HEART FAILURE AND YOUR
TREATMENT PLAN
JOHN MUIR HEALTH
HEART FAILURE (HF) AND YOUR TREATMENT PLAN

INTRODUCTION
It is possible to lead a normal active life, even
if you have heart failure. Taking control ofheart failure is key to your success. You cantake control by following the treatment plan
prescribed for you. Your care is not just theresponsibility of your doctor or nurse. In fact,
the success of your treatment plan depends on
your active involvement.
Following your treatment plan can make youfeel better, prevent your heart failure fromgetting worse and help you live longer.
Right now, it may seem hard to follow yourtreatment plan. Many people feel this way atfirst. However, taking all of your medicinesand making the suggested changes in your life
can give you the edge that makes you feelbetter. Your doctor or nurse can help you
overcome barriers that may prevent you fromfollowing your treatment plan. That way you
can deal with your symptoms before they

become a problem, so you can stay out of thehospital.
You may have trouble following yourtreatment plan during times of travel,
increased stress, holidays or illness. Manypeople do. If you have a setback or relapse infollowing your treatment plan, you may feellike you have failed. But your doctor or nurse
does not expect you to be perfect. It is never
too late to start over and get back on the plan.
You will be happy you did.

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FOLLOWING YOUR TREATMENT PLAN•

Take your medicines exactly as directed. Carry a list of medications with you wherever yougo. Plan for prescription refills.

•Weigh yourself every day to see if you are retaining fluid.

•Follow a low-sodium diet. Allow extra time for food shopping, so that you can read labels.

•Monitor your symptoms every day.

•Ask your doctor about drinking alcohol.

•Get vaccinations such as flu shots routinely.

•Control your body weight if you are overweight or have diabetes.

•Schedule time for regular physical activity. Stay active. For example, walk or ride astationary bicycle. Your doctor can provide a safe and effective exercise plan based on yourdegree of heart failure and how well you do on tests that check the strength and function ofyour heart. DO NOT exercise on days that your weight has gone up from fluid retention or
you are not feeling well.

•Quit smoking cigarettes and cigars if you smoke.

•Learn when to consult your doctor or nurse.

•Make following your treatment plan a permanent part of your life.

•Get enough rest, including after exercise, eating or other activities. This allows your heart
to rest as well. Keep your feet elevated to decrease swelling.

•

Actively participate in follow-up appointments with your doctor.

Page 3HEART FAILURE AND YOUR TREATMENT PLANEVALUATING YOUR HEART
A physical examination may reveal either an irregular or a rapid heartbeat. There may bedistended neck veins, enlarged liver, swelling of the limbs (peripheral edema) and signs of
fluid around the lungs (pleural effusion). Listening to the chest with a stethoscope may
reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, high or low.
If you have heart failure, your doctor will monitor you closely. This means having followup appointments at least every 3 to 6 months, figuring out any underlying cause andtreating it and periodic testing of your heart function.
An enlargement of the heart or decreased heart functioning may be seen on several tests,
including the following•Chest X-rays show your heart’s size and shape and can show if there is fluid or aroundyour lungs.

ECHOCARDIOGRAMS AND EJECTION FRACTION
An echocardiogram is the test mostcommonly used to evaluate heart function.
The test will tell your doctor and you about
your heart and heart valve function. It isimportant to know your heart function,
because it is one way to determine theseverity of your heart failure. It also helps
guide your care.

refers to the percentage of blood that is
pumped out of the heart each time it beats.

Heart function is commonly evaluated using a
number called ejection fraction (EF) . Somepeople mistakenly believe their ejection
fraction indicates the amount of heart muscle
that is still working. The ejection fraction

However, you can have a normal ejection
fraction and still have heart failure. This may
be related to a condition called diastolic heartfailure.

A heart does not pump all of the available
blood out each time it beats. A normal heartpumps out or ejects only about 50-65% of theblood inside. If the heart is damaged, theejection fraction frequently falls below 40%.
This is called systolic heart failure.

Page 4HEART FAILURE AND YOUR TREATMENT PLAN
Heart failure may also alter the following lab test results:•CBC•

Blood Chemistry•

Serum Sodium

•

BUN

•

Creatine•

Liver Function Tests•

Uric Acid•

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). BNP is a hormone madewhen the heart is overworked.

•Urinalysis•

Urinary sodium•

Creatinine Clearance

Heart failure is a serious disorder. Many forms of heart failure can be controlled with medication,
lifestyle change and correction of any underlying disorder. Heart failure is usually a chronicillness It may worsen with infection or other physical stressors.
Sometimes, hospitalization is required for acute HF. Hospitalized patients may receive oxygenand intravenous medications that can dilate blood vessels and promote the loss of fluid. Othermedicines may be given that help improve the heart’s ability to pump blood. Unstable patients
receiving several medications may need also advanced monitoring with special catheters.

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For a select number of patients, heart failure
symptoms can be improved with a special
type of pacemaker. It paces both the right andleft sides of heart. This is referred to as
biventricular pacing or cardiac
resynchronization therapy (CRT).
CRT is recommended for patients who have aregular heart pattern on their EKG, but awidened pattern, and a weakened heart (EFless than or equal to 35%) with moderate tosevere heart failure despite optimal medical
therapy. Improved quality of life, decreased
hospitalizations and improved heart function
has been demonstrated in patients who receiveCRT.
Other patients can benefit from Implantable
Cardioverter Defibrillaors (ICDs). With aweakened heart (EF less than or equal to35%) and mild to moderate heart failure you
are at risk to develop dangerous heart beatpatterns that can result in cardiac arrest. AnICD is a small electronic devise that monitors
your heart beat. It can send impulses to slow
your heart down or briefly shock your heartback to a normal rhythm.
Severe cases of HF require more drastic
measures. For example, excess fluid can beremoved through dialysis. Circulatory
assistance can be provided by implanted
devices such as the intra-aortic balloon pump
(IABP) and the left ventricular assist device(LVAD). These devices can be life saving, butthey are not permanent solutions. Patients
who become dependent on circulatory support
will need a heart transplant.

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