistakenly believe that the heart has stopped or is dietary changes, weight , quitting smoking, care team about any questions. onto fluid.Notify your doctor if you gain 2 -3 pounds about to stop. Heart failure simply means that the and exercise. These all will be covered in the remainder over two days or 4-5 pounds over one week. heart is not moving throughout the body as well of this book. as it should. This occurs either because the heart is weak and does not squeeze blood out as it should Many of the symptoms of HF are associated with the (systolic heart failure), or because it does not relax and congestion that develops as fluid backs up into the fill with blood as it should (diastolic heart failure). In and leaks into the tissues. This is the form of HEART FAILURE SELF-MANAGEMENT SKILLS either case the result is not enough blood goes to heart failure called “congestive heart failure.” Other symptoms occur because not enough -rich where it needs to go in the body. As the heart The three most important things to focus on at first are weighing yourself daily at the weakens, its pumping action also weakens. Blood and blood gets to other parts of the body. body fluids back up in the lungs, abdomen and/or feet same time and recording your weight, taking your medications as prescribed by your and ankles. doctor, and eating food that is low in sodium. We call these “Self-Managment Skills.” This excess fluid can make it difficult to breathe. You might also notice a feeling of fullness in the abdomen or swelling in the legs and ankles. The causes of heart failure include:

•• Heart attack •• Irregular heart beat or fast heart rhythm •• of the heart muscle •• Severe disease •• problems •• High •• Alcohol abuse and other drugs Heart failure is a serious illness. It can affect how long you live. With proper medicine in the right doses and careful management, you can live longer and feel better. Many people with heart failure normal lives. They can do so because they have learned to take good care of themselves. You too can help control your heart failure by understanding and following your treatment plan.

3 4 SELF-MANAGEMENT SKILL #1: •• Do not add salt to your food during cooking or at READING FOOD LABELS DAILY WEIGHTS the table. Food labels will tell you how much sodium is in the •• Weighing yourself daily is very •• Season without salt – use fresh or dried herbs, food you eat. These labels are found on all food important and can help you spices, commercial spice blends (such as Mrs. products except fresh fruits and vegetables. The labels better manage your HF. Dash ® salt-free seasoning) or lemon juice to sea- also tell about serving size, fat, , Because HF can cause your son foods. carbohydrates, sugar, protein, and calories per serving. body to hold onto fluid and •• Read food labels carefully. Ingredients to avoid in- “Serving Size” is the top information line on the label, salt, you may gain weight. clude salt, sodium, sodium chloride, monosodium right under “Nutrition Facts.” Always look at serving glutamate (MSG), brine, broth, corned, pickled, >>Find a scale which has large size first. All of the amounts on the label refer and smoked. Below you will find helpful definitions. enough numbers to read to that amount of food, not the total package. Right easily. >>Sodium-free: Less than 5 mg per serving below “Serving Size,” the label shows how many •• If you weigh yourself every day at the same time, >>Very low sodium: 35 mg per serving servings are in the package. It is important to multiply you will be able to notice slight gains in weight. >>Low sodium: 140 mg per serving the numbers on the label (sodium, fat, calories) by the This may be an early sign that your heart failure is number of servings you actually eat. getting worse. >>Reduced sodium: Sodium content is 25% less than the standard product For instance, on this label for Macaroni and Cheese, •• If you gain you gain 2-3 pounds over two days or the serving size is one cup, and there are two servings 4-5 pounds over one week, call your doctor. Tell >>Unsalted: No salt added (or two cups) in the package. If you eat the whole your doctor’s office staff that you are a HF patient •• Salt substitutes may be used if permitted by your package, that is two servings. So if you eat one cup, and are calling because you have gained weight. doctor. you are getting 470 mg of sodium. If you eat the whole Your doctor then will be aware that your symp- •• When dining out: package, that’s 940 mg (470 x 2 = 940). If you are toms may be getting worse. >>Ask that your order be prepared without added limiting your sodium to only 2,000 mg per day, that •• Your doctor will decide if you should change any salt or MSG (mono-sodium glutamate). 940 mg is almost half of what you are allowed for the medicines, or come in to his or her office. >>Order baked, broiled, grilled, or steamed foods whole day. There is a lot of sodium in this package. without sauces, butter, breading, and gravies. A few tips: •• Read the serving size and number of servings in •• Weigh yourself once a day in the morning. The >>Use salad dressings sparingly, as most are high the container of food. best time is right after you wake-up and urinate, in salt. • If you are on a , notice the number and before you eat. • >>Avoid soups, broths, salted crackers or rolls, of calories per serving of food. •• Wear the same clothes, or nothing, each time you pickles, cheese, olives, seasoned croutons, and •• Read the amount of fat, cholesterol, and sodium in RECOMMENDED FOODS weigh yourself. cured meats. each serving of the food. •• Write down your weight each day on a weight >>The found on the menu at some Bread/Cereal/Rice/Pasta •• Many labels will also tell you the amount of vita- chart (handed out separately, or back of this restaurants may mean the item is low-fat and/ •• Breads/rolls without salted tops; muffins mins and other . book), or an ordinary calendar. or cholesterol. These items may often be higher •• Most ready-to-eat and cooked cereal in sodium. When choosing a low-fat, low-cho- The “% Daily Value” shows you how much of the recommended amounts the food provides in one •• Unsalted crackers and breadsticks SELF-MANAGEMENT SKILL #2: lesterol meal in a restaurant, ask that it is served with as little salt content as possible. serving, if you eat 2,000 calories a day. For example •• Low-sodium or homemade breadcrumbs and stuff- FOLLOWING A LOW one serving of this food gives you 20 percent of your ing • When purchasing convenient foods, buy low SODIUM (SALT) DIET • total recommendation. sodium varieties. Choose frozen dinners with less Vegetables •• Have no more than than 300 mg per serving. •• Most fresh, frozen and low-sodium canned 2,000 mg of so- REMEMBER: •• Many nonprescription medications contain so- vegetables dium each day from •• Have no more than 2,000 mg of sodium each day food and drink or as dium. Make sure you read the labels or ask your •• Low-sodium and salt-free vegetable juices pharmacist about the sodium content. or as prescribed by your doctor. prescribed by your Fruits • You will get used to eating in a lower sodium way. •• In general, avoid foods >300 mg of sodium per doctor. • •• Most fresh, frozen and canned fruits It may take many weeks, so keep working hard at serving. •• It is good to select •• All fruit juices foods with no more changing your eating habits. than 140 mg of sodi- Milk/Yogurt/Cheese um per serving. Foods •• All milk, but limit to a total of two cups per day with more than 300 mg of sodium per serving may •• All yogurts not fit into a reduced-sodium meal plan.

5 6 •• Most low-sodium cheeses including low-sodium Fats/Snacks/Sweets/Condiments/Beverages ricotta, low-sodium cream cheese and low-sodium •• Salad dressing/canned soups/gravies/sauces EXERCISING AND ACTIVITY cottage cheese made from instant mixes or other high-sodium Regular physical activity helps you feel better. When you increase the speed or intensity of your exercise. ingredients Meats/Poultry//Dry Beans and you are active, it helps the heart and lungs use oxygen Ask your doctor about getting involved in a cardiac •• Salted snack foods; olives; bouillon better. rehabilitation program in your local area. Most Peas/Eggs/Nuts • Meat tenderizers/seasoning salt/most flavored insurance plans cover the cost of the rehabilitation •• Any fresh or frozen , lamb, , poultry, fish • Physical activity also helps: program. These programs have trained staff who can and some shellfish vinegars/soy sauce/ and barbeque sauce/ condiments like mustard, ketchup, relish •• Lower your blood pressure help you: •• Eggs and egg substitutes •• Commercially softened water •• Control your weight •• Low-sodium peanut butter •• Increase your exercise tolerance •• Decrease stress and tension •• Dry peas and beans •• Decrease HF symptoms SELF-MANAGEMENT SKILL #3: •• Boost your energy level •• Improve your quality of life Fats/Snacks/Sweets/Condiments/Beverages TAKING YOUR MEDICATIONS •• Low-sodium or unsalted versions of butter, marga- GET MOVING! rine, salad dressing, soups, soy sauce, condiments Tips for Managing Your Medicines WAYS TO SAVE ENERGY •• Always take your medi- and snack foods Choose any activity you enjoy. If you like the activity, •• Avoid becoming too tired. Plan ahead so that you cation as prescribed by you are more likely to continue doing it. Walking is a •• Pepper, herbs and spices; vinegar, lemon or lime are not doing all of your work in one day, or at one your doctor, even if you great choice. It may be more enjoyable if you ask a juice time during the day. are feeling well. friend or family member to join you. •• Space your activities and work over the whole day. •• Low-sodium carbonated drinks •• Check with your Exercise should be guided by common sense: Do some work and then take a break. The trick is or pharmacist to quit while you’re ahead, before you feel tired. If before taking any over- FOODS TO AVOID •• Rest before you feel tired you do small amounts of work at a time, you will the-counter or dietary •• Be able to carry on a conversation while you are be able to do more in the long run. Bread/Cereal/Rice/Pasta supplements. This includes: vitamins, minerals and exercising •• Breads, rolls, crackers with salted tops herbal products. •• Sit rather than stand when doing activities such as •• Rest if you feel short of breath ironing, washing dishes, shaving, or brushing your •• Quick breads, self-rising flour, biscuit mixes, regu- •• Do not increase or decrease the dosage of your teeth. lar bread crumbs medications, or stop taking them without first •• Avoid activities that make you grunt, groan, or •• Instant hot cereals checking with your doctor. strain •• At work, take advantage of breaks and lunchtime to sit and rest. •• Commercially made rice, pasta or mixes •• Report any unusual symptoms or concerns to your doctor. EXERCISE •• When doing a task, gather all the supplies you will Vegetables need. That way, you will avoid making unnecessary •• Call your doctor or pharmacist if you have any You’ll get the most benefit from a regular exercise •• Regular canned vegetables/juices, including sauer- trips. Get a small laundry cart with wheels for an questions regarding your medications. routine. It is best if you exercise 5 to 7 days a week for kraut easy way to carry items throughout the . •• Ask your doctor or pharmacist what to do if you 30–60 minutes (begin with 5–10 minutes several •• Frozen vegetables with sauces •• When climbing up stairs, put two feet on each miss a dose of a medication. times per day and add about 5 minutes per week as •• Commercially made potato and vegetable mixes tolerated). step. Stop and rest if you feel you need to. •• Always carry a list of your medications. •• If you feel tired, dizzy, or short of breath, you need Fruits •• Ask questions about your medications. WARM UP AND COOL DOWN to stop and rest. •• All fruits processed with salt or sodium •• Your doctor, pharmacist, and nurse can help you Each time you exercise, start with a 5 minute warm-up •• Ask your family and friends for help! learn about your medications and why they are Milk/Yogurt/Cheese (begin slowly). At the end of each exercise session, •• Even on your good days, it’s important to save your important to helping you feel better. •• Buttermilk—limit to one cup per week finish with a 5 minute cooldown period (end slowly). energy. When you are feeling good, you may be •• Malted and chocolate milk •• Keep medications in a safe place, and where This may include stretching . Starting an tempted to overdo things. children cannot reach them. •• Regular and processed cheese, cheese spreads exercise program can be the hardest part! Once you •• You may have a certain time each day when you and sauces and cottage cheese •• Store medications properly, and keep them in their get started, it’s likely that you will continue your feel more energetic. Plan to do difficult tasks dur- original containers. program. You’ll feel better and have more energy. Your ing this time. That way, you can take it easy during Meats/Poultry/Fish/Dry Beans and daily activities will seem easier. •• Try using a daily pill container with daily compart- your low-energy periods. Peas/Eggs/Nuts ments to organize breakfast, lunch, dinner, and STEP IT UP! •• Any smoked, cured, salted or canned meat, fish or bedtime medications. poultry including bacon, chipped beef, cold cuts, Does your regular routine seem too easy? Are you ham, frankfurters, sausage, sardines and ancho- ready to step it up? You should increase the amount of vies; frozen breaded meats and frozen dinners time you exercise little by little. Ask your doctor before •• Salted nuts

7 8 THE HEART AND HOW IT WORKS The left is the main pumping chamber of the IS MY HEART WEAK? DO I HAVE A heart. Once blood is collected in the left ventricle, the “BAD” PUMP? ventricle contracts and the opens. This The heart has two independent pumping systems, one The valves are flaps that open and close to allow blood allows blood to pass into the ascending , the Often your doctor or others give you information on the right side and one on the left side. to flow from the to the ventricle. major that supplies blood to the entire body. about how “bad” or “good” your heart is. When they Each of these systems has two chambers: The correct direction for blood flow is from the atrium After the oxygen-rich blood is used by the body, it discuss the ability to pump, they are usually into the ventricle. returns to the right side of the heart, and the whole making reference to the main pumping chamber of the •• Atrium (pronounced AY-tree-um) process begins again. heart (left ventricle) and its (EF). •• Ventricle (pronounced VEN-trick-ul) Occasionally blood flow does not follow the correct route. This will be discussed later. An EF is the percent of blood pumped out of the left The atria are located on the top of the ventricles. ventricle each time the heart beats. The heart never These are the hearts filling chambers. To further understand the role that each side of the pumps out all the blood when it beats. A normal EF is heart plays in pumping blood, let’s now look at each 50-70 percent. Any number in this range is considered The ventricles are the major pumps of the heart. The side individually. a “good” pump. When the EF is less than 40 percent left ventricle is generally the strongest pumping part of the risk of heart failure and other problems with the the heart. THE RIGHT SIDE heart is greater. Your doctor will discuss some of these risks if needed. The right side of the heart receives blood from the of the body. This is “non-oxygenated” or “used” The EF can be measured with several different tests. blood. The blood is referred to as used because it The tests include: already has done its work, delivering oxygen to the far sites of the body before returning to the heart. •• Echocardiogram •• TEE The blood is returned to the right side into the first chamber in the top portion, the right atrium. This •• chamber is able to expand to hold the •• MUGA that will fill its cavity. When there is enough blood, the •• Cardiac CT or MRI of the heart tricuspid heart valve allows the blood to flow into the •• Gated image from a nuclear stress test right ventricle (the bottom part of the right side of the heart). Ask your doctor or nurse if you would like more information on these tests. The main function of the right ventricle is to pump the blood to the lungs. The blood needs to return to the lungs to pick up oxygen. We sometimes say that the blood becomes “oxygenated” or “fresh” again. When the pumping action triggers the , it opens. This allows the blood to flow into the lungs. In the lungs, the blood picks up oxygen and leaves behind (which you breathe out). The blood, now rich in oxygen, is sent to the left side of the heart.

THE LEFT SIDE The left side of the heart receives blood from the lungs. This blood is now oxygen-rich. The blood enters the left heart from special veins coming directly from the lungs (pulmonary veins). The first chamber to receive the blood is the left atrium. As with the right side, when the atrium fills, The heart’s atria and ventricles are connected by the the valve connecting the atrium and ventricle opens. heart valves. This allows the blood to pass into the left ventricle. The valve in this case is the (pronounced MY-trul). 9 10 CAUSES OF HEART FAILURE HEART VALVE DISEASE Blood pressure is the force pushing blood through the Sometimes the heart valves themselves are not Heart Failure occurs because a problem with the heart is making it hard for the heart to vessels of the body. When your blood pressure is high, working properly. This can lead to heart failure. your body has to work harder to deliver the blood. push blood out or making it hard for the heart to relax and fill with blood. Because of this extra hard work load, high blood The valves between the chambers of the heart control pressure (also known as hypertension) may cause the the flow of blood leaving and entering the heart. Two main types of abnormalities can occur that lead to Some of these problems are: heart muscle to thicken to compensate for the HEART ATTACK (MYOCARDIAL failure: ) increased blood pressure. These changes put even •• more strain on the heart. The heart muscle eventually •• The valves can become narrow () and •• Heart attack When a coronary artery is completely blocked and thickens and weakens. Once this occurs, the heart no cause a back-up of blood. blood flow is stopped to part of the heart muscle near longer has the ability to fill normally with blood. •• High blood pressure (hypertension) that artery, a heart attack occurs. This is referred to as •• The valves can close improperly, causing blood to •• Heart valve disease a (pronounced my-oh-CAR-dee- leak backward (insufficiency). •• ul in-FARKshun). Once this happens, the damage is Either way, the heart has to work harder. Narrowing of •• Alcohol abuse not reversible. The damaged part of the heart loses its the heart valves forces the heart to pump harder, so ability to pump. The rest of the heart tries to take on blood can flow through the narrow (stenotic) area into •• that work load. After some time of doing that extra the next chamber. Extra work also is added when a The following is a more detailed explanation of each of work, the heart is tired and strained. Eventually, it valve does not close properly. these. pumps less blood to the body. Over time, both of these extra work-load conditions CORONARY ARTERY DISEASE can lead to heart failure. Sometimes valve problems resulting from , or birth defects, can This disease is caused by a process called cause heart failure. . It is a progressive build-up of plaques within the coronary artery walls limiting blood flow to the heart. It often to a heart attack (myocardial infarction) and is the most common cause of heart failure. This build-up narrows the opening (lumen) of the vessel, so blood has a difficult time passing through to the heart muscle itself. As a result, a part of the heart muscle will not get the proper amount of oxygen-rich blood. This part will become too weak to pump the blood effectively. The rest of the heart will have to pick up this work load. This strain and extra work load may lead to the heart getting weaker.

11 12 ARRHYTHMIAS (IRREGULAR OR FAST DILATED HYPERTROPHIC CARDIOMYOPATHY RESTRICTIVE CARDIOMYOPATHY HEART BEAT) (DCM) is the most common Hypertrophic cardiomyopathy (HCM) is very complex. Restrictive cardiomyopathy (RCM), the rarest form of Sometimes the heart beat goes fast, or is irregular (or non-. It occurs when the It causes thickening of the heart muscle (especially the cardiomyopathy, is a condition in which the walls of both). This can put a strain on the heart, causing your main pumping chamber of the heart is enlarged, ventricles or lower chambers), stiffness of the left the lower chambers of the heart (the ventricles) are body to retain fluid resulting in heart failure. This is dilated and weak. The heart dilates and the muscular ventricle, mitral valve changes and cellular changes. abnormally rigid and lack the flexibility to expand as usually treated with medication and resolves quickly. wall becomes thin. The overall pumping action is Because of these changes the heart becomes a less the ventricles fill with blood. effective pump. A person having heart failure from just an , reduced. The causes of RCM include: once treated, may never have heart failure again. The causes of HCM include: The causes of DCM include: •• Build up of for no known INFECTIONS •• Most cases of dilated cardiomyopathy are idio- •• Family history — abnormal gene passed on by (idiopathic) parents Both viruses and bacteria can attack the heart muscle pathic (an exact cause is not known) •• Build up of abnormal proteins () in the and make it weak. This type of problem effects people •• Sometimes a viral illness may be responsible •• High blood pressure heart muscle at any age, and often very unexpectedly. •• Occasionally it may be inherited (familial cardio- •• Aging •• Chemotherapy or chest exposure to radiation • Idiopathic (an exact cause is not known) • Excess (hemochromatosis) in the heart myopathy) • • •• Heart valve disease (valvular cardiomyopathy) •• Other systemic diseases () Cardiomyopathies (pronounced KAR-dee-ohmy-AW- •• (heavy drinking, alcoholic cardiomy- pa-theez) literally means heart muscle condition or opathy) disease. It is used by doctors to classify heart failures, and helps lead to more effective treatment. •• Drug abuse or taking drugs that are toxic to the COMMON CONGESTIVE HEART FAILURE MEDICATIONS heart Types of cardiomyopathies include: •• There are numerous medications that your doctor -CONVERTING ENZYME might prescribe to help control your heart failure. • Ischemic (pronounced is-ke-mik) cardiomyopathy •• (ACE) INHIBITORS • Because each patient presents different ACE inhibitors block the effects of a blood protein •• Dilated (pronounced DYE-lay-ted) cardiomyopa- •• Women after (postpartum cardiomy- circumstances, your physician will prescribe called angiotensin-converting enzyme (ACE). ACE thy opathy) medications that are best for you. inhibitors are “vasodilators” because they relax or •• Hypertrophic (pronounced hy-per-TROfik) cardio- dilate the blood vessels and help lower blood pressure. myopathy In general, these medications can help you in several ways, including: These medications decrease the workload of the heart, •• Restrictive cardiomyopathy slow the progression of heart failure, and improve •• Controlling the symptoms of heart failure by symptoms. ACE inhibitors help to keep you out of the ISCHEMIC CARDIOMYOPATHY helping the heart pump better hospital, improve your chances of living longer, and •• Keeping you out of the hospital make you feel better. Coronary artery disease and heart attacks can lead to the most common type of cardiomyopathy called •• Reducing your risk of Common ACE inhibitors: (Capoten®), ischemic cardiomyopathy. This was discussed above. Continue to take the medications prescribed by your (Vasotec®), (Zestril®, Prinivil®), doctor, even if you are feeling better. (Accupril®), (Altace®)

BETA-BLOCKERS ANGIOTENSIN RECEPTOR BLOCKERS These medications work to decrease the workload of (ARBS) the heart by lowering blood pressure and slowing the . As a result, the pumping action of the heart Angiotensin receptor blockers (ARBs) have actions and heart failure symptoms are improved. Beta- similar to those of ACE inhibitors and are often used blockers help to keep you out of the hospital, improve for patients who cannot take ACE inhibitors. However, your chances of living longer and make you feel better. in some cases, they may be used together with ACE inhibitors. ARBs help to keep you out of the hospital, Common beta-blockers: carvediolol (Coreg®), improve your chances of living longer, and make you (Lopressor®, Toprol XL®), feel better. (Tenormin®), (Zebeta®) Common ARBs: (Diovan®) and (Atacand®)

13 14 AND NITRATES ANTAGONISTS NOTES AND QUESTIONS Hydralazine and nitrates work by decreasing how hard Aldosterone antagonists work by blocking the effects your heart has to pump blood through the body. These of a stress called aldosterone (a substance Please use this space to write a list of questions or concerns you may have. The list will help you remember issues medications are considered a “vasodilator” because that can make heart failure worse). These medications you want to discuss. Take this list to your appointments and to the hospital. they relax or dilate the blood vessels and help lower are commonly used to treat heart failure when blood pressure. Hydralazine and nitrates are often symptoms persist after other drug are used in combination with each other for patients who maximized. cannot take an ACE inhibitor or ARB. Hydralazine and nitrates can help to keep you out of the hospital, Common aldosterone antagonists: improve your chances of living longer and make you (Aldactone®), (Inspra®) feel better. Common nitrates: isosorbide dinitrae (Isordil®), (Imdur®) Digoxin, also known as , helps the heart pump more strongly and helps to control the heart rhythm. This helps to improve blood circulation and reduce swelling of the feet and lower legs. Digoxin helps you Diuretics, often called water pills, increase the amount feel better and function better on a daily basis. of urine the body produces, helping to get rid of extra fluid and salt. By removing extra fluid from the body, diuretics help lower the workload of the heart and decrease the amount of fluid that collects in the feet, lungs, and other areas in some people with heart failure. Your doctor may want you to take supplement with this medication. Common diuretics: (Lasix®), (Bumex®), torsemide (Demadex®)

This booklet tells you and your family about routine care for heart failure.

Please ask us any questions you may have.

Tell us of any problems you think you may have after you leave the hospital.

We will be very happy to assist you.

15 16 DAILY WEIGHT CHART DAILY WEIGHT CHART This chart allows you to track your weight for an entire year. Please record your weight each day by filling in the This chart allows you to track your weight for an entire year. Please record your weight each day by filling in the box that corresponds to the correct month and day. box that corresponds to the correct month and day.

JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 12 12 13 13 14 14 15 15 16 16 17 17 18 18 19 19 20 20 21 21 22 22 23 23 24 24 25 25 26 26 27 27 28 28 29 29 30 30 31 31

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