Understanding Heart Failure

The term "heart failure" sounds pretty scary -- as if the heart has "failed" or stopped beating. Actually, the term
means that the heart isn't pumping as well as it should. Usually the heart has been weakened over time by an
underlying problem, such as clogged arteries, high blood pressure, a defect in its muscular walls or valves, or some
other medical condition.

Your body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood so it can function
normally. In people with heart failure, the body doesn't get an adequate supply. As a result, they tend to feel weak,
fatigued or short of breath. Everyday activities such as walking, climbing stairs, carrying groceries and yard work
can become quite difficult.

How common is congestive heart failure?

If you've been diagnosed with congestive heart failure or know someone who has, you're not alone. Nearly 5
million Americans are currently living with this condition, with 550,000 new cases diagnosed each year.
Congestive heart failure affects people of all ages, from children to young adults to the middle-aged to senior
citizens. However, it's more common among older people. Therefore, as the older population grows over the next
few decades, so will the number of people living with congestive heart failure or caring for a loved one who has
it.

Can it be cured?
Heart failure is a serious condition, and there is usually no cure. But we deliberately use the phrase "living with heart
failure" because that is what people who have it learn to do. In most cases, heart failure can be managed by taking
medications and making healthy changes in habits such as diet and exercise. The help of families and friends can be
beneficial as well. These changes are often the key to leading a full, enjoyable life.

Learning about Heart Failure

Coming to terms with heart failure may be easier if you understand what's happening inside the body. This
section explains what happens when someone develops heart failure.

Heart failure can involve the left side of the heart, the right side or both. However, it usually affects the left
side first. Each side is made up of two chambers: the atrium, or upper chamber, and the ventricle, or lower
chamber. The atrium receives blood into the heart, and the ventricle pumps it where it needs to go. Heart
failure occurs when any of these chambers lose their ability to keep up with the amount of blood flow.

What is left-sided heart failure?

Left-sided or left-ventricular (LV) heart failure involves the left ventricle (lower chamber) of the heart.
Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the
rest of the body. Because this chamber supplies most of the heart's pumping power, it's larger than the others
and essential for normal function.

If the left ventricle loses its ability to contract (called systolic failure), the heart can't pump with enough force
to push enough blood into circulation. If it loses its ability to relax (diastolic failure) because the muscle has
become stiff, the heart can't properly fill with blood during the resting period between each beat. This is an
important distinction because the drug treatments for each type are different.

In either case, blood coming into the left chamber from the lungs may "back up," causing fluid to leak into
the lungs. (The technical term for this is pulmonary edema.) Also, as the heart's ability to pump decreases,
blood flow slows down, causing fluid to build up in tissues throughout the body (edema). This excess fluid or
congestion explains the term congestive heart failure, which you've probably heard used before.

What is right-sided heart failure?

The right atrium receives the "used" blood that returns to the heart through the veins; then the right
ventricle pumps it into the lungs to be replenished with oxygen. Right-sided or right-ventricular (RV) heart
failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is,
in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side
loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.

How quickly does heart failure develop?

Heart failure is usually a chronic disease, meaning that it's a long-term condition that tends to gradually
become worse. By the time someone is diagnosed, chances are that the heart has been losing pumping
capacity little by little for quite a while. At first the heart tries to make up for this by:

Enlarging. When the heart chamber enlarges, it stretches more and can contract more strongly, so it pumps
more blood.

Developing more muscle mass. The increase in muscle mass occurs because of an increase in size of the
contracting cells of the heart. This allows the heart to, at least initially, pump more strongly.

Pumping faster. This helps to increase the output of the heart.

T he body also tries to compensate in other ways. The blood vessels narrow to keep blood pressure up, trying
to make up for the heart's loss of power. The body diverts blood away from less important tissues and organs
to maintain flow to the most vital organs, the heart and brain. These temporary measures mask the problem
of heart failure, but they don't solve it. This helps explain why some people may not become aware of their
condition until years after the heart begins its decline. (It's also a good reason to have a regular check up with
your doctor.) Eventually the heart and body just can't keep up, and the person experiences the fatigue,
breathing problems or other symptoms that usually prompt a trip to the doctor.

Less active, less fit people have a 30-50% greater risk for developing high blood pressure.
read more...

Signs and Symptoms of Heart Failure

Once a person has been diagnosed with heart failure, it's important for them to keep track of symptoms and
report any sudden changes to their physician. This table lists the most common signs and symptoms, explains
why they occur and describes how to recognize them.

Sign or Symptom Why It Happens People with Heart

Failure May Experience...
Shortness of breath (also called dyspnea) Blood "backs up" in the pulmonary veins (the vessels that return
blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak
into the lungs. . . . breathlessness during activity (most commonly), at rest, or while sleeping, which may come
on suddenly and wake them up. They often have difficulty breathing while lying flat and may need to prop up
the upper body and head on two pillows. They often complain of waking up tired or feeling anxious and
restless.
Persistent coughing or wheezing Fluid builds up in the lungs (see above). . . . coughing that produces white or
pink blood-tinged phlegm.
Buildup of excess fluid in body tissues (edema) As blood flow out of the heart slows, blood returning to the
heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose
of sodium and water, also causing fluid retention in the tissues. . . . swelling in the feet, ankles, legs or
abdomen or weight gain. They may find that their shoes feel tight.
Tiredness, fatigue The heart can't pump enough blood to meet the needs of body tissues. The body diverts
blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. . . . a
tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying
groceries or walking.
Lack of appetite, nausea The digestive system receives less blood, causing problems with digestion. . . . a
feeling of being full or sick to their stomach.
Confusion, impaired thinking Changing levels of certain substances in the blood, such as sodium, can cause
confusion. . . . memory loss and feelings of disorientation. A caregiver or relative may notice this first.
Increased heart rate To "make up for" the loss in pumping capacity, the heart beats faster. . . . heart
palpitations, which feel like the heart is racing or throbbing.

Links on This Site

What Is Congestive Heart Failure?

Less active, less fit people have a 30-50% greater risk for developing high blood pressure.
read more...

Can managing stress reduce or prevent heart disease?

Managing stress makes sense for your overall health. But current data don't yet support specific recommendations
about stress reduction as a proven therapy for cardiovascular disease.
Background
"Stress" response describes the condition caused by a person's reaction to physical, chemical, emotional or
environmental factors. Stress can refer to physical effort and mental tension. It's hard to define a high level of
emotional or psychological stress to measure in a precise way. All people feel stress, but they feel it in different
amounts and react to it in different ways.
More and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and
psychosocial factors. These factors include job strain, social isolation and personality traits. But more research is
needed on how stress contributes to heart disease risk. We don't know if stress acts as an "independent" risk factor
for cardiovascular disease. Acute and chronic stress may affect other risk factors and behaviors, such as high blood
pressure and cholesterol levels, smoking, physical inactivity and overeating.
More research is also needed on stress's role in heart disease risk among women and minorities. Also, only a few
studies have examined how well treatment or therapy works to reduce the effects of stress on cardiovascular disease.
Studies using psychosocial therapies to prevent secondheart attacks are promising. After a heart attack or stroke,
people who feel depressed, anxious or overwhelmed by stress should talk to their doctor or other healthcare
professional. These feelings are relatively common, and help is available.
Related AHA publications:
 Heart and Stroke Facts
 Targeting the Facts... heart disease, stroke and risks
 Six Steps to a Healthier Heart
 Silent Epidemic... fighting heart disease and stroke for women ages 25 to 44
 "How Can I Manage Stress?" in Answers By Heart kit
See also:

Exercise Stress Test

Framingham Heart Study
Risk Factors and Coronary Heart Disease
Thallium Stress Test
Women, Heart Disease and Stroke
Managing Stress

Think about the times in your life when you've felt stress: maybe while giving a presentation at work, worrying
about your children, racing to meet a deadline, or arguing with your spouse. Do you remember how your heart was
pounding and your breathing got heavier? People with heart failure need to avoid that kind of physical response to
stress. Emotional stress and anxiety actually make the heart work harder, which can make symptoms worse. That's
why patients and their caregivers should work together to keep stress under control.

Naturally, people with heart failure feel anxious about their diagnosis and what might happen to them or their
families. And everyone has certain stress-causing "triggers"? things such as rush-hour traffic, a demanding boss,
finances or family conflict. No one can control all of these challenges, but there are ways to cope with them better.
Here are 12 good strategies for reducing stress. Use them if you have heart failure, or pass them along to a loved one
who does.

Talk with family, friends, clergy or other trusted advisers about your concerns and stresses, and ask for their support.

Take 15 to 20 minutes a day to sit quietly, breathe deeply and think of a peaceful scene.

Learn to accept things you can't change. You don't have to solve all of life's problems.

Count to 10 before answering or responding when you feel angry.

Don't use smoking, drinking, overeating, drugs or caffeine to cope with stress. These will actually make things
worse.

Look for the good in situations instead of the bad.

Exercise regularly. Do something you enjoy, like walking, swimming, jogging, golfing, walking a pet, tai chi or
cycling. Check with your doctor to determine what activity level is right for you.

Think ahead about what may upset you and try to avoid it. For example, spend less time with people who bother
you. If you're still working or volunteering, cut back on your hours and adjust your schedule so you can avoid
driving in rush-hour traffic.

Plan out productive solutions to problems. For example, talk with your neighbor if the dog next door bothers you,
and set clear limits on how much you'll do for family members.

Learn to say no. Don't promise too much. Give yourself enough time to get things done.

Join a support group ... maybe for people with heart disease, for women, for men, for retired persons, or some other
group with which you identify.

Seek out a mental health professional or counselor if you can't cope on your own. Helping people is their specialty.
Ask your doctor, family or friends for recommendations. If they can't help, ask your minister, rabbi or a hospital
social worker for some names.

Links on This Site

Stress and Heart Disease

Congestive Heart Failure

Nearly one-third of all Americans with high blood pressure don't know they have it.
read more...

Diet
People with heart failure often can improve their symptoms by watching what they eat and including some
exercise in their lives. The healthcare team may include a dietitian, nurse specialist or other health educator who
specializes in helping people improve their diets. (If not, ask the physician for a referral to this kind of help.)
They'll discuss current eating habits with patients and their families and make recommendations for a more
heart-healthy diet.

People with heart failure shouldn't feel as though they have to change all of their eating habits at once. What's
important is that they're making changes, ideally just one at a time. Once they make small changes, bigger
changes won't seem so difficult. Every step taken — no matter how small it seems — is a step toward managing
heart failure and feeling better.
Reading Food Labels
Fortunately, the new easy-to-read food labels can help with finding foods low in saturated fat, cholesterol and
sodium, and with keeping track of the number of grams or milligrams consumed each day. According to Food and
Drug Administration regulations, no manufacturer can say that their product is "low-fat" or "low-sodium" unless
they can prove that claim. Learning to read these labels is a good first step in developing a sensible eating plan.
It means that one serving of the product has . . .
If the label says

Calorie free Less than 5 calories

Sugar free Less than 0.5 grams of sugar
Fat free Less than 0.5 grams of fat
Low fat 3 grams of fat or less
Reduced fat or
At least 25 percent less fat than the regular product
less fat
Low in saturated 1 gram of saturated fat or less, with not more than 15 percent of the calories coming from
fat saturated fat
Lean Less than 10 grams of fat, 4 grams of saturated fat and 95 milligrams of cholesterol
Extra lean Less than 5 grams of fat, 2 grams of saturated fat and 95 milligrams of cholesterol
At least one-third fewer calories or no more than half the fat of the regular product or no more
Light (lite)
than half the sodium of the regular product
Cholesterol free Less than 2 milligrams of cholesterol and 2 grams (or less) of saturated fat
Low cholesterol 20 or fewer milligrams of cholesterol and 2 grams or less of saturated fat
Reduced
At least 25 percent less cholesterol than the regular product and 2 grams or less of saturated fat
cholesterol
Sodium free or
Less than 5 milligrams of sodium and no sodium chloride in ingredients
no sodium
Very low sodium 35 milligrams or less of sodium
Low sodium 140 milligrams or fewer of sodium
Reduced or less
At least 25 percent less sodium than the regular product
sodium
High fiber 5 grams or more of fiber
Good source of
2.5 to 4.9 grams of fiber
fiber
Coping with demands
A 1997 survey by the National Family Caregivers Association found that many caregivers grow closer to their loved
one and develop newfound inner strength. However, many also reported feeling depressed and isolated, having less
personal time, and receiving no consistent help from other family members. You need to take these realities into
account. Remember that caring for yourself will make you better able to care for someone else. We offer the
following strategies to help you deal with the role of caregiver.

Seeking help from others

As a caregiver, you might benefit by ...

 Sharing your feelings. Talk to the patient, other family members and friends, trusted advisors or anyone
who can help you sort through your concerns. You might be feeling guilty right now, thinking you should
have recognized past habits or symptoms that may have contributed to the present situation. You might feel
depressed, or fearful about losing your loved one. Express your feelings and consider professional
counseling if you are extremely distressed.

 Enlisting the help of family and friends. You can't do everything on your own. If you are the primary
caregiver, you'll need to ask others for help when the patient isn't feeling well. If family and friends aren't
available, seek out a volunteer group that provides such help. If you aren't the primary caregiver but live
nearby, help in whatever way you can. Visit or call more often. Offer to drive the patient to doctor
appointments, pick up medications, prepare healthy meals or help with household chores.

 Joining a caregiver support group. Spend time with others in similar situations. Call the social worker at
your local hospital to find out when and where they meet. Or consider joining an on-line discussion group.

Taking steps to feel more in control of the situation

You might also benefit by ...

 Learning more about heart failure. The more you know, the more in control you're likely to feel. Visiting
this Web site is a good start. You also can ask the healthcare team for written information and reading
recommendations or do more research on your own.

 Planning for the future. Even though heart failure can be managed, it can't be cured. You may derive peace
of mind from working with your loved one to make sure that finances, wills and insurance policies are in
order.

Giving yourself a break

Recognize the importance of ...

 Making time for yourself. Make time for the activities you enjoy, such as reading, going to a movie,
exercising or visiting friends.

 Not blaming yourself for your loved one's behavior. If they persistently refuse to go along with doctor
recommendations, there's little that you can do. Continue to offer support and encouragement.

Understanding Your Role

Caregiver Bill of Rights Medical Alert
Planning for the Future Financial Concerns
Additional Resources
Caring for Yourse

Understanding Your Role as Caregiver

Doctors ask people with heart failure to change their lives -- by eating differently, remembering medications,
paying closer attention to their bodies and reducing stress. Such changes are hard because they often require
breaking long-time habits. But they're usually easier when loved ones get involved. If you live with or are close
to someone who has heart failure, you're likely to have the greatest impact on their success in following
instructions from the healthcare team.

We offer the following ideas to get you started, and encourage you to adapt them to your own circumstances and
preferences.

Lending emotional and moral support

As a caregiver, you might help by ...

 Acknowledging that change takes time. It's natural for people to have trouble changing habits developed
over many years. It might help your loved one to know that you realize this. Try not to nag them into doing
what's been recommended. Instead, listen to their concerns and stay positive, even if they fail to follow
doctor's orders. Offer encouragement and praise for any good new habits.
 Suggesting that your loved one join a support group for people with heart failure or other heart
conditions. Local hospitals, community centers and newspapers typically offer information about group
meetings. There are also e-mail discussion forums available on the Internet. One good example is a forum
called "The Beat Goes On," maintained by a heart failure patient at
http://www.jonsplace.org/heartforum.htm.
 Understanding that there may be some loss of physical intimacy with a spouse or partner. The
diagnosis of heart failure often means stopping or limiting sexual activity until the condition is under
control.
Helping with medical care issues

With regard to your loved one's treatment, you might help by ...
 Participating actively during hospital and doctor visits without dominating the conversation. Help your
loved one keep track of information about medication, diet and exercise, rehabilitation and at-home record
keeping. The volume of information might overwhelm you at first, so be sure to ask questions and take
notes. See our section on working with a physician for more specific advice on this topic.

 Helping the patient follow through on the healthcare team's advice. Help them manage medications
and follow any other prescribed treatments. Offer to exercise together regularly and, if necessary, quit
smoking at the same time. Buy and prepare low-fat, low-cholesterol foods that your loved one will like, or
emphasize why they're so important. Use the Internet or local library to gather more advice on heart-healthy
lifestyles. For more specific hints, see our sections on diet and lifestyle and exercise.

 Communicating with the doctor and other healthcare providers. Doctors often rely on family
caregivers for information about the patient's condition, changes in symptoms and progress with diet and
exercise recommendations. They may ask you questions when you're present at office visits. Don't feel like
you have to make excuses for your loved one if he or she isn't making progress. The healthcare team needs
to know how things really are at home.
Other tips

You might also help by ...

 Involving the entire family. Effective management of heart failure is often a group effort. Suggest active
outings based on how much activity your loved one can perform, prepare healthy meals, and do whatever
else is needed to get everyone involved. Encourage other family members to make changes now to lower
their own risk for heart failure.

 Helping the patient without doing everything for them. People with heart failure often have certain
physical limits, but they also need to stay active and exercise moderately. Ask the doctor or other healthcare
provider for advice about what your loved one should or shouldn't do.
Caregiver Bill of Rights

I have the right:

To take care of myself. This is not an act of selfishness. It will enable me to take better care of my loved one.

I have the right:

To seek help from others even though my loved one may object. I recognize the limits of my own endurance and
strength.
I have the right:
To maintain facets of my own life that do not include the person I care for, just as I would if he or she were healthy. I
know that I do everything that I reasonably can for this person, and I have the right to do some things for myself.

I have the right:

To get angry, be depressed and express other difficult emotions occasionally.

I have the right:

To reject any attempt by my loved one (either conscious or unconscious) to manipulate me through guilt, anger or
depression.

I have the right:

To receive consideration, affection, forgiveness and acceptance from my loved one for as long as I offer these
qualities in return.

I have the right:

To take pride in what I am accomplishing and to applaud the courage it sometimes takes to meet the needs of my
loved one.

I have the right:

To protect my individuality and my right to make a life for myself that will sustain me when my loved one no longer
needs my full-time help.

I have the right:

To expect and demand that as new strides are made in finding resources to aid physically and mentally impaired
persons in our country, similar strides will be made toward aiding and supporting caregivers.

Links to Other Sites

American Association of Homes and Services for the Aging

American Association of Retired Persons

The Mended Hearts, Inc.

Heartmates: Resources for the Spouse, Family and Loved Ones of a Heart Patient

National Family Caregivers Association

National Federation of Interfaith Volunteer Caregivers

The Well Spouse Foundation

You can get personalized treatment information based on the latest clinical research.
read more...

Medical Alert
The very symptoms that help physicians diagnose heart failure might also show that the condition is worsening or
not responding to current treatment. If your loved one suddenly experiences a new symptom, or their current
symptoms worsen, call the doctor right away. Quick action could prevent an emergency trip to the hospital later.
Here are the warning signs to watch for:
 Sudden weight gain (three or more pounds in one day, five or more pounds in one week, or whatever
amount you were told to report). That's why it's so important for patients to weigh themselves at the same
time daily, after urinating, preferably before breakfast, in the same clothes, on the same scale and at the
same spot.

 Shortness of breath while at rest (not related to exercise or exertion).

 An increase in swelling of the lower limbs (legs or ankles).

 Swelling or pain in the abdomen.

 Trouble sleeping (awakening short of breath, using more of pillows).

 Frequent dry, hacking cough.

 Increased fatigue or feeling tired all the time.

Of course, if your loved one is ever in severe distress, call an ambulance immediately. Some people with heart
failure experience a sudden change in symptoms that requires emergency care.

Understanding Your Role Coping With Demands

Caregiver Bill of Rights Medical Alert
Planning for the Future Financial Concerns
Additional Resources Caring for Yourself

Planning for the Future

You're probably hesitant to burden your loved one with "What if?" questions. What if their heart failure should
worsen? What if they become too ill to communicate? These issues are extremely difficult to raise, especially when
you're trying to be positive. However, you need to work together to plan for the future.

Keep in mind that planning for the future isn't the same as giving up. Actually, this is a way for patients to control
their own destinies and make things easier on family members. Though it's difficult, dealing with these issues can
bring peace of mind.

As soon as you feel up to it, talk with your loved one about drawing up an Advance Directive. This is the official
term for any instructions that a patient gives for their future medical care, should they become unable to make
decisions for themselves (e.g., unconscious, too ill to communicate). There are two types: a Living Will and a
Durable Health Care Power of Attorney, or Health Care Proxy.

What's a Living Will?

This document explains a patient's wishes for medical care in case he or she becomes unable to communicate. State
law may define when a living will goes into effect and may restrict the medical interventions to which it applies.

What's a Durable Health Care Power of Attorney or Health Care Proxy?

This document allows the patient to name another person to make decisions about medical care if he or she is unable
to do so. This person may be called a proxy, healthcare agent, surrogate or attorney-in-fact. In some states, this
person is allowed to make medical decisions for the patient only at the end of life, while in others he or she can
make decisions at any time the patient is unable to do so.

How do we get started?

Each state regulates Advance Directives differently, so you'll need to consult with your physician, nurse, social
worker or family lawyer to know what is required. Or you can visit the Web site of Choice in Dying, a non-profit
organization dedicated to fostering communication about complex end-of-life decisions. The site features state-
specific information about Advance Directives.
While you're at it, take the time to make sure that financial matters, including wills and life insurance policies, are
also in order.

August 4, 2003

Caring for Yourself

To a certain extent, everyone with heart failure is their own caregiver. They care for themselves by following doctor
recommendations for managing their condition.

But some people with heart failure don't have family members and friends living nearby who can help them. Perhaps
a spouse has passed away or is limited by some health condition. Adult children and other relatives might live
hundreds or thousands of miles away — a pretty common situation in today's mobile society. Because heart failure
most commonly affects older people, there's an even greater chance that siblings and friends have passed away.

If you're in this situation, you can care for yourself by taking advantage of caregiving and support services. Ask the
healthcare team or hospital social worker for information about services such as:

Meal delivery programs

Errand services

Senior transportation services or vans

Community pharmacies that deliver medications

Senior centers

Emergency response systems

Home health agencies

Mental health agencies

Support groups

Visiting home helpers or nurses' aides

Churches, religious congregations and volunteer centers often sponsor programs that provide meals, transportation
and visiting services for people in need. National service organizations might also be able to help.

American Association of Homes and Services for the Aging

This national nonprofit organization represents over 5,000 nursing homes, continuing care retirement communities,
assisted living residences, senior housing facilities and community service organizations for the elderly.

American Association of Retired Persons

AARP is a nonprofit organization dedicated to shaping and enriching the experience of aging for all Americans. Its
Web site features a detailed caregiving section, which includes information on topics such as locating outside help
and dealing with finances. The site also offers guidance on independent living and dealing with a chronic illness.

Eldercare Locator 1-800-677-1116

This nationwide directory assistance service helps connect older persons and caregivers with a variety of local
support services. You can call their toll-free number Monday through Friday, 9 a.m. to 8 p.m. Eastern time. The staff
person will ask you for a brief description of the problem and for your loved one's county, city and/or ZIP code (to
locate local services). The Eldercare Locator is a public service of the U.S. Department of Health and Human
Services' Administration on Aging and is administered by the National Association of Area Agencies on Aging and
the National Association of State Units on Aging.

National Federation of Interfaith Volunteer Caregivers

This organization promotes the ministry of caregiving in all religious congregations throughout the United States.
Through their Web site you can locate caregiving programs in certain areas of the country, link to additional
resources and participate in an online forum for caregivers.

The Mended Hearts, Inc.

This extended support group for heart patients, families and caregivers offers emotional support and practical
advice. Through the Web site, you can link to local chapters in more than 250 cities across the United States.

Understanding Your Role Coping With Demands

Caregiver Bill of Rights Medical Alert
Planning for the Future Financial Concerns
Additional Resources

alt="Caring for Yourself" name="eighth"> Caring for Yourself

Links to Other Sites

American Association of Homes and Services for the Aging

American Association of Retired Persons

The Mended Hearts, Inc.

Heartmates: Resources for the Spouse, Family and Loved Ones of a Heart Patient

National Family Caregivers Association

National Federation of Interfaith Volunteer Caregivers

The Well Spouse Foundation

 An estimated 2 million Americans are living with atrial fibrillation.
read more...

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Lifestyle and Exercise
People diagnosed with heart failure usually need to rethink their daily routines and make some changes for the
better. Most people are concerned about four main areas:
 Work: Can they still work? Full time or part time?
 Recreation: Can they go hiking, play golf, swim and attend sporting events?
 Leisure: Can they travel, work in the garden and do volunteer work?
 Sex: Can they have sexual intercourse?
Of course, the answers will vary according to the specific diagnosis. In some severe stages of heart failure,
patients may be limited in the types of physical activity they can perform. Be sure to talk to your healthcare
professional before starting any physcial activity program. The healthcare team can help patients and their
families understand the road that lies ahead.

We understand that change is difficult, but try to see this as a chance to expand your horizons, rather than something
you have to put up with. Whether you have heart failure or care for someone who does, your attitude about change
will make a real difference in your quality of life. Recreation, exercise, family outings and other leisure activities
may provide a newfound source of pleasure.

The Importance of Rest

People with heart failure need to schedule time every day for rest and relaxation, much like they'd schedule a
doctor's appointment or lunch with friends. Rest times are essential because they give the heart a chance to pump
more easily. A person might try napping after lunch, putting their feet up for a few minutes every couple of hours, or
sitting down while doing certain household tasks, such as preparing food or ironing.

Why is daytime rest important?

Daytime rest can help prevent people from "overdoing it," which can make them feel much worse for a day or two.
It also makes it easier to cope with feelings of tiredness caused by nighttime sleep interruptions. People with heart
failure sometimes find themselves awakened by symptoms such as shortness of breath and coughing. Their sleep
may also be interrupted because they need to urinate more often. This is a result of the diuretics (water pills) that
may have been prescribed to help rid the body of extra fluid. If getting a good night's sleep is hard, then resting
during the day is even more essential.

Is there any way to get a better night's sleep?

To improve nighttime sleep, people with heart failure can use pillows to prop up their heads, and avoid naps and big
meals right before bedtime. Sometimes diuretics can be timed so that they're less likely to cause the need for
urination during the night. This usually means taking them in the morning. The doctor can provide more information
about this
Exercise and a Healthy Heart
As a general rule, it's better for people with heart failure to stay active. That might sound like contradictory
advice, since the heart is already having trouble keeping up with the body's demands. Why make it work even
harder? Well, moderate exercise actually can help the heart get stronger. Most people find that exercise improves
their symptoms, reduces stress and boosts energy levels. Regular exercise also may lead to other important
health advantages, including weight loss, better circulation and blood pressure, and lower cholesterol levels -- all
of which are especially important for people with heart failure.

The healthcare team will work with the person to develop an appropriate exercise plan. Often they'll start by
doing a stress test to measure the patient's heart function during exercise (either walking on a treadmill or riding
an exercise bike). This helps the physician know how much activity the heart can handle.

Cardiac rehabilitation programs

Many people with heart failure aren't used to regular exercise or feel nervous about starting. That's when a cardiac
rehabilitation program can be helpful. A cardiac rehab program lets patients start exercising slowly in a supervised
setting, either at a hospital or outpatient center. While they exercise on a treadmill, stationary bike, or indoor track a
few times a week, nurses or therapists monitor them for any discomfort or changes in symptoms. Over time their
tolerance for exercise is likely to increase. Also, many people find it easier to stick with a structured program ? and
then keep exercising when it's over. Cardiac rehab programs often provide additional classes in smoking cessation,
nutrition and stress management.

Please note: these programs aren't always covered by health insurance.

Exercise tips
Whether or not they take part in a formal exercise program, people with heart failure need to make time for
moderate aerobic exercise, like walking, swimming or biking. They should always stay within their physician's
recommendations and their own comfort zone. Here's a checklist of what to do and what to avoid.

DO ...
 Wear comfortable clothes and flat shoes with laces or sneakers.

 Start slowly. Gradually build up to 30 minutes of activity, three to four times per week (or whatever your
doctor recommends). If you don't have a full 30 minutes, try two 15-minute sessions to meet your goal.

 Exercise at the same time of day so it becomes a regular part of your lifestyle. For example, you might
walk every Monday, Wednesday and Friday from noon to 12:30 p.m.

 Drink a cup of water before, during and after exercising (but check with the doctor, because some people
need to limit their fluid intake).

 Ask family and friends to join you. You'll be more likely to stick with it.

 Note your activities on a calendar or in a log book. Write down the distance or length of time of your
activity and how you feel after each session. If you miss a day, plan a make-up day or add 10-15 minutes to
your next session.
  Use variety to keep your interest up. Walk one day, swim the next time, then go for a bike ride on the
weekend.

 Join an exercise group, health club or YMCA. Many churches and senior centers offer exercise programs,
too. (Get your doctor's permission first.)

 Look for chances to be more active during the day. Walk the mall before shopping, choose a flight of stairs
over an escalator, or take 10-15 minute walking breaks while watching TV or sitting for some other
activity.

DON'T ...
 Get discouraged if you stop for a while. Get started again gradually and work up to your old pace.

 Do isometric exercises that require holding your breath, bearing down or sudden bursts of energy. If you're
taking part in an exercise class or physical therapy, ask the leader or therapist what these are. Also avoid
lifting weights and competitive or contact sports, such as football.

 Engage in any activity that causes chest pain, shortness of breath, dizziness or light-headedness. If these
happen, stop what you're doing right away.

 Exercise right after meals, when it's very hot or humid, or when you just don't feel up to it.

The Effects of Smoking

Smokers who have heart failure can automatically eliminate a major source of stress on their heart by quitting. Each
puff of nicotine temporarily increases heart rate and blood pressure, even as less oxygen-rich blood circulates
through the body. Smoking also leads to clumping or stickiness in the blood vessels feeding the heart. People who
quit smoking are more likely have their heart failure symptoms improve.

Lifetime smokers often need help to quit successfully. The healthcare team can provide information about smoking
cessation programs, as can the American Lung Association and the American Cancer Society. These tips may also
help smokers quit.
 Keep busy doing things that make it hard to smoke, like working in the yard, washing dishes and being
more active.
 Fight the urge by going places where smoking isn't allowed and staying around people who don't smoke.
 Avoid situations that tempt you to smoke, like drinking coffee or alcohol.
 Find a substitute to reach for instead of a cigarette. Try a hard candy.
 Don't throw in the towel if you smoke a cigarette. Just resolve not to let it happen again.
 Remind yourself that you're likely to feel better if you stop smoking.
 Tell family members and friends that you need to quit smoking and could really use their support. If your
husband, wife, son or daughter smokes, ask them to quit with you.
Watching for Physical Changes
Heart failure requires patients and their caregivers to pay close attention to any changes in symptoms. If they notice
something new, or a sudden worsening of a current symptom, they should notify the doctor. Here's what to watch
for:
 Sudden weight gain — three or more pounds in one day, five or more pounds in one week, or whatever
amount they were told to report. That's why it's so important for people with heart failure to weigh
themselves every day — preferably every morning, before breakfast and after urinating, with the same type
of clothes on, without shoes, on the same scale and in the same spot.
 Shortness of breath while at rest, not related to exercise or exertion.
 Increased swelling of the lower limbs (legs or ankles).
 Swelling or pain in the abdomen.
 Trouble sleeping (awakening short of breath, using more pillows).
 Frequent dry, hacking cough.
 Loss of appetite.
 Increased fatigue or feeling tired all the time.
Sex and Heart Failure
"Can I -- or my husband, wife or partner -- still have sex after heart failure is diagnosed?"

Try not to feel embarrassed about raising this question with your physician or other healthcare providers. They've
heard it before.

Most people with heart failure can continue sexual relations once symptoms are under control. They may feel more
comfortable and confident when following certain guidelines suggested for heart patients:
 Choose a time when you're rested, relaxed and free from the stressful feelings brought on by the day's
schedules and responsibilities.
 Avoid having sex right after eating a heavy meal.
 Select a familiar, peaceful setting that's free from interruptions.
 If you start to feel uncomfortable or tired during intercourse, stop and rest for a short time.
There's no reason why heart patients can't resume usual sexual activity as soon as they feel ready to do so. However,
if their condition is severe and they can't tolerate exercise, they may need to find less demanding ways to express
love and affection. They can spend time hugging, kissing and touching instead.

People with heart failure should remind themselves that it's OK if they're not ready to have sex right away. Feelings
like stress, anxiety and depression are natural after a serious health diagnosis and often cause a loss of interest.
Patients will need to work with their partners to demonstrate their love in other ways.
The Best Clothing Choices
The Best Clothing Choices

People with heart failure should try to wear clothing that permits good blood flow. They also should avoid tight
socks or stockings (like thigh-high or knee-high hose), which can slow blood flow to the legs and cause clots.

In addition, they should avoid temperature extremes as much as possible. When it's too hot or too cold, the body
works harder to keep its temperature normal.