This blog is about understanding the diagnosis and treatment of CHF (congestive heart failure). It is intended to educate newly diagnosed patients with CHF, as well as their family members and friends.
What is CHF?
Congestive heart failure (CHF) occurs when the heart is unable to pump circulating blood to the rest of the body. As a result fluid can get backed up in into the lungs and other parts of the body.
Symptoms of CHF
Common symptoms of heart failure include:
- Shortness of breath during daily activities.
- Having trouble breathing when lying down.
- Excessive awakening at night due to the urge to urinate
- Weight gain with swelling in the legs, ankles, or lower back.
- General fatigue and weakness.
What are the causes/risk factors for developing CHF?
High blood pressure (hypertension) and structural heart changes are the most common conditions that lead to the development of CHF.
Additional Risk Factors include:
- Coronary artery disease
- Substance abuse
- Congenital defects (birth defects)
- Cardiomyopathy
- Diabetes
- Smoking/Tobacco use
- Family history
Treatment: Treatment of CHF includes a combination of dietary & lifestyle changes, as well as medication. Your healthcare provider (doctor, nurse practitioner, or physician’s assistant) will prescribe the treatment and medication regimen that is appropriate for you.
Dietary changes/restrictions:
It is imperative to limit your sodium (salt) intake if you suffer from CHF. Those with mild to moderate CHF should limit their daily salt intake to 3 grams or less, while those who suffer from severe heart failure should limit their daily salt intake to 2 grams or less. It is necessary to limit your sodium intake is because it causes the body to retain water which causes the heart to work harder to pump the extra volume.
- Do not add salt to meals
- Avoid canned and processed foods
- Rinse canned foods with water before preparation
- Use fresh or frozen fruits and vegetables
- Read food labels to determine sodium content
- Substitute low-sodium foods
- Substitute fresh herbs and spices for salt, such as cilantro, crushed red peppers, or Mrs. Dash
- Use salt substitutes cautiously and sparingly, as they contain high amounts of potassium
In addition to reducing your sodium intake, your healthcare provider may have you monitor your fluid intake and possibly place you on a daily fluid restriction. The purpose of restricting fluid intake is to decrease the workload of the heart. Too much fluid in the body causes the heart to work harder. Consult your healthcare provider before restricting your fluid intake, as this is only necessary on an individual basis.
Activity:
It is important to stay as active as possible without overdoing it. Patients with CHF have better outcomes when they adhere to a regular exercise routine.
- Before beginning any exercise regimen consult with your primary care provider.
- Begin walking 200-400 feet each day, at least 3 times per week.
- Increase physical activity slowly, as tolerated.
- Keep an activity diary, documenting the duration of activity as well as heart rate and any symptoms you experience during the exercise.
Common Medications for patients with CHF:
Diuretics: Examples of diuretics include: Lasix (furosemide), Demadex (torsemide), Bumex (bumetanide), Microzide (hydrochlorothyiazide), and Aldactone (spironolactone). These medications work by enhancing the removal of sodium (salt) and water thus decreasing fluid volume and the workload of the heart.
- Take diuretic medications in the morning to avoid waking up in the middle of the night to urinate.
- It is very important to weigh yourself daily, preferably on the same scale, at the same time of day. Doing this daily allows you assess for weight gain. A weight gain of 1-2 lbs overnight, or 3+ lbs in one week suggests fluid retention and indicates that it is necessary to contact or visit your healthcare provider.
- Diuretics such as Lasix, Demadex, and Bumex, and hydrochlorothyiazide may lead to potassium deficiency. Therefore it is important to monitor yourself for signs and symptoms of potassium deficiency.
Signs and symptoms of potassium deficiency include:
- Weakness all over the body
- Depressed reflexes
- Irregular heart rate
- If you are taking a diuretic that may cause a potassium deficiency, it is important to incorporate potassium rich foods in your diet.
- Potassium rich foods include: bananas, avocados, raisins, prunes, apricots, dates, cantaloupe, oranges, greens, spinach, peas, tomatoes, fresh turkey, mushrooms, beef, and fish.
- Spironolactone is a potassium sparing diuretic. If you take spironolactone alone and not in conjunction with another diuretic such as Lasix, Demadex, Bumex, or hydrochlorothyiazide do not use salt-substitute seasonings because they may contain potassium additives.
- Since Spironolactone is a potassium sparing diuretic it will cause you to retain potassium instead of excreting it, thus with this diuretic it’s important to monitor your potassium intake.
ACE- Inhibitors: Examples include: Vasotec (enalapril), Zestril (lisinopril), Monopril (fosinopril), Lotensin (benazepril), Altace (ramipril) and Capoten (captopril). Angiotensin converting enzyme (ACE) inhibitors decrease the workload on the heart by dilating blood vessels therefore decreasing blood pressure.
- Potential side effects include: dry nagging cough, low blood pressure, dizziness upon standing, weakness, increased potassium levels, and swelling of the face, neck, or tongue. While taking an ACE inhibitor, if you experience any swelling of the face, neck, or tongue seek medical attention immediately, as this is potentially a life-threatening emergency.
ARBs: Examples include: Micardis (telmisartan), Cozaar (losartan), Diovan (valsartan), Avapro (irbesartan), Teveten (eprosartan), and Atacand (candesartan). Angiotensin receptor blockers (ARBs) work very similarly to ACE-inhibitors; however, they do not produce the side effect of a dry nagging cough that some patients experience while on an ACE-inhibitor.
- Potential side effects include: low blood pressure, dizziness upon standing, and increased potassium levels.
Beta-blockers: Examples include: Coreg (carvedilol), Lopressor (metoprolol), Inderal (propranolol), Tenormin (atenolol), Trandate (labetalol), and Zebeta (bisoprolol). Beta (adrenergic) blockers decrease the workload on the heart by decreasing heart rate and blood pressure.
- Potential side effects include: dizziness upon standing, a large drop in blood pressure, nausea, and weakness.
When to notify your healthcare provider
Contact your healthcare provider if you experience any of these symptoms:
- Rapid weight gain of 1-2 lbs overnight, or weight gain of 3 or more pounds in one week.
- Decrease in exercise tolerance lasting 2-3 days.
- Cold symptoms (cough) lasting more than 3-5 days.
- Excessive awakening at night due to the urge to urinate.
- Developing difficulty in breathing.
- Experiencing heart pain at rest or worsening heart pain also known as angina.
- Increased swelling in the feet, ankles, or hands.
Test your knowledge
1. What is Congestive Heart Failure?
- a) Insufficient blood volume in the heart.
- b) The heart’s inability to pump blood out to the rest of the body causing a backup of fluid.
- c) The inability of the veins to bring blood back to the heart.
- d) All of the above.
2. What dietary changes need to be made with Congestive Heart Failure? Select all that apply.
- a) Limit daily salt intake to 3 grams or less.
- b) Use herbs and spices on food instead of salt.
- c) Use fresh or frozen fruits and vegetables.
- d) Include lots of canned and processed foods into your diet.
- e) Carefully read food labels for salt content.
3. Before begging any exercise program what is the first most important thing to consider/do?
- a) Keep an activity dairy where you document the amount of exercise you did, your heart rate, and any symptoms you experienced.
- b) Make sure you have well-fitting shoes.
- c) Consult with your primary care provider before beginning any exercise program.
- d) Plan on working out strenuously at least three times per week.
4. Some diuretics cause potassium levels in your body to fall below normal. What signs and symptoms would you need to watch for that indicates potassium deficiency? Select all that apply.
- a) An increase in energy.
- b) Weakness all over the body.
- c) Depressed reflexes.
- d) Irregular heart rate.
5. Which symptom experienced would direct you to pick up the phone and call your healthcare provider?
- a) A decrease in swelling in the feet, ankles, or hands.
- b) A cough that lasted 1 day.
- c) An increase in exercise tolerance.
- d) A rapid weight gain of 1-2 lb overnight, or a gain of 3 pounds or more in one week.
Answer Key:
1. b
2. a, b, c, e.
3. c
4. b, c, d
5. d
If you have any additional questions regarding CHF and treatment, you may text your questions to (425) 310-2777 and one of our registered nurses, who created this blog, will try to answer your questions in a timely manner.
The following links to the mayoclinic and the national institute of health are great websites to obtain additional information and possibly answer any additional questions that you may have concerning CHF: http://www.mayoclinic.com/health/heart-failure/
national institute of health – heart failure
This blog was put together by: Hayley Baker RN, Olga Krasnogorov RN, and Michelle Topel RN.
References
Ignatavicius, D. D., & Workman, M. L. (Eds.). (2010). Medical-surgical nursing: Patient
centered collaborative care (6th ed., Vol. 1). St. Louis, MO: Saunders Elsevier.
Porter, R. S. (2011). The merck manual of diagnosis and therapy. (19 ed.). Whitehouse Station, NJ: Merck.
CHF Congestive Heart Failure 