Many people with heart failure can lead normal active lives because they have LEARNED TO TAKE GOOD CARE OF THEMSELVES. They (or you) can TAKE CONTROL by understanding and carefully following the treatment plan.

Helpful Tips to Monitor Your Symptoms

  • Check for swollen ankles and legs which may indicate fluid retention.
  • Check your breathing If you notice you have to stop and rest more than usual or breathe harder when doing your daily activities, this may mean that fluid is building up in the lungs. Needing extra pillows at night to make your breathing easier or inability to lie down flat may also indicate fluid accumulation in the lungs.
  • Monitor your weight You can take steps to control your symptoms and help keep your heart failure from getting worse.
Here’s how:
  • Comply to fluid restriction
  • Weigh yourself every day and keep a record of your weight
  • Eat low salt, heart healthy diet
  • Do regular exercise
  • Take your medication
  • Manage stress
  • Quit smoking
  • Limit or avoid alcohol
It is important to monitor all your symptoms on a regular basis. These are the symptoms that you / family members should look out for to decide if you should go to the nearest hospital / IJN immediately.
  • Severe and persistent shortness of breath / increasing shortness of breath (SOB).
  • Frequently waking up at night due to SOB or needing more pillows to sleep comfortably.
  • Persistent chest pain, rapid heart beat or palpitations.
  • Fainting, worsening dizziness.
  • Rapid weight gain of more than 1.5 - 2 kg. in 1-2 days.
  • Increasing swelling of the legs or ankles, abdomen.
  • Increasing fatigue, loss of appetite / nausea.
  • Worsening cough with pink – stained sputum.
Managing fluid intake in heart failure.
  • In heart failure, the body often retains fluid, leading to:
  • Increased blood pressure (heart needs to work harder).
  • Shortness of breath (due to fluid in the lungs).
  • Swelling on ankles, face and hands.
  • Nausea and bloating.

You may be advised to limit your intake of fluid each day ranging from 800ml - 1200ml or more depending on your condition. Fluid includes all drinks, and anything that is liquid at room temperature.


Tips for fluid control.

  • Use measuring cups to accurately measure your fluid intake.
  • Spread your fluid allowance over the day.
  • Use a small rather than a large cup.
  • Remember to count the fluid from food that contains large amount of fluid.
  • Limit salt and salty foods as these may make you feel thirsty.
  • Brush your teeth or chew mint or chewing gum to freshen your mouth.
  • Suck slowly on lemon slices or frozen fluid from your fluid allowance, which could be more thirst quenching.


Reducing Salt Intake with Heart Failure.
Too much salt in your diet can make the body retain water. It may worsen symptoms such as swelling, bloating and shortness of breath. Therefore, your heart has to work harder to pump this extra fluid in the body.
Intake of less than 1 teaspoon of salt (2300mg of sodium) in a day is recommended. You may need to start reading your food labels to monitor your intake.

Reading food labels.
  • Use the per 100g column to compare different products.
  • Sodium content of < 120mg per 100g is recommended.
  • Avoid products containing > 400mg per 100g of sodium per serving.
Below are two examples of different products. Compare the sodium content using the Quantity per 100g column since the serving size differs.
Product 1 has higher sodium content than Product 2. Tips to reduce salt intake
  • Choose fresh foods as much as possible as the sodium content is usually lower.
  • Limit intake of high salt foods.
  • Choose products labelled as ‘low salt’ or ‘no added salt’.
  • Don’t add extra salt or sauces during meals.
  • Use natural herbs, spices, pepper, lemongrass, garlic, onion, shallots, lemon, tomato, vinegar to add flavor to foods.
  • Make your own stock by boiling chicken, meat bones and vegetables instead of using stock cubes or powders.
  • Limit added gravy or soups to food especially when eating out.
Stop smoking
Smoking narrows your blood vessels thus making your heart work harder to pump blood through your body. It will make your heart failure worse. Also stay away from people who smoke so that you avoid any second-hand smoke.

Limit or avoid alcohol
Alcohol makes it harder for the heart to work.
Regular exercise is essential for Heart Failure patients Exercise will slow down the progress of your disease, prevent weakness and gives you more energy to cope with activities of daily living.
Benefits of Exercise
Along with prescribed medication, exercise will:
  • Help you feel better – stronger and with less breathing trouble.
  • Help you to walk further, work or shop with less fatigue and enjoy fun activities longer.
  • Help you sleep better at night.
  • Help maintain and/or improve your balance and help prevent falls.
  • Help you lose weight, if needed.
  • Help you feel more positive and confident.
  • Help to relieve some stress.
  • Help lower cholesterol, blood sugar and blood pressure.
How often should I exercise?
To achieve maximum benefits, you should gradually work up to an aerobic session lasting 20 to 30 minutes, at least 3 to 4 times a week.What If I Can’t Do 20 or 30 Minutes of Exercise? Everyone has to start somewhere. As such, even if you start with intermittent 5- minute walks, and 5- minute breaks and at a slow pace, it is alright. Over time, string the exercise together, take less breaks and increase your pace and duration gradually.
Which type of exercise is the best?
A combination of: Flexibility exercises (e.g. stretching, tai chi and yoga) Cardiovascular or aerobic exercises like walking, jogging, bicycling (stationary or outdoor), and low-impact aerobics or water aerobics.
What type of exercise should I avoid?
  • Avoid too much isometric exercises such as push-ups, sit-ups or even lifting heavy objects. Isometric exercises involve straining muscles or getting a muscle group to work.
  • High intensity exercises e.g. badminton, tennis, competitive games.
How hard should I exercise?
You should be able to walk and talk at the same time. If you have trouble breathing or feel worn out, you are doing too much. Do not push yourself. Listen to your body, only do what feels right to you. You can use the Borg scale. Don’t go beyond scale 13.
General Workout Tips
  1. Wait at least an hour after eating a meal before exercise.
  2. Gradually increase your activity level, especially if you have not been exercising regularly.
  3. Remember to have fun! Choose an activity that you enjoy. Exercising should be fun and not a chore.
  4. Warm up. Take time to include a 5 minute warm-up, including stretching exercises, before any aerobic activity.
  5. Cool down. Include the 5 minute cool down after the activity. Stretching can be done while standing or sitting.
  6. When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
  7. Dress appropriately to suit the weather conditions and wear protective footwear.
  8. Keep an exercise record. This will allow you to see your progress.
  9. Lifting should be limited to 5 kg weights.
Listen to Your body!
  1. Have abnormal ankle swelling or bloating in your stomach.
  2. Have an increase in coughing or wheezing or shortness of breath.
  3. If you exercise shortly after taking your medicines, you may become dizzy or faint. A change in timing of exercise will relieve this problem.
Heart failure may alter some aspects of your sex life. Your desire for sexual activity may be reduced, especially during periods when you are unwell. Some of the medication prescribed may reduce sexual drive and cause impotence. If you experience any of these symptoms, you should discuss them with your doctor or your heart failure coordinator.
Stress makes your blood pressure go up. This makes your heart work harder. It may make your heart failure symptoms worse. You can’t avoid all stress, but you should try to relax and avoid events that cause stress when you can. Here are some ideas:
  • Do things you enjoy like reading, painting or listening to music.
  • Write down how you feel. Putting your thoughts on paper can help you feel better.
  • Go for a walk or get exercise.
  • Spend time with caring friends, family or a support group.
  • Learn to manage your time better .Don’t take on too many things at once.
  • If you can, avoid stressful settings, like rushing to appointments or sitting in heavy traffic.
  • Meditate or do breathing exercises.
Try this quick and easy breathing exercise to help reduce stress.
  • Sit in a comfortable chair and put your hand in your lap, or lie down. Close your eyes.
  • Think about being in a peaceful place, like walking barefoot or lying down on a beach. Hold that picture in your mind
  • Breathe in slowly and deeply through your nose. Take the air into your belly. Breathe out slowly through your nose.
  • Each time you breathe out repeat a calming word or phrase like “relax, let go”
  • Do it for 5 to 10 minutes.
Stress Emotional Management

The normal reactions are feelings of anger, sadness, frustrations and worries about the future. Many people manage with the help of staff and family to adjust back to normal life.

The actual management of your heart failure takes place on a daily basis at home with your families. Families play an important role in the health and illness of the individuals.

Heart failure patients who have emotional support from family and friends often feel better and have a more positive outlook on life. They are better able to deal with and recognize symptoms of heart failure and cope with the changes they have to make.

However, as caregivers, your family may experience emotional response like anger, resentment and depression- they have to get support and help if they find that they cannot cope.

TIPS TO MANAGE MEDICATIONS
1. Keep a list of all the different medications that you take which include:
  • Medication name - ‘generic name’ (name of actual drug) and brand name.
  • Correct dose and when you should take the medication.
  • What the medication is used for (Use the Medicine Chart provided with this book to write down the medication that your doctor has prescribed for you).
2. Take your medication at the correct dose and correct time.

3. Do not take a double dose.
  • If you have missed taking a dose by a few hours, take it as soon as you remember.
  • If it is nearly time for your next dose, skip the one you missed and take the next dose at its scheduled time.
4. Use equipment that can help you organize your medications e.g. pill box, medication intake chart, phone or watch timer, smartphone users – medication reminder apps.

5. Do not stop taking any heart failure medication without talking to your doctor first, even if you feel better.

6. Tell your pharmacist or doctor if you feel that your medications are not working or are causing you problems.

7. Do not share your medications with someone else, even if the other person also has heart failure. You may cause more harm to the other person.

8. Always check with your pharmacist or doctor before taking any new prescription, over-the-counter or complementary, natural/ traditional therapies as they can:
  • Be dangerous when taken with your medications.
  • Interfere with your heart failure treatment.
The normal reactions are feelings of anger, sadness, frustrations and worries about the future. Many people manage with the help of staff and family to adjust back to normal life. The actual management of your heart failure takes place on a daily basis at home with your families. Families play an important role in the health and illness of the individuals. Heart failure patients who have emotional support from family and friends often feel better and have a more positive outlook on life. They are better able to deal with and recognize symptoms of heart failure and cope with the changes they have to make. However, as caregivers, your family may experience emotional response like anger, resentment and depression- they have to get support and help if they find that they cannot cope.
Heart failure is a serious condition and can worsen even with the best treatment. This progression can be unpredictable and can result in the patient becoming very ill and unable to make decisions about his/her medical care then. You may want to ask about the possibility of becoming very ill and the options in your care should this occur. Letting people know what you want should the end become near may help your family make decisions should you become unable to do so because of the illness.