Failing Heart Home Care
Home care for congestive heart failure includes:
- Measure your weight daily.
- Keep a log of the results.
- Stop smoking
- Avoid exposure to secondary smoke
- Eat a healthy heart diet:
- Limit your intake of fat to 30% of your total calories.
- 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
- Low cholesterol diet.
- Low salt diet.
- Eat foods rich in omega-3 fats
- If you have been prescribed medications to control high cholesterol, so not skip doses.
- Follow an exercise plan developed with your doctor
- Weight loss if you are overweight.
- Take any prescribed heart medications as directed:
- Don't skip doses of your heart medication
- Avoid running out of your prescribed heart medications
- Don't stop your medication when you feel better
- Talk to your doctor before stopping your heart medication if you feel worse.
- Be aware of potential drug side effects
- Learn how to take your blood pressure.
- If you have high blood pressure, don't skip doses of your medication
- Check your blood pressure every day:
- If you have diabetes:
- Check your blood sugar every day.
- Keep a log of your results.
- Take your diabetes medication as directed
- Learn how to take your own pulse.
- Notify your doctor if your heart rate is high or irregular
- Control chronic stress and anxiety
- Let your doctor know if you are suffering from severe or prolonged depression.
- Avoid alcohol, or drink alcohol in moderation:
- For men: no more than 2 alcoholic beverages per day
- For women: no more than 1 alcoholic beverage per day
- Learn everything you can about congestive heart failure:
- The more you know about your condition, the easier it will be to participate with your doctor in making treatment decisions.
- Ask your doctor about good sources for information.
- Write down questions to ask your doctor
Failing Heart Diet
Dietary changes for people with congestive heart failure include:
- Control dietary salt: Lower dietary sodium by following a special diet that is low in salt. All heart failure patients should limit salt intake to 1,000-1,500 mg of sodium per day. Foods that are high in salt should be avoided.
- Do not use table salt; consider a salt substitute with your doctor's consent. Season foods with dried herbs, garlic, onion, or lemons.
- Fluid restriction: Ask your doctor what degree you need to restrict fluid consumption. Ask your doctor how many 8 ounce cups (240 ml) of water you allowed to drink per day.
- Remember 2 cups (1 pint or about 500 ml) of retained fluid will equal one pound (2.2 kg) of fluid weight gain.
- Heart healthy diet: Follow a proper heart diet, which is low in saturated fats and cholesterol. Most people with heart failure taking a diuretic medication need to eat potassium rich foods.
- Potassium rich foods include bananas, apricots, raisins, oranges, grapefruit, and peas.
- Magnesium: Eat foods rich in magnesium. Heart failure drugs can deplete the body's stores of magnesium. This has been correlated with more severe symptoms and a higher death rate.
- Foods high in magnesium include wheat germ, soybeans, oatmeal, nuts, seeds, low-fat diary items, and seafood.
A generally healthy diet for people with heart disease should include:
- Control calories:
- Eat quality fats:
- Use virgin olive oil and other unsaturated, low-cholesterol fats.
- Eat the right amount of fats, carbohydrates and protein:
- Limit your fat intake to 20 or 30 percent, but don't substitute simple carbohydrates for fat.
- Less than 7% of the day's total calories from saturated fat.
- Up to 10% of the day's total calories from polyunsaturated fat.
- Up to 20% of the day's total calories from monounsaturated fat
- Avoid fad diets:
- Eat a well-rounded diet instead.
- Eat small, frequent meals.
- Avoid large and heavy meals.
- Limit cholesterol in diet:
- To less than 200 milligrams a day.
- Limit iron intake:
- Eat enough dietary fiber:
- Whole grains are best.
- Eat plenty of fresh fruit and vegetables
- Reduce salt in your diet
- Optimal: no more than 1,500 milligrams per day.
- Check with your doctor about supplementing your diet with B vitamins:
Failing Heart Fluid Restriction
Some people with severe congestive heart failure may require fluid restriction. Basically, two cups (one pint or about 500 cc) of fluid will equal roughly one pound of fluid weight gain.
All beverages and foods that are liquid at room temperature are considered to be fluids. Don't forget products that contain "hidden fluids" such as non-dairy creamer, pudding, syrup, yogurt, sour cream, watermelon, grapefruit, popsicles, ice cubes, and gravy.
Tips on limiting fluid intake:
- Drain fluid from canned fruits and vegetables before consumption
- Place your allowed amount of water per day in your own personal container so you can monitor your fluid intake; poor water out of the container when you receive "extra fluids" from another source
- Avoid coffee, tea, soft drinks, and alcoholic beverages
- Use lemon wedges or hard candies to moisten a dry mouth; this can often take the edge off thirst
- Rinse your mouth with water but do not swallow it
- Take your medications with your allowed fluids at mealtime
- Perform weight measurements morning and evening and adjust your fluid intake accordingly; in most cases this should be adjusted so that you gain only one pound
- Become aware of how much fluid your coffee cup, bowls, and water glasses hold; if possible use smaller cups and glasses
Failing Heart Low Salt
All congestive heart failure patients should limit salt intake to 1,000-1,500 mg of sodium per day. One teaspoon of salt contains about 2,300 mg of sodium.
Tips on how to reduce your salt consumption:
- Avoid cooking with salt.
- Avoid fast food.
- Avoid salty foods, such as pickles, cured meats, salty snacks, and canned soup.
- Avoid seasonings that contain sodium, such as soy sauce, steak sauce, garlic and onion salt, and monosodium glutamate.
- Do not add salt to your food at the dinner table.
- Read food labels and buy foods that are low in salt.
- When eating out, ask that your food be prepared without added salt.
Failing Heart Self-Monitoring
Self-monitoring for congestive heart failure includes:
- Monitor your blood pressure:
- Use a home blood pressure device every day.
- Keep a logbook of your results
- Your heart failure may be out of control when your blood pressure is higher than usual.
- Your heart failure may be out of control when your blood pressure is lower than usual.
- Monitor your pulse:
- Take your pulse daily while you are at rest.
- Notify your doctor of a persistent, unusually high or low pulse rate.
- Monitor your weight:
- Heart failure patients should weigh themselves every day.
- Obtain a weight at the same time each day and record the weight on paper.
- Keeping a log of daily weights is especially important for patients who may have difficulty with their memory.
- Your heart failure may be out of control if you gain more than 2 pounds (1 kg) over one day.
- Your heart failure may be out of control if you gain more than 5 pounds (2.5 kg) over one week.
- Monitor your diet:
Failing Heart BP Checks
If you have heart failure, it is a good idea to learn how to take your blood pressure at home.
There are a number of devices commercially available for home blood pressure assessment. Many have digital readouts and don't require the use of a stethoscope. The digital blood pressure devices offer ease of use and the ability to take your own blood pressure quickly and accurately without assistance. After calculating the pulse, the digital blood pressure device will display the systolic and diastolic pressures. The stethoscope technique is still considered by many professionals to be the most accurate.
Tips for Obtaining an Accurate Blood Pressure
- Remain seated or lying flat with the arm supported at heart level.
- No smoking or caffeine for 30 minutes prior to measurement.
- Rest for 5 minutes before taking your blood pressure.
- The blood pressure air bladder should nearly encircle the arm: persons with large arms may require an extra large adult cuff. Cuffs are usually marked to indicate the acceptable size range.
- Apply cuff 1/2 inch above elbow crease.
- Locate brachial pulse and place the stethoscope bell at this location.
- With the valve closed, pump up cuff bulb to approximately 210 mm Hg, or a point where no sounds are heard through the stethoscope.
- Open the valve slowly (2-3 mm Hg per second) and listen for the point where the tapping sounds are first heard. The corresponding reading on the dial is the systolic pressure.
- Then, listen for the point where the tapping sounds stop. The corresponding reading on the dial is the diastolic pressure.
- Perform two more readings per session, separated by 5 minutes.
- The blood pressure must be elevated during at least 3 separate sessions to diagnose hypertension.
Systolic Pressure Guideline for Adults
|Systolic Blood Pressure||Assessment|
|Over 140-159||Hypertension Stage 1|
|160 or higher||Hypertension Stage 2|
Diastolic Pressure Guideline for Adults
|Diastolic Blood Pressure||Assessment|
|90-99||Hypertension Stage 1|
|100 or higher||Hypertension Stage 2|
Failing Heart Pulse Checks
If you have congestive heart failure, it is important to learn how monitor your pulse at home.
The pulse may be taken in a few locations, but the most commonly used location is the wrist.
Locations for Taking a Pulse
- Wrist: the radial artery is located in the wrist crease, on the thumb-side. This is an excellent place to measure the pulse.
- Neck: the carotid artery lies on either side of the Adam's apple, just in front of the large muscle in the neck. Check the pulse on one side only: never press on both carotid arteries at the same time.
- Elbow: the brachial artery is located in the elbow crease, on the inner aspect of the elbow, next to the bicep tendon.
- Groin: the femoral artery is located in the crease between the thigh and the abdomen, halfway between the pubic hair and the hip.
- Ankle: the posterior tibial artery is located on the inside of the ankle, right behind the prominent bone, called the medial malleolus, on the inside aspect of the ankle.
In order to feel the pulse, place the tips of your index and middle fingers over the artery, and then press gently. Do not obstruct the flow through the vessel.
Interpreting Pulse Results
Count the number of pulsations that occur over 20 seconds, and then multiply this number by three. The result is the heart rate, or number of heartbeats per minute.
When measuring the pulse, try to assess the rate and the rhythm. Take note of an unsteady rhythm or extra beats. Report a rapid heart rate or extra beats to your doctor.
Normal Values for Resting Pulse
|Age Range||Average Beats Per Minute|
Failing Heart Taking Control
The successful treatment of congestive heart failure requires your participation. Here are answers to some important questions.
Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.
How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.
How can you participate in your health care?
To participate you must:
- Learn to take responsibility for your own health.
- Learn to partner with your doctor.
- Learn how to make active decisions about your health.
How can you learn what you need to know?
- Educate yourself.
- Be skeptical: Learn to separate fact from fiction.
- Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
- Be careful about where you get your health information.
- Some of the best sources for health information on the web are professional societies and non-profit organizations.
- Ask your doctor what he or she recommends.
- Examine the credentials of the authors.
- If you are reading about symptoms and disease, your best source is a licensed physician.
- Pay attention to when the content was last updated.
- Make sure the person is not just trying to sell you something.
Important questions you need to answer:
- What things in your control can increase your risk for disease?
- What can you do to decrease this risk?
- What are vaccines and how can they help you?
- How do your lifestyle choices increase your risk for disease?
- How can you reduce stress?
- What minor health problems can you treat at home?
- When is a medical problem "serious"?
- When should you call the doctor?
How can you find the right doctor?
- Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
- Establish a relationship in advance with your doctor.
- Make sure you are comfortable with your primary care physician.
- The internet contains many resources where you can do research to locate the doctor that is best for you.
- You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
- Be open-minded, and allow your doctor to know you well. This will improve communication.
Important information you need to make your decision:
- Physician credentials:
- Internship and residency training is usually best from respected institutions, universities, and major hospitals.
- Look for board certification in the specialty.
- Ask about membership in medical societies.
- Community and professional reputation are also important.
- Are other patients happy with the doctor?
- Has the doctor been disciplined by hospitals or agencies?
- How long has the doctor been in practice?
- In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
- Does the doctor communicate well? Are your questions answered during busy times?
- Does the doctor welcome you to help make decisions about your care?
- Is the doctor available when you need care?
- What is the doctor's after-hours coverage?
- Is he or she a member of a large group?
- Do the doctors' cross-cover one another?
- Where do they admit patients?
What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.
For any recommended test, medication, or surgery, remember to ask:
- How will this help me?
- How much will it cost?
- Is it covered by your insurance?
- What are the potential side effects and risks?
- What are my alternatives?
For tests, remember to ask:
- Is it done in the office or at another facility?
- Is it painful?
- How will the results of this test influence my care?
For surgery or other procedures, remember to ask:
- How long will it take to heal?
- How many cases has the doctor done?
- What would your doctor do if he or she were the patient?
- Where is it done?
- Who will perform it?
- What are the doctor's qualifications?
What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.
The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
- To be spoken to in words that you understand
- To be told what's wrong with you
- To know the benefits of any treatment and any alternatives
- To know what a treatment or test will cost
- To share in treatment decisions
- To read your medical record
- To refuse any medical procedure
What should you do before an office visit?
- Bring all important medical information with you to the visit.
- Make sure you can answer questions about the following:
- Allergies and side effects to medicines
- Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
- Insurance information
- Marital and sexual history
- Past injuries and hospital stays
- Past medical problems
- Past surgeries and operations
- Pre-visit questionnaires
- Use of tobacco, alcohol and drugs
- Work history
What should you expect from the visit?
- You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
- Bring along a book or toys for the kids. You may also have to wait during busy times.
- Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
- Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
- Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
- Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
- If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
- Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.
What should you know about your medications?
Every year many people become ill because of problems with medications.
Remember to ask:
- What side effects to expect.
- What drug interactions are possible.
- Find out if a new medicine reacts with those that you are taking now.
- Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
- Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
- Make sure you can drive or operate machines safely while taking a medicine.
- Ask your doctor how much a prescription costs.
- Is there a less expensive option or a generic version?
What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.
Three simple questions can help you get the most from your treatment plan:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do these things?
Other important points:
- Be sure you understand your treatment plan.
- Stick with the treatment plan and allow time for improvement.
- Don't stop medicines when you feel better; check with your doctor first.
- Call your doctor if your condition is becoming worse.
- Your doctor should tell you what to expect and when to follow-up or call the office.
Failing Heart Warning Signs
See a doctor immediately if you have congestive heart failure and any of the following:
Notify your doctor for:
- Difficulty sleeping
- Urinary frequency
- Urinating more often during the night
- Inability to take your prescribed medication
- Worsening fatigue
- Worsening leg swelling (bilateral)
- Paroxysmal nocturnal dyspnea:
- Weight gain:
- A gain of more than 2 pounds (1 kg) over 1 day
- A gain of more than 5 pounds (2.5 Kg) over 1 week
- Worsening palpitations
Failing Heart Wheezing
- Avoid exposure to smoke.
- Avoid cough medicine.
- Avoid sedative medications.
- Avoid substances that trigger wheezing.
- Drink plenty of liquids to remain hydrated.
- Place a vaporizer or nebulizer in the bedroom at night.
Home care for those who take medication for wheezing includes:
- Follow asthma home care instructions.
- Learn to use prescribed inhalers correctly.
- Use short-acting inhalers every 20 minutes, or as directed by your doctor.
- Long-acting medications must be used regularly.
Continue to Failing Heart Prevention
- Bibbins-Domingo K, Lin F, Vittinghoff E, Barrett-Connor E, Hulley SB, Grady D, Shlipak MG. Predictors of heart failure among women with coronary disease. Circulation. 2004 Sep 14;110(11):1424-30. 
- Chen QM, Tu VC. Apoptosis and heart failure: mechanisms and therapeutic implications. Am J Cardiovasc Drugs. 2002;2(1):43-57. 
- Ebinger MW, Krishnan S, Schuger CD. Mechanisms of ventricular arrhythmias in heart failure. Curr Heart Fail Rep. 2005 Sep;2(3):111-7. 
- Mitchell J, Taylor A. Congestive heart failure in women. J Fam Pract. 2005 Jul;Suppl:6-7.