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Heart Talk: Living with Heart Failure Education for patients, families and caregivers


Table of Contents What is heart failure?

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Can heart failure be treated?

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What you can do

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Heart failure classes

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Step 1: Take your medications

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Step 2: Go to your clinic appointments Step 3: Watch your symptoms and weight • Weigh yourself • Heart Failure Action Plan and weight tracking tool

P. 12 P. 12 P. 12 P. 13 - 14

Step 4: Watch what you eat and drink • Reading a nutrition label • Foods high in salt • Tips to eat healthy • What you can eat • What you should not eat • Drinking too many fluids?

P. 15 P. 15 P. 16 P. 16 P. 17 P. 18 P. 19

Step 5: Exercise and keep active

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Step 6: Limit alcohol and caffeine and do not use tobacco

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Planning for the future

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Make this a permanent part of your life

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Review: The 6 steps

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Heart failure quiz

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What is heart failure? Heart failure is when the heart is not pumping well. Sometimes heart failure is also called: • congestive heart failure • pulmonary edema • fluid on lungs Symptoms (what you will be feeling): • hard time breathing • swollen ankles, legs, or belly/abdomen (sometimes called “edema”) • weak and tired • fluid weight gain Can heart failure be treated? YES! Although heart failure is a chronic disease (it will never go away no matter how good you feel) it can be treated so that you can continue to live your life. Heart failure is treated with: • medications • procedures • surgery Be sure to talk to your care team about the right kind of treatment for you. What YOU can do! You have an important role in keeping yourself feeling good and out of the hospital. People with heart failure can lead happy lives for many years by following these 6 steps: 1. take your medications 2. go to your clinic appointments 3. watch your symptoms (how you feel) and weight 4. watch what you eat and drink 5. exercise and keep active 6. limit alcohol and caffeine and do not use tobacco Each of these steps is further explained in this booklet. Keep reading!

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Heart failure classes Learning how to take care of your health is important. That’s why JPS Health Promotions offers classes to learn more about heart failure and how to quit smoking. These are just two of the classes available. For a complete list of classes, dates and times, visit our website at www.jpslearnforlife.org or call 817-702-7300. Step 1: Take your medications It is important to take your medications exactly as instructed. Your medicines may change after each clinic appointment, or when you are in the hospital. It can be confusing, but keeping track is very important. Be sure to always take all your medication bottles to all of your clinic appointments. This should include all vitamins, herbs and over-the-counter medications. Patients who take their medicines as instructed live longer, feel better and spend less time in the hospital. The following pages are sample schedules to help you keep track of when to take your medications.

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Medicine name (generic and name brand) and amount:

Why am I taking this medicine?

How much do I take?

Each MORNING after you wake up, follow this schedule:

What medicines do I need to take?

How do I take this medicine?

Doctor who gave it to me?

Morning


Medicine name (generic and name brand) and amount:

Why am I taking this medicine?

Each day at NOON, follow this schedule:

What medicines do I need to take?

How much do I take?

How do I take this medicine?

Doctor who gave it to me?

Noon


Medicine name (generic and name brand) and amount:

Why am I taking this medicine?

Each EVENING at dinnertime, follow this schedule:

What medicines do I need to take?

How much do I take?

How do I take this medicine?

Doctor who gave it to me?

Evening


Medicine name (generic and name brand) and amount:

Why am I taking this medicine?

How much do I take?

Each NIGHT before you go to bed, follow this schedule:

What medicines do I need to take?

How do I take this medicine?

Doctor who gave it to me?

Night


If I need medicine for

If I need medicine for

If I need medicine for

If I need medicine for

If I need medicine to stop smoking

If I need medicine for a headache

Medicine name and amount:

How much do I take?

How do I take this medicine?

Remember to tell every member of your care team about all your medicines, vitamins and other medications you may take without a prescription.

What other medications can I take?


Step 2: Go to your clinic appointments Do not be afraid to talk to your care team about your questions and concerns. Always ask someone if you don’t understand something, or if you feel something is “just not right.” Your care team is there to help you. Tips to follow: • speak with the nurse about scheduling a clinic appointment before you leave the hospital or other care facility • set it up on the best day and time for you • make sure you have a ride to your appointments • GO TO ALL YOUR SCHEDULED APPOINTMENTS • bring a friend or family member • bring all medication bottles, including vitamins, herbs and over-the-counter medications, to all clinic appointments • ASK QUESTIONS Step 3: Watch your symptoms and weight Keep these things in mind: • when your body holds extra fluid (water), your weight goes up • weight gain from fluid can start up to two weeks before you feel other symptoms • weighing yourself every day helps you keep track of your weight WEIGH YOURSELF: Things you will need to do: • buy a scale if you do not already have one • make sure you can read the numbers on the scale easily • write your weight down EVERY DAY using the chart on page 14 or on a calendar • bring the weight chart or calendar to all your clinic appointments Remember to weigh yourself every morning at the same time and: • after urinating • before having anything to eat or drink • wearing the same amount of clothing • using the same scale P. 12

Tell your doctor when you gain 3 pounds in one day OR 5 pounds in one week.


shortness of breath with activity swelling in the legs or feet loss of appetite dizziness or fainting confusion

• • • • •

• • • • •

trouble breathing when lying down sudden weight gain of 2 or more pounds daily tired, weak and feeling run-down cough with mucus production nausea, vomiting and upset stomach

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• no coughing with mucus production • weight unchanged (taken daily at the same time) • low-salt/low-fat meal planning • keep all follow-up appointments

Keep up the good work!

breathe easy taking medications as directed keep a relaxed and low stress level stay active - exercise walking is good - start slow and increase as tolerated

Indicators and actions:

Green Zone - Control:

• • • • •

Symptoms may include:

Continue taking medications and contact your care team if symptoms continue for 2or 3 days. If you don’t have a care team then return to the urgent care center.

• weight gain of 2 or more pounds for 3 days in a row • extreme weakness, fatigue or being overly tired • worsening swelling of the hands, feet or abdomen

Seek immediate medical attention! Call your care team, 9-1-1 or go to the emergency room.

chest Pain severe shortness of breath fast, irregular heartbeat coughing with production of white or pink mucus

Yellow Zone - Caution:

• • • •

Symptoms may include:

Red Zone - Emergency:

Heart Failure Action Plan


Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone:

Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone: Date: Weight: Zone:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Date: Weight: Zone:

Use this chart or a calendar to keep track of your weight and see which zone you are in each day. Share this with your care team at your appointments.

Heart Failure Action Plan


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Step 4: Watch what you eat and drink Salt is also called “SODIUM” and is found in most foods you eat. Why do you need to limit the salt (sodium) in your diet? • Salt acts like a sponge and makes your body hold onto water. Eating too much salt can cause you to gain weight, make your legs swell and cause water to go to your lungs making it harder to breathe. How much salt (sodium) can you have each day? • It is recommend you eat less than 2,000 mg of salt each day. Taking the salt shaker off the table and watching your diet can help. SALT = SODIUM and SODIUM = SALT READING A NUTRITION LABEL This is an example of a nutrition label. Check to see how many servings are in the box or can. If you eat a portion larger than the serving size, you are eating more salt than is listed on the label. Your goal is to LOWER the amount of salt (sodium) you eat. Sodium (salt) is found in many foods, in addition to the salt you may add to your foods: 1 teaspoon salt = 2,000 mg sodium 1 teaspoon baking soda = 821 mg sodium 1 teaspoon baking powder = 339 mg sodium 1 teaspoon MSG = 492 mg sodium It is important you read labels to find out the sodium content of foods. It may also be helpful to know the government ruled that some words used on labels must mean what they say: Key words: “Sodium Free” (or “salt free”) “Very low sodium” “Low-Sodium” “Reduced Sodium” “Light in Sodium” “Unsalted”/ “Without added salt” “No salt added”

Meaning: Very little salt (less than 5 mg per serving) 35 mg sodium or less per serving 20% sodium reduction from original At least 25% reduction from the original 50% sodium reduction from the original No salt added during process No salt added during process P. 15


Step 4 continued... FOODS HIGH IN SALT These foods should be avoided or limited: • canned foods • frozen dinners • deli meats • hot dogs • jar tomato and pasta sauce • ham and bacon • french fries • sea salt • Adobo seasoning • salad dressings • pickles and olives • sausages and kielbasa • cheeses • soy sauce TIPS TO EAT HEALTHY If you do eat salt, tell your care team because: • medications may need to be adjusted • more clinic visits may be needed • you may need to talk with a diet specialist called a dietitian If you eat out, choose heart healthy foods. A few suggestions are: • order baked or broiled foods (chicken, fish and steamed vegetables) • ask for salad dressing, sauce or gravy on the side

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What you can eat Food Group

Recommended Foods

Grains most breads that are not topped with salt (Note: Yeast breads usually have less sodium than those made with baking soda) many cold cereals, especially shredded wheat, bran flakes and puffed rice or wheat cooked cereals, pastas, rice and other starches made without salt or with very little salt Vegetables

fresh or frozen vegetables without added sauces, salt or sodium homemade soups (salt-free or low-sodium) low-sodium or sodium-free canned vegetables and soups

Fruits

fresh and canned fruits

Milk nonfat, skim or 1% fat milk nonfat milk powder nonfat or low-fat yogurt small amounts of low-fat natural cheese (not processed cheeses or cheese products) or reduced sodium cheese Meat and other proteins

fresh meats and fish (check labels on frozen products) tuna packed in water dried beans and peas edamame (fresh soybeans) eggs, especially egg whites

Desserts and snacks

fruit Angel food cake fruit crisps unsalted pretzels, popcorn, or nuts low-fat pudding

Fats

tub or liquid margarine unsaturated fat oils (canola, olive, corn, sunflower, safflower, peanut)

Condiments fresh or dried herbs spices vinegar lemon or lime juice pepper sauce salt-free seasoning mixes simple salad dressings (such as vinegar and oil) P. 17


What you should NOT eat Food Group

Not Recommended

Grains breads or crackers topped with salt cereals (hot or cold) with more than 300 mg sodium per serving biscuits, cornbread, and other “quick� breads prepared with baking soda bread crumbs or stuffing mix from a store (homemade is okay if from a low-sodium recipe) Vegetables canned vegetables (unless they are salt-free) frozen vegetables with sauces sauerkraut and pickled vegetables canned or dried soups (unless they are low-sodium or salt-free) french fries and onion rings Fruits

dried fruits preserved with sodium-containing additives

Milk buttermilk processed cheese and cheese foods (natural cheese should be eaten only in small amounts) Meat and other proteins

cured or smoked meats (bacon, ham, sausage) canned meats (chili, deviled ham, vienna sausage) canned or smoked fish high-sodium frozen meals

Desserts and snacks

baked goods made with baking soda salted snacks, such as nuts, chips, or pretzels

Fats

salted butter or margarine

Condiments salt, sea salt, garlic salt seasoning mixes containing salt bouillon cubes ketchup barbeque sauce worcestershire sauce soy sauce miso salsa pickled items (pickles, olives, relish) Alcohol check with your doctor. generally, do not have more than one drink per day (1 drink = 5 ounces [oz] wine, 12 oz beer, or 1.5 oz of liquor) P. 18


Step 4 continued... DRINKING TOO MANY FLUIDS? Most people with heart failure can drink normal amounts of fluid. Do not restrict your fluids unless you are told to do so by your care team. By staying away from salt and watching the fluid intake in your diet, you can live longer, feel better and spend less time in the hospital. Step 5: Exercise and keep active In general, exercising, having sex and driving are okay. Make sure to talk to your care team about what kind of exercise is safe and good for you. Tips to follow for exercising and having sex: • follow the treatment plan your care team gives you • wait at least 1 hour after eating before exercising or having sex • stop and rest for a while if you get tired or have a problem • pace yourself • choose a time when you feel your best Step 6: Limit alcohol and caffeine and do not use tobacco Limit alcohol: If you are allowed to drink alcohol, have no more than: • 2 drinks a day (for men) • 1 drink a day (for women) One drink is: • 1.5 oz of 80 proof liquor or 1 oz of 100 proof liquor • 5 oz glass of wine • 12 oz bottle of beer Alcohol can make your heart failure worse. It can also affect your medicines. Limit caffeine: Caffeine is usually OK in moderation (always check with your doctor). If allowed, have no more than 1 or 2 cups per day. Do not use tobacco: If you smoke (cigarettes or cigars), please STOP! Ask your care team about help to quit smoking. It is bad for everyone, but especially for people with heart failure. It makes the heart work harder and can lead to heart attacks.

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Planning for the future Some things to keep in mind to plan for the future: Taking good care of yourself or your loved one is not always enough. A legal document called an advance directive or living will can help your family and medical team in emergencies if you are unable to make your wishes known. Everyone should have an advance directive. An advance directive can include: • a “medical durable power of attorney” (someone you name to make medical decisions when you cannot) • cardiopulmonary resuscitation (CPR) instructions • Do-Not-Resuscitate Order (DNR) Many states have free templates on the internet for creating your own advance directive or living will. You can also speak with an attorney about it. Talk with your family and your doctor about your feelings and care wishes. Make this a permanent part of your life! Following these 6 steps and anything else your care team tell you to do will improve your health. You can stay active and enjoy a better quality life by following their advice. We know it can be hard. If you are having trouble following the advice of your care team, please ask them for help. Write down any problems you are having or questions you would like to ask your care team. Remember to bring the list with you to your clinic appointments for answers. Things that are hard for me and questions I have:

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Review: The 6 steps

1. Take your medications 2. Go to your clinic appointments 3. Watch your symptoms (how you feel) and weight 4. Watch what you eat and drink 5. Exercise and keep active 6. Limit alcohol and caffeine and do not use tobacco

Patients who follow these steps live longer, feel better, and spend less time in the hospital. Heart failure quiz 1. Heart failure is a medical condition where… a) the heart has a hard time pumping blood to the body b) people run out of breath with activities like walking c) some people get swelling in their legs d) all of the above 2. Patients with heart failure should… a) monitor their weight closely b) attend all clinic appointments c) call for help if they are gaining weight or are running out of breath faster d) all of the above 3. Medicines in patients with heart failure… a) can help the heart pump better b) can help people live longer lives c) should be adjusted by their care team d) all of the above 4. Patients with heart failure should… a) follow the advice of their care team b) take the medications their care team recommends c) watch the salt intake in their diet d) all of the above

The answer to all the questions is “d.”

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NOTES


JPS Cardiology Clinic 1400 South Main Street Fort Worth, Texas 76104 817-702-6926 JPS Health Network

Heart Failure Education

September 2013


Heart Talk: Living with Heart Failure (JPS Health Network)