Heart Failure Guide

Heart Failure: Introduction

Definitions of common terms

Heart failure is an illness that cannot be cured. With careful management it can be brought under control. Patients need to know that heart failure can progress even though their symptoms may improve. This means that the patient should:

  • follow a low sodium(salt) and low fat diet
  • remain physically active
  • weigh themselves daily
  • take all medicines ordered by their healthcare provider
  • stop smoking
  • keep follow-up appointments

Heart Failure

  • pumping action of the heart is inadequate
  • blood backs up into the lungs, making breathing difficult (left-sided failure)
  • blood also backs up into the veins, causing swollen legs and feet (right-sided failure)
  • also known as Congestive Heart Failure

Common Causes

  • coronary artery disease
  • cardiomyopathy (an enlarged heart due to many different causes)
  • myocarditis (inflammation of the heart muscle)
  • heart valve dysfunction
  • high blood pressure
  • pulmonary disease (increases stress on the heart)

Heart failure signs and symptoms

  • fatigue
  • paroxysmal nocturnal dyspnea (waking up gasping for breath)
  • orthopnea (shortness of breath when lying down)
  • dyspnea on exertion (shortness of breath with activity)
  • anorexia (loss of appetite) and abdominal complaints
  • lower extremity edema (swelling of the feet and legs)

Ejection Fraction

  • the percentage of blood that is pumped out of the heart each time it beat
  • an assessment of heart function
  • normal is 55-65%
  • most commonly determined by an echocardiogram and/or nuclear medicine studies

Activity

What the nurse needs to know

Aerobic activity has been shown to slow or reverse ventricular remodeling (the hypertrophy or dilatation) that occurs in response to increased myocardial stress, which in turn will improve cardiac function.

Exercise can improve peak O2 consumption and restore the abnormal autonomic, neurohormonal, and hemodynamic functions that occur in heart failure due to sympathetic nervous system (SNS) stimulation.

SNS stimulation leads to vasoconstriction causing hypertension and increased workload on the heart, as well as increased cortisol levels, which can elevate blood glucose.

Burning excess calories can help optimize weight.

What the patient needs to know

  • exercise helps your heart be more efficient:
    • activity improves muscle tone, including your heart muscle
    • decreases stress
    • increases energy
    • improves circulation
    • controls weight
    • lowers cholesterol
    • lowers blood pressure
  • research shows that activity including exercise, work, and sex is healthy and safe for most people with heart failure.
  • everyday activities (walking, vacuuming, gardening, walking in the mall, chair exercises) are a great way to keep moving.
  • check with your healthcare provider prior to starting an exercise program or increasing your current activity level; ask if cardiac rehab referral would be right for you.
  • the key to becoming active is to start slowly – the goal is to be active at least 30 minutes most days of the week. it doesn’t have to be 30 minutes in a row; for example, it could be three 10-minute blocks of activity.
  • walking is good exercise. start with 5 minutes and work your way up to 30 minutes everyday.
  • it is important to be active, but be smart: stop and rest when you get tired. you should be able to carry on conversation during the activity – if you cannot, you may be working too hard and should slow down.
  • do something healthy everyday to relax and reduce stress. activities such as reading, yoga, hobbies such as crafts, are all ways to decrease the effects of stress on your heart.
  • do not exercise or increase activity if you are short of breath at rest, feel exhausted, have a fever or feel ill, have chest pain, or are going through a major change in your medication regimen.

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