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 creating a home health routine. 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 family care givers 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 care giver to ensure that the prescribed home health and medication regime 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 home 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 family care giver 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 care givers living with stress or depression. In fact, people with heart failure and their family care givers 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 family care giver 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 family care giver 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 family care giver 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 family care giver 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 in home 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 an in home 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.

In home caregiving, home health nursing care, or hospice care 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.