Discharge Instructions for Heart Failure

The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart is not able to pump as well as it should. Blood and fluid may back up into the lungs. Some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms of heart failure. Heart failure can occur because of an injury to the heart or from natural processes. You can control symptoms of heart failure with some lifestyle changes and by following your health care provider's advice.

Activity

Ask your health care provider about an exercise program. Simple activities, such as walking or gardening, can help. Exercising most days of the week can make you feel better. Don't be discouraged if your progress is slow at first. Rest as needed. Stop activity if you get symptoms, such as chest pain, lightheadedness, or shortness of breath. Find activities that you enjoy. Examples might be brisk walking, dancing, swimming, and gardening. These will help you stay active and strengthen your heart. Ask your provider about cardiac rehab. This is a program that helps you to exercise safely.

Diet

Follow a heart healthy diet. And make sure to limit the salt (sodium) in your diet. Salt causes your body to hold water. This makes your heart work harder because there is more fluid for the heart to pump. Limit your salt as directed by your provider by doing the following:

• Limit canned, dried, packaged, and fast foods.

• Don't add salt to your food.

• Season foods with herbs instead of salt.

• Watch how much liquids you drink. Drinking too much can make heart failure worse. Talk with your provider about how much you should drink each day.

• Limit the amount of alcohol you drink. It may harm your heart. Women should have no more than 1 drink a day. Men should have no more than 2 a day.

• Ask that your meals have no added salt when you eat out.

• Talk with your provider before using salt substitutes. They often have potassium in them. This may not be good for your health. This will depend on how well your kidneys are working and what medicines you’re taking. Some people need extra potassium. Others don’t.

Tobacco

It's important to quit if you smoke. Smoking increases your chances of having a heart attack by harming the blood vessels that provide oxygen to your heart. This makes heart failure worse. Quitting smoking is the number one thing you can do to improve your health. Enroll in a stop-smoking program to improve your chances of success. Talk with your health care provider about medicines or nicotine replacement therapy. Also ask your provider about smoking cessation support groups.

Medicine

Take your medicines exactly as prescribed. Learn the names and purpose of each of your medicines. Keep an accurate medicine list and current dosages with you at all times. Don't skip doses. If you miss a dose of your medicine, take it as soon as you remember. If you miss a dose and it's almost time for your next dose, just wait and take your next dose at the normal time. Don't take a double dose. If you are unsure, call your provider's office. Make sure not to mix up your medicines or forget what you've taken the same day. Refill your prescriptions before you run out of medicine. Talk with your health care provider if you have trouble with the cost of your medicines.

Weight monitoring

Weigh yourself every day. A sudden weight gain can mean your heart failure is getting worse. Weigh yourself at the same time of day and in the same kind of clothes. Ideally, weigh yourself first thing in the morning after you empty your bladder, but before you eat breakfast. Your provider will show you how to track your weight. Call your provider if you have a sudden, unexpected increase in your weight.

Your provider may ask you to report if your weight goes up by more than 2 pounds in 1 day,  5 pounds in 1 week, on average. This is a sign that you are retaining more fluid than you should be. Clues to weight gain include checking your ankles for swelling, or noticing you are short of breath when you lie down.

Follow-up care

Have a follow-up appointment as instructed. Depending on the type and severity of heart failure you have, you may need follow up within 7 days from hospital discharge. Keep appointments for checkups and lab tests that are needed to check your medicines and condition.

Recognize that your health and even survival depend on you following your provider's advice.

Symptoms

Heart failure can cause a variety of symptoms. They include:

• Shortness of breath.

• Trouble breathing at night, especially when you lie down.

• Swelling in the legs and feet or in the belly (abdomen).

• Becoming easily tired.

• Irregular or rapid heartbeat.

• Weakness or lightheadedness.

• Swelling of the neck veins.

It's important to know what to do if symptoms get worse or if you develop signs of heart failure getting worse. Keep track of how you feel each day. Report any changes to your health care provider.

When to call your doctor

Contact your health care provider right away if:

• You have sudden weight gain. This means more than 2 pounds in 1 day or 5 pounds in 1 week. Or it could be whatever weight gain you were told to report by your provider.

• You have trouble breathing that's not related to being active.

• There's new or increased swelling of your legs or ankles.

• You have swelling or pain in your abdomen (belly).

• You have trouble breathing at night. This means waking up short of breath or needing more pillows to breathe.

• You have frequent coughing that doesn't go away.

• You're feeling much more tired than usual.

Call 911

Call 911 right away if:

• You are severely short of breath, such that you can't catch your breath even while resting.

• You have severe chest pain that doesn't get better with rest or nitroglycerin.

• You have pink, foamy mucus with cough and shortness of breath.

• You have an ongoing rapid or irregular heartbeat.

• You are passing out or fainting.

• You have stroke symptoms, such as sudden numbness or weakness on one side of your face, arm, or leg or sudden confusion, trouble speaking or vision changes.