Congestive Heart Failure A guide for people with congestive heart failure

It is now well established that digoxin is an effective drug for the treatment of heart failure. Since treatment with angiotensin-converting enzyme (ACE) inhibitors reduces mortality in congestive heart failure, digoxin should be added to ACE inhibitors in patients with moderate or severe heart failure. The beneficial effects of digoxin may be due, in part, to its well-documented sympathoinhibitory effects that can avert the adverse effects of long-term excessive sympathetic adrenergic stimulation in heart failure.


What is congestive heart failure?
Congestive heart failure happens when your heart becomes weaker. It does not mean that your heart has stopped working. When your heart is weaker, it may not pump enough blood to meet the needs of your body.
Heart failure can range from mild to severe. Blood that should be pumped out of your heart backs up into your lungs and other parts of your body, causing shortness of breath or swelling in your feet and legs.

What causes it?
Congestive heart failure usually happens because of other heart problems such as: • a heart attack (also called myocardial infarction) • high blood pressure • heart valve disease (when heart valves do not open and close properly)

• a birth defect
It can also be caused by a medical condition called cardiomyopathy. Cardiomyopathy happens when the heart muscle is weakened because of a viral infection. It can also be caused by drinking too much alcohol.

What are some possible symptoms?
Heart failure can range from mild to severe. If you have it, you may notice some or all of these symptoms: • trouble breathing while resting or while doing activities • feeling tired after doing something that is normally simple or easy • sudden weight gain (2 to 5 pounds or more in 1 to 2 days) • swelling of your lower limbs (your legs or ankles) • swelling or pain in your abdomen (stomach area) • trouble sleeping unless you are propped up on 2 or more pillows • frequent, dry, hacking cough (common when lying down) • loss of your appetite What are some treatment options?
Usually, your symptoms can be controlled with medicines, rest and diet. It is good when symptoms of heart failure are found early. Then, treatments can be started right away. Starting treatments sooner can allow you to live a more normal life.
The most common treatments are: • checking your weight daily

Check your weight daily
A symptom of congestive heart failure is sudden weight gain. This may be because your kidneys are holding salt and water in your body. A sign of this could be if your shoes, belt or rings suddenly feel tight.
Here are some things you can do to keep track of your weight: • Weigh yourself first thing every morning after urinating and before eating.
• Record your weight on a calendar or in a book. Check if you have had a weight gain of 2 to 5 pounds in 1 to 2 days of normal eating. If you have, it is probably from fluid (such as water) rather than real weight gain.
• Call your doctor if you have sudden weight gain because of fluid. He or she can give you directions on how to get rid of the extra fluid. This will keep your symptoms from becoming worse.

Eat less sodium
Limit your sodium to no more than 2000 mg a day. This is about 1 teaspoon of salt a day.
Everyone needs some sodium in their bodies. Sodium helps your body balance fluid levels inside and outside of your cells.
Eating salt is usually how we get sodium in our bodies. But too much sodium in your body makes your heart work harder. Sodium makes your body hold in fluid. Your heart has to work harder to pump the added fluid.

Tips to help you eat less salt
• Instead of adding salt when cooking, try other herbs and spices.
• Do not add any more salt to your food after it is cooked.
• Read food labels carefully: ▪ Buy products that do not have salt or sodium as one of the first 3 ingredients.
▪ Check for ingredients that have the word sodium in them. For example, sodium sulphite or monosodium glutamate. Any ingredients with the word sodium in them mean added salt.
• Find restaurants that have low sodium meals on their menus. Fast food restaurants are not good choices. Most fast foods have a lot of sodium.
• Talk to a dietitian. A dietitian is a professional who has a lot of knowledge about food. Dietitians help people learn how to eat for good health. A dietitian can help you learn more about which foods have a lot of salt.

Stop drinking alcohol
Alcohol causes your heart to not pump as well. You must stop drinking completely if your congestive heart failure is caused by drinking too much alcohol.
Ask your health care team for information to help you with this.

Limit the amount of fluids you drink
Do not drink more than 1.5 litres or 6 cups of fluid per day. Fluids include drinks like water, coffee, tea, soup, and juice. This amount includes fluids you take with your medicines.
Many people with congestive heart failure hold too much fluid in their bodies. If you have too much fluid, your doctor may prescribe diuretic medicine (water pills). This medicine will help you get rid of this extra fluid.
But water pills (such as furosemide or Lasix) may make you feel thirsty. This does not mean that your body needs more fluid.
If you feel thirsty, try sucking on small amounts of hard candy. This will help if your mouth is dry. If you are diabetic, make sure these are sugar-free candies.

Exercise regularly
Regular physical activity can help to improve your level of energy. The amount of exercise that is best for you depends on your individual situation. Talk to your cardiologist. Together, you talk about how much exercise is best for your body.
Do not exercise right after eating.

Rest regularly
Plan rest times throughout your day. Your heart pumps more easily during rest times. You may find that it helps to take a nap after lunch. Putting your feet up for a few minutes every couple of hours can also help.

Take your medicines
Here is a list of medicines that help treat congestive heart failure. These medicines help to improve the way your heart works.
You may need more than 1 kind. Take the medicines that your doctor prescribes for you.

Vasodilators ACE inhibitors Angiotension
Receptor Blockers (ARB) • Lowers blood pressure by relaxing the blood vessels (arteries and veins).
• When the arteries are relaxed, there is less strain on the heart. It can pump out the blood more easily.
• When the veins are relaxed, less blood returns to the heart for pumping.
• One type of ACE inhibitor slows down or reverses damage to the heart muscle. This helps to make the heart pump better.
If you feel weak or dizzy when taking one of these medicines, talk with your doctor.
Digoxin (Lanoxin ® ) • Helps strengthen the heart muscle. More blood is pumped with each heartbeat.
Diuretic (water pill) • Helps kidneys make more urine to get rid of excess fluid.

Potassium
• Helps to control your heart rhythm. Diuretics cause you to lose potassium through your urine. Extra potassium is often needed.
• Helps reduce leg cramps. Leg cramps are common when your potassium level is too low.
Beta Blocker • Helps to slow down or reverse damage to the heart muscle. This helps the heart to pump better.

Spironolactone
• Helps to decrease symptoms of heart failure. It helps the heart to pump better. This medicine is a type of diuretic.
Please ask your health care team about pamphlet D-5151 Cardiac (heart) Medicines. It provides more information about the medicines you have been prescribed. You can take some control over your congestive heart failure symptoms. The treatments above have helped people with heart failure feel better.

Have feedback about this document?
Please fill out our survey. Use this link: bit.ly/uhn-pe Paper and printing generously donated by Art Printing Company Visit www.uhnpatienteducation.ca for more health information. Contact pfep@uhn.ca to request this brochure in a different format, such as large print or electronic formats.