Tips for Managing Congestive Heart Failure

Congestive heart failure, or CHF, is a condition in which the heart is unable to pump enough blood to meet the body’s needs. Sometimes called just “heart failure,” the term is a little misleading. Heart failure doesn’t mean that the heart has failed or that it no longer works; rather, it means that the heart is struggling to pump enough blood throughout the body.

Causes of CHF
There are many causes of CHF, and these include:

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• Blocked blood vessels that supply the heart with blood
High blood pressure
• Diabetes
• Cardiomyopathy, or weakened heart muscle
• Congenital heart diseases
• Infection of the heart muscle
• Toxic amounts of certain drugs, such as alcohol and cocaine
• High blood lipids (cholesterol and triglycerides)
• Family history of heart failure

While maybe not a direct cause, certain lifestyle factors can contribute to or worsen CHF, such as being overweight or obese, smoking, drinking excessive amounts of alcohol, a high sodium intake, and lack of physical activity.

You may be surprised to learn that having diabetes puts you at risk for CHF. Heart failure is one of the most common complications of diabetes, and while many factors play a role, the two main culprits are hyperglycemia (high blood sugars) and insulin resistance (strongly linked with Type 2 diabetes). Data from the well-known Framingham Heart Study showed that the frequency of heart failure is twice as high in men with diabetes and five times as high in women with diabetes compared to a control population.

Symptoms of CHF

How do you know if you have CHF? Symptoms that may indicate congestive heart failure are:

• Shortness of breath
• Feeling very tired and/or weak
• Swelling in your ankles, feet, or legs (called edema)
• Swelling of the stomach
• Sudden weight gain (due to fluid retention)
• A cough that doesn’t go away
• Coughing up blood-tinged mucus
• Having to urinate often
• A rapid or irregular heartbeat
• Chest pain
• Nausea or a lack of appetite

Of course, these symptoms can be due to other medical issues, so it’s important to get them checked out by your doctor.

The Heart Failure Society of America suggests this easy way to remember symptoms of CHF: Think of the acronym “FACES,” which stands for Fatigue, Activities limited, Chest congestion, Edema, and Shortness of breath.

For a more complete overview of CHF, see the article here.

Managing CHF
The good news about CHF is that it may improve with proper treatment. However, if this condition isn’t treated, it can lead to serious complications, including kidney and liver damage, heart valve problems, and irregular heartbeat. It probably goes without saying that well-managed diabetes can improve the outlook of CHF, as well.

Medicine: Treatment of CHF likely includes the use of certain types of medicines, including drugs for high blood pressure such as ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, and diuretics. Other drugs may be used, too, like digoxin. It’s common to take several types of medicines for CHF.

Surgery: Surgery could be needed to treat an underlying condition, such as a faulty heart valve or blocked arteries. In severe cases of CHF, a heart transplant may be performed.

Smoking cessation: Smoking lowers oxygen levels in the body, raises blood pressure, and makes your heart have to work harder. Talk with your doctor about ways to stop smoking.

Weight loss: Losing weight can be hard. However, being overweight puts an extra burden on a heart that’s already struggling to do its job. Start off with trying to lose a small amount of weight. Work with a dietitian or consider trying a safe and healthy program to lose weight (if you’re not sure what’s safe, check with your doctor or dietitian).

Weight monitoring: You’ll likely need to weigh yourself regularly to check for fluid retention and the need to alter your treatment plan. Your doctor should give you guidance on how often to monitor your weight. For accurate weights, weigh yourself at the same time each day (morning is best after you’ve urinated), wearing no clothes or the same clothes. Keep track of your weights, too.

Fluid intake: Depending on the stage of CHF, you might need to limit how much fluid you drink. For example, your doctor may advise you to limit your fluid intake to 2000 ccs per day — that’s about two quarts. Fluids obviously include any type of beverage, but also includes things like soup, ice, gelatin, ice cream and sherbet, and popsicles.

Sodium intake: Eating too much salt and sodium can cause you to retain fluid. Find out how much sodium you should be consuming from your doctor or dietitian. To cut sodium from your diet, avoid using salt on foods or in cooking; avoid foods with visible salt on them, such as saltine crackers or salted nuts; and limit your intake of canned or processed foods (soups, canned vegetables, luncheon meats, boxed rices, etc.). Try to eat fresh or frozen foods, and choose no-salt-added or lower-sodium versions of foods whenever possible.

Dietary supplements: Some research shows that people who have CHF may be lacking in certain nutrients, which can affect health and quality of life. Coenzyme Q10, L-carnitine, vitamin D, and hawthorn are sometimes suggested as being helpful for CHF. Because dietary supplements can interact with medicines, don’t take them without first talking with your doctor.

Alcohol: You may not be able to drink alcoholic drinks if you have CHF. Alcohol can interfere with medicines, and can weaken your heart. Ask your doctor about drinking alcohol.

Physical activity: CHF can make you feel tired, but it’s helpful to stay active. Physical activity can strengthen your body, making it easier for your heart to do its job. However, you need to find out what types of activity and how much you can safely do from your doctor.

Sleep: Getting quality sleep can sometimes be hard if you have trouble breathing — propping your head up may help. If you are waking up to urinate often, ask your doctor about changing the time that you take your diuretic.

Blood sugars: Work with your diabetes team to help you manage your blood sugars as best you can. Your diabetes medicines may need to be changed, for example, or you may need to make a few tweaks to your eating plan. Checking your blood sugars regularly is important, too.

Stress: No doubt, having CHF can be extremely stressful. But it’s important to try and manage stress, not only for a better quality of life, but also because stress triggers certain hormones in the body that can put a burden on your heart — and raise your blood sugars, too. Seek out ways to help you better deal, such as yoga, meditation, deep breathing, socializing, support groups, or counseling.

For more information about CHF, visit the Heart Failure Society of America’s website.

Want to learn more about heart failure and diabetes? Read “Living Well With Heart Failure,” by certified diabetes educator Joy Pape.