Managing Congestive Heart Failure

According to the Centers for Disease Control and Prevention, about 6.2 million adults in the United States have congestive heart failure. While the disease is a contributing factor to nearly 400,000 deaths per year, people with heart failure can use a number of tools and habits to manage it and continue living well.

Weigh in. Every morning, after you go to the bathroom but before eating, use a digital scale to weigh yourself in your bedclothes. Make sure your scale is on a hard floor, not on a rug or carpet. If you have a blood pressure cuff, use it to keep track of your blood pressure.

Avoid salt. Did you know that there is 2,300 mg of sodium in one teaspoon of salt? That’s more than you should have in a whole day. For those who have congestive heart failure, one salty or sodium-heavy meal can cause a trip to the Emergency Room. Avoid high-salt foods, like deli meat (ham, pastrami, smoked turkey, or bologna), hot dogs, bacon, and sausage and condiments and sauces that are high in sodium, like soy sauce, steak sauce, barbecue sauce, canned gravies, and cooking sherry or cooking wine.

Beware of seemingly healthy substitutes. Salt by any other name is still salt. Don’t be fooled into thinking that garlic, onion, or celery salt are good substitutes. Sea salt is still 99.9% sodium chloride, the same ingredient in regular table salt that makes you retain fluid. Despite claims, it is not good for you! Some salt substitutes include potassium, which can be harmful if you have kidney or other health issues or if you are taking certain medications. Check with your healthcare provider before introducing a salt substitute.

Look for hidden salt. Avoid foods with the word “soda” on the ingredients list, such as baking soda (sodium bicarbonate) or sodium carbonate. Preservatives such as sodium alginate, sodium sulfite, or sodium benzoate in processed foods also add to their high-sodium content. Try low-sodium and low-fat snacks such as homemade popcorn, low-fat yogurt, and rice cakes. Be sure to check the label for sodium and fat content. When eating out, ask for sauces or dressings on the side and avoid fried foods. Avoid fast foods like pizza, burgers, fried foods, and Chinese food.

The best alternative. Learn to eat a low-salt diet by focusing on fresh fruits and vegetables and fresh meat and fish. Try cooking simple meals from scratch. Fresh-squeezed lemon juice or lime juice are good flavor boosters.

Get some exercise, but not too much. Talk to your health care provider about a safe and effective workout for your fitness level. Try to get some aerobic exercise every day, even if just for a few minutes. Frequency and duration are more important than intensity. Some exercises, like yoga and tai chi, also help relieve stress. No matter what activity or exercise program you start, remember to start slowly. As you get stronger, you can gradually increase your workouts. Choose an activity you enjoy and have family members or a friend join you to make it fun. Every day should have an equal mix of activity and rest. Finally, be sure to get plenty of sleep each night.

Keep in touch with your provider. Keep your appointments with your health care providers and stay up-to-date on your vaccinations. Your provider can help monitor your fluid intake, especially if you are struggling with fluid retention or taking higher doses of diuretics (water pills such as Furosemide or Torsemide). Your provider can also work with you to determine your “dry weight,” your weight without extra fluid, and explain why it is important.

Know when to get help. Call your healthcare provider if you have:

Difficulty breathing during routine activities that were previously no problem.
Rapid weight gain of 2 to 3 lbs. in a day or 5 lbs. in a week.
Bloating or pain in your abdomen or loss of appetite.
Dry, hacking cough, especially when you lie down.

Congestive heart failure is among the more difficult diseases to manage. With a lot of self-discipline and serious habit-changing effort, it is possible to live well and fully.

Scott Rogge, MD, FACC, is a cardiologist with SVMC Cardiology, part of Southwestern Vermont Medical Center and Southwestern Vermont Health Care, in Bennington.