This document provides information on congestive heart failure (CHF), also known as congestive cardiac failure (CCF). It discusses the definition, types, causes, symptoms, diagnostic evaluation, treatment, and surgical management of CHF. The main types are left-sided, right-sided, and biventricular failure. Causes include high blood pressure, coronary artery disease, heart attack, and diabetes. Symptoms depend on the type but commonly include shortness of breath, swelling, and fatigue. Diagnosis involves blood tests, imaging like echocardiograms, and stress tests. Treatment focuses on medications, lifestyle changes, and may include surgery like coronary artery bypass grafting.

1. CONGESTIVE HEART FAILURE
PRESENTED BY
R.PRIYA

2. INTRODUCTION
The burden of Heart Failure in India appears high, and estimates of prevalence
range from 1.3 million to 4.6 million, with an annual incidence of 491 600–1.8
million. Heart failure is a common, costly, and potentially fatal condition, and it is
the leading cause of both hospitalization and readmission amongst older adults. In
2015, it affected about 40 million people globally.Overall around 2% of adults have
heart failure and in those over the age of 65, this increases to 6–10%. Rates are
predicted to increase. The risk of death is about 35% the first year after diagnosis,
while by the second year the risk of death is less than 10% for those who remain
alive. This degree of risk of death is similar to some cancers.In the United
Kingdom, the disease is the reason for 5% of emergency hospital
admissions. Heart failure has been known since ancient times, with the Ebers
papyruscommenting on it around 1550 BCE.

3. DEFINITION OF CCF
• Heart failure (HF), also known as congestive heart failure (CHF),
(congestive) cardiac failure (CCF), and decompensation cordis,
is when the heart is unable to pump sufficiently to maintain blood
flow to meet the body tissues needs for metabolism.

4. TYPES OF CCF
•Left-sided heart failure. Left-sided heart failure is the most
common type of heart failure. ...
•Right-sided heart failure. The right heart ventricle is responsible for
pumping blood to lungs to collect oxygen. ...
•Both sided heart failure/Biventricular heart failure
• CLASSIFIED BY PUMPING ABILITY OF THE HEART
•Diastolic heart failure. ...
•Systolic heart failure.
• CLASSIFIED BY COURSE OF DISEASE
• Acute heart failure
• Chronic heart failure

5. LEFT SIDE HEART FAILURE
Left-sided heart failure: The left ventricle of the heart no longer pumps enough
blood around the body. As a result, blood builds up in the pulmonary veins (the blood
vessels that carry blood away from the lungs). This causes shortness of breath,
trouble breathing or coughing – especially during physical activity. Left-sided heart
failure is the most common type.
Left-sided heart failure is usually caused by coronary artery disease (CAD), a
heart attack or long-term high blood pressure.

6. RIGHT SIDE HEART FAILURE
Right-sided heart failure: Here the right ventricle of the heart is too weak to pump
enough blood to the lungs. This causes blood to build up in the veins (the blood
vessels that carry blood from the organs and tissue back to the heart). The increased
pressure inside the veins can push fluid out of the veins into surrounding tissue. This
leads to a build-up of fluid in the legs, or less commonly in the genital area, organs
or the abdomen (belly).
Right-sided heart failure generally develops as a result of advanced left-sided heart
failure, and is then treated in the same way. It is sometimes caused by high blood
pressure in the lungs, an embolism in the lungs (pulmonary embolism), or certain
lung diseases such as COPD.

7. BOTH SIDED HEART FAILURE
Biventricular heart failure: In biventricular heart failure, both sides of the heart are
affected. This can cause the same symptoms as both left-sided and right-sided heart
failure, such as shortness of breath and a build-up of fluid.

8. CLASSIFIED BY PUMPING ABILITY
SYSTOLIC HEART FAILURE AND DIASTOLIC HEART FAILURE
Heart failure with reduced pumping ability: The heart muscle has become
weaker, and no longer pumps enough blood around the body when it contracts
(squeezes). As a result, the organs in the body don’t get enough oxygen. The
medical term for this is “heart failure with reduced ejection fraction.”
(SYSTOLIC HEART FAILURE)
Heart failure with preserved pumping ability: Although the heart muscle is still
strong, it can no longer relax and widen enough after it has squeezed blood out, so
it doesn’t fill up with blood properly. Despite pumping strongly enough, not
enough blood is pumped out into the body as a result, especially during physically
strenuous activities. Doctors call this “heart failure with preserved ejection
fraction.”(DIASTOLIC HEART FAILURE)

9. CLASSIFIED BY COURSE OF DISEASE
ACUTE HEART FAILURE
Heart failure can develop suddenly, for instance after a heart attack or
due to certain heart rhythm problems. This is known as acute heart
failure.
CHRONIC HEART FAILURE
But it usually develops gradually over time as a result of a different
medical problem, such as permanently high blood pressure. This is
known as chronic heart failure.

10. CAUSES AND RISK FACTOR
•High blood pressure. heart works harder than it has to if blood pressure
is high.
•Coronary artery disease. ...
•Heart attack. ...
•Diabetes. ...
•Some diabetes medications. ...
•Certain medications. ...
•Sleep apnea. ...
•Congenital heart defects.

11. •Age. Growing older increases risk of damaged and narrowed
arteries and a weakened or thickened heart muscle.
•Sex. Men are generally at greater risk of heart disease. ...
•Family history. ...
•Smoking. ...
•Poor diet. ...
•High blood pressure. ...
•High blood cholesterol levels. ...
•Diabetes.
CAUSES AND RISK FACTOR

12. PATHOPHYSIOLOGY OF CCF

13. PATHOPHYSIOLOGY CON…

14. SIGNS AND SYMTOMS

15. SIGNS AND SYMTOMS
LEFT SIDED HEART FAILURE SIGNS AND SYMPTOMS
•Awakening at night with shortness of breath
•Shortness of breath during exercise or when lying flat
•Chronic coughing or wheezing
•Difficulty concentrating
•Fatigue
•Fluid retention causing swelling, or edema, in the ankles, legs and/or feet
•Lack of appetite and nausea
•Rapid or irregular heartbeat
•Sudden weight gain
As these symptoms occur, they cause the heart to try to pump harder, which
causes further damage such as:
•Enlarged heart
•Rapid heart rate
•High blood pressure
•Less blood flowing to the arms and legs

16. SIGNS AND SYMPTOMS
• RIGHT SIDE HEART FAILURE SYMPTOMS
• feet, legs, and ankles will likely to swell because blood is backing up in veins.This symptom is
called edema.
•If it backs up into stomach or liver, may notice that abdomen is distended, too.
• might find that have to go to the bathroom more, especially at night.This is caused by fluid
buildup, too.
As heart failure gets worse, may also see some of these symptoms:
•It’s hard to breathe.
•neck veins are swollen.
•pulse is fast or feels “off.”
•chest hurts.
•gaining weight from excess fluid.
•don’t feel like eating.
•skin is cold and sweaty.
•very tired.
•confused and forget things.
•Other types of heart failure have same symptoms

17. DIAGNOSTIC EVALUTION OF HEART FAILURE
• Blood tests. doctor may take a blood sample to look for signs of diseases that can affect the heart. He or she may also check
for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) if diagnosis isn't certain after other tests.
• Chest X-ray. X-ray images help doctor see the condition of lungs and heart. doctor can also use an X-ray to diagnose
conditions other than heart failure that may explain signs and symptoms.
• Electrocardiogram (ECG). This test records the electrical activity of heart through electrodes attached to skin. It helps doctor
diagnose heart rhythm problems and damage to heart.
• Echocardiogram. An echocardiogram uses sound waves to produce a video image of heart. This test can help doctors see the
size and shape of heart along with any abnormalities. An echocardiogram measures ejection fraction, an important
measurement of how well heart is pumping, and which is used to help classify heart failure and guide treatment.
• Stress test. Stress tests measure the health of heart by how it responds to exertion. may be asked to walk on a treadmill while
attached to an ECG machine, or may receive a drug intravenously that stimulates heart similar to exercise.
• Sometimes the stress test can be done while wearing a mask that measures the ability of heart and lungs to take in oxygen and
breathe out carbon dioxide. If doctor also wants to see images of heart while 're exercising, he or she may use imaging
techniques to visualize heart during the test.
• Cardiac computerized tomography (CT) scan. In a cardiac CT scan, lie on a table inside a doughnut-shaped machine. An X-
ray tube inside the machine rotates around body and collects images of heart and chest.
• Magnetic resonance imaging (MRI). In a cardiac MRI, lie on a table inside a long tubelike machine that produces a magnetic
field, which aligns atomic particles in some of cells. Radio waves are broadcast toward these aligned particles, producing
signals that create images of heart.
• Coronary angiogram. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at groin or in arm and guided
through the aorta into coronary arteries. A dye injected through the catheter makes the arteries supplying heart visible on an X-
ray, helping doctors spot blockages.
• Myocardial biopsy. In this test, doctor inserts a small, flexible biopsy cord into a vein in neck or groin, and small pieces of the
heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.

18. DIAGNOSTIC EVALUTION
Cardiac catheterization
• How the procedure is done:
• A very small tube (catheter) is inserted into a blood vessel in upper thigh or arm.
• The tip of the tube is positioned either in the heart, or where the arteries supplying
the heart originate.
• A special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-
ray.
• The pictures that are obtained are called angiograms.
• This procedure may involve some discomfort from placement of the catheter. may
be required to rest in a certain position after the procedure.
• What cardiac catheterization shows:
• Blockages in the coronary arteries are visible on the X-rays.
• The parts of heart that are fed by the blocked or narrowed arteries may be
weakened or damaged from lack of blood.

19. TREATMENT FOR HEART FAILURE
• Vasodilators expand blood vessels, ease blood flow, and reduce
blood pressure.
• Diuretics correct fluid retention.
• Aldosterone inhibitors help with fluid retention and improve chances
of living longer.
• ACE inhibitors or ARB drugs improve heart function and life
expectancy.
• Digitalis glycosides strengthen the heart’s contractions.
• Anticoagulants or antiplatelets such as aspirin help prevent blood
clots.
• Beta-blockers improve heart function and chances of living longer.
• Tranquilizers reduce anxiety.

20. TREATMENT CON
 Beta blockers (Carvedilol,metoprolol,bisoprilol)
These medicines lower heart rate and blood pressure, and protect heart from certain substances that can
damage heart. Beta blockers are often started at a very low dose and then are increased until a dose is reached
that works best.
Common side effects of beta blockers:
•Dizziness
•Feeling tired
•Worsening of usual symptoms (this might improve over time without changing medicines)
Stopping beta blockers suddenly can cause symptoms to get worse. Don't stop taking medicine without talking
to doctor or nurse.
Call doctor if feel faint, pass out, have increased shortness of breath or wheezing, or have other symptoms
that bother .
 ACE inhibitors(lisinopril,captopril)
Angiotensin converting enzyme (ACE) inhibitors reduce the amount of heart-damaging hormones body
produces. They also dilate blood vessels and lower blood pressure to lessen the workload of heart.
Common side effects of ACE inhibitors:
•Dizziness
•Changes in kidney function
•Dry cough that often improves with time
•Increased potassium levels
will have regular blood tests to check kidney function and potassium levels while taking this medicine.
Get medical help right away if have swelling of mouth, lips, or tongue. This could be an allergic reaction that

21. TREATMENT CON
 Angiotensin receptor blockers (losartan)
• Angiotensin receptor blockers are similar to ACE inhibitors, but they don't cause the cough that some people have when
taking ACE inhibitors.
• Common side effects of angiotensin receptor blockers:
• Dizziness
• Changes in kidney function
• Increased potassium levels
• will have regular blood tests to check kidney function and potassium levels while taking this medicine.
• Get medical help right away if have swelling of mouth, lips, or tongue. This could be an allergic reaction that can be life-
threatening.
 Combination medicines (Entresto, or sacubitril/valsartan)
• Entresto is a medicine that combines the angiotensin receptor blocker (ARB) valsartan with a substance known as sacubitril
that causes the heart to squeeze harder and can help body eliminate excess fluid. The effect of this combination can be more
powerful than either drug alone. Entresto is usually started after a person has been able to tolerate target doses of either an
angiotension converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB), so this is not usually the first
medicine used to treat heart failure. It is currently only used if other medicines have not improved the heart’s ability to pump
effectively. If are taking an ACEI (such as lisinopril or enalapril) will need to stop that medication for 36 hours before starting
Entresto. This is very important; not doing so could result in a serious reaction.
• Common side effects:
• Dizziness
• Changes in kidney function
• Increased potassium levels
• Get medical help right away if have swelling of mouth, lips, or tongue. This could be an allergic reaction that can be life-
threatening.
• Call doctor if have rapid weight loss soon after starting Entresto

22. TREATMENT CON
 Aldosterone antagonist( spironolactone,eplerenone)
These medicines prevent body from producing too much of the hormone aldosterone that can damage heart.
Common side effects of aldosterone antagonists:
•Changes in kidney function
•Increased potassium levels
•Swelling or tenderness in the breasts (in both men and women)
will have regular blood tests to check kidney function and potassium levels while taking this medicine.
 Digoxin (Lanoxin)
This medicine slows heart rate and might improve the pumping ability of heart. 'll get a blood test to make sure the dose 're
taking is right for .
Common side effects of digoxin:
•Nausea
•Poor appetite
•Digestive problems
Call doctor if are nauseated, or notice a yellow tinge or "halos" in vision.
Hydralazine and nitrates (Apesoline, Nitrobid, I mdur,Isordil)
Hydralazine and nitrates are often used together to treat heart failure. They dilate blood vessels so it's easier for heart to
receive and pump blood.
Common side effects of hydralazine and nitrates:
•Dizziness
•Headache

23. TREATMENT CON
 Diuretics: furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex), metolazone (Zaroxolyn)
These medicines are called water pills because they remove excess fluid from the body to help breathe easier and feel
better.
If take a diuretic once a day, take it in the morning. If take it twice a day, try to take the second dose no later than 4 p.m.
to lessen the urge of going to the bathroom during the night.
If take metolazone plus another diuretic, take metolazone first, about 30 minutes before the other diuretic.
Diuretics (especially metolazone) can cause to lose potassium, so doctor might prescribe a potassium supplement. Not
everyone taking diuretic medicine needs extra potassium, so ask doctor if have any questions.
If diuretic dose is changed, will need lab tests to monitor kidney function.
Common side effects of diuretics:
•Increased urination
•Dizziness
•Dehydration
•Changes in kidney function
•Ringing or buzzing in the ears
•Skin rash or hives
•Itching
•Increased blood sugar levels

24. SURGICAL MANAGEMENT OF CCF
 Coronary Artery Bypass Graft (CABG) Surgery
Coronary artery bypass graft (CABG) surgery involves the use of a blood vessel graft to bypass
one or more blocked coronary arteries. The bypass restores normal blood flow to the heart
muscle. The graft goes around the clogged artery/arteries and forms new pathways for oxygen-
rich blood to flow to the heart muscle. The blood vessel grafts usually come from own arteries
and veins in the chest, leg or arm.
The bypass grafts are put in place by sewing one section of the artery or vein around a tiny
opening just below the blockage in the diseased coronary artery and attaching the other end to
a tiny opening made in the aorta. This redirects the blood flow around the blockage. If an
internal thoracic (mammary) artery is used, one end is connected to the coronary artery while
the other stays attached to the aorta.
During the surgery, surgeon will place temporary pacing wires and a chest tube before
sternum is closed with special wires. chest incision will be closed with internal stitches or
traditional external stitches. The chest tube is needed to drain fluid. The pacing wires are placed
in case have an abnormal heart rhythm after surgery. This is common, and if it happens, the
wires are attached to a temporary pacemaker until heart rhythm returns to normal. The
surgery generally lasts 3 to 5 hours, depending on the number of arteries that are being
bypassed.

25. SURGICAL MANAGEMENT OF CCF
Valve Surgery
As heart failure gets worse, changes in the left ventricle (lower chamber of the heart)
papillary muscles to stretch out of shape. The papillary muscles support mitral valve
to keep blood flowing in only one direction. When the papillary muscles get weak,
support the mitral valve leaflets, and the valve starts to leak .Mitral valve
reshaping the leaflets and supporting the mitral valve with a ring.
Mitral valve repair surgery helps to
•Preserve the natural anatomy of the heart
•Improve the heart’s ability to pump properly
•Decrease heart failure symptoms
•Improve survival
Heart failure can be caused by aortic valve stenosis (stiffness) or regurgitation (leaky
valve cannot open fully, or if blood leaks backward into the left ventricle, the heart
strongly to meet the body’s needs for oxygen-rich blood and heart failure can occur.

26. SURGICAL MANAGEMENT OF CCF
 Implantable left ventricular assist device (LVAD)
A left ventricular assist device (VAD -- also called ventricular assist system
of mechanical circulatory support device (MCSD). It is a mechanical pump
in patients who have heart failure to help the heart’s weakened left ventricle
pumping chamber of the heart) pump blood throughout the body.
The VAD devices can be used as “bridge to transplant” or destination
Clinic is one of the few institutions worldwide that has access to all clinically
mechanical ventricular assist systems, including the Heartmate II®, HVAD,
devices, allowing us to choose the device that will best suit an individual
needs. Cleveland Clinic also participates in clinical trails so we are able to
technology developed for our patients The pump unit is placed in the chest.
by the surgeon into the apex of the heart where it receives blood. A tube
blood from the device to the aorta (the large artery that takes blood from the
rest of the body. It works by pumping blood by continuous flow from the left
aorta..

27. SURGICAL MANAGEMENT OF CCF
 Heart transplant
The surgery
Once are in the operating suite, the actual heart transplant procedure can take anywhere from
longer. Each person's case is different.
The donor heart
A surgeon from the heart transplant center goes to harvest the donor heart. The surgeon will
donor heart is in good condition before beginning surgery. The donor heart is removed by
pulmonary artery in the mid-section. The atria are removed from the veins leading into the
The transplant
When the donor heart arrives in the operating room, surgeon will remove most of heart and
will be placed in proper position and attached to major blood vessels.
Recovery
How quick a patient recovers after heart transplant depends on many factors: age, general
to the transplant. Most patients are up and about within a few days after surgery and home in
days.

28. SURGICAL MANAGEMENT OF CCF
 Aneurysm Repair Surgery
How do prepare for the procedure?
Before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the surgery. may need to
discontinue certain medications before the procedure. health care team will provide specific instructions to help prepare
for the procedure.
What happens during the procedure?
The surgeon will perform the repair under general anesthesia. After have been given the general anesthesia, the surgeon
will make a long incision in the skin to open the chest or abdomen (depending upon the area in which the aneurysm
occurs). The normal segments of the aorta above and below the bulging section is clamped and the aneurysmal segment is
opened. Tubes constructed of artificial material, such as polyester, are positioned inside the artery in the region of the
aneurysm and fastened in place with sutures or stitches to essentially become a new aorta. This procedure replaces and
repairs the area of the diseased aorta.
How long does the procedure last?
The procedure itself generally takes three to four hours, but the preparation and recovery time add several hours. The
surgery may require a minimum hospital stay of five to 10 days. Some patients may require a stay at a rehabilitation
facility to regain their independence. Full recovery may take from four to six weeks.
What happens after the procedure?
surgeon will give specific instructions need to follow after the surgery until incision heals adequately. Restrictions may
include:
•No driving until approved by physician (usually within one to two weeks after the procedure, when are no longer taking
pain medication)
•No baths until the incisions heal; showers and sponge baths around the incision are permitted
•Avoid lifting more than 10 pounds for approximately four to six weeks after the procedure

29. PREVENTION OF CCF
Stop smoking
• Smoking is the most preventable risk factor for cardiovascular disease and stroke. Smokers
(including cigarette, pipe, and cigar smokers) have more than twice the risk of a heart attack
than nonsmokers. Smoking is also the biggest risk factor for sudden cardiac death. Even one to
two cigarettes a day greatly increases the risk of heart attack, stroke, and other cardio-vascular
conditions. Nonsmokers who are exposed to constant smoke also have an increased risk.
• Goal:
• Eliminate the use of all tobacco products. Stay away from others’ smoke.
 Lower high blood pressure
Blood pressure is a measurement of the pressure or force inside the arteries with each heartbeat. High
blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart
failure, stroke, and kidney disease. High blood pressure is the biggest risk factor for stroke.
•Goals
• Ideal blood pressure is less than 120/80. For patients with diabetes and established cardiovascular
disease, blood pressure should be less than 130/85.
• Control blood pressure through diet (low-salt diet), exercise, weight management, and if needed,
medications.
• Also limit alcohol, as it can increase blood pressure.

30. PREVENTION OF CCF
 Lower total cholesterol, LDL (bad) cholesterol, and triglyceride levels
Excessive lipids (fatty substances including cholesterol and triglycerides), especially in the
cholesterol, cause the build-up of fatty deposits within arteries, reducing or blocking the flow
oxygen to heart. There’s a sharp increase in the risk for cardiovascular disease when total
240 mg/dl and above.
•Goals:
• Total cholesterol less than 200 mg/dl.
• LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease.
• LDL should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as
diabetes or those who have multiple heart disease risk factors.
• For all others, LDL cholesterol should be less than 130 mg/dl.
• Triglycerides less than 150 mg/dl.
For most patients, it is recommended to have cholesterol level checked as early as age 20.
profile includes an evaluation of fasting total cholesterol, HDL, LDL, and triglyceride levels.
can tell how often to have cholesterol tested.
 Raise HDL (good) cholesterol
HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver
passed out of the body. High levels of HDL seem to protect against cardiovascular disease.
Low HDL: less than 40 mg/dl
•Goal:
• Greater than 55 mg/dl for women, greater than 45 mg/dl for men; the higher the HDL level, the better.

31. PREVENTION OF CCF
Control diabetes
• Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This
sugar levels. People with diabetes (especially women) have a higher risk of cardiovascular
diabetes increases other risk factors, such as high cholesterol, LDL, and triglycerides; lower
pressure. Keeping diabetes under control is essential in reducing risk.
• Goal:
• Hemoglobin A1c test less than 6.5 if have diabetes.
• Hemoglobin A1c less than 5.7 if do not have diabetes.
• Follow up with doctor on a regular basis.
Maintain a healthy body weight
• The more weigh, the harder heart has to work to give body nutrients. Research has shown
contributes to the onset of diabetes and cardiovascular disease. Excess weight also raises blood
triglycerides, and blood pressure, lowers HDL cholesterol, and increases the risk of diabetes.
 Exercise
The heart is like any other muscle -- it needs a workout to stay strong and healthy. Exercising
helps improve how well the heart pumps blood through body. Activity and exercise also help
reduce so many other risk factors: can lower blood pressure, lower high cholesterol, reduce
stress, achieve and maintain a healthy body weight, help self quit smoking, and improve blood
sugar levels.
•Goal:
• Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated
with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic
activities include brisk walking, cycling, swimming, jumping rope, and jogging.
• If walking is exercise of choice, use the pedometer goal of 10,000 steps a day.

32. PREVENTION OF CCF
 Follow a heart-healthy diet
The old saying " are what eat," may be truer than ever - especially when it comes to cardiovascular
are related to diet: high blood pressure, high blood cholesterol, diabetes, and obesity.
•Goal:
• Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats), and
• Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and
• Mono-unsaturated fats also are preferred and are found in olive, canola and peanut oils.
• Also eat plant-based foods such as fruit and vegetables, nuts, and whole grains.
 Contributing Risk Factors
 Individual response to stress:
Although stress is not considered a traditional risk factor, some researchers have noted a relationship
disease risk and stress in a person’s life, their health behaviors, and socioeconomic status. Stress may
factors.
Learn to manage stress by practicing relaxation techniques, learning how to manage time, setting realistic
some new relaxation techniques such as guided imagery, massage, Tai Chi, meditation, or yoga.
 Drinking too much alcohol:
Drinking too much alcohol can lead to increased blood pressure, heart failure, and stroke. It is also linked
irregular heartbeats, obesity, and cancer. Research has shown that those who drink one drink per day (4
beer, or 1-1/2 oz. of 80-proof spirits) may have less risk. However, the American Heart Association does
non-drinkers start using alcohol or that drinkers increase the amount they drink.
If have a family history of cardiovascular disease or high cholesterol, it is even more important to decrease
Get cholesterol levels tested every year. Know numbers, including blood pressure, BMI, waist
A1c. Make sure follow up with health care provider every year for a checkup.