This document provides information and guidance for managing congestive heart failure (CHF) at home. It discusses weighing daily and maintaining a low sodium diet as two of the most important ways to manage symptoms. It also covers fluid intake limits, types of heart failure medications, managing activity levels, and when to contact a doctor for worsening symptoms like weight gain or increased shortness of breath. The document aims to educate heart failure patients on lifestyle and medication management.

1. Dawn Martinez, RN
Heart Failure Program Coordinator

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3. Table of Contents
• What Is Congestive Heart Failure? 5
• What Does Congestive Heart Failure Mean? 6
• What Causes Heart Failure? 7
• Managing Your Heart Failure At Home 8
• Blood Pressure And Heart Failure 9
• How To Weigh Yourself Every Day 10
• Why Should I Weigh Every Day? 11
• Fluid Control 12
• Items That Count As Fluids, and Fluid Control Tips 13
• Why Is A Low Sodium Diet Important? 14
• Low Sodium Diet Tips 15
• Common High Sodium Foods & Spices 16
• Common Low Sodium Foods & Spices 17
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4. Table of Contents
• Tips for Dining Out 18
• More Diet Tips 19
• Heart Failure Medicines 20
• Types of Heart Failure Medication 21
• Medication Tips 22
• Activity Guidelines 23
• How Much Is Too Much Activity? 24
• Why Stop Smoking and Drinking? 25
• Stress Management 26
• How Can My Family Help Me? 27
• When To Call My Doctor 28
• When To Call 911 29
• Questions For Your Healthcare Team 30
• Resources 31
• More Information 32
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5. What Is Congestive Heart Failure?
• Your heart has become too weak or too stiff to pump out
enough blood to meet your body’s needs.
• It is not the same as a heart attack. Not all people with
heart failure have had heart attacks. Heart attacks are due
to blockages in the blood vessels that feed the heart.
• It does not mean your heart is “stopping.” You can live
with heart failure for a long time, but it is a serious disease
that can affect your quality of life and how long you live.
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6. What does Congestive Heart Failure
Mean?
• When your heart doesn’t pump
enough blood out to your body,
fluid begins to build up in your
blood vessels, especially the blood
vessels to the lungs. This fluid leaks
into the lungs, belly, and feet &
legs. It causes you to feel short of
breath, weak, and to have swelling
in the legs, feet, and belly.
• Congestive Heart Failure, CHF,
Heart Failure, and HF are all names
for the same condition.
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7. What Causes Heart Failure?
• There are many conditions which may lead to heart
failure. High Blood Pressure, High Pressure in the
Lungs, Irregular Heart Beat, Coronary Artery Disease
(blockages in the heart’s blood vessels), and Heart
Valve Problems are very common causes.
• Smoking, Alcohol Abuse, Cocaine or other street drug
use, some types of Heart Infections, and Diabetes can
also lead to heart failure. Sometimes we cannot figure
out why a person has gotten heart failure.
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8. Managing Your Heart Failure At Home
There are several important ways that you
can help control your heart failure
symptoms. These are things you can do
in addition to taking all of your
medications and following all of your
doctor’s instructions!
Two of the most important ways you can
help take care of yourself are:
Weigh yourself every day, and
write it down.
Eat a low sodium (salt) diet.
Other things you can do to control your
heart failure are: check your blood
pressure, get enough exercise and rest,
and stop drinking alcohol and smoking.
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9. Blood Pressure And Heart Failure
Many HF patients have high
blood pressure too. High
blood pressure makes your
weak heart work even
harder, and you may feel
much worse as a result. You
may have more problems
and more symptoms.
It is important to take any
medications your doctor
prescribes for your blood
pressure. Following a low
salt diet will also lower your
blood pressure.
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10. How To Weigh Yourself Every Day
Doing “Daily Weights” is a bit more than just stepping on the
scale each day. It is important that you follow these tips to
make your weight as accurate as possible:
Weigh in the morning, after using the bathroom but
before breakfast.
Use the same scale every day. Make sure it is on a hard
floor, not a rug or carpet.
Wear the same amount of clothing every time you
weigh.
Record your weight in your Heart Failure Log each day.
If you are just getting home from the hospital, weigh
on your scale right away and record it. Your weight will
probably be different than the hospital scale weight.
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11. Why Should I Weigh Every Day?
Your condition may change very
quickly when you have CHF.
One of the earliest signs of a
change in your heart failure is
weight gain. If you are weighing
yourself each day, the scale will
show the extra fluid you are
carrying before you even begin
having symptoms. This is an
important step in keeping you
out of the hospital by catching
changes very early.
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12. Fluid Control
Your doctor may instruct you to drink only a certain amount of fluids
each day, so that the fluids don’t build up in your body and make
your heart failure symptoms worse. Usually, the instructions will
tell you to drink only a certain amount in liters or ML or CC. The ML
and CC are the same thing, and a liter is 1000 ML.
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1 quart = 4 cups = 32 ounces = 960 ML = approximately 1 Liter
1 pint = 2 cups = 16 ounces = 480 ML
1 cup = 8 ounces = 240 ML
1 ounce = 30 ML

13. Items That Count As Fluids, & Fluid
Control Tips
• All drinks: water, tea, milk, coffee, beer, wine, liquor, soda,
punch, and juices, etc.
• Ice cubes, Ice cream, popsicles, sherbet, sorbet
• Jello, gelatin salads
• Cream and liquid non-dairy creamer
• Soup, stock, broth
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Lemon wedges, sour hard candies, and gum help moisten your
mouth.
Mouthwash to refresh a dry mouth.
Measure out your allowed fluid for the day, and stick to it.
Use small cups and glasses—makes you feel as if you are having
more fluid if you have to refill your glass.
Eat allowed fruits ice cold between meals to refresh dry mouth.
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14. Why Is A Low Sodium Diet Important?
• Sodium is an important chemical that our
bodies need to function properly, but
when there is too much sodium, or
salt, in the body our kidneys hold on to
extra fluid to dilute the salt or thin it out.
Heart failure weakens the heart and it
cannot handle this extra fluid, so you
begin to have symptoms of fluid
overload, like swelling and shortness of
breath.
• A low sodium diet is about 2000mg (or 2
grams) daily. This is about one teaspoon
of salt! Your body actually needs only
about 1/8 teaspoon to function each day.
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15. Low Sodium Diet Tips
• It may be very difficult to
change your eating habits, so
don’t be discouraged if you
make mistakes. Each day, take
small steps toward the ideal
low salt, low fat diet and you
will reach your goal.
• The easiest salt tip: GET RID OF
THE SALT SHAKER!
• Low salt and low fat do NOT
equal no flavor!
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16. Common High Sodium Foods & Spices
• Packaged mixes: gravies, sauces, taco seasoning, marinades, mac-n-cheese, dinner
kits (Hamburger Helper), instant potato mixes, etc.
• Season Salt, Garlic Salt, Lite Salt, any seasonings with “salt” in the name.
• MSG, monosodium glutamate, Accent, meat tenderizer.
• Soy Sauce (even the “lite” kind), Worcestershire, Teriyaki Sauce, etc.
• Ketchup, Jarred Salsa, BBQ Sauce, Cocktail Sauce, Salad Dressings, Steak Sauce,
Hot Sauce.
• Most spice mixes such as Cajun Seasoning, Poultry Seasoning, Steak Seasoning,
etc.
• Pickles, Relishes, Chutneys, Jarred Horseradish Sauce, Antipasti, Dips.
• Canned Soups, Gravies, Broths, Tomato Sauces, Tomato Paste.
• Canned and Jarred Vegetables, Canned Beans, Sauerkraut, etc.
• Lunch or Deli Meats, Canned Meats/Fish, Yellow Cheeses, Velveeta or American
Cheese, Hot dogs, Sausages, Bacon, Bacon Bits, Imitation Seafood (Krab)
• Most Frozen or Prepared Bread Products or Kits such as Instant Cereals/Grits,
Frozen Waffles, Corn Bread Mix, Dressing Mix, etc.
• Salty snacks: Chips, Nuts, Pretzels, Saltines, etc.
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17. Common Low Sodium Foods & Spices
• Mrs. Dash Seasonings and Marinades
• Pure Dried Spices such as Basil, Oregano, Italian Seasoning, Onion or Garlic
Powder, Black Pepper
• Fresh Herbs and Garlic
• Flavored Vinegars, Citrus Juices
• Unsalted or “No Salt Added” Canned Soups, Broths, and Vegetables
• Dried Beans, Grains, and Pastas
• All Fresh or Frozen Vegetables and Fruits
• All Fresh/Frozen Meats, Poultry, Seafood, Eggs and Egg Substitutes
• White and Cream Cheeses, Ricotta, Cottage Cheese
• Frozen Dinners with less than 600MG of Sodium each
• Milk, Yogurt, Frozen Yogurt
• Most Breads, Muffins, Rolls, etc.
• Low Sodium Vegetable Juices, Tomato Sauces, etc.
• Fresh, Refrigerated Salsa (From the Produce Section).
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18. Tips For Dining Out
• Ask Questions! Your Waiter or Cook Can
Explain How Most Of The Dishes Are
Prepared and Make Recommendations For
Low Salt and Low Fat Dishes.
• Avoid Dishes with Gravies, Sauces, Soy
Sauce, or MSG. Order Plain Foods such as
Plain Baked Potato, Rice, Etc. Do Not Order
Smoked or Cured Foods.
• Oil & Vinegar Dressing for Salads. Avoid
Marinated Salads, Croutons, Creamy
Dressings, Bacon Bits, Yellow Cheese, Olives,
Pickles, and Antipasti.
• Get Grilled, Broiled, or Baked Entrees.
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19. More Diet Tips
• Watch your portion sizes. Most packaged meals contain more than one
serving.
• Read the Nutrition Labels. Look for Sodium Free (less than 5mg per
serving), Very Low Sodium (35mg or less per serving), or Low Sodium
(140mg or less per serving), High Fiber (5gm or more per serving), Low
Cholesterol (20mg or less per serving), Cholesterol Free (less than 2mg per
serving), Low Fat (3gm or less per serving), and Fat Free (less than ½ gm
per serving).
• Try to keep sodium, fat, and cholesterol less than 5% of the Daily Value per
serving. Daily Value is based on 2000 calorie diet usually, sometimes 2500
calories.
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20. Heart Failure Medicines
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Heart Failure medicines help your weak heart to work
better and help relieve your symptoms. Sometimes you
will also take medicines to control other health conditions
which may make your heart failure worse. Depending on
your particular needs, you may take very different
medications from other heart failure patients.

21. Types of Heart Failure Medication
• ACE Inhibitors or ARBs: Work in the kidney system to lower the blood
pressure so the heart doesn’t have to work as hard.
• Beta Blockers: Slow the heart rate while letting the heart pump better by
stopping some of the harmful chemicals that are produced during heart
failure episodes. They also lower blood pressure. Sometimes you may feel
worse when starting or changing the dose of beta blockers, but this effect
is temporary.
• Digoxin: Helps the heart beat stronger. This helps your heart pump more
blood out to the rest of the body.
• Isordil dinitrate and hydralazine decrease how hard the heart has to pump
by lowering the blood pressure.
• Diuretics, or “water pills,” get rid of excess fluid in your body. This will help
get rid of some of the swelling in your body and may help you breathe
more easily. The heart doesn’t have to work as hard to pump blood to the
body when the extra fluid is removed. Some diuretics cause you to lose
potassium, so your doctor may prescribe a potassium supplement for you.
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22. Medication Tips
• Take all your medication exactly as directed. Take them at the same times
every day. Using a pill organizer or writing times on the bottle lid may help
you.
• Always keep the medicines in the original bottle (except for the ones in
the pill organizer) and question your pharmacist if the pills change shape
or color when you refill them.
• Do not run out of any medications. Make sure you have enough to last the
whole trip if you are travelling. If you do run out of your medicine, call
your doctor right away.
• Keep an up-to-date list of your medications with you at all times. Take your
medicine bottles to all your doctor’s appointments, including any vitamins,
herbs, or other supplements you take. Tell the doctor about any home
remedies or over-the-counter medicines you take too.
• Don’t change the dose of medicine you are taking or skip any doses unless
your doctor has instructed you to do so. If you miss a dose, don’t take it
with the next dose!
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23. Activity Guidelines
• Group your activities with planned
rest periods between them. A 30
minute rest period is usually enough.
Don’t overdo it!
• Avoid activities in extreme
temperatures.
• Do not perform heavy lifting.
• Don’t start exercising unless your
doctor has said it is OK. Ask about a
cardiac rehab program to help you
increase your activity slowly.
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24. How Much Is Too Much Activity?
• If you are tired, stop and rest.
• IMMEDIATELY STOP THE ACTIVITY IF:
– You have increased shortness of breath
– Chest pressure or pain
– Dizziness or feel faint
– Palpitations or a racing heart
– Unusual, severe weakness or tiredness
– If the symptoms do not go away call your doctor or go to
the emergency room!
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Smoking causes the body’s blood vessels to tighten up. Your weak heart then
has to work much harder to pump blood out to the body. Smoking causes
damage to the lungs, which may make it harder for you to tolerate the
symptoms of heart failure.
Drinking alcohol can lead to a weak heart muscle and worsen your HF
symptoms even more. The extra fluid you drink with alcohol may make your
swelling and shortness of breath worse. Alcohol damages the liver. The liver
helps your body use the medications you must take. If your liver is damaged,
your heart failure medicines may not work as well.
If you are having trouble stopping smoking, drinking, or using street drugs, talk
to your doctor or nurse. There are many ways your healthcare team can help
you quit!

26. Stress Management
• It is important to control stress in your daily life. Stress
causes chemical changes in your body which put a strain on
your weakened heart.
• Many people use meditation, yoga, mindfulness activities,
journaling, or guided imagery to relieve stress. Ask your
nurse about these techniques or others that may help.
• If you feel overwhelmed by the stressors in your life,
speaking with a counselor may also help.
• Sometimes people with serious chronic diseases like HF
become depressed due to all the changes and issues
associated with their diseases. If this occurs, your doctor
may recommend medications or other types of treatment
to help you deal effectively with these stressful issues.
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27. How Can My Family Help Me?
• Heart Failure is a complicated disease which can be difficult to
manage alone. The many medications, diet and fluid restrictions,
and all the other “rules” for taking care of yourself can become
confusing, especially when you are very tired or your brain is feeling
“fuzzy” from the HF.
• Your family can assist in many ways: by helping you organize your
medications, going to doctor visits with you, and helping you shop
for HF healthy foods. They can also watch for signs and symptoms
that you may not be aware of, so that early treatment can keep you
out of the hospital!
• Your family can help you when you are feeling overwhelmed or
upset as well. Most HF patients go through periods where they are
angry or sad or feel lost because of all the life changes their heart
failure has caused. Talking to a trusted friend or family member, or
another CHF patient can help with this stress.
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28. WHEN TO CALL MY DOCTOR
• Weight gain of 2-3 pounds in 1 day or 5 pounds
in less than a week.
• Worsening shortness of breath or when at rest.
• New or worsening swelling of feet, legs, belly, or
hands.
• Feeling full, hungry but unable to eat much,
bloated or tight.
• New or worsening cough (wet or dry).
• Needing more pillows than usual to sleep or
unable to breathe well when lying down, unable
to sleep due to restlessness.
• Feel dizzy or lightheaded but have not passed
out and do not have new or worsening irregular
heartbeat.
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29. WHEN TO CALL 911
• ANY CHEST PAIN OR PRESSURE
THAT DOESN’T GET BETTER AFTER
FIFTEEN MINUTES OF REST OR
AFTER TAKING PRESCRIBED DOSES
OF NITROGYLCERIN
• SEVERE SHORTNESS OF BREATH,
COUGHING UP FOAMY PINKISH OR
WHITE SPUTUM
• FAST OR VERY IRREGULAR HEART
BEAT THAT MAKES YOU FEEL WEAK
OR DIZZY
• A FAINTING SPELL
• SEVERE CONFUSION AND
DIFFICULTY THINKING
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30. Questions For Your Healthcare Team
1. ____________________________________
Answer: _____________________________
2. ____________________________________
Answer: _____________________________
3. ____________________________________
Answer: _____________________________
4. ____________________________________
Answer: _____________________________
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31. Resources
My Heart Failure Doctor: ___________________
Phone: (___)___-____
Pharmacy: ______________________________
Phone: (___)___-____
My Primary Doctor: _______________________
Phone: (___)___-____
Mainland Center Hospital: (409)938-5000
Mainland Heart Failure Nurse: (409) 938-5159
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32. More Information
• American Heart Association:
www.americanheart.org
• Freedom from Smoking:
www.ffsonline.org
• Heart Failure Society of
America:
www.hfsa.org
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