Managing Congestive Heart Failure

How to Live Longer and Better With Congestive Heart Failure

Congestive heart failure and its warning signs

The term "heart failure" is something of a misnomer. It makes it sound like the heart has stopped working, but that isn't really the case. What congestive heart failure means is that the heart isn't pumping efficiently enough to keep up with the body's needs. "Heart inefficiency" might be a better term. With the proper treatment and lifestyle changes, many people with congestive heart failure can lead active lives for many years.

Stages of congestive heart failure . A patient's doctor might refer to a classification system devised by the American College of Cardiology and the American Heart Association. This categorizes congestive heart failure patients into four stages, from A (the person is at high risk for developing heart failure because of high blood pressure, coronary artery disease, or another medical condition) to D (the person has end-stage heart failure, requiring frequent hospitalizations or even hospice care).

At the earliest stage, someone may not even notice his heart failure, or it may seem to disappear once he starts taking medication. His heart failure might never progress past this point, especially if he takes good care of himself. Or at later stages he may have difficulty with everyday activities, like walking up stairs or carrying groceries. He may feel more fatigued than usual because his cells aren't getting the nutrients they need. Fluid in his lungs can cause shortness of breath -- especially when he's lying down -- or it might accumulate in his legs or ankles, causing painful swelling.

To keep heart failure from worsening. A patient must make major changes in his life: He'll need to eat differently, remember to take his medications, keep as active as possible, and reduce stress. Some of these changes might require breaking habits acquired over many years. As a caregiver, you can help him maximize his quality and length of life. Here are some ways to help.

Watch out for warning signs. Keep alert for worsening symptoms. Call the doctor immediately if you observe any of the following:

  • Sudden weight gain (three or more pounds in one or two days)
  • Increased swelling in the legs or ankles
  • Shortness of breath while at rest
  • A dry, hacking cough or wheezing
  • Dizzy or fainting spells
  • Increased fatigue or feeling unwell all the time
  • Abdominal pain or swelling

Easing congestive heart failure with diet and exercise

Encourage heart-healthy eating

Following a diet specifically designed for people with congestive heart failure can dramatically diminish the disease's symptoms. The key to this diet is limiting salt, because too much sodium can lead to fluid retention, which worsens congestive heart failure symptoms. Although you should ask the doctor for specific dietary guidelines, these are some of the keys to a better diet:

  • Cook with less salt. Reducing the sodium in a patient's diet doesn't mean condemning him to a lifetime of bland foods. Season with herbs, spices, and freshly ground pepper instead of salt. Citrus juices and vinegars can make a delicious base for marinating meat. For treats that are naturally low in sodium, stock up on plenty of fresh fruits and vegetables. Ask the doctor for a referral to a nutritionist who can offer more tips on preparing low-sodium foods.
  • Look for sodium content on labels. Packaged foods, canned soups, and condiments are often loaded with sodium. Before buying, examine the nutritional information. Be sure to look at how many servings each package contains and how much sodium is in each serving. And don't forget to check the ingredient list: If sodium or salt is listed in the first five ingredients, find an alternative. For example, look for low-sodium versions of canned vegetables.
  • Be a salt sleuth when eating out. A patient doesn't have to give up going out to restaurants, but he does need to watch what he orders. Many restaurants are willing to accommodate special dietary needs; ask your waitperson if the cook can prepare foods without adding salt or MSG. Substitute steamed vegetables or fresh fruit for French fries or rice pilaf. Ask for salad dressing on the side, or request vinegar or lemon wedges instead.

Even if someone follows these suggestions, it may not be easy for him to change a lifetime of eating habits. Acknowledge that it's difficult and listen to his concerns. Discuss wh at foods he does and doesn't like and involve him in meal planning. If he lives alone, you might help him prepare large amounts of low-sodium foods that he likes and freeze individual portions.

Keep the patient moving

It may seem counterintuitive, but if a person has congestive heart failure, he should stay as active as possible. Although strenuous exercise may overtax a heart that's having difficulty pumping, moderate exercise can actually help the heart get stronger. Other health benefits of exercise include weight loss, lower cholesterol levels and blood pressure, and improved circulation.

If he has always been a couch potato, it may be difficult to encourage him to get going. The good news is that even short bursts of moderate exercise can be beneficial. Simply parking farther away from the store or taking the stairs instead of the elevator can add more physical activity to his day. Housework and gardening are great ways for someone with congestive heart failure to get some exercise. You might also encourage him to join you in a morning walk around the neighborhood.

Of course, he needs to avoid stressing his heart. Talk to his doctor about what activities he can safely enjoy, and what levels of exercise are appropriate. You might also ask for a referral to a cardiac rehabilitation program.

Stop smoking, minimize discomfort, and manage medications to ease congestive heart failure

Eliminating smoking

If you, the patient, or another caregiver smokes, now is the time to stop. Smoking decreases lung function, which makes the symptoms of congestive heart failure worse. But recognize that it's not easy to stop smoking. Here are a few ways you can help:

  • Ask the patient what he thinks would make it easier for him to stop smoking. He may have suggestions you haven't thought of.
  • Encourage him to talk about his feelings and what he's going through. Smoking may be a comforting lifelong habit; let him mourn a little.
  • You may be tempted to nag or yell if he slips up, but it's more effective to be supportive. Be positive and encouraging -- and vent your own frustration to a friend instead.
  • Help him avoid situations that may trigger the desire to smoke. If he's used to enjoying a cigarette after meals, try going for a short walk outside instead.
  • Be understanding as he goes through withdrawal. Try not to take it personally if he's especially irritable, short-tempered, and tired.
  • Quit smoking yourself. If you must smoke, don't do it around the patient. Not only will your smoking make quitting more difficult for him, but the secondhand smoke may worsen his heart failure symptoms.

If he finds it too diff icult to quit on his own, talk to his doctor. Nicotine replacement therapy, support groups, and counseling may all be helpful.

Keeping comfortable

Symptoms of congestive heart failure, such as swelling and shortness of breath, can be very uncomfortable. Here are some ways you can help someone feel better:

  • Comfortable, nonbinding clothing and shoes may make it easier for him to tolerate the leg and ankle swelling that often accompanies heart failure.
  • Support stockings, which you can purchase at your local drugstore, may alleviate leg swelling during the day.
  • Pillows that elevate a person's head at night may help him breathe more easily while sleeping.
  • Limited amounts of salt and liquids can minimize retention of fluids, significantly lessening his symptoms.

Staying on top of medications

One of the most important things for managing congestive heart failure is to take medications consistently and according to instructions. Know which drugs the person you're caring for needs to take and how often he should take them. Also find out what to do if he misses a dose.

If he lives alone, you can fill a pillbox with the medications he should take each day of the week. You can also post a simple daily medication schedule on his refrigerator or in his bathroom so he can check off each dose as he takes it.

If he has difficulty following the schedule, you might want to call him at regular intervals to make sure he's taken his medications.

Making the most of doctors' appointments

Start with a notebook

One of the most important aspects of managing congestive heart failure is keeping track of symptoms, medication side effects, and other concerns. Writing down this information in a notebook will help you the person in your care stay on top of any changes in his condition.

Encourage him to get in the habit of recording basic information whenever possible, including his weight, diet, activity level, breathing difficulties or coughing, and medications taken plus any side effects. Have him note any changes in his condition, including swelling, shortness of breath, and fatigue. Finally, you both should jot down any questions or concerns you'd like to bring up with the doctor.

When visiting the doctor

Most patients have a lot of visits to different doctors. T o get the most out of appointments, bring the notebook and try to do the following:

  • Prepare a list of questions before each visit. Leave spaces for the answers.
  • Take notes during the appointment. If either of you doesn't understand something, don't be afraid to ask for an explanation.
  • If the person you're caring for isn't following treatment or lifestyle recommendations, make sure the doctor knows it. Trying to protect him isn't in his best interest.
  • Do your best to understand all the doctor's instructions before you leave, but don't hesitate to call the office if you have questions later.

Stay on top of depression and anxiety

Depression and anxiety are common in people with congestive heart failure. Feeling unwell, being unable to do some of the things he once enjoyed, and uncertainty about the future can all contribute to feelings of sadness. But if a patient seems consistently unhappy, he may be depressed. Look out for these signs of depression, and if you notice any, notify his doctor:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

Depression is a serious problem that requires evaluation and treatment. But you may be able to help manage his moods with these activities:

  • Help him stay active and connected by doing things he enjoys. Talk to the docto r about any physical restrictions he may have and how to get around them.
  • Help him structure the day around activities that give him pleasure and a sense of purpose. For example, he could plan to meet friends for lunch, or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don't foster unrealistic expectations. Instead of saying, "You'll be hiking again in no time," you might say, "If we keep walking together every day, you'll probably notice that it gets a lot easier."
  • Let him talk about his fears and concerns. If it's difficult for you to listen to his feelings, you may want to find someone for him to talk to -- perhaps a therapist or some other mental health professional. A support group may also be helpful.

Help a patient help himself

Whether he lives alone, with you, or in a long-term care facility, you should encourage him to care for himself as much as possible. Although you may be tempted to take care of everyth ing for him, he'll feel better about himself if you help him perform tasks on his own. As long as he's able, he should be involved in managing his symptoms and making decisions about his treatment. By taking on too much responsibility for him, you risk taking away his independence (which can lead to depression) -- and exhausting yourself in the process.

Plan for the future

Depending on the severity of his congestive heart failure, he may still have many years of active living ahead of him. But you both should realize that his condition could ultimately worsen. As the disease progresses, talk to him about what end-of-life treatments he does and doesn't want. Find out at what point he wants a do-not-resuscitate (DNR) order added to his medical chart. Talk to him about a living will and an advance health care directives . Although these conversations can be painful, it's useful to remember that these are important decisions.

You should also discuss future plans with his doctor. Ask about his prognosis whenever his condition or treatment plan changes, and don't hesitate to ask tough questions about what you can reasonably expect. Having as much information as possible will make it easier for everyone to make difficult choices.

Stephanie Trelogan

Stephanie Trelogan writes about heart disease, stroke, and depression issues that concern people caring for their aging parents. See full bio

about 1 year, said...

Hi, Everyone. Don't mind for this long story, but please help me out. Please suggest me the solution for my father. Now from few weeks, my father was suffering from shortness of breath, full illness, full nerve pains, non-sleepiness. My father recently diagnosed as a CHF and his EF% is around 25-30% and he has a Pacemaker also. Till now he hasn't undergone with any of the surgeries for his attacks though he had 3 times. At the third time, he was placed with a pacemaker in the year 2006(at that time EF was 30%) Now the doctors said, the voltage of pacemaker is going to end in another few months, we need to change it. He was hospitalized with shortness of breath, swollen legs three years ago for the first time, and after two years again he came to the same problem and now it is repeating the again and again. A few weeks ago he was hospitalized and treated with Digoxin, Lasix, Aldactin and at the time of discharge they suggest to medicate with 1-Lasix 2-Tideplus/Ditor plus 20MG 3-Isologine 4-Remotor CV-10 I think these medicines are not suited for him. The problem is repeating continuously. The doctor was saying that we can't do more that this for him even if you anywhere in the world. We are doing best for him. When he was taking these tablets 1-Lasix/Zytanix 2.5 2-Tide plus/Ditor plus 20MG 3-Ab-Phyllin 4-Ivabrad 5MG 5-Clopitab 6-Fibator EZ He was fine, after changing the medicine he became full dull. Please suggest me any best treatment for my father.

over 1 year, said...


about 2 years, said...

I was diagnosed almost two years ago. My doctor did not verbally tell me, I saw it on a patient printout given after a office visit. I think what perked my interest to find out more was a TV commercial. I then began my quest to find out what was CHF, prognosis, and treatment. Upon my research I found out my doctor was prescribing the right Pharmacueticals, but never talked to me about what I should do other be consistent in taking my meds. Before the diagnosis, I believed in supplements and naturopathic medicines. I've started up again, inter grating my Pharmacueticals, with my supplement. A high quality multi-vitamin, and ubiquinol, are my two favorite additions. I've never felt hopeless about my condition, though it has cause major life-style changes. I'm just began taking my health into my own hands, and not leaving it all up to my doctor.

about 3 years, said...

I was just diagnosed with Heart Failure. What a horrible term! How can one not feel like a failure?

over 3 years, said...

very helpful.i have mild to moderate chf.......trying the best I can to keep positive and move my body at least 30 minutes a day co q10, I take 600 mg a day.....

over 3 years, said...

Wow, I could go on and on here. I haven't been formally diagnosed as of yet, but have had what seemed to be exacerbation, recently. I thought I'd had a heart attack about 6 months ago and have had every cardiac test since, to find out what was causing my angina, etc. I complained of a cough way back right after the suspected heart attack (everyone says I didn't have one, tests and all) but all of the doctors just brushed it off. I finally got a new internist, he sent me to a new cardiologist, who still brushed off the cough, found nothing wrong with my heart. I just knew he was going to tell me then that I had CHF, but nope, he said all looked good, maybe I was having esophageal spasms and wanted me to go to a gastroenterologist. HUH! Why did I feel like I was suffocating if it was my esophagus? It just didn't make sense to me...I had two separate appointments witht he gastro and cancelled them both. I then went back to my internist to discuss my blood test results, etc. I then told him about this cough and that maybe we were looking at the wrong thing, maybe I had COPD? I was at a loss. Thank goodness he listened to me and immediately ordered a chest xray. He found fluid in my lungs, but the only explanation he had was an infection, but I didn't feel sick, I was just coughing my head off and having difficulty breathing. Nevertheless he started me on Bactrim along with steroids. Needless to say, they didn't help. In the meantime, I called the cardiologist to ask him to make sure I hadn't had a heart attack cause I now had fluid in my lungs. He assured me that I hadn't had one, then I told him my suspicions of CHF and you could have heard a pin drop!!!! He then told me about Diastolic Congestive Heart Failure, which I had never heard of, didn't know there were two kinds. He told me there was a blood test the internist could do to check for it. I went tot he internist a few days later, feeling like I'd been hit by a Mack Truck to ask him about the DHF and he refused and told me there was nothing wrong with my heart, but I had an appointment lined up with a Pulmonologist to check for Pulmonary Function. I took my xray with me tot hat appointment and almost immediately he told me I had Diastolic Dysfunction and that it was likely due to Sleep Apnea. He ordered the test the cardio told me to have them run, BNP levels, and set me up for Sleep Study. Guess what? I have Sleep Apnea along with an elevated BNP. I have yet to hear it from the horse's mouth, so to speak, but from all of my research online, an elevated BNP is a good indicator of DHF. It makes sense, I've had swollen ankles for years and now the coughing and pulmonary edema along with abdominal bloating which I assume is also edema. I cannot do hardly anything without feeling like Ive ran a marathon.....very disheartening, especially when my husband just wants to make me sit down and do nothing. I don't want to rest til I die. I want to LIVE!!! I want to enjoy my horses and family, etc. I wish he understood more about this disease. I have tried to aducate him, but everytime I have to lean over to catch my breath, etc, he hollers, "What's wrong"? OMG!!! I keep telling him, I keep having to repeat myself!!!! :(( I found the information here very helpful, but will be glad when the doctor gives me the confirmed diagnosis and tells me what I can do safely. Sorry, I was long winded, but needed to get it off my chest. Thank you all and hope everyone and/or your loved ones feel better.

about 4 years, said...

thank you

almost 5 years, said...

i have been diagnosed with chf, recently went to the dr as i have been having a dry cough, he told me probably allergies of which i have none. should i be worried and get a 2nd oppionion.

over 5 years, said...

I'm a sixty nine year young male, had a couple of heart attacks, a quad bypass, lived in a NY high stress reality. Living with CHF now, and I'm not liking it a bit, BUT this is what it is. Not getting caught up with self pity is a full time job, pushing myself to exercise more is not always easy, eating healthier takes effort, not doing these things are deadly for a person with CHF. Really understanding this makes it easier to go the extra mile, or inch and that works for me. Sometimes if I start going down the rabbit hole (depression), I get physical, I walk, I call someone I love on the phone. Life is a tough challenge from birth, and gets tougher during the end game. Having realistic expectations, fighting back, and accepting existential reality works for some of us. Have someone you can talk to. For all those who commented on this thread I wish you peace, acceptance, self love and love for others.

almost 6 years, said...

My husband has CHF, third stage, and was used to playing darts competitively. Ater having been shocked by his ICD about 2 weeks ago, he has become very stressed by his condition and depressed. Last night, he decided to go to a doubles competition and experienced severe dizziness and shortness of breath. Luckily, he withdrew from the competition before it started but was scared and extremely upset because he is very competitive and all his life has played sports. He thought that darts would be ok as it is not as physically demanding, however, I think the stress of 'what might happen" is getting to him. I tried to stop him going because I feared this would happen, but I think that it was probably best that he saw it for himself. He did the right thing by withdrawing. His doctor said "listen to your body" and for once he did. This is progress as I have been trying to get him to follow the lifestyle changes for six years without much success. I feel that the shock he received from his device was a blessing in disguise.

almost 7 years, said...

informative with reasonable precision

almost 7 years, said...

reassured me that I did the best that I could for my Dad when he was in the final stages of CHF. He passed away in November 2010.

almost 7 years, said...

Hi norman, thanks for your suggestion! It is extremely helpful for us to know how caregivers are responding. Take care -- Emily | Community Manager

almost 7 years, said...

I have CHF but find it problematic to explain to family since the title sounds so drastic. It really ought to be changed. Can you develop research/article on zinc toxicity of dental creams, like Fixodent, since its use can bring on similar symptoms ?

almost 7 years, said...

Good advice! Thank you.

almost 7 years, said...

As the "patient" (who is not at all patient) :), I always find it reassuring to know that I am not alone in my feelings. I am very fortunate to have found a wonderful new husband after my former bi-polar husband suddenly went ballistic a few years ago and that made my heart failure surface. My new husband is the polar opposite of the other one and encourages me at every turn. No one can understand how very, very helpful that can be to someone with CHF unless they have experienced it. I feel as if I have been reborn. If I must pick one item about this article that I found extremely helpful, it would be the emphasis on how important it is to always be supportive. It makes such an incredible difference to those of us who often feel that we are living on the edge. LadyAyn

about 7 years, said...

Abnormally high blood pressure increases the amount of work the left ventricle has to do to pump blood out into the circulatory system. Over time, this greater workload can damage and weaken the heart. This can lead to heart failure if this damage is allowed to go on unchecked.

over 7 years, said...

My husband has been out of the hospital about a week now but is still very weak, disorientated,emotional, fatigued.He had pneumonia when he went in the hospital and then cogestive heart failure. At Home he requires oxygen 24-7, homcare, hurses, and physio therapist. Is there any hope for recovery. He is 84 years old. Your advice would be greatly appreciated.

over 7 years, said...

This article is very helpful and helps me a lot in understanding my daily ups and downs with CHF. You furnish great, easy to understand information and it is very much appreciated!

over 7 years, said...

Physical inactivity is a major risk factor for heart disease and stroke and is linked to cardiovascular mortality. Regular physical activity can help control blood lipid abnormalities, diabetes and obesity. Aerobic physical activity can also help reduce blood pressure. The results of pooled studies show that people who modify their behavior and start regular physical activity after heart attack have better rates of survival and better quality of life. Healthy people as well as many patients with cardiovascular disease can improve their fitness and exercise performance with training.

almost 10 years, said...

My mom has been a CHF patient for quite sometime now - this article is incredibly uplifting and appreciated. thank you, thank you so much. - Hortencia Esquivel

over 10 years, said...

This information with suggestions is extremely helpful! I appreciate the image of the checklist to post in the bathroom. Knowing what to look for and what steps I can take is a comfort.