CHF Patient Education

What is CHF? Nutrition Medications CHF Zone Review Question and Answer Session

CHF Overview

What is CHF?

Congestive Heart Failure (CHF) happens when blood backs up, or congests, into the liver, abdomen or lungs.

This typically happens when the heart muscle is damaged, weakened, stiffened and/or enlarged.

One may also notice swelling of their legs or ankles or possibly even the whole body if left untreated.

Congestive Heart Failure

Coronary Artery Disease High Blood Pressure Faulty heart valves Damaged heart muscle History of heart attack Congenital heart defects Smoking Poor diet Lack of exercise

Risk Factors

For anyone still smoking, NCH offers smoking cessation information and assistance.

Please let one of us or your nurse know if you are interested in assistance to quit.

Florida Quit Line 1-800-U-Can-Now Staffed 24/7

Smoking Cessation

Fatigue Shortness of

Breath Swelling Sudden Weight

Gain Cough Palpitations

Symptoms

Stop Smoking Reduce sodium intake

◦ No prepackaged frozen meals or canned products Preventative medical care Take your medications as directed Maintain a healthy weight Monitor your weight daily Report any significant changes to your doctor

immediately◦ Weight gain >5 pounds in a week◦ Weight loss > 8 pounds in a week

Prevention of Flare ups

Prior to starting any activity or exercise program please consult with your doctor.

Exercise regularly following your doctors guidelines.

Ask your doctor about a Cardiac Rehabilitation Program.

Activity

Moderate physical activity can actually help the heart grow stronger.

Plan activities with two to three 20-30 minute rest periods every day.

Short walks are a good way to begin your exercise program.

Try to avoid activities in extreme hot or cold temperatures.

Look for activities you enjoy doing such as bicycling, fishing, gardening, or swimming.

Activity

If you experience any of the following symptoms during your activity, stop and rest. ◦ Shortness of Breath◦ Cough◦ Chest discomfort◦ Pain◦ Dizziness◦ Fast heart beat◦ Extreme weakness

If after rest the symptoms do not go away, call your doctor or go to the emergency room.

Stop and Rest

Do not exercise beyond your outlined

recommendations.

Remember, that more is not always better and

something is better than nothing!!

CHF NutritionHelping to live healthier

Fluid restrictions are sometimes used by doctors to help prevent an overload of fluid in the body.

If you become fluid overloaded you may experience shortness of breath, increased swelling and/or weight gain.

Fluid Control or Restrictions

Eat allowed fruits and vegetables ice cold between meals.

Chew on ice cubes (but remember they count as part of your fluid balance!).

Use small cups/glasses for beverages. Freeze allowed beverages in ice cube trays. Drink in sips instead of gulps. NO straws. Measure your daily fluid allotment and store

it in a container in the refrigerator.

Hints for Fluid Control

Remember that 2 cups of retained fluid is equal to about 1lb of fluid weight gain.

Keep your home well humidified. Try lemon wedges, sour hard candies, or

chewing gum to stimulate saliva and moisten a dry mouth.

Rinse your mouth with non-alcohol mouthwash.

Again, do not use a straw.

Hints for Fluid Control

Changing your diet is not easy. It may take several weeks before your

adjust to the new tastes and flavors of your meals.

Most people with CHF should follow a low sodium diet.

Following a low sodium diet will help keep water from building up in your body and may help prevent you from having to take some medications.

Low Sodium Diet

A low sodium diet is considered 2300 mg of sodium per day, but your doctor may recommend 2000 mg of sodium per day due to your CHF.

How much is 2000 mg of sodium?◦ ¼ teaspoon = 600 mg of sodium◦ ½ teaspoon = 1200 mg of sodium◦ ¾ teaspoon = 1800 mg of sodium◦ 1 teaspoon = 2400 mg of sodium

Low Sodium Diet

Page 15 in your packet gives you a list of sodium content in some common foods.

Pages18-19 give you some helpful hints on spices and dining out.

Pages 20-21 give you a starting reference list of foods allowed or to avoid.

2000 Milligrams of Sodium

No single meal should have more than 600 mg of sodium.

Stop adding salt to food. Take the salt shaker off the table. Do not add salt when cooking. Pick foods naturally lower in salt such as

fresh fruits, vegetables, meat, chicken and fish, dried beans, rice, canned products labeled as “No Salt Added”

Low Sodium Diet Tips

Avoid prepackaged frozen meals, canned foods, and pickled foods whenever possible.

If you use a canned food, get the “No salt added” products instead of the ‘Low Sodium”

Use dry beans rather than canned beans. Salt is often used in the canning process to ensure long shelf life.

Avoid commercial spice mixtures (the first ingredient is often salt).

Low Sodium Diet Tips

Garlic. It is beneficial to your heart and immune system as well as tasty and full of flavor.

Herbs and spices will add flavor and are loaded with health boosting nutrients.

Crush herbs in your hand before adding to food to release added flavor.

Peppers add spice and flavor to meals. Remove the pepper seeds for a milder taste.

Mozzarella or Swiss cheese are the lowest in sodium.

No Salt? What about flavor?

Reading labels is the best way to find out how much sodium something has in it. It may seem challenging at first, but many people find it fun after they become accustomed to it.

Lets learn about a food label and what information they can give us.

Please refer to your booklet on page 17-18 for detailed information.

Labels

Reading Food LabelsNutrition Facts

Serving Size 1 cup (228g)Servings per Container 2

Amount per ServingCalories 250 Calories from Fat 110

% Daily Value*

Total Fat 12g 18%

Saturated Fat 3g 15% Trans Fat 3g Cholesterol 30mg 10%Sodium 470 mg 20%Total Carbohydrates 31g 10% Dietary Fiber 0g 0% Sugars 5gProtein 5g

Vitamin A 4%Vitamin C 2%Calcium 20%Iron 4%

*Percent Daily Values are based on a 2000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Calories 2,000 2,500

Total Fat Less than 65g 80gSat Fat Less than 20g 26gCholesterol Less than 300mg 300 mgSodium Less than 2400 mg 2400mgTotal Carbohydrates 300g 375gDietary Fiber 25g 30g

1. Start here with Serving Size

2. Check Calories

3. Limit these Nutrients

4. Get enough of these Nutrients

5. Footnote

6. Quick guide to % Daily Values

a. 5% or less is LOW

b. 20% or more is HI GH

MedicationsAlways take as instructed by your physician

Beta blockers Digoxin Diuretics Angiotensin-converting

enzyme (ACE inhibitors) Angiotensin II (A-II)

receptor blockers

CONGESTIVE HEART FAILURE MEDICATIONS

Beta Blockers slow the heart rate, lower blood pressure and lessen the risk of some abnormal heart rhythms

Examples: Propanolol, Metoprolol, Coreg, Atenolol, Sotalol

Beta Blockers

Beta Blockers Frequently prescribed medications to treat

HTN and a primary CHF medication Can be taken at any time of day, with or

without food Taking with food slows absorption and

minimizes side effects Often prescribed with other medications

Beta Blockers Side Effects:

◦ Low heart rate Take your pulse everyday and get medication

parameters from your doctor◦ Dizziness/Hypotension

Be careful when standing up from a seated position◦ Fatigue/Lethargy◦ Sudden weight gain◦ Impotence◦ Vomiting/Diarrhea

Digoxin increases the strength of heart contractions and tends to slow your heart beat

Examples: Lanoxin

DIGOXIN

Digoxin Can be taken with or without food but high

fiber diets may decrease absorption Take at least two hours before or after high

fiber or antacids Consult with your MD before taking any

herbal or over the counter medications Take your pulse everyday and get

parameters from your MD

Digoxin Side Effects:

◦ Fatigue◦ Slowed Heart Beat◦ Headache◦ Vomiting/Diarrhea◦ Toxicity

Blurred vision, light flashes, or yellow-green visual halos around objects

REPORT TO MD IMMEDIATELY

Diuretics prevent fluid from collecting in your body and decrease fluid in your lungs, making breathing easier

Examples: Lasix, Bumex, Hydrochlorothiazide

DIURETICS

Diuretics Take in the morning If taking twice per day, then take in the

morning and afternoon May need potassium or magnesium

supplements Use sunblock to prevent photosensitivity Follow a low sodium diet Have your BP and kidney function checked

regularly by your MD

Diuretics Side Effects:

◦ Electrolyte imbalance◦ Orthostatic Hypotension◦ Dehydration

Dark, concentrated, smelly urine Extreme thirst

◦ Toxicity Ringing in the ears Abdominal pain Fever REPORT THESE IMMEDIATELY

ACE inhibitors lower blood pressure, improve blood flow and decrease your hearts workload

Examples: Captopril, Enalapril, Lisinopril, Ramipril

Angiotensin-converting enzyme (ACE inhibitors)

ACE Inhibitors Take on an empty stomach, one hour before

meals Do not use salt substitutes Choose foods low in salt and potassium NSAIDS may cause body to retain salt and

water and decrease the effectiveness of your ACE

ACE Inhibitors Side Effects:

◦ Nausea/Vomiting/Diarrhea ◦ Dizziness/Hypotension◦ Skin Rash◦ Cough

Most common If persists or severe, contact MD

◦ Toxicity High Potassium Swelling in face, neck or tongue (ANGIOEDEMA) REPORT TO MD IMMEDIATELY

Reduces high blood pressure, making it easier for the heart to pump blood, improving heart failure. These drugs provide the same benefits of the ACE Inhibitors without the potential side effect of persistent cough

Examples: Avapro, Diovan, Micardis, Cozaar

Angiotensin II (A-II) receptor blockers

ARB Take on a full or empty stomach Take at least two hours before or after an

antacid It may take a few weeks to feel full benefit

of medication Have kidney function and blood pressure

monitored by your MD

ARB Side Effects:

◦ Hypotension/Dizziness◦ Headache◦ Nausea/Vomiting/Diarrhea◦ Elevated Potassium Level◦ Confusion

CHF Zones

These are quick glance reviews to give you an idea of how well controlled your CHF is today.

Everyday goals◦ Weigh yourself every morning before breakfast.◦ Take your medication as prescribed.◦ Check for swelling in your feet, ankles, legs and

stomach.◦ Eat a low salt diet.◦ Balance activities and rest periods.

CHF Zones

Congratulations! Your symptoms are under control. No shortness of breath. No weight gain more than 2 pounds. No swelling in your feet, ankles, legs or

stomach. No chest pain. No decrease in your ability to maintain a

normal activity level.

Green Zone is your Goal!

Call your doctor’s office if:◦ Short of breath.◦ Swelling in your feet, ankles, legs and stomach.◦ Feeling tired, no energy.◦ New or increasing cough.◦ Dizziness.◦ Chest pain.◦ Feeling uneasy.◦ It becomes harder to breath lying down or you

must sleep in a chair.◦ Weight gain of 3 pounds in a day or 5 pounds in a

week.

Yellow Zone is a WARNING!

Go to the emergency room or call 911 if you have any of these symptoms:

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Struggling to breath or unrelieved shortness

of breath while sitting still. Weight gain or loss of 5 pounds in 2 days. Unrelieved chest pain. Confusion.

Red Zone is an EMERGENCY!!

Questions and Answers