PMC: Living with Heart Disease

Living with

HEART DISEASE

Heart & Vascular Institute

Heart & Vascular Institute

606-430-8771 www.pikevillehospital.org

Index Live Well with Heart Disease ........................................... 3 Risk Factors .................................................................. 5 Know the Signs of an Emergency ..................................... 7 Cardiac Rehab Program ................................................ 9 Learn to Eat Healthy .................................................... 11 Shop Heart-Healthy ................................................... 13 Medication for Heart Disease ....................................... 17 Taking Medication ...................................................... 19 Your Emotional Health ................................................ 21 Diabetes ................................................................... 23 Managing Your Risk Factors ......................................... 25 Smoking: This Time, Quit for Good ................................ 27 Smoking: Working Through Withdrawal ....................... 29

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Living with Heart Disease…

Live Well with Heart Disease

Making changes in your life is the best way to make a healthier you. If you have heart disease, heart failure, a heart valve problem or are recovering from a heart attack or heart surgery, cardiac rehabilitation can help.

This workbook will help you understand the factors that put you at risk of another heart problem, learn ways to manage and reduce your heart disease risks, track changes in your risk factors over time and know when to contact your health care provider about a problem.

What is Cardiac Rehab?

Cardiac Rehab is a program for people who have had a heart attack, bypass surgery, angioplasty, stent replacement or angina. You’ll find that, although you can undergo cardiac procedures and take medicine for your heart problems, the most important steps are those you take yourself. In fact, if you achieve and maintain a healthy lifestyle, you will enhance the efforts of your surgery and medication.

Education provided by this program will help you fully understand your heart and how to live a healthy lifestyle. With support from the Cardiac Rehab staff and your group members, you will begin to resume daily occupational, social and leisure activities, leading to a faster recovery.

What is Heart Disease?

Heart disease refers to any condition that makes it difficult for the heart to do its job and is the number one cause of death and disability in the United States.

There are many factors that can cause heart disease. Lifestyle, the foods you eat, your family’s health history and your overall health condition could be underlying causes.

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Living with Heart Disease…

Understanding Arteries and Heart Disease Arteries are blood vessels that carry oxygen-rich blood throughout the body.

Arteries can become damaged by a waxy buildup called plaque. Plaque causes the arteries to stiffen and narrow (atherosclerosis) making it hard for blood to flow. If plaque builds up in the coronary arteries, which carry blood to the heart muscle, it can lead to Coronary Artery Disease (CAD).

Your Heart is at Risk • When a coronary artery narrows, less blood and oxygen flow to the heart muscle. The decreased blood flow can cause symptoms of angina (often felt as temporary pain or pressure in or near the chest).

• When a coronary artery narrows too much, very little blood and oxygen reach the heart muscle beyond the site of narrowing. If a clot forms, blood flow in the artery may stop. This can result in a heart attack. If the muscle goes without oxygen for too long, that part of the heart muscle dies.

Healthy Arteries

Unhealthy Arteries

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Living with Heart Disease…

Risk Factors

High Cholesterol — As blood cholesterol rises, so does the risk of CAD.

Abnormal cholesterol levels increase the chance of plaque buildup in the arteries.

Keeping your non-HDL (total cholesterol minus your HDL) less than 100 is the most important level to control. You are at risk for heart disease if you have: • Total cholesterol higher than 200 mg/dL • Bad cholesterol (LDL) 100 mg/dL or higher (or above 70 mg/dL) • Good cholesterol (HDL) lower than 40 mg/dL (men) or 50 mg/dL (women) or triglycerides higher than 150 mg/dL

High Blood Pressure — High blood pressure increases the heart’s workload,

causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. Blood pressure of 140/90 and higher is hypertension.

Tobacco Smoke — Smokers’ risk of developing CAD is two to four times

that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with CAD. People who smoke also have an increased risk for blood clots and stroke. This is an important risk factor you can change.

Physical Inactivity — An inactive lifestyle is a risk factor for coronary heart

disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease. It is recommended to exercise at least five days per week for a minimum of 30 minutes.

Obesity and Overweight — Being overweight increases the heart’s

workload. It also raises blood pressure, blood cholesterol and triglyceride levels, and lowers good cholesterol (HDL) levels. If you control your weight you could eliminate most of the risk factors for heart disease.

Diabetes — Diabetes seriously increases your risk of developing heart disease.

If you have diabetes, it’s extremely important to work with your health care provider to manage it. Diabetes makes you more likely to have a silent heart attack (one without symptoms).

Stress — Stressful events can raise heart rate and blood pressure. Stress can

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also bring on feelings of depression and anxiety. These feelings do not directly lead to heart disease, but do affect overall health and quality of life.

Living with Heart Disease…

Grandfather

Grandmother

Grandfather

Grandmother

• Diabetes

• Diabetes

• Diabetes

• Diabetes

• Stroke

• Stroke

• Stroke

• Stroke

• High Blood Pressure

• High Blood Pressure

• High Blood Pressure

• High Blood Pressure

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

Mother

Father

• Diabetes

• Diabetes

• Stroke

• Stroke

• High Blood Pressure

• High Blood Pressure

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

Sibling

You

Sibling

• Diabetes

• Diabetes

• Diabetes

• Stroke

• Stroke

• Stroke

• High Blood Pressure

• High Blood Pressure

• High Blood Pressure

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

• Heart Disease/Heart Attack

• Obesity/Overweight • High Total Cholesterol or

LDL (bad) Cholesterol

• Low HDL (good) Cholesterol • Smoking or Exposure to

Secondhand Smoke

• Physical Inactivity • Advancing Age

Know Your Family History – A Risk Factor for Heart Disease Like the color of your eyes, tendencies for many health conditions are genetically passed from one family member to another.

The more you know about your family’s health history, the more you can do to reduce your risk of heart disease. Get started today with these easy steps:

If you have a blood relative with heart disease, your risk for developing it significantly increases. Heart disease can be passed along to younger generations, but so can healthy habits that help you and others avoid health complications.

1. Map out your family’s health history. Use this diagram to make a record of your blood relatives who live or have lived with heart disease.

2. Talk with your doctor or health care professional about what this means to you and others in your family.

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Living with Heart Disease…

Know the Signs of an Emergency Heart disease is the number one killer of men and women. Although there is no cure for heart disease, cardiac rehab and other treatments can lower your risk of recurrent heart attack or stroke. It is very important to know and watch for the warning signs of a heart attack and stroke. Talk with family and friends about the signs and how important it is to call 9-1-1 immediately if they or someone they know are experiencing these warning signs or symptoms.

Heart Attack Warning Signs Chest Discomfort Pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back

Discomfort in Other Areas of the Upper Body Pain or discomfort in one or both arms, the back, neck, jaw or stomach

Shortness of Breath Often comes with or before chest discomfort

Other Signs May include: breaking out in a cold sweat, nausea or light-headedness (Women are more likely to have other common symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain)

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Living with Heart Disease…

Signs of a Stroke • Sudden Numbness or Weakness of the face, arm or leg, especially on one side of the body • Sudden Confusion, trouble speaking or understanding • Sudden Trouble Seeing in one or both eyes • Sudden Trouble walking, dizziness, loss of balance or coordination • Sudden, Severe Headache with no known cause

Act FAST to increase recognition and response to stroke symptoms. In a brain attack, every second counts.

FACE

— Ask the person to smile.

ARM

— Ask the person to raise both arms.

Does one side of the face droop?

Does one arm drift downward?

SPEECH — Ask the person to repeat a simple sentence.

Does the speech sound slurred or strange?

TIME

— If you observe any of these signs, call 9-1-1.

(You need to get to PMC’s Emergency Department in less than 3 hours for treatment.)

If you think you or someone you know is having a heart attack or stroke, call 9-1-1 immediately.

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Living with Heart Disease…

Cardiac Rehab Program Cardiac Rehab is a vital part in the recovery of heart disease. According to the American Heart Association, “research shows that cardiac rehabilitation patients who are exercise-trained are less likely by 26% to suffer from cardiac death than patients who only receive general care.”

Your family doctor, Cardiologist or Cardiothorasic Surgeon can refer you to the Cardiac Rehab Stage II Program. Cardiac Rehab is covered by most health care plans and Medicare.

Cardiac Rehab is located on the first floor of Pikeville Medical Center in the Miners Building. The program consists of three one-hour exercise sessions a week, totaling 36 sessions over a three month period. We are flexible to your schedule.

The department is open Monday thru Friday.

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Living with Heart Disease…

What are the Benefits of Attending Cardiac Rehab?

• Reduce the risk of another heart attack or death • Alleviate or lessen activity related symptoms • Limit or reverse the progression of atherosclerosis (hardening of the arteries) • Reduce blood pressure • Receive close nurse supervision • Positive motivation through support groups • Smoking cessation counseling • Decrease body weight and fat stores • Improve physical fitness • Modify lipid (cholesterol) levels • Improve vessel function • Psychological, vocational or occupational counseling • Nutritional counseling • Stress management

Success in Cardiac Rehab is based on the level of patient participation.

People who attend regularly and actively participate have a better quality of life and a better long term outcome. The heart is a muscle, and like all muscles in the body, it must be exercised to keep it in shape.

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Living with Heart Disease…

Learn to Eat Healthy Choose a wide variety of foods. Eat healthier types of food and cut back on unhealthy snacks. Learn to reduce portion sizes. This will help you not only become healthier but will also help you manage your weight.

Eat More:

Have Less:

• Fresh fruits and vegetables

• High-fat animal products

• Whole grains

• Snack foods and fast food

• Foods high in unsaturated fat

• Foods high in sodium

• Non-meat sources of protein

• Alcohol

What is a Calorie?

A calorie is a unit of energy you get from the foods you eat. Your body burns some calories to fuel its functions and other calories are burned during activity. Calories you don’t burn off are stored as fat. To maintain a healthy weight, you need to track how many calories you eat. The chart on page 12 shows recommended calorie intake based on gender, age and activity level.

Remember to: • Eat fresh foods (fresh foods hold lots of nutrients) • Stay away from food with added fat, sugar, color or sodium • Compare labels to find foods high in fiber, vitamins and other nutrients • Put processed foods back on the shelf • Don’t buy pasta meals or rice with powdered flavor packets; instead season with fresh herbs • Keep portion size reasonable

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Living with Heart Disease…

Using MyPyramid MyPyramid helps you choose the best types and right amounts of foods to eat. Serving suggestions are based on MyPyramid’s guidelines for a daily intake of 2,000 calories.

Grains • Foods such as bread, pasta, rice, cereal and tortillas • At least half the grains you eat should be whole grains; look for foods that list a whole grain (whole wheat or whole rolled oats) as the first ingredient

Vegetables • Eat plenty of different colored vegetables for a variety of nutrients Good choices include: dark green vegetables (spinach, collard greens, broccoli); bright red and orange vegetables (carrots, red bell peppers, tomatoes); starchy vegetables (potatoes, squash)

Fruit • Most of your fruit should come from whole sources Try any fruit that’s fresh, frozen or canned in its own juice (no sugar added)

Oils • Fats that are liquid at room temperature are considered oils

• Too many oils and excess fat leads to weight gain and an increased risk for heart disease This group includes oils with which you can cook, plus foods that are mostly oil such as mayonnaise and salad dressing

Milk • Includes milk and milk-based foods such as cheese, cottage cheese and yogurt • Choose low-fat or nonfat milk products • If you’re allergic to milk, get calcium from leafy greens and from calciumfortified foods, such as orange juice and soy products

Meat and Beans • Includes foods high in protein (meat, poultry, fish, soy products, beans, nuts, seeds and eggs) • Look for meat with little or no visible fat; before cooking cut off all visible fat

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Living with Heart Disease…

Shop Heart-Healthy It is important to pay attention to food labels and make healthy choices as you shop.

Below is a Nutrition Facts label. When shopping look for the words highlighted on this chart and make good decisions!

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Living with Heart Disease…

Let Packaging Claims Work for You Claims on a product’s front label can be confusing. “Healthy” and “natural” have no nutritional meaning. But what about “reduced fat” and “light in sodium?” The claims below are defined by the government. Brands with these claims are more healthy than the standard version of the product.

Be a Heart-Smart Shopper Most people shop by habit. Now is the time to turn off the automatic pilot! Make a shopping list before you enter the store. Stick to the list and avoid impulse buys.

The following tips can help you make heart-healthy choices while you shop.

• Produce section: Start shopping here.

You can trim fat by building meals around produce instead of meat.

Fresh fruits and vegetables contain almost no sodium.

• Meat counter: Try fish or chicken instead of red meat. Remember: beans, tofu or nuts are also good alternatives to meat. Avoid meats that are cured or smoked. These processes add a lot of sodium.

• Dairy section: Try low-fat dairy products. If you usually buy whole milk, try reduced-fat or 1% instead.

• Snack food section: Look for low-fat, low-sodium versions of your favorite snacks. Snack foods often contain trans fat, so read labels with care.

• Frozen food section: Frozen dinners are often high in fat and sodium. Look for plain frozen foods without sauces.

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Living with Heart Disease…

What Can You Choose Instead?

Lots of foods give you the taste or texture you crave without overloading you with fat and sodium. Below are a few switches you can make. Start by making one change a week and work up to a change a day. Of course, what you choose depends on what you like. Put a star beside the options you might try first. Can you think of other heart-healthy switches for foods you often eat?

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Living with Heart Disease…

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Living with Heart Disease…

Medication for Heart Disease

Many people with heart disease take the four medications listed on this chart. Other common medications are listed at the bottom

Type:

What it does:

Statin

• Reduces the amount of LDL (bad) cholesterol and other fats in the blood (this then reduces the chance of clogged arteries) • May improve levels of HLD (good) cholesterol

ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Aspirin

of the page.

• Lowers blood pressure • Decreases strain on the heart (this makes it easier for the heart to pump and improves blood flow)

• Helps prevent blood clots, which could block an artery • May reduce your risk of a heart attack

Beta-Blocker

• Lowers blood pressure (slows heart rate) • May strengthen the heart’s pumping action over time

Medication You May Also Take...

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Antiarrhythmic – helps slow and regulate a

Antihypertensive – helps treat high

fast or irregular heartbeat (arrhythmia)

blood pressure (hypertension)

Anticoagulant – helps reduce the risk that a

Calcium channel blocker – helps blood

blood clot will form and block the artery

flow more easily through the arteries

Living with Heart Disease…

Possible Side Effects:

Notes:

Upset stomach, gas, constipation, abdominal pain or cramps, abnormal liver function, muscle soreness, pain, and weakness

Well tolerated, with few side effects

Low blood pressure (may make you dizzy), dry cough, change in kidney function, too much potassium in the body, swelling of mouth, lip or tongue

Dose will be increased as your body gets used to the medication. Call your health care provider immediately if your mouth, lips or tongue becomes swollen. While taking this medication, you will have regularly scheduled lab test to monitor potassium levels and kidney function.

Bleeding, heartburn or indigestion, ringing in the ears, sleepiness, headache

If taking other blood thinners, such as Coumadin (Warfarin) or Plavix (clopidogrel), check with your doctor before using aspirin.

Low blood pressure (may make you dizzy), low heart rate, depression, tiredness sexual dysfunction. Heart failure symptoms may be worse at first, but will improve over time.

Dosage will be increased as your body gets used to the medication. Do not stop taking the medication suddenly. Call your health care provider if you experience any side effects.

Digoxin – slows heart rate and helps the

Nitrate (nitroglycerin) – helps prevent and

heart pump more with each beat

treat angina.

Diuretic – helps rid the body of excess water

Vasodilator – helps blood flow more easily

(important if you have high blood pressure

through the arteries

or heart failure)

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Living with Heart Disease…

Taking Medication Nitroglycerin Nitroglycerin is a medicine used to widen blood vessels and increase blood flow.

Physicians prescribe nitroglycerin to relieve the discomfort of angina. If taken daily, it may help prevent bouts of angina and can often stop an attack. If your symptoms do not stop five minutes after taking this medication, seek medical attention immediately.

How Do I Use Fast-Acting Nitroglycerin?

• Sit or lie down before you take nitroglycerin If you are driving, pull over and park the car. Taking nitroglycerin can lower your blood pressure, which may make you feel dizzy.

• Place the tablet under your tongue and leave it there until it dissolves completely DO NOT SWALLOW. The medication will not work if swallowed. If using spray, spray once inside your cheek.

• Wait 5 minutes If the angina goes away, rest awhile and return to your normal routine.

• If after 5 minutes, chest pain is not better or gets worse, call 911 immediately • After calling 911, stay on the line with the emergency operator (he or she will give you further instructions)

How to Store Your Nitroglycerin Properly?

• Carry your nitroglycerin with you at all times • Store pills in the original container and in a dark, dry place • Check the expiration date on your bottle If past the expiration date, it may not work.

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* Talk to your doctor before using nitroglycerin if you are taking medications for erectile dysfunction

Living with Heart Disease…

Understand the Medication You’re Taking Always know details about the medications you are taking. This helps you take them correctly and safely. Below are questions you need to ask your doctor or pharmacist. Write down the answers they give you to better understand your medications.

• What is the medication’s brand name and generic name, if any?

• Why was I prescribed this medicine? How does it help me?

• How many times per day and at what time of day do I take this medication?

• What dosage should I take?

• What do I do if I miss a dose?

• Should I expect any side effects from this medication?

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Living with Heart Disease…

Your Emotional Health

Research has shown emotional well-being leads to longer, healthier lives for people with heart disease. It is just as important as your physical health. The next few pages will teach you how to deal with the emotional concerns experienced by people suffering from heart disease.

Depression Depression can make you feel unhappy, down or sad every day. You may lose interest in hobbies, activities and people you used to enjoy. Depression may also cause you to: • Feel worthless, guilty or helpless • Feel hopeless about the future • Have trouble sleeping or sleep more than usual • Not feel like eating or eat more than usual • Feel tired, weak or low in energy • Have trouble concentrating, remembering or making decisions • Withdraw from family and friends Remember: Depression is a treatable problem and is very common among people with heart disease. If you have signs of depression, talk with your Cardiac Rehab Team or health care provider

Stay Involved You’ve gone through a life-altering event and this is the time you need support from friends and family. Find people who: • Will listen when you need to talk • Give you advice when needed • Are affectionate toward you

What Can You Do? • Keep doing the hobbies you enjoy • Try a new activity • Stay involved with your family and friends • Join a heart disease support group

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Living with Heart Disease…

Dealing with Stress Learning how to react to life’s ups and downs can make a difference in your health.

Learning to be aware of yourself and the choices you make is the first step in dealing with stress. Keep these simple ideas in mind: • Identify your stressors • Have realistic expectations • Change your response to stress • Talk to someone about your stress • Take time to relax • Visualize peaceful settings when relaxing

Sex and Intimacy People who have heart trouble often develop strong feelings that can affect their desire for sex. Some are afraid for the future and feel angry this has happened to them. As your body heals, your interest and desire for sex are likely to return.

An intimate relationship is built on shared feelings. Talking honestly with your partner is the first step to rebuilding intimacy. When you talk remember the following: • Choose a time when you are both relaxed • Pick a place where you feel at ease and won’t be interrupted • Listen to each other • Acknowledge each other’s concerns • Support each other and be patient If you’ve had Heart Surgery it takes your breastbone time to heal. Until then, try positions that put less strain on your chest and avoid movements that cause chest discomfort. * Having sex is only part of being intimate. Don’t push yourself if you are not ready. Try hugging, kissing and touching first.

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Living with Heart Disease…

Diabetes If you have diabetes, your body has trouble using a sugar called glucose for energy. As a result, the sugar level in your blood becomes too high. If high blood sugar is not treated your arteries can be damaged. Diabetes also elevates other health problems such as high blood pressure and high cholesterol.

Testing your blood sugar each day helps you make better food choices. If you use insulin, test results will show if your medication needs to be adjusted. Keep a record of your test results and the times you performed each test.

How Carbs Affect Blood Sugar Eating foods containing carbohydrates allows your body to have energy that last.

Unfortunately carbohydrates raise sugar levels higher and faster than other kinds of food. People with high blood sugar need to limit the amount of carbohydrates they eat at one time. There are three types of carbohydrates to be aware of: • Starches raise your blood sugar. Starchy vegetables include potatoes, peas and corn.

• Sugars raise your blood sugar level quickly. Foods with natural sugars include fruits, dairy products and honey. Added sugars are found in many desserts, candy, soda and juices. Alcohol may contain both.

• Fiber delays absorption of sugar and helps control blood sugar levels.

Fiber is found in fruits, vegetables, whole grains, beans and nuts.

When you eat is just as important as what you eat for blood sugar control. Eating several small meals spaced evenly throughout the day can help you stay in your target range. Remember to never skip breakfast!

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Living with Heart Disease…

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Living with Heart Disease…

Managing Your Risk Factors What is Cholesterol?

Cholesterol is a waxy, fat-like substance (lipid) carried in the blood. Cholesterol is found in every cell of your body and serves many vital functions. Our bodies need cholesterol to: • Maintain healthy cell walls • Make hormones • Make vitamin D • Make bile acids, which aid in fat digestion Sometimes, however, our bodies make more cholesterol than we really need, and the excess circulates in the bloodstream. High levels of cholesterol in the blood can clog blood vessels and increase the risk for heart disease and stroke.

Types of Lipids Each type of lipid affects the body in different ways. To function normally, the body needs the right balance of these types.

• LDL is often called “bad” cholesterol. When the body has too much LDL, it can build up in the artery walls. This can lead to a heart attack or stroke. LDL should be 100 or lower.

• Triglycerides are lipids, often measured with cholesterol. A high triglyceride level may lead to plaque buildup in arteries.

Triglyceride levels should be 150 or lower.

• HDL is known as “good” cholesterol. It picks up leftover LDL cholesterol from the arteries and carries it back to the liver to be used again. HDL should be 40 or higher for men; 50 or higher for women.

• Total cholesterol is the combined measure of all types of cholesterol.

This number should be under 200.

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Living with Heart Disease…

Understanding Blood Pressure As the heart pumps blood through the body, force is created inside the arteries.

Your blood pressure reading is the measure of this force. If your blood pressure is high, your heart must pump harder to push blood through the arteries. This can weaken the heart and damage blood vessels over time.

Checking Your Blood Pressure Blood Pressure can be measured by a health care provider or you can do it at home. The test always gives you two numbers a systolic pressure “over number” and a diastolic pressure “bottom number.” For example: 120 - systolic

80 - diastolic

Systolic The top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts).

Diastolic The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).

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Living with Heart Disease…

Smoking: This Time, Quit for Good For people who smoke, quitting is one of the most important decisions you can make for your heart. Quitting is not easy, but it will lower the risk of having a heart attack.

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Have a “Quit Plan”

Track Your Triggers

Quitting smoking takes patience and a plan. Choose and mark a date on your calendar as your “quit date.” Your doctor and Cardiac Rehab Team can work with you to develop this plan, help you learn how to quit and teach you how to deal with the urge to smoke.

In most cases, certain emotions, places or people can trigger the urge to smoke. For one full day, write down each instance you feel the need to smoke. Record the time of day and what you were doing right before you had the urge. You may start to see a pattern. The next step is to find ways to avoid or deal with these triggers.

Living with Heart Disease…

Choose a Quit-Smoking Product to Help Quit-smoking products make it much more likely for a person to quit for good.

Some products can be bought over the counter and others require a prescription.

Talk to your health care provider or cardiac rehab team about these products.

They can help you make a decision about which to try.

All products conflict with certain other medications or medical conditions. If you have questions, ask your pharmacist or doctor. * These products contain nicotine. Don’t smoke while using a nicotine product. Doing so could give you a dangerous overdose of nicotine.

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Living with Heart Disease…

Smoking: Working Through Withdrawal As your body adjusts to not smoking, you will most likely go through a short period of withdrawal. This will pass. Talk with your health care provider and cardiac team about what your going through. The following are tips to help you manage the first few weeks without smoking.

Be Prepared

Munch on Healthy Snacks

Nicotine is a powerful and addictive drug. Not smoking can bring on Here are a few snacks to keep your withdrawal symptoms including mood mouth busy while your urges to smoke swings, lower energy and trouble pass: thinking clearly. These symptoms will • Crunchy snacks: apple slices, go away in time. carrot or celery sticks with nonfat dip, pretzels, rice cakes Keep Yourself Busy or air-popped popcorn Find activities to keep you busy. This will act as a distraction when you get the urge to smoke. Activity makes it less likely for you crave a cigarette. Below are a few activities for you to try when the urge strikes: • Garden • Play a game with your kids or grandkids • Walk around the block • Stretch your arms and shoulders • Drink a glass of water • Brush your teeth • Go outside to get some fresh air • Exercise

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• Sweet snacks: angel food cake, low-fat cookies or muffins, sugarless gum or hard candy • Creamy snacks: fat-free pudding, yogurt or applesauce

Living with Heart Disease…

Learn from Slipups If you slip up and have a cigarette, this does not mean you have failed. This can be a chance for you to learn. Realize why you smoked. Ask yourself, “What was I doing when I smoked?” Were you with a smoker? Were you lonely? Once you find this out, you can then try to prevent this from occurring again.

Learn to take control. If you slip up again, put the cigarette out.

Get Support • Ask a friend if you can call and talk when you get the urge to smoke • Ask friends and family members not to smoke around you or keep cigarettes in the house • Ask a friend or family member who smokes to quit with you

My Quit Contract Signing a contract can make you feel a stronger commitment to quitting. Ask a friend or family member to witness your signing. Be sure to ask someone who believes you can quit.

I,______________________________, will quit smoking on ___________________ and will call my support person for help if I slip and smoke again.

My signature: ____________________________________________________________________________ My support person’s signature: ____________________________________________________________________________

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