Getting Started on a Treatment Plan for Heart Failure
If you are diagnosed as someone who suffers from heart failure, it is important that your functional capacity be accurately assessed. Simply put, you and your doctor should assess your ability to perform ordinary daily activities. Not only does your ability to perform these activities contribute to your overall well-being and quality of life, but it also contributes to a longer life as well. This is why a patient's functional capacity, as measured by the New York Heart Association (NYHA) classification system, is emphasized in the recognition and treatment of heart failure. When treatment of heart failure is successful, your functional capacity, or NYHA Class, improves.
The assessment
Your physician will determine your overall functional capacity during the initial diagnosis of heart failure, but will continue to reassess and redefine your functional capacity during the course of treating the heart failure. Many factors contribute to a thorough assessment of your functional capacity, including your:
- physical capabilities
- emotional status
- social supports
- cognitive abilities
Cognitive abilities
"Cognitive" is a medical term that describes how we learn, or how we acquire knowledge. Cognition is the "quality of knowing", which includes perceiving, recognizing, conceiving, judging, sensing, reasoning and imagining. This is the term that physicians use to describe how well your mind works.
Social and emotional factors
Social and emotional factors are especially important in determining your ability to comply with all the treatments that are required for people with heart failure. Not only do you have to take medications on a daily basis, but you are also asked to adhere to certain activity and dietary recommendations. Treating heart failure successfully requires that both you and your doctor stay focused on all the lifestyle changes that lead to fewer hospitalizations for heart failure.
Getting familiar with heart failure symptoms
In general, once the diagnosis of heart failure has been made, you should become familiar with the typical symptoms of worsening heart failure. Two of the most common symptoms are worsening shortness of breath, and leg swelling. A good way to keep track of the extra fluid that accumulates in your lungs and elsewhere in your body is to weigh yourself each morning on a reliable and accurate bathroom scale.
Keep an eye on weight gain
I tell my patients with heart failure that if their weight has increased by more than 3 to 5 pounds since the last time I saw them, they should call me. This is an appropriate time to review the treatment plan and to reconsider dietary and activity recommendations, as well as medications. At this time we can decide if the regimen should be maintained or altered.
Keep a diary
I also tell my patients with heart failure that they should carry a small notebook with them to record not only their daily weight, but to describe what they were doing (for example, climbing stairs) when they experienced any increased shortness of breath or limited exercise tolerance. Such a notebook comes in handy when speaking to your physician about the progress of your heart failure treatment.
Dietary Therapy in Heart Failure
Three are a number of diet considerations for people with heart failure.
Cutting down on sodium
Any patient who suffers from heart failure has probably been told that modifications in daily salt intake are a necessary part of the heart failure treatment. There are several potential problems associated with a high daily intake of salt. Most importantly, excessive salt intake can lead to loss of potassium in the urine of a patient with heart failure. Low potassium in the blood may cause a number of serious complications including changes in weakness and even paralysis. Moreover, increased salt intake may change the dosing requirements of drugs that are used to treat heart failure, such as diuretics (drugs that increase urine output).
Be careful with restricted-sodium diets: Although a restricted-sodium diet seems to be a part of most treatment plans for heart failure, there have been no clinical studies that have evaluated a specific amount of sodium restriction in the daily diet. Therefore, it remains debatable whether mild (3 grams per day) or moderate (2 grams per day) sodium restriction is advisable for most patients with heart failure. It is important to realize that diets that are very restricted in sodium content can be tasteless. This can lead a patient to stray from the diet and result in more hospitalizations for worsening heart failure.
For people with moderate failure, just be "salt-wise": Many physicians, including myself, tell their patients with mild to moderate symptoms of heart failure to just avoid adding salt to their meals. This means no salt-shakers in the house. Additionally, the patient with symptoms of mild heart failure should avoid foods that are rich in salt content. Reading the ingredients on most packaged foods or purchasing a pocket-sized book that lists the salt (and usually cholesterol/fat) content of many foods can be enormously helpful in this endeavor. The above measures will lead to a daily dietary intake of about 3 grams of sodium.
For those with severe heart failure, be extra "salt-wise": Patients with more severe symptoms of heart failure, or those requiring high doses of diuretic medications, may find it necessary to restrict their sodium intake even more vigorously. This can be achieved by purchasing only sodium-free foods and altogether avoiding processed foods and milk products (such as cheese) that are high in salt content.
Talk with a dietician: In dealing with dietary issues, the patient with heart failure (or high blood pressure, for that matter) can often benefit from consulting a dietician or nurse practitioner who is trained in dietary education and counseling. These specialists provide patients with useful handouts and can even help patients alter family recipes or menus to suit a more sodium-restricted diet.
Cutting down on alcohol consumption
It's also important for heart failure patients to cut way back on alcohol. The ingestion of alcohol may acutely impair the ability of the heart to pump blood effectively in patients with cardiac disease. Chronic alcohol abuse may also lead to cardiomyopathy, a condition where the heart becomes big and dilated, and can no longer contract effectively. For patients with cardiomyopathy, alcohol is absolutely prohibited. With most of my heart failure patients who want to continue to drink alcohol, I advise them to consume no more than one drink per day. This means one beer or one glass of wine, or a mixed drink containing approximately 1 ounce of alcohol per day.
Considering vitamins
My patients often ask me about the use of vitamins in their daily regimen. There has been much press in recent years on the role of the antioxidant vitamins C and E in cardiovascular disease. The evidence of the cardiovascular benefits of antioxidants appears to be strongest for vitamin E, given promising data from the entire spectrum of available scientific research. In general, vitamin supplementation in the form of a multi-vitamin (the generic form is adequate and includes the antioxidant vitamins C and E) can prove useful in any patient with a chronic illness that is associated with malnutrition or wasting. Some heart failure patients take diuretics, which are medications that increase the frequency of urination. Diuresis can lead to the loss of certain vitamins, particularly those that are water-soluble, in the urine. For those patients who take diuretics as part of their pharmacological treatment, taking a daily multi-vitamin can be especially helpful.
Exercise Recommendations in Heart Failure
It was once thought that "taking it easy", or bedrest, were essential for the long-term health of heart disease and heart failure patients. The reasoning was that any sort of exercise might tax the heart and lead to further chest pain or heart failure.
The truth is that even short periods of inactivity can lead to muscle wasting and weakness. Now, when a patient suffers from a heart attack or undergoes coronary artery bypass surgery, he is usually referred for cardiac rehabilitation exercise training while still in the hospital. Heart failure patients are treated much the same way. Exercise, carefully tailored to the patient's abilities, can lead to improvement in the symptoms of cardiac disease, whether it is chest pain from coronary artery disease or lung congestion from heart failure. In patients with heart failure, regular exercise can lead to improvement in function.
Regular exercise in the form of walking or cycling is encouraged in patients who suffer from mild to moderate symptoms of heart failure. Patients with mild symptoms of heart failure are only slightly limited in their physical activity. They are comfortable at rest but may experience some fatigue or shortness of breath with ordinary activities. Patients with more moderate symptoms of heart failure may experience fatigue or shortness of breath even with the most minimal of activities, such as climbing stairs slowly one-by-one.
As with those patients who have suffered from a heart attack, it is essential that the patient with heart failure develop an exercise routine with the help of his physician. Although exercise in the form of walking or cycling seems straightforward, there are varying degrees of energy expenditures associated with the rate and duration of the activity. For instance, walking at a rate of 2 mph is considered very light exercise while walking at a rate of 4-5 mph requires more moderate amounts of energy expenditures. You should talk with your physician to determine what level of exercise is right for you given your heart function.
Summary
A person who is diagnosed with heart failure needs to have his functional status determined by a physician. This is the first step toward a therapy program. This status is not necessarily "for keeps"; a patient who is initially classified as having moderate heart failure, for example, may be downgraded to suffering from mild heart failure by virtue of effective medical treatment with drugs, dietary modification, and exercise.
It is essential that the patient with heart failure realize that he can decrease the number of hospitalizations due to worsening heart failure by carefully monitoring his daily symptoms and reporting any changes to his physician. An understanding of, and adherence to, regular exercise and dietary recommendations (in addition to necessary medications) can further decrease the amount of time spent in the hospital for "tune-ups".
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