House Calls runs every other Saturday. Today’s column is written by Trish Walker, a registered nurse with Sutter Coast Home Care. It is the third in a four-part series about congestive heart failure.
Heart failure treatment consists of many parts, from medication, to diet/fluid restrictions, smoking cessation, and exercise. Self-care is the key.
The cornerstone of treatment is medication. Your doctor will use the results of your lab work, heart function tests, and your symptoms to determine what medications you need to take to help control your symptoms and minimize side-effects. It is important to report any changes in your symptoms, or any side-effects, to your doctor so that your medications can be adjusted correctly. Do not change medications or stop them yourself. If you do, you are risking your own health and life.
Most patients take five to seven medications daily, which can be overwhelming. You need to learn why you are taking them, how they help your heart, how often to take them, and any possible side-effects.
Some of them need adjusting every couple of weeks until you reach a level that is best for your heart. Medications that you may be taking for other diseases may interact with your heart medications. It is extremely important that your doctor is aware of all your medications. Take them with you to your doctor’s appointment, not just a list. This way your doctor can identify any omissions, duplications, and clear up any confusion.
Over-the-counter medications you take need to be discussed with your doctor, because they can cause your heart medications to be ineffective.
Here is a brief description of heart drug classifications most often prescribed:
• ACE Inhibitors are a first-choice medication leading to decreased hospitalization and improved quality of life. They decrease your blood pressure so your heart doesn’t work as hard. A common side-effect is a chronic cough.
• Beta-Blockers are given to the majority of patients and significantly decrease death rates. They decrease your heart rate and blood pressure. Common side-effects are dizziness and lightheadedness.
• Diuretics are a first-line treatment for patients with signs/symptoms of fluid overload. They promote urination, reduce swelling and decrease your blood pressure. Side-effects are dehydration and abnormal lab values. It is important to get labs drawn to monitor your sodium, potassium and kidney function.
• Digoxin helps improve symptoms for patients on ACE inhibitors and beta-blockers, and also
Dietary changes are important. You should follow a heart-healthy diet that is low in fat, cholesterol and sodium. Your doctor will specify how much sodium you may have in your daily diet. Too much sodium will cause fluid retention, which leads to swelling and shortness of breath.
You can limit sodium by not adding salt to your food and keeping the salt shaker off your table. You should avoid foods known to be high in sodium, and read labels. Did you know 80 percent of sodium in your diet comes from processed foods? Food shopping will require more time and thought. You will be surprised to know how much sodium is in bread. If you go out to eat dinner, ask that your food not be cooked with added salt. Keep a dietary log — if you have fluid retention you will be able to determine the cause, and adjust your diet accordingly.
Monitor your fluid intake. Fluid is anything that turns to liquid at room temperature. Fluid control is especially important in advanced cases. You will be limited to 1.5 to 2 liters of fluid/day. Every liquid item you consume can be measured by placing an equal amount of water into a 2 liter bottle.
Staying active and keeping your muscles strong will help you both physically and mentally. Pace yourself. Monitor for shortness of breath or fatigue to guide you on whether you should increase or decrease activity. Make sure to discuss any exercise program with your doctor.
Stop smoking. It raises your blood pressure and decreases the amount of oxygen in your blood. It also puts you at a greater risk for a heart attack or stroke. Avoid alcohol. It causes elevated blood pressure and over time depresses the ability of your heart to pump effectively.
Keep a log of your daily weight and symptoms. This helps you monitor how well your plan is working. Your diuretics may need adjusting to prevent hospitalization. It is vital to keep follow-up doctor appointments. This way both you and your doctor can see what progress you have made, and be alert to any potential problems.
When you take control of your health your symptoms will improve and you will start feeling better. Don’t expect it to happen overnight. Be patient! When you begin to feel better, make sure you don’t revert to your old ways. You must make a lifelong commitment to your health to prevent hospitalization and death.
The fourth and final article in this series will discuss end-stage heart failure, treatment changes and the effects on family and caregivers.