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Living Life to the Fullest: Proper Care for Congestive Heart Failure

Congestive heart failure (CHF) is the inability of the heart to pump blood effectively to the body. CHF does not mean that the heart has stopped working completely, but does mean that the heart is not pumping as strongly as it should. As a result, some of the blood that is normally pumped out of the heart backs up into the lungs and other parts of the body, causing a build-up of fluids in the body (resulting in swelling), shortness of breath and fatigue. While prevention of heart failure is optimal, it’s important that those who are diagnosed, along with their family members, know how to maintain quality of life and provide proper care.


Coping With the Symptoms of Heart Failure


The seriousness of heart failure usually determines the impact on a person’s life. “The type of assistance that patients with heart failure need is directly dependent on the degree of severity of the heart failure,” Dr. Douglas Mann, Lewin Professor and Chief of the Cardiovascular Division at Washington University School of Medicine, and the Cardiologist-in-Chief of Barnes-Jewish Hospital, explains. Mild heart failure may have little effect, while severe heart failure can interfere with even simple activities of daily living, such as bathing and dressing. “One symptom of heart failure is shortness of breath, so someone with class three or four [more severe] heart failure may need help getting groceries, even help getting up the stairs and going to the bathroom, or they could be bed-bound,” Dr. Marrick Kukin, Director of the Heart Failure Program at St. Luke’s-Roosevelt Hospital Center in New York City, and Professor of Clinical Medicine at the Columbia University College of Physicians & Surgeons, notes.


In cases of moderate to severe heart failure, support from loved ones is essential to successful adaptation. According to Dr. Mann, “The great majority of patients with severely advanced heart failure will require assistance ambulating.” In order to cope and help in the best way possible, Dr. Kukin suggests caregivers practice patience when assisting their loved one with heart failure. “They [patients] need to be encouraged to try some activities, but also to rest,” Dr. Kukin explains. “If they walk three steps and have to catch their breath, that’s OK.” Assuring your loved one that s/he can indeed make it to the kitchen table for lunch, no matter how long it takes, gives them confidence and strength (both mental and physical).


Medications, such as diuretics (water pills used to reduce swelling and congestion), ACE (angiotension-converting enzyme) inhibitors and beta-blockers, can also support the day-to-day life of a heart failure patient. “Both ACE inhibitors and beta blockers have been shown in clinical trials to reduce hospitalization, lower mortality, and make patients with heart failure feel better,” Dr. Kukin notes. He encourages both the person living with heart failure and the family caregiver to ensure the medication regime prescribed by the health care provider is followed.


Diet & Exercise: Things to Keep in Mind


Upon diagnosis of heart failure, a person’s diet and exercise routine must be tailored to ensure optimal health and well-being. If you’re the family member responsible for caring for your loved one, don’t worry about having to cook two meals, or engage in different exercise programs — the following suggestions are great preventative measures for your heart health, as well, so join in!


Perhaps the most important dietary guideline to follow is reducing sodium. Salt increases blood pressure, putting further strain on the heart, and also causes fluid retention by the kidneys. “It’s essential that the person who has heart failure follow a low-sodium diet (two grams per day), which means no saltshaker, and avoiding foods that have high sodium concentration, such as canned soups, hard cheeses, pizza, and processed meat,” Dr. Kukin explains. Begin reducing sodium intake by using other spices to flavor food, limiting the consumption of processed foods and fast food — and increasing the amount of fruits, vegetables and fresh foods in your refrigerator.


Dr. Kukin also suggests that those living with heart failure limit the amount of fluids they consume, as excess fluids can cause fluid retention (and swelling), and also often result in decreased serum (blood) sodium. However, “It is extremely difficult to keep patients from drinking water if they are thirsty,” Dr. Mann notes. He suggests patients restrict fluid to less than two liters per day if they have moderate hyponatrenia (lower than normal serum sodium), and follow more strict limitations when severe hyponatrenia is present.


Having heart failure doesn’t mean dining out is out of the picture, either — it just means you and your loved one will have to be more aware of your choices. Avoiding restaurants that only serve fried or fast food, asking that food be prepared without salt or MSG, and planning meals around busy schedules will ensure a heart-healthy diet.


Physical activity strengthens muscles — and the heart is a muscle — so exercise is also a very important part of maintaining health in the wake of heart failure. “Once a patient gets a diagnosis of heart failure, we don’t want them to become couch potatoes,” Dr. Kukin explains. “We want them to be physically active within their means.” He recommends swimming and walking — even if rest is needed in between laps, or even steps. “ … the caregiver has to encourage the patient to walk, even if it’s half a block, then rest and walk some more. Try to increase it [exercise] by a few feet each day.” According to Dr. Kukin, the only exercise that should really be avoided is extreme weight lifting.


“In general, the goal of exercise should be 30 minutes of moderate activity 5 days a week, for a total of 150 minutes per week,” Dr. Mann adds. According to Dr. Mann, the only time exercise should really be avoided is in the most severe cases of heart failure, or when an exercise-induced arrhythmia is present.


Avoiding Stress & Depression: Living Life to its Fullest


Although those diagnosed with heart failure can live fulfilling and enjoyable lives, there is no cure for heart failure — which oftentimes leaves patients and their family caregivers living with stress or depression. In fact, people with heart failure and their caregivers have depression at much higher rates than the general public. According to Dr. Mann, rates of depression have been reported in 15 percent to 35 percent of heart failure patients, depending on the methodology used for the diagnosis of depression. It’s essential that both parties — the caregiver and their loved one living with heart failure — commit to being aware of mood changes and emotions in themselves and each other.


Stress takes its toll on the body, decreasing the physical health and emotional well-being of both the caregiver and his/her loved one with heart failure. To reduce stress, take walks together, talk about your feelings and emotions (or jot them down in a journal), and take time each day to be in peace (meditation or yoga are great options).


In order to reduce the stress that comes with a diagnosis, Dr. Kukin suggests both the patient and the caregiver educate themselves about heart failure. “Knowledge is freedom. Knowing a little bit more about the heart’s pumping, heart function, why the patient is taking various medications, why they’re being restricted in sodium, and why they’re being encouraged to exercise is all very important.”


Depression is associated with increased risk of cardiovascular disease, so it goes without saying that treatment is essential. In addition, “ … depression can impact the quality of life for patients with heart failure, and has been associated with a four-fold increase in overall mortality,” Dr. Mann notes. “Depression can also impact cognitive function, which makes it more difficult to instruct patients on medication use, as well as dietary restriction.” Dr. Mann stresses the importance of the caregiver role in diagnosing depression. He suggests being aware of changes in mood, or mental status, and seeking treatment when necessary. While it can be difficult to talk about depression — whether about your own depressed feelings or the feelings of the person in your care — it is important to reach out to a health care provider and discuss a treatment plan.


The Warning Signs: When to Seek Medical Attention


While it’s completely feasible to cope with the symptoms of heart failure and live a safe, satisfying life at home (especially with the help of a loved one or professional caregiver), there are certain warning signs that indicate medical help is a necessity.


Dr. Kukin cites the following as indications of heart failure worsening: difficulty lying in bed (orthopnea), swelling in the calves or ankles (edema), early satiety (feeling full quickly), and waking up in the middle of the night to catch breath. Excessive weight gain (3 pounds in one day, or 5 pounds in one week) can also point to problems, so Dr. Kukin suggests those living with heart failure keep a scale handy and weigh themselves daily, with the help of a caregiver if necessary.


Other Treatment & Care Options


Depending on the prognosis, there are treatment options for certain heart failure patients. Electrical devices, like defibrillators and mechanical heart assistance can provide life-prolonging therapy, Dr. Kukin notes — but are expensive and involve surgical procedures.


Home care or hospice can also be options for those living with health failure and their loved ones. Home care can provide assistance with activities of daily living, transportation services, and companion care. For more on hospice care, please refer to “

What Everyone Should Know About Hospice Care



About the Experts


Dr. Marrick L. Kukin is the Director of the

Heart Failure Program at St. Luke’s-Roosevelt Hospital Center in New York City

, and is Professor of Clinical Medicine at the

Columbia University College of Physicians & Surgeons

, New York, NY. Dr. Kukin’s areas of research have included beta blockade and other neurohormonal antagonists in congestive heart failure, and the use of inotropic agents in heart failure. Among other honors, he received the Denber Award for Excellence in Cardiovascular Research from the Mount Sinai School of Medicine, and was voted the Michael Lesch Teacher of the Year by the cardiology fellows in 2008. Dr. Kukin has recently been appointed as a co-editor of “Progress in Cardiovascular Diseases.” He is an associate editor of “Congestive Heart Failure” and a reviewer for “American Heart Journal,” “Circulation,” “European Journal of Heart Failure” and “Journal of the American College of Cardiology.” Dr. Kukin’s articles have been published in various scientific journals, and he edited a book entitled, “

Oxidative Stress and Cardiac Failure

,” (Futura/ Blackwell Publishing, Armonk NY 2003). Dr. Kukin is co-founder of the New York Heart Failure Club, where he continues to serve as Co-Chairman of the Program Committee.


Dr. Douglas Mann is the Lewin Professor and Chief of the

Cardiovascular Division at Washington University School of Medicine

, and the Cardiologist-in-Chief of

Barnes-Jewish Hospital

. Dr. Mann's primary area of research is in the molecular and cellular basis of heart failure, with a particular emphasis on the role of inflammatory mediators in disease progression in the failing heart. He has published more than 200 articles and reviews in this field, is the editor for a leading textbook in heart failure: “

Heart Failure, A Companion to Braunwald’s Heart Disease, (2nd edition)

” and is a co-editor for the ninth edition of “Braunwald’s Heart Disease.” Dr. Mann has previously served as the deputy editor for “Chest,” and was an associate editor for “Circulation.” He is currently is a member of the editorial board of “Circulation,” “The Journal of the American College of Cardiology,” “Cardiology Today,” “Heart and Vessels,” “Heart Failure Reviews,” “Heart Failure Monitor,” “Congestive Heart Failure,” and the “Journal of Cardiac Failure.” He has received numerous awards, including the Michael E. Debakey award for excellence in research, and the Alfred Soffer Award for Editorial Excellence from the American College of Chest Physicians. He is the immediate past president.

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