n Bovril, beef tea and Oxo. Lo salt or salt substitutes are not recommended because they may affect your medication. 3 n23: living with heart failure. Looking

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Your nurse: contact For more urgent attention or out-of-hours help, contact your general practitioner (GP). How can this leaflet help? Your doctor has diagnosed that you have heart failure. This leaflet is designed to help you understand more about it. Effective treatment of heartfailurewill help you keep it under control and help you feel better. You maybe feeling worried or afraid, andperhaps you have not taken in everything you have been told. These feelings are normal and are part of coming to terms with what is happening to you. This information will answer some of your questions. You should share it with your family so theycan also understand your heart failure. It is important to work with your doctor and nurse tomakedecisions that you arehappy with. This information will allow you to discuss any changes needed in your lifestyle and set realistic targets. Read this information carefully and ask the doctors or nursing staff to explain anything youdonÕt understand. How the heart works The heartisamuscular organ which pumps blood, enriched with oxygen and nutrients,around the body. In fact it is really two pumps that workside by side: nThe right side receives blood from the bodyand pumps it tothe lungs where the blood is filled with oxygen.nThe left side receives blood, rich with oxygen, from the lungs and pumps it back around the body to the muscles and organs. What is heart failure? Heart failure is a common heart problem. The term heart failure sounds alarming, but it it is simply a technical term for a weak heart muscle. This means that your heartcannotpump as wellas it used to. It makes the heart less efficient at circulating oxygen and nutrients to muscles and organs and returning waste products to the kidneysand lungs. Heart failure is not the same as a heart attack, although it can develop as a result of a heartattack. Because your heart is less efficient you mayfeel more tired and breathless. Fluid can sometimes build up in your body. This is why you may get swollen ankles, feet and legs. If water begins tocollect in your lungs, you will feel even more short of breath. What causes heart failure? Heart failure may be caused by damage to the heart muscle. This is most commonly due to: nHeart attack nAnginanHigh blood pressure nFaulty heart valves nAviral infection of the heartmusclenDrinking too much alcohol nHeart rhythm disorder nAn unknown cause1n23:living with heart failure Looking After Your Heart

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What are the symptoms? nShortness of breath, difficulty breathing or a coughare all common symptoms of heart failure and are due to fluid collecting in the lungs. The breathlessness is often more noticeable when you are exercising or lying down. You may also have an irritating cough. Heart failure can lead to you waking up at night, and you may need to get out of bed before you feel better. Not all breathlessness is due to heart failure however. It is normal to be breathless when you do physical exercise. However, excessive breathlessness, when compared to your friends of the same age, is a cause ofconcern. Breathlessness is also common insmokers and people with breathing conditions. Overweight people may become very breathless when they do exercise. nTiredness and weakness during exercise or when you do activities such as housework. This is partly due to reduced blood flow to the exercising muscles. nA swollen stomach and swollen feet, ankles and legsare other signs of fluid building upin your body. This is due to gravity and the effort it takes for the heart to pump your blood up from your feet. Not all swollen ankles are due to heart failure however. Overweight people are prone to swollen ankles without having heart failure. Other conditions, such as varicose veins, are also common cause of swollen ankles. Healthypeople can suffer from swollen ankles if they have not moved for a long time, for example, on a long journey.nYou will gain weight as your body retains extra fluid and this is due to your heart not pumping efficiently. Sometimes this weight gain can happen rapidly, for example, up to 2 or 3 pounds (one kilogram) in two days or 5 to 6 pounds (two to three kilograms) in a week. In other cases, slow progressive weight gain, which is not caused by overeating, may be a sign that your heart failure is not fully controlled. Weigh yourself regularly. You should do this after going to the toilet but before eating. Gaining weight may mean that fluid is building up in your body. How is heart failure diagnosed? When a patient describes these symptoms to a doctor, they may suspect heart failure. A careful examination of the heart and lungs will confirm the diagnosis but a number of tests are also needed. nA chest x-ray is useful to confirm the diagnosis and work out how much fluid has built up in the lungs. nAn electrocardiogram (ECG) will be able to confirm signs of a heart attack or rhythm change. nAn ultrasound scan or echocardiogram is the most useful test used to assess the pumping action of the heart. This is a painless test that provides screen and video pictures of the heart working. It allows the doctor to assess your heartÕs performance. How is heart failure treated? Some conditions that lead to heart failure can becured, such as anaemia, heart-rhythm disorders or an overactive thyroid. Similarly, certain valve diseases can be corrected by an operation. In most cases, however, heart failure is the result of a weakened pump function of the heart. Thisis a life-long condition but symptoms can be successfully treated with medication and yourlife can be improved with the appropriate lifestyle changes and treatment. 2n23:living with heart failure Looking After Your Heart

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Many drugs can be used to treat heart failure. If you are taking such drugs, your doctor will discuss them with you individually and your healthcare professional will give you leaflets explaining how they work. Things to remember about taking your medicine: nYou should take your tablets every day. They are essential to treat your heart failure. nTake your tablets regularly. Never skip a dose, even if you feel better nDepending on your symptoms, you may be prescribed one or more medicines. This may be altered when you are reviewed. nAlways keep a note of what tablets you are currently taking. nMake sure you never run out of your tablets nKeep taking your tablets until your doctor agrees that you can stop. nDo not take Ôover the counter medicinesÕ without telling the pharmacist about the medicines you are taking Ð they may affect how your medicines work. Surgery for heart failure Heart failure is not usually treated with surgery. But if it is appropriate in your case, theconsultant will discuss with you. What you can do for yourself A few simple lifestyle changes can really make a difference. 1) Stop smoking Your doctor has probably already told you to stop smoking and congratulations if you have. However, you may need extra help if you are still finding it difficult to stop. Why should you stop smoking when you have heart failure? Smoking harms both your heart and lungs. If you have heart failure, smoking puts added pressure on your weak heart. Smoking releases the following poisons which affect your heart. nNicotine is a poison in your body and causes your heart rate and blood pressure to increase. nCarbon monoxide competes with the cells in your bloodstream that carry oxygen. This reduces the amount of oxygen that your blood can carry. nTar is deposited in your lungs and makes it more difficult for your lungs to exchange oxygen and carbon dioxide. We know it is not easy to stop smoking but you must stop now and forever. If you need help or advice, please ask the staff or you can contactnSMOKELINE on 0800 84 84 84 or nFAGENDS on 0800 195 2131 web: www.roycastle.org 2) Reduce your salt intakeToo much salt in your diet can make your heart failure worse. We need a certain balance of salt (sodium) and water in our body. However, too much salt or too much water can upset the balance. If you have heart failure it is important that you take less salt because it encourages your body to keep more water. You should cut down on your salt intake. Always taste food before you add any salt and try never to add salt at the table. You can try using herbs, spices, pepper, mustard or lemon instead. Many foods contain a lot of salt and you should avoid them. These foods include the following: nProcessed meats, such as salami or bacon nCanned soup and vegetables nTomato sauce and juice nMost Ôfast foodsÕ nChinese foodsnSome fish and cheese nCrisps and salted peanutsnBovril, beef tea and Oxo Lo salt or salt substitutes are not recommended because they may affect your medication.3n23:living with heart failure Looking After Your Heart

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3) Drink fluid Unless your consultant has specifically asked you to drink less fluid, you should try to drink between three and four pints of fluid each day. Drink more if the weather is very warm. 4) Reduce the amount of alcohol you drink If you drink more than the recommended number of units of alcohol it acts as a poison to the heart. Too much alcohol has been shown to cause heart failure. If this is the case for you, you must stop drinking alcohol altogether. Even if other things are causing your heart failure, alcohol can make your condition worse so you should not drink more than one or two units each day. One unit of alcohol is:nA small glass of wine. nHalf a pint of Ônormal-strengthÕ beer; or nA single pub measure of spirit, such as rum or gin.Remember if you drink pints you are also taking in a lot of fluid and this may put an added strain on your heart. 5) Watch you weight Being overweight means that your heart has to work harder. So if you are overweight, you should ask for advice about losing weight. It is important to monitor your weight because this will show whether your body is retaining fluid.Weigh yourself regularly in the morning, after you have been to the toilet and before getting dressed, and keep a record of this. Your doctoror nurse will show you how to take and record your weight if you need help to do this. Remember! If your weight increases over a number of days, this may mean that you are retaining fluid. If you experience an unexplained weight gain of 2 to 3 pounds (one kilogram) or more in two days, you should report this to your doctor or nurse so they can treat you promptly to avoid deterioration in your condition. 6) Keep yourself active To begin with, your doctor or nurse will tell you to reduce your activity. But, as your medication begins to take effect, you will be encouraged to be more active. At home it is important to keep as active as possible and keep doing normal activities. By staying active you will find that you feel generally stronger and able to do more things. Many people with heart failure actually say that they feel better when they exercise regularly, for example, walking, cycling, swimming, dancingand bowling. This is because it gives you stamina, makes you supple and strengthens the body. It also makes you feel better psychologically and can help you socialise. The aim is that you should always be able to talk during any form of exercise. If you are getting very breathless you need to slow down. Remember these important dos and donÕts when you are exercising nDo start by warming up, for example gentle walking nDonÕt exercise after a meal nDo work at your own speed nDonÕt exercise in extremely hot or extremely cold temperatures nDo wear sensible footwear nDonÕt exercise if you are feeling unwell. Stop immediately if you become unwell nDo some cool-down exercise when you have finished, for example gentle stretches. 4n23:living with heart failure Looking After Your Heart

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7) Do enjoy yourself Relax more. Relaxation includes activities that allow you to release physical and mental tension. This can be in the form of leisure activities, for example, having a hobby, walking, watching television or joining a relaxation class. It is really up to you to find something you enjoy. Relaxation: nGives you more energy nReduces physical aches and pains nPromotes sleep nImproves self-confidence 8) Make sure you are immunised People with heart failure can become unwell very quickly with flu (influenza) and this can develop into pneumonia which is a more serious infection. You should discuss this with your GP each autumn, and ask if you can be immunised each year with the flu jab. Ask your GP too about whether you need the pneumonia vaccination. 9) Sexual relationships Many people with heart failure can continue to make love without any problems. However, you and your partner may want to find less physically demanding ways of sharing your affection. You can get more advice from your doctor or nurse. When to seek professional advice Get in touch with your doctor or nurse if you experience any of the following: nSudden weight gain of more than 3 pounds (one kilogram) in two days. nWeight gain of more than 5 to 6 pounds (two to three kilograms) in one week. nIncreased shortness of breath. nIncreased swellings in the legs or stomach. nA cough that does not go away. nAny side effects from your medication.Your GP or nurse can treat you at home for problems, but if they are not treated you may have to go into hospital. So, if you are feelingworse do not be afraid to ask your GP or nurse for help. The number for your nurse can be found on the front page.5n23:living with heart failure Looking After Your Heart

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Your medicines Drug nameDoseTimes a dayActionComments Your weight DateWeightDateWeight Your test Date:Sodium: Blood pressure:Potassium: Pulse:Urea:Weight: Date:Sodium: Blood pressure:Potassium: Pulse:Urea: Weight: n23:living with heart failure Looking After Your Heart 6

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Expert Patient programme: There is a free self management programme for people living with long term health conditions. For more information, or to attend a course, please ring: nLiverpool (0151) 549 1706 nSefton (01704) 885 340 nKnowsley (0151) 443 4441 NHS Direct: 0845 46 47 For free advice and information on any health matter, 24 hours a day, 7 days a week. This leaflet is available in other formats on request. 8Leaflets produced in partnership by your local NHS services: Aintree Hospitals Foundation Trust, Knowsley Primary Care Trust, Liverpool Primary Care Trust, Royal Liverpool and Broadgreen University Hospital Trust, Sefton Primary Care Trust. © February 2007 n23:living with heart failure Looking After Your Heart

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