This document provides information about congestive heart failure (CHF), including its symptoms, causes, and treatment options. It describes the two main types of CHF - systolic and diastolic dysfunction - and explains how both result in decreased blood flow and fluid backing up into the lungs and body tissues. Key recommendations for managing CHF include following a low-sodium diet, daily weight monitoring, taking medications as prescribed, and exercising in moderation. The document emphasizes the importance of calling a doctor or nurse for worsening symptoms like rapid weight gain in order to prevent hospitalization.

1. Everyone deserves a happy heart.

2. Have you had any of the following SYMPTOMS? Shortness of breath Extreme fatigue Weight gain Swelling in extremities A persistent cough Difficulty sleeping flat

3. These are symptoms of Congestive Heart Failure THIS MEANS YOUR HEART ISN’T PUMPIMG SUFFICIENTLY TO GETBLOOD OUT TO THE REST OF THE BODY. SO THE KIDNEYS, BRAIN, LUNGS & LIVER DON’T GET ENOUGH BLOOD AND OXYGEN.

4. NORMAL HEART The blood comes into the heart via the VENA CAVA Enters the RIGHT ATRIUM Through pressure build up is pushed to the RIGHT VENTRICLE via the TRICUSPIC VALVE From there it goes to the PULMONARY ARTERIES to the LUNGS through the PULMONIC VALVE In the LUNGS THE BLOOD PICKS UP OXYGEN The blood come back to the Heart via the PULMONARY VEINS It enters the LEFT ATRIUM Through the MITRAL VALVE the blood enters the LEFT VENTRICLE. From there it goes through the AORTIC VALVE to the AORTA From where it is pumped to the rest of the body giving, oxygen, and nutrients to the KIDNEYS LIVER AND BRAIN AND HEART 4

5. THERE ARE TWO TYPES 1. systolic dysfunction 2. DIASTOLIC DYSFUNCTION

7. Not all the blood is pumped out each time the heart pumps

8. Also causing the blood to back up to the lungs , and the rest of the body

10. In a Nutshell Both types cause decreased blood flow to the rest of your body. Both types cause blood to back up into the lungs and tissues, causing shortness of breath and swelling and increased weight gain.

11. WHAT CAN YOU DO TO PREVENT THE FLUID BACKING UP AND PREVENT GOING TO THE HOSPITAL? CUT OUT SALT INYOUR DIET. (no more than 1 tsp a day) WEIGH YOURSELF EVERY DAY WATCH HOW MUCH FLUID YOU DRINK MAXIMUM – 8 8OZ GLASSES OF all liquid TAKE MEDICATIONS AS DIRECTED EXERCISE A LITTLE BIT EVERY DAY STOP WHEN FATIGUED PACE YOURSELF REMEMBER LIFE IS ABOUT QUALITY NOT QUANTITY.

12. JUST LIKE HOME PLUMBING WHEN THE SYSTEM GETS OVERLOADED FLUID BACKS UPIN THE sink and we have to call the plumber. You are a human being so we call the doctor or go to the hospital Or – you call the CHF nurse or the advice nurse

13. 1. SALT/ SODIUM/ NA Maximum 2 grams= 2, 000 mg = 1 tsp A DAY (At first you won’t like it, but you will get used to it). Soon salty foods will taste bad!!

14. WHY SHOULD I CUT OUT SALT? SALT IS LIKE A SPONGE IT SOAKS UP WATER THE INCREASED WATER IN YOUR BODY PUTS MORE PRESSURE ON THE THE ALREADY WEAKENED HEART

15. But “I never add salt to my food”say some people. LEARN TO READ LABELS: It doesn’t matter, because salt is hidden in many of the foods you eat. It is a preservative, and is in: Most canned foods, Most fast foods Where you would never expect to find it. Cured meats Like Bacon, Ham, Sliced Turkey Breasts.

16. OTHER WORDS FOR SODIUM Monosodium glutamate (MSG) Sodium bicarbonate (Alka Seltzer) Sodium nitrate Sodium Saccharin Sodium Citrate

17. Remove Salt shaker from the table (replace with salt-free herb mixes and spices) Eat fresh or plain frozen vegetables Know how to read food labels Choose low sodium-snacks such as sodium-free pretzels, sodium-free crackers, or air-popped popcorn Know how to choose low sodium food in restaurants Choose restaurants that offer low sodium foods and preparation methods Tips on how to reduce sodium intake

18. 2. DAILY WEIGHTS A 2 – 3 LB gain in 24 hours is usually WATER or fluide NOT FAT When this happens, YOU AR aT RISK for becoming hospitalized with shortness of breath THAT IS WHY IT IS IMPORTANT TO WEIGHT YOURSELF EVERY DAY

19. HOW DO I WEIGH MYSELF? 1.At the SAME time every day ON A DIGITAL SCALE First thing in the morning With the SAME CLOTHES ON OR YOUR BIRTHDAY SUIT AFTER URINATING BEFORE EATING OR DRINKING WRITE IT DOWN ON A LOG YOU KEEP NEAR THE SCALE. IF YOU GAIN 2- 3 LBS IN ONE DAY OR 5 LBS IN 5 DAYS CALL THE DOCTOR, ADVICE NURSE OR YOUR CHF NURSE WE CAN HELP YOU FROM HOME BY ADDING OR CHANGING MEDICATIONS OR SENDING YOU TO THE LABS.

20. Water Water constitutesapproximately 60% of the total body weight of an adult. It is involved in many of the physical processes of the body. Fluctuations in the amount of water in the body can have harmful and even fatal consequences.

23. WHY SHOULD I WEIGH MYSELF EVERYDAY ? TO BE AWARE OF YOUR FLUID STATUS A 2- 3 LBS WEIGHT GAIN IS A BIG WARNING SIGN THAT YOU COULD GET INTO TROUBLE AND END UP IN THE HOSPITAL. IT IS LIKE A DOMINO EFFECT REMEMBER WE CAN NIP IT IN THE BUD AND HELP YOU ON THE PHONE BEFORE YOU END UP SO SICK THAT YOU HAVE TO GO TO THE HODPITAL.

24. MEDICATIONS IMPORTANT!! TAKE ALL MEDICATIONS AS DIRECTED DO NOT STOP A MEDICATION WITHOUT TALKING TO YOUR DOCTOR. IF A MEDICATION DOESN’T AGREE WITH YOU IE: CAUSES RASH, COUGH OR UPSET STOMACH. CALL YOUR DOCTOR, ADVICE NURSE OR CHF NURSE WE CAN HELP YOU FIND SOMETHING SIMILAR THAT MAY AGREE WITH YOU ORGANIZE YOUR MEDICATIONS IN A MEDI-SET AT THE BEGINNING OF EACH WEEK. IF YOU RUN OUT WHILE FILLING THE MEDI-SET CALL AHEAD FOR REFILLS.

25. MORE ABOUT MEDICATIONS TO TREAT CHF. Diuretics ACE Inhibitors Angiotensin Receptor Blocker ( ARB) Beta-Blockers Digoxin Aldosterone Antagonist Hydralazine and Nitrate

26. DIURETICS Common Names Furosemide ( Lasix) Metolazone ( Zaroxoyln) Bumetamide (Bumex) How They Help Helps rid the body of excess water, which reduces swelling and may improve breathing. Less fluid to pump means the heart doesn’t have to work as hard. TAKE EARLY IN AMSO YOU CAN GO ABOUT YORU ACTIVITIES LATER ON IN THE DAY. Side Effects Leg cramps Dizziness or lightheadedness Accidental loss of urine (incontinence) LOSS OF POTASSIUM : YOU MAY BE GIVEN A POTASSIU SUPPLEMENT TO TAKE – DO NOT TAKE OVER THE COUNTER POTASSIUM EAT BANANAS, SWEET POTATOES, TOMATOES AND ORANGES

27. ACE- INHIBITORS Ace Inhibitors Common Names Lisinopril (Zestril, Prinivil) Captopril (Capoten What They Do Lowers Blood Pressure Help heart pump easier Slows down further weakening of the heart Lessens symptoms Dilate blood vessels and improve circulation SIDE EFFECTS: Cough – if you develop a cough call your doctor – we ca put you on a different medications Low Blood Pressure:If you feel dizzy or lightheaded or weak, let your doctor know Raise Potassium: If your kidneys are weakened you may be at risk we will monitor your blood work and draw labs.

28. Angiotensin Receptor Blocker ( ARB) USUALLY PUT ON THIS WHEN ONE IS ALLERGICE TO ACE INHIBITOR : NAMES:

29. Beta-Blockers Common Names Carvedilol (Coreg) Bisoprolol (Zebeta) Metoprololsuccinate (Toprol XL) Atenolol (Tenormin) What they do Help the heart pump easier Lowers blood pressure Prevent angina (chest pain) Help control heart rate & rhythm Slows progression of Heart Failure Cardioprotective Side effects Dizziness Tiredness Slow heart rate

30. Digoxin What it does Slows heart rate Helps heart pump more blood with each beat. So, more oxygen-rich blood travels to the body Very Rare Side Effects Loss of appetite, nausea, vomiting and diarrhea Extremely slow heart rate Unusual, severe tiredness/weakness Blurred vision or yellow/green/white colors in vision * Call KAISER if any of these occur 28

31. ALDOSTERONE ANTAGONISTS Common Name Spironolactone (Aldactone) How they work Alters hormones that are damaging the heart, decreases strain on the heart. Given for advanced heart failure. Side effects Cause breast enlargement or tenderness, especially in men Increase potassium levels. Have your blood checked to make sure your potassium level is normal. This would manifest by Leg cramps, palpitations etc.

32. HYDRALAZIINE AND NITRATES How they work Lowers blood pressure and decreases how hard the heart has to work. Two separate medications used together. Side effects Headache Flushing Dizziness Rash Upset Stomach

33. Alternative Therapy Interactions Ephedra (ma huang) Ephedrine metabolites Chinese herbs Hawthorne (cratageus) :❚ Garlic Ginseng Gingko Coenzyme Q-10 Some natural or synthetic products containing the following substances may interfere with or adversely affect the intended effects of certain medicines used to treat heart failure: Tell your doctor about any natural medicines or alternative or herbal therapies that you are taking. Beware of extravagant claims about the benefits of alternative or herbal therapies.Never take alternative or herbal medicines in place of your regular medicines

34. OTHER THINGS TO AVOID ALCOHOL – limit intake SMOKING – DON’T DO IT NSAIDS- Aspirin. Ibuprofen, Aleve etc. all retainn fluid

35. 33 When To Call Your Health Care Provider Rapid weight gain or unintentional weight loss (dehydration) Worsening of swelling in your feet, legs or abdomen Inability to tolerate your normal activities or worsening fatigue If breathing becomes more difficult or if you have trouble breathing at night or while lying flat Change in blood pressure or heart rate or regularity (racing heart) Dizziness or lightheadedness New cough

36. 34 When To Call 911! Chest pain or chest tightness Pain in jaw, shoulder or arm Severe shortness of breath Coughing up pink, frothy sputum

37. What are YOUR goals? 1.Name 3 things you would like to do that you have been too fatigued to do? 2. What future plans do you want to be around for? 3. Have you filled out an Advance directive to ensure that if something were to happen to you – that someone trustworthy would be able to speak on your behalf and carry out your wishes?

38. REMEMBER WE ARE HERE TO HELP YOU. WE WANT TO KEEP YOU HAPPY AT HOME, WHERE YOU BELONG, NOT in the hospital/ WE WANT TO HELP YOU REACH YOUR GOALS WE WANT TO IMPROVE THE QUALITY OF YOUR LIFE WE WANT YOU TO BE ABLE TO HAVE YOUR FINAL WISHES CARRIED OUT AS YOU WANT THEM.