Lifestyle changes
Managing fluid build-up
Medications
When to consult your doctor

Congestive heart failure cannot be cured, but it can be managed effectively. There are more treatment options available today than ever before. Treatment can control your symptoms and improve the quality of your life. Moreover, there are effective ways to treat the underlying cause of this condition.

The first step is a proper medication regime, adopting a healthy lifestyle and monitoring your condition. As the condition progresses, doctors who specialize in the treatment of congestive heart failure can offer more advanced treatment options.

The goal of treatment is to reduce the amount of work the heart has to do, control fluid build-up, increase the heart's ability to pump blood, and ultimately slow the progression of the disease. By slowing the progression of the disease you decrease the need for hospitalization and the risk of death.

The following include some questions you may wish to discuss with your doctor.

Lifestyle Changes

What are some healthy habits I should adopt? Are there some types of physical activity I should avoid?

Lead a smoke free life. This includes stopping smoking and eliminating your exposure to second hand smoke. Smoke makes the heart work harder, decreases the amount of oxygen in the blood, and damages blood vessels. Your doctor or nurse can provide you with information on how to quit smoking.

For smoking cessation information, see Resources under Stop Smoking.

Get vaccinated against flu and pneumonia. Talk to your doctor about immunizations for flu/pneumonia because preventing respiratory infection is very important in the management of congestive heart failure.

Reduce your salt/sodium intake. Two grams per day should be your limit. Salt makes your body retain fluid, which forces your heart to work harder. Reducing your salt intake also helps reduce the fluid build-up of congestive heart failure, and can lessen the need for some medications such as diuretics. Be sure to read food labels in order to avoid liquids and foods that are high in salt.

Limit foods high in fat, cholesterol and sugar. Eat foods high in fiber and potassium. Speak to your doctor about whether you need to reduce your daily intake of calories to lose weight. For more information on nutrition, see resources under Diet and Nutrition.

Reduce your consumption of alcohol. Discuss with your doctor whether you should decrease or eliminate alcohol consumption. Excessive alcohol can be poisonous to the heart.

Exercise in moderation. Participating in regular activity is one of the most important things you can do to improve your overall health, and may decrease the progression of congestive heart failure. Walking is a very good activity for improving health. Generally speaking, a regular walking program that includes 5-10 minutes of walking per day, three times per week in the first week, and then increasing to 20-30 minutes per day by week eight is recommended. Swimming and cycling are also good forms of exercise.

Your doctor or other members of your health care team can recommend the type and amount activity that is right for you.

Physical activities that cause shortness of breath or dizziness are not recommended. These include:

• Contact or competitive sports
• Activities that require a sudden burst of energy (baseball, hockey)
• Exercises in which you have to hold your breath or bear down
• Weight lifting activities (your own weight or other weights)

Do not over do it. Make sure to balance activity with rest periods. Do this by planning ahead, scheduling rest periods into your activities, alternating heavy and light tasks over the day and throughout week, and setting priorities. If your congestive heart failure is severe, bed rest may be necessary.

Take time to relax and get support from family and friends. Arrange for any help with work that will be too difficult to carry out on your own. Certain activities such as pushing or pulling heavy objectives and shoveling may worsen congestive heart failure and its symptoms.

Seek emotional and psychological support. Congestive heart failure can be difficult for you and your whole family. Seek emotional and psychological support if you need it. Talk to your health care team about support available in your community. Often a social worker, psychologist, clergy or heart failure support group is only a phone call way.

Sexual activity does not have to stop. If you feel anxious or have worries about this aspect of your life, it may be help to discuss any problems or concerns with your partner and doctor.

For more information, see resources under Exercise.

Managing Fluid Build-Up

How do I control fluid build-up? When should I contact my doctor?

Limit your fluid intake. Remember that a symptom of congestive heart failure is fluid build-up. Drink no more than 6-8 glasses of fluid per day, and drink the same amount everyday. Try to spread your fluid intake over the course of an entire day.

Weigh yourself three times per week and record it in a diary in order to monitor your fluid build-up. See your doctor if your weight suddenly increases by one kg (two lbs) in two days, or three kg (six lbs) in one week.

Tips on managing fluid build-up include:

• Breathing exercises each hour when awake will help clear the lungs.
• A strong cough will help clear the lungs.
• Support stockings may help reduce leg swelling.
• Raise your legs when resting and use a foot-stool when sitting.
• Raise the head of the bed 4-6 inches or use a wedge-shaped pillow to prevent fluid in lungs from interfering with breathing.

Medications

What medications will I need to take? Do they have any side effects? Should I take them even when I am feeling well? Should I consult my pharmacist before I take over-the-counter medications?

Medications are very important in the treatment of congestive heart failure. Their function is to remove excess body fluid, improve your blood circulation, improve the heart's ability to pump, and maintain proper heart rhythm.

Your doctor may suggest that you stop smoking or lose weight to help reduce the workload on the heart before prescribing medications. These lifestyle changes can help reduce risks associated with high blood pressure and coronary artery disease - two recognized causes of congestive heart failure.

The following types of medications are used in treating congestive heart failure:

• ACE Inhibitors reduce the stress on your heart by lowering high blood pressure, and may prevent symptoms from getting worse. Examples of this type of medication include captopril, cilazapril, enalapril, fosinopril, lisinopril, quinapril. People who experience a dry cough may be prescribed angiotensin-receptor blockers (also known as "ARBs") medication instead.

  Side effects may include weakness, dizziness or light-headedness, skin rash, and dry cough. If you experience swelling of the face, tongue, hands or feet, seek medical help immediately. Please note that this side effect is very rare.

• Diuretics are used to prevent or reduce the swelling, shortness of breath and bloating that results from fluid back-up. You will notice that these drugs increase the flow of urine. Diuretics remove water and salt from the body, but sometimes also remove potassium. If this happens, you might need to take potassium pills to replenish the body's supply. Some diuretic have the added benefit of helping to lower blood pressure. Examples of diuretics are bumetanide, furosemide, hydroclorothiazide, metolazone, torsemide, and chlorthalidone.

  Side effects may include weakness, dizziness, muscle cramps, nausea, dry mouth and increased thirst. Contact your doctor if you develop a skin rash.

• Beta blockers may be added if angiotensin-receptor blockers (ARBs) and diuretics do not control symptoms adequately. These include medications such as bisoprolol, carvedilol and metoprolol.

  Side effects may include fatigue.

• Digitalis Glycosides are used to increase the strength of heart's pumping action. An example of this type of medication is Digoxin.

  Side effects may include weakness, dizziness, muscle cramps, nausea, vomiting, diarrhea, blurred vision, confusion, major appetite loss, and weakness. Contact your doctor if these side effects cannot be explained by another cause, such as the flu.

Always speak with your doctor if the side effects bother you. Never stop taking your medications without first discussing it with your doctor. Never skip a dose, even if you are feeling better.

If you plan to take over-the-counter medications such as antacids, laxatives, cough or cold medications, ibuprofen and other anti-inflammatory drugs, ask your pharmacist to help you find an over-the-counter medication that does not make your symptoms worse or make your prescription medicines less effective.

Remember that the medications do not cure congestive heart failure; they only improve your symptoms. If you stop taking your medications, your symptoms will return.

When to consult your doctor

You should consult you doctor if you experience any of the following problems:

• Increased shortness of breath
• Weight gain of more than 1kg (2 lbs) in two days, or 3 kg (lbs) in one week
• Extreme fatigue
• Nausea or vomiting
• Feeling bloated or full all the time
• Increased swelling in feet, ankles or legs
• Increased urination at night

See also Working with your Doctor.

Last Revised: December 17, 2007