Congestive Heart Failure

Learning About Heart Failure

What is heart failure?

Heart failure means that your heart muscle does not pump as much blood as your body needs. Failure does not mean that your heart has stopped. It means that your heart is not pumping as well as it should.

What can you expect when you have heart failure?

If you have heart failure, medicines and lifestyle changes may be able to slow or even reverse the disease. But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure gets worse, you may need to limit your activities. Heart failure can also get worse suddenly, and if this happens, you'll need emergency care.

Heart failure can also lead to other health problems. These may include heart attack, stroke, and trouble with your heart rhythm (arrhythmia).

What are the symptoms?

In the early stages of heart failure, you may:

Feel tired easily.
Be short of breath when you exert yourself.
Feel like your heart is pounding or racing (palpitations).
Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:

Feel short of breath even at rest.
Have swelling (edema), especially in your legs, ankles, and feet.
Gain weight. This may happen over just a day or two, or more slowly.
Cough or wheeze, especially when you lie down.

How can you prevent heart failure?

To reduce your chance of getting heart failure:

Do not smoke. Smoking can make heart failure worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good. Also avoid secondhand smoke.
Manage your cholesterol and blood pressure. Exercise and eating healthy foods can help you do this. Follow your doctors' advice.
Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
Control diabetes. If you have diabetes, take your medicines as directed, and work with your doctor to make a diet and exercise plan to control the disease.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.

How is heart failure treated?

You'll probably have to take several medicines.
You'll need to make lifestyle changes, such as eating less salt, getting regular exercise, not smoking, and limiting how much alcohol you drink. You may need to take breaks during the day. If you are overweight, it's best to lose some weight.
You may need surgery to open clogged arteries or to repair or replace a heart valve.
You may need a pacemaker or defibrillator (ICD). A pacemaker helps your heart beat. An ICD uses electrical pulses or shocks to help control heart rhythms.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Heart Failure: After Your Visit

Your Care Instructions

Heart failure occurs when your heart does not pump as much blood as the body needs. Failure does not mean that the heart has stopped pumping but rather that it is not pumping as well as it should. Over time, this causes fluid buildup in your lungs and other parts of your body. Fluid buildup can cause shortness of breath, fatigue, swollen ankles, and other problems. By taking medicines regularly, reducing sodium (salt) in your diet, checking your weight every day, and making lifestyle changes, you can feel better and live longer.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Medicines

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Do not take any vitamins, over-the-counter medicine, or herbal products without talking to your doctor first. Do not take ibuprofen (Advil or Motrin) and naproxen (Aleve) without talking to your doctor first. They could make your heart failure worse.
You may be taking some of the following medicine.

Beta-blockers can slow heart rate, decrease blood pressure, and improve your condition. Taking a beta-blocker may lower your chance of needing to be hospitalized.
Angiotensin-converting enzyme inhibitors (ACEIs) reduce the heart’s workload, lower blood pressure, and reduce swelling. Taking an ACEI may lower your chance of needing to be hospitalized again.
Angiotensin II receptor blockers (ARBs) work like ACEIs. Your doctor may prescribe them instead of ACEIs.
Diuretics, also called water pills, reduce swelling.
Potassium supplements replace this important mineral, which is sometimes lost with diuretics.
Aspirin and other blood thinners prevent blood clots, which can cause a stroke or heart attack.

You will get more details on the specific medicines your doctor prescribes.

Diet

Do not eat more than 2,000 milligrams (mg) of sodium each day. That is less than 1 teaspoon of salt a day, including all the salt you eat in cooking or in packaged foods. And try to lower your sodium to less than 1,500 milligrams a day if you are 51 or older, are black, or have high blood pressure, diabetes, or chronic kidney disease. People get most of their sodium from processed foods. Fast food and restaurant meals also tend to be very high in sodium.
Ask your doctor how much liquid you can drink each day. You may have to limit liquids.

Weight

Weigh yourself without clothing at the same time each day. Record your weight. Call your doctor if you gain more than 3 pounds in 2 to 3 days. A sudden weight gain may mean that your heart failure is getting worse.

Activity level

Start light exercise (if your doctor says it is okay). Even if you can only do a small amount, exercise will help you get stronger, have more energy, and manage your weight and your stress. Walking is an easy way to get exercise. Start out by walking a little more than you did before. Bit by bit, increase the amount you walk.
When you exercise, watch for signs that your heart is working too hard. You are pushing yourself too hard if you cannot talk while you are exercising. If you become short of breath or dizzy or have chest pain, stop, sit down, and rest.
If you feel "wiped out" the day after you exercise, walk slower or for a shorter distance until you can work up to a better pace.
Get enough rest at night. Sleeping with 1 or 2 pillows under your upper body and head may help you breathe easier.

Lifestyle changes

Do not smoke. Smoking can make a heart condition worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good. Quitting smoking may be the most important step you can take to protect your heart.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.
Limit coffee and soft drinks with caffeine. Caffeine can raise your heart rate and cause changes in your heartbeat.
Avoid getting sick from colds and the flu. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor whether you need a second dose. Get a flu shot each fall. If you must be around people with colds or the flu, wash your hands often.

When should you call for help?

Call 911 if you have symptoms of sudden heart failure such as:

You have severe trouble breathing.
You cough up pink, foamy mucus.
You have a new irregular or rapid heartbeat.

Call your doctor now or seek immediate medical care if:

You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You have sudden weight gain, such as 3 pounds or more in 2 to 3 days.
You have increased swelling in your legs, ankles, or feet.
You are suddenly so tired or weak that you cannot do your usual activities.

Watch closely for changes in your health, and be sure to contact your doctor if:

You develop new symptoms.

Medicines for Heart Failure: After Your Visit

Your Care Instructions

Most people with heart failure benefit from taking several medicines to protect their heart. These medicines can help you feel better and live longer. It is important to take all your medicines exactly as directed to get the best results. While the medicines can cause side effects, most people feel better if they take their medicines.

If you think that any of your medicines are causing side effects, discuss this with your doctor.

What medicines are used for heart failure?

Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril or captopril, help blood flow by relaxing blood vessels and lowering blood pressure. The heart is then able to pump more blood through your body without working harder.
Angiotensin II receptor blockers (ARBs), such as losartan, work like ACE inhibitors, and they may be used by some people as an alternative.
Diuretics, also called water pills, reduce swelling by helping the kidneys get rid of excess fluid.
Beta-blockers, such as metoprolol or bisoprolol, can slow heart rate, decrease blood pressure, and help slow the advance of heart failure.
Digoxin lessens symptoms in some people with heart failure.
Aspirin and other blood thinners prevent blood clots, which can cause a stroke or heart attack.

What should you know about these medicines?

ACE inhibitors

Before you start taking an ACE inhibitor, tell your doctor whether:

You take anti-inflammatory medicines—such as ibuprofen (Advil, Motrin) or naproxen (Aleve)—antacids, potassium pills or salt substitute, or lithium.
You are taking a diuretic.
You are pregnant or breast-feeding or are planning to get pregnant.
You have kidney disease.

Side effects include:

A dry cough. If the cough is bad enough to make you stop the medicine, talk to your doctor. You may need to try a different medicine.
Lightheadedness. This may happen when you stand up quickly. It usually gets better with time.

Angiotensin II receptor blockers (ARBs)

Before you start taking an ARB, tell your doctor whether:

You take anti-inflammatory medicines such as Advil or Aleve, antacids, potassium pills or salt substitute, or lithium.
You have kidney disease.
You are taking a diuretic.
You are pregnant or breast-feeding or are planning to get pregnant.

Side effects include:

Lightheadedness and dizziness. These are the most common side effects.

Diuretics (water pills)

Before you start taking a diuretic, tell your doctor whether:

You take lithium or anti-inflammatory medicines such as Advil or Aleve.

Side effects include:

Frequent urination. Ask your doctor about timing these pills so that you do not have to use the bathroom at a bad time.
Muscle cramps. This may mean that you are losing too much potassium, an important mineral. Call your doctor if you get muscle cramps.
Breast tenderness, which may occur in men who take spironolactone. Call your doctor if you develop breast tenderness that bothers you.

Beta-blockers

Before you start taking a beta-blocker, tell your doctor whether:

You have asthma or diabetes.

Side effects include:

Dizziness or tiredness. This usually gets better with time.
Swelling. This may occur in your face, hands, legs, and feet. Call your doctor if you have swelling.
Shortness of breath or wheezing. Call your doctor right away if you have either of these side effects.

Digoxin

Before you start taking digoxin, tell your doctor whether:

You have kidney disease.
You are taking a diuretic or other medicines, including over-the-counter medicines.

Side effects include:

Nausea or vomiting.
Confusion, changes in vision, a racing or slowed heartbeat, or dizziness. Call your doctor right away if you have any of these side effects.

Aspirin and other blood thinners

Before you start taking aspirin or other blood thinners, tell your doctor whether:

You have a history of stroke or stomach ulcers.
You have high blood pressure, are already taking blood-thinning medicines, or are taking anti-inflammatory medicines such as Advil or Aleve.

Side effects include:

Upset stomach. Try taking aspirin with food.
Bleeding. Call your doctor if you have unusual bleeding, such as large or many bruises, blood in your urine, red or black stools, or bleeding from the nose or gums.

Limiting Sodium and Fluids With Heart Failure: After Your Visit

Your Care Instructions

Sodium causes your body to keep extra water, making it harder for your heart to pump. By limiting sodium, you will feel better and lower your risk of having to go to the hospital.

People get most of their sodium from table salt. Fast food and restaurant meals also tend to be very high in sodium. Your doctor will probably limit your sodium intake to less than 2,000 milligrams (mg) a day. That is less than 1 teaspoon of salt a day, including all the salt you eat in cooked or packaged foods. And try to limit your sodium to less than 1,500 mg a day if you are 51 or older, are black, or have high blood pressure, diabetes, or chronic kidney disease.

Usually, you have to limit the amount of liquids you drink only if your heart failure is severe. Limiting sodium alone often is enough to help your body get rid of extra fluids. However, your doctor may tell you to limit your fluid intake to a set amount each day.

How can you care for yourself at home?

Read food labels

Read food labels on cans and food packages. The labels tell you how much sodium is in each serving. Make sure that you look at the serving size. If you eat more than the serving size, you have eaten more sodium than is listed for one serving.
Food labels also tell you the Percent Daily Value. If the Percent Daily Value says 50%, it means that you will get at least 50% of all the sodium you need for the entire day in one serving. Choose products with low Percent Daily Values for sodium.
Be aware that sodium can come in forms other than salt, including monosodium glutamate (MSG), sodium citrate, and sodium bicarbonate (baking soda). MSG is often added to Asian food. You can sometimes ask for food without MSG or salt.

Buy low-sodium foods

Buy foods that are labeled "unsalted" (no salt added), "sodium-free" (less than 5 mg of sodium per serving), or "low-sodium" (less than 140 mg of sodium per serving). A food labeled "light sodium" has less than half of the full-sodium version of that food. Foods labeled “reduced-sodium” may still have too much sodium.
Buy fresh vegetables or plain, frozen vegetables. Buy low-sodium versions of canned vegetables, soups, and other canned goods.

Prepare low-sodium meals

Use less salt each day when cooking. Reducing salt in this way will help you adjust to the taste. Do not add salt after cooking. Take the salt shaker off the table.
Flavor your food with garlic, lemon juice, onion, vinegar, herbs, and spices instead of salt. Do not use soy sauce, steak sauce, onion salt, garlic salt, mustard, or ketchup on your food.
Make your own salad dressings, sauces, and ketchup without adding salt.
Use less salt (or none) when recipes call for it. You can often use half the salt a recipe calls for without losing flavor. Other dishes like rice, pasta, and grains do not need added salt.
Rinse canned vegetables. This removes some—but not all—of the salt.
Avoid water that has a naturally high sodium content or that has been treated with water softeners, which add sodium. Call your local water company to find out the sodium content of your water supply. If you buy bottled water, read the label and choose a sodium-free brand.

Avoid high-sodium foods, such as:

Smoked, cured, salted, and canned meat, fish, and poultry.
Ham, bacon, hot dogs, and luncheon meats.
Regular, hard, and processed cheese and regular peanut butter.
Crackers with salted tops.
Frozen prepared meals.
Canned and dried soups, broths, and bouillon, unless labeled sodium-free or low-sodium.
Canned vegetables, unless labeled sodium-free or low-sodium.
Salted snack foods such as chips and pretzels.
French fries, pizza, tacos, and other fast foods.
Pickles, olives, ketchup, and other condiments, especially soy sauce, unless labeled sodium-free or low-sodium.

If you cannot cook for yourself

Have family members or friends help you, or have someone cook low-sodium meals.
Check with your local senior nutrition program to find out where meals are served and whether they offer a low-sodium option. You can often find these programs through your local health department or hospital.
Have meals delivered to your home. Most cities have a Meals on Wheels program. These programs provide one hot meal a day for older adults, delivered to their homes. Ask whether these meals are low-sodium. Let them know that you are on a low-sodium diet.

Limiting fluid intake

Find a method that works for you. You might simply write down how much you drink every time you do. Some people keep a container filled with the amount of fluid allowed for that day. If they drink from a source other than the container, then they pour out that amount.
Measure your regular drinking glasses to find out how much fluid each one holds. Once you know this, you will not have to measure every time.
Besides water, milk, juices, and other drinks, some foods have a lot of fluid. Count any foods that will melt (such as ice cream or gelatin dessert) or liquid foods (such as soup) as part of your fluid intake for the day.