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An everyday guide to

living with heart failure

1 About heart failure
Acknowledgements Contents

The British Heart Foundation (BHF) would How to use this guide 2

like to thank all the heart failure patients,
nurse specialists, consultant cardiologists About heart failure

2 The symptoms and
and researchers who have helped to develop

how to control them
this resource. What is heart failure? 5
What causes heart failure? Can it be cured? 6
Special thanks are due to: How bad is my heart failure? Will it get worse? 7
• c olleagues from the BHF Care and Education Questions and answers 8

Research Group and the Department of Health
Sciences, University of York, for developing the
The symptoms and how to control them
original BHF Heart Failure Plan, upon which this The symptoms of heart failure 11
guide is based What you can do to control your symptoms 12
Self-management 18
and to the following for their input on this
Managing your medication 19

new edition:

of further problems
3 Reducing your risk
• Jennifer Barbour Reducing your risk of further problems
BHF Heart Failure Specialist Nurse Controlling your blood pressure 37
NHS Dumfries and Galloway Eating a healthy diet 38
• Professor John Cleland Managing your fluid balance 42
Head of Academic Cardiology Unit Stopping smoking 48
University of Hull Limiting your alcohol 49
• Tracey Dare Keeping active 50

BHF Heart Failure Specialist Nurse
Dorset County Hospital NHS Foundation Trust Living with heart failure
• Caroline Jones
Looking after yourself at home and at work 61
BHF Heart Failure Specialist Nurse
Getting out and about 63

4 Living with heart failure
North Yorkshire and York PCT
Dealing with stress, worry and anxiety 64
• Laura Mackintosh
Managing the changing relationships 74
BHF Palliative Heart Failure Specialist Nurse
Sex 77
NHS Forth Valley
Financial worries 79
• Annie McCallum
Facing severe illness 80
Head of Gloucestershire Heart Service
Planning for the future 83

NHS Gloucestershire
• National Council for Palliative Care (NCPC) Getting help and information
Heart Failure Group.
Talking to your doctor, GP or nurse 91
Help for carers 92
Useful organisations 99

5 Getting help
and information
Useful publications and DVDs 102

What to do in an emergency 104

Index 106

About the British Heart Foundation 108


1 About heart failure
How to use this guide

This guide is for adults of all ages who have If you still have questions after reading About
heart failure
heart failure, and for their families or carers. An everyday guide to living with heart failure:
Being told that you have heart failure can be very • T alk to your heart failure specialist doctor
frightening for you and your family. It raises all or nurse, or to your GP, if your questions are
sorts of questions, such as: Why me? What can about your particular condition. They are in the
I do about it? What is my future going to be like? best position to advise you on your symptoms
and treatment.
We have developed An everyday guide to living
• Contact the useful organisations and
with heart failure to help you understand and
helplines listed on pages 99-101 for
manage your condition better. We want to show
information and support.
you how to control your symptoms well, so that
• See the booklets or DVDs listed on pages
you can have a good quality of life and continue
102-103 for additional information on the
to do many of the things that you enjoy.
things we discuss in the guide.
We have based this guide on advice from
people with heart failure and from medical
and nursing experts on heart failure. Think
of it as a source of practical help and guidance
rather than something that has to be followed
rigidly. Feel free to dip in and out of it in your
own time – the index at the back will help you
find what you need.
Your heart failure nurse may work through this
guide with you, or you may use it as a personal
reference guide at home. You may also want to
share it with your carer or family and friends, so
that they understand your condition and know All the information in this guide has
how they can support you. (By ‘carer’ we mean been checked very carefully, but…
the main person who cares for you. It could be
your partner, a relative or a friend.) • please check with your own doctors
and heart failure nurses before
In the back pocket you will find a handy pull-out
Personal record. Use this to record your symptoms you do anything different from
and other important information, and take it with the advice they have given you
you to your hospital or GP appointments.
• remember that it can be dangerous
to suddenly stop taking medication
• if you plan to start doing more
activity or exercise than you are
doing now, make sure you check
this with your doctor or nurse first.

2 British Heart Foundation

What is heart failure?

What is heart failure? 5 Your heart is a powerful muscle that delivers How does my doctor know
blood and oxygen around your body through I’ve got heart failure?
a regular pumping action. ‘Heart failure’ is the
What causes heart failure? Can it be cured? 6 Your doctor can usually work out if you have

2 The symptoms and
term we use to describe a set of symptoms that

how to control them
occur when your heart fails to deliver as much heart failure by talking to you about your
blood and oxygen around your body as it should. symptoms and doing a physical examination.

How bad is my heart failure? Will it get worse? 7 There are many reasons why this may happen,
including weakness and/or stiffness of the heart
The most common symptoms of heart failure are:
• s hortness of breath when you are resting
muscle, narrowed or leaking valves and abnormal or doing normal activities
Questions and answers 8 heart rhythms.
The term ‘heart failure’ sounds pretty frightening,
• swelling of the feet, ankles or abdomen
(stomach area)
so it might be more helpful to think of it as: • fatigue (which means being unusually
‘My heart is failing to work properly and needs tired and weak).
medication to support how it works.’ These symptoms can also be caused by other

of further problems
3 Reducing your risk
medical conditions, so in most cases further
tests will be needed to confirm a diagnosis of
heart failure. The most common tests are:
• a n electrocardiogram (ECG) to assess your
heart rhythm
• a BNP test – a blood test which measures
the levels of certain hormones related to
heart failure
• a chest x-ray, which shows a picture of your
heart and lungs
• an echocardiogram, which allows doctors

4 Living with heart failure
to see how the valves, muscle and pumping
action of your heart are working
“My first question to the consultant • general blood tests – to check, for example,
how well your kidneys are working
was: ‘How long have I got to go?’ • lung function tests to see how well your
He said, ‘No, don’t worry… it’s lungs are working.
called heart failure because We say more about symptoms on page 11.
the heart doesn’t have the full
capability to pump as much
blood as it should… but you
know you shouldn’t like think

5 Getting help
and information
about death every day.’ And I
laughed [with relief] and said,
‘Fine, okay, I’ll manage that.”

An everyday guide to living with heart failure 5

What causes heart failure? Can it be cured? How bad is my heart failure? Will it get worse?

Heart failure can be caused by one or more Can heart failure be cured? Doctors divide heart failure into four ‘classes’. Will my heart failure get worse as
conditions. The most common causes are:
When heart failure is caused by an underlying
These are sometimes known as the New York time goes by? What is my future like?
Heart Association (NYHA) scores. They are:
• heart attack problem that can be treated, such as heart valve Your condition may not necessarily get worse

2 The symptoms and
• high blood pressure disease, uncontrolled high blood pressure or Class 1 – No symptoms

how to control them
with time. This guide will show you how to
• cardiomyopathy (a disease of the severe anaemia, there is a good chance that your Your heart is not working as well as it should, make changes to your lifestyle that will help
heart muscle). heart failure symptoms will go away or be but you may not have any symptoms. You can control your symptoms. It will also show you
reduced, and your heart muscle could return to usually do everything you want to, and may have how you can recognise early on that something
Heart failure can also be caused by:
normal. And with the right treatment and good as much energy as you would expect. You may may have changed. We say more about this
• a viral infection affecting the heart management of symptoms you could lead a full still need medication or other treatment to in ‘Self-management’ on page 18.
muscle and active life. reduce the risk of your condition getting worse.
• heart valve problems Very occasionally, some people do have one or It’s also encouraging to remember that only
However, in most cases heart failure is caused a few years ago, little could be done if you had
• alcohol or recreational drugs two symptoms which will need to be treated
by a heart attack, and currently cannot be cured. heart failure, but now there are many treatments
• an uncontrolled irregular heart rate or controlled.
When you have a heart attack often part of your to help you. Treatments are being continually
heart muscle dies. This means that the rest of Class 2 – Symptoms on moderate exertion

of further problems
3 Reducing your risk
• some chemotherapy medication improved and new ones are becoming available
your heart has to work harder, causing the You may not be able to do quite as much as you all of the time.
• congenital heart problems (heart
symptoms of heart failure. used to. You get breathless more than usual –
problems you are born with) Please discuss any concerns about your
for example, when you are gardening, shopping
• thyroid gland disease, or Over recent decades, BHF-funded research has symptoms, treatments or future with your
or doing the housework.
• anaemia. contributed to a substantial reduction in the nurse or doctor and ask them to explain your
number of people dying from heart attacks and Class 3 – Symptoms on mild exertion management plan to you. They should also
Sometimes we just don’t know what the cause
strokes. And through research into the causes of You are quite limited in what you can do. be able to give you an honest view of how
is. This can be hard to accept. But the important
heart and circulatory disease, we have become It doesn’t take much effort to make you feel your quality and length of life may be affected.
thing is to control your symptoms well. By doing
better at preventing heart attack victims from exhausted and too breathless to carry on. (See ‘Facing severe illness’ on page 80.)
so, you’ll help to prevent them from getting
having another heart attack. But this means that You are usually comfortable while you’re resting.
worse and ensure that you have the best Do bear in mind, however, that it isn’t possible
more and more people are surviving to live with
possible quality of life. Class 4 – Symptoms at rest for them or anyone to tell you exactly how
the often debilitating consequences of their

4 Living with heart failure
You become breathless even when you aren’t long you will live. They can only say what is
We say more about managing your symptoms disease, in particular heart failure.
being particularly active – for example, when likely, or what happens to the average person.
in Section 2, ‘The symptoms and how to control
The next big challenge is to discover how to help walking around at home or even when sitting Heart failure affects people of all ages and
them’ and Section 3, ‘Reducing your risk of further
the heart repair itself, so that heart failure can be down. You may find it difficult to look after everyone is different. Some people live for
problems’. We look at dealing with everyday
cured rather than treated. Our Mending Broken yourself properly on your own – for example, you many years with heart failure.
situations in Section 4, ‘Living with heart failure’.
Hearts appeal aims to do just that. By raising get too breathless when having a bath or shower.
We discuss the causes and treatments of heart money to fund research into regenerative You may need to sleep sitting up because you get
failure in more detail in our booklet Living with medicine we hope that, in as little as ten years’ out of breath or cough when you lie down.
heart failure (see page 102 for how to order). time, we will have treatments that will mend
You may find that you don’t fit exactly into one
heart muscle that has been damaged by a heart
class of heart failure. Your doctor will be able
attack. We also hope to learn how to mend blood
to tell you more based on your examination

5 Getting help
vessels and repair heart valves, so that heart and
and tests. Whichever stage your heart failure

and information
circulatory disease will no longer be a major
is at, your heart failure nurse and doctor will work
cause of disability in the UK.
out an appropriate ‘management plan’ for you.
For more information about this research visit This will identify things that they can do and help you to do, to improve your symptoms and try
to stop things getting worse.

6 British Heart Foundation An everyday guide to living with heart failure 7

Questions and answers 2  Does having heart failure mean that Is having heart failure just a part The symptoms and how to my heart is dead or dying? of getting older? Heart failure means that your heart is not able Many people put the symptoms of heart failure 2 The symptoms and how to control them to deliver as much blood and oxygen to various down to old age and think that nothing can be parts of your body as it used to. The ejection fraction is the amount of blood that is pushed out of the left ventricle every time the heart beats. It’s true that heart failure is more common in older people. No matter how old you are. A normal ejection fraction is around 50-65%. it’s vital that you learn What does my ejection fraction mean? of further problems 3 Reducing your risk to actively manage your symptoms and do what Your doctor may have told you about the ejection you can to keep your condition under control.” 5 Getting help and information 8 British Heart Foundation . This may be done about them. ejection fraction is used alongside other tests to help to diagnose [symptoms] can improve over heart failure. heart failure by a heart attack. fraction of your left ventricle in your heart. because of problems with your is not an inevitable part of getting older. some people with heart failure have a him grow up…The fact that my normal ejection fraction. or to children with congenital heart disease. It is usually expressed as a percentage (%). and it can happen at other treatment can help to control and improve any age. because as we get older we are more likely to have one of the control them because of damage to your heart muscle caused conditions that cause it. No-one has an ejection fraction of 100% as there “I felt devastated because I had is always some blood left in the left ventricle after given birth to my first child five each heartbeat. or for other reasons. However. So. Sometimes it happens to young adults. About heart valves. your symptoms. An ejection fraction below 40% weeks beforehand and I didn’t know whether I would still be 4 Living with heart failure is abnormal but may not be associated with any symptoms to suggest heart failure. It does not mean that your heart is dead or dying but that it is not working as well as it should be. time was very helpful as it gave me hope and something to focus on. On the other alive to look after him and watch hand. Medication and one in ten of us will get it.

If the congestion is in your lungs (pulmonary oedema) it can lead to severe shortness of breath. life got back takes away all the waste products. ankles or abdomen (stomach area) it’s just an ‘I must sit down’ tired. salt.” as well as they used to. You may have heard your doctors calling it ‘congestive heart failure’. which describes which and information part of your heart is most affected. fatigue. When there to a manageable course. the fluid is under control but I still The poor pumping action of the heart can cause get tired and there is a limit to my a build-up of blood to your lungs and other physical activity. ‘I just can’t take another step’ tired. the blood doesn’t do this as have imagined four years ago that 4 Living with heart failure well and some parts of your body don’t work I could breathe so well again. If your muscles are affected. it’s a weary tired as if everything is What you can do to control your symptoms 12 The main symptoms are: an effort… I can’t say it’s a ‘go • s hortness of breath when you are resting or being active to sleep’ tired. Your doctor may also say that you have either left 5 Getting help or right heart failure. Self-management 18 • swelling of your feet. which is called fatigue. This congestion can cause swelling in your ankles. Managing your medication 19 What causes these symptoms? “I initially suffered from breathlessness.” • fatigue (feeling unusually tired or weak). An everyday guide to living with heart failure 11 . It is even called ‘congestion’.” parts of your body. I could not is congestion. After a Your blood carries oxygen. in the small of your back (oedema) or in your abdomen (ascites). I don’t really know. at night feeling I couldn’t breathe and these changes have affected the pressure etc. waking The symptoms happen because your heart muscle has become stiff or weak and stretched. “Initially the breathlessness was the thing that got to me most. Your heart works harder to try to clear the problem. panic attacks. water and other nutrients to all parts of your body and long uncertain journey. These have lessened now that of further problems 3 Reducing your risk inside the heart. It’s a bit like a traffic jam. but is not able to. this can cause unusual tiredness and weakness. The symptoms of heart failure The symptoms of heart failure 11 What are the most common symptoms “It’s not a ‘tired’ tired where you of heart failure? want to go to bed and sleep.

See page 42. Feeling breathless. See page 48. especially if you have been advised Sudden weight gain to restrict your fluids. frightened and anxious can make you feel worse and even more out of breath.What you can do to control your symptoms Controlling your symptoms is an important part of treating heart failure. You may find that you’re more out of breath when stopping smoking. salt and potassium There are a number of medications that can reduce congestion. If you put on weight over 2-5 days. Fatigue (feeling unusually tired and weak) Fatigue is very common in any long-term illness. 12 British Heart Foundation An everyday guide to living with heart failure 13 . If your heart is not pumping enough blood through them. phone 999 for an ambulance. Or it could be a side effect of your medication. See pages 42-47. You may also find it difficult to lie flat. the kidneys symptoms and help strengthen your heart. wheezing or coughing including physical activity in your everyday plan. If you have any of these symptoms… …your symptoms can be controlled like this Swelling of your feet. You can reduce your risk of congestion by: being careful how much liquid you drink. eating a healthy diet to control your weight. causing it to swell. you If the symptoms are very bad and you 5 Getting help should call and speak to your heart are frightened. An extra 2-3 pounds (1-2 kilos) can mean that your body is holding on to an extra reducing the amount of salt in your diet. it is keeping a record of your weight. However. can’t get rid of any extra water and salt (which you usually pass in the form of urine). See page 38. it is probably caused by fluid congestion. 1 litre of fluid. See page 47. ankles or abdomen Manage your medication Your kidneys have the job of keeping the right balance of water. These problems are also caused by congestion and can happen when there is a 4 Living with heart failure build-up of fluid in the lungs. It may help if you learn Being out of breath can be a very frightening and unpleasant experience. of if you get new ones. worse. On the following pages. See page 50. described on page 11. you’re doing activities such as walking or going upstairs. or because you are not sleeping properly or not getting enough exercise. if you put on weight over a period of several weeks. which we days. See page 68. tick all the symptoms you get. Live a healthy lifestyle and keep active of further problems 3 Reducing your risk A build-up of water can make your weight go up by several pounds in just a few All the symptoms we have described could be caused by congestion. It can be caused by your muscles not getting enough oxygen. more likely to be caused by an increase in body mass (muscle or fat). anxiety and stress. This extra water can build up in different parts of your body. See page 46. See pages 19-34. or if they suddenly get and information failure nurse or doctor or your GP. Being how to do relaxation or relaxation exercises. control your in your body. Learn to deal with stress and worry Symptoms can be made worse by worry. Share this section with your carer or family so that they know what to do if your symptoms get worse.  Important If any of these symptoms are new.

• that you have little control over your life and see what changes you can make. after taking your GTN medication the second time. Light-headedness or dizziness of further problems 3 Reducing your risk In some conditions. See page 68. as prescribed and follow the steps on page 104.If you have this symptom… …here’s what you should do: Getting good support and coming to terms with changes in your life will help you to feel calmer A heavy pressure across your chest. • arrhythmias (abnormal heart rhythms) Your doctor can do an ECG to check your heart that your illness has taken over do you need: for an abnormal rhythm. make adjustments to the type of 5 Getting help been prescribed. This is quite common in people with heart If the light-headedness or dizziness is a the pain may occur for other reasons. • financial support • low blood pressure your bed. • to look at your commitments – be realistic • n  ot drinking enough fluid and becoming Make sure that you are drinking enough. Or you may need to review and information work you do) – you don’t always have to give your fluid allowance. Your failure. Don’t get up suddenly. For example. you feel thirsty all the time. important if you have cardiomyopathy. This may be particularly these symptoms. 4 Living with heart failure Feeling helpless or fed-up • anxiety Try some relaxation techniques if you are You may feel Look at the support system that you have and anxious. immediately. Other possible causes are: (See our booklets on cardiomyopathy in our Inherited heart conditions series. you should ever have a blackout. • powerless to change your situation • more help in the house • uncertain about the future or even how you • help with looking after your family or children • getting up too quickly Take your time getting up from a chair or from will feel the next day. little blood and oxygen getting to your heart chest pain. See page 104 for Your doctor or GP may also suggest some information about what to do if you think you medication to help your feelings of anxiety or are having a heart attack. listed on Blackouts (syncope) page 103. It can be caused by not enough oxygen new symptom. It may be caused by too If this is the first time you have experienced deal with your emotions. Or If you know you have coronary heart disease and Good days and bad days you have been prescribed medication such as GTN (glyceryl trinitrate). They may be able to lower the dose or change your medication to reduce the symptoms. such as cardiomyopathy. friend or professional • to make some changes to your lifestyle? 14 British Heart Foundation An everyday guide to living with heart failure 15 . the next. Tell your carer. If about how much you can juggle dehydrated. contact your nurse or doctor doctor will have told you how to deal with getting to your brain. or because you’ve overdone symptoms stable. See ‘Dealing with stress. talk to your nurse as there are people who can help you to This is called angina. be having a heart attack. talk to your doctor • to change the way you do something (for about any diuretics (water tablets) you have example. or both with this for more than a few weeks. take your medication You might feel full of beans one day and terrible Look at the ‘overactivity-rest cycle’ on page 52.) Call 999 for an ambulance. call 999 immediately as you may muscle. Remember. worry and anxiety’ on page 64. if your chest pain does not go away things one day and have exhausted yourself. If you are having difficulties or chest pain. It could just be the way your illness Try to adjust what you do each day to keep your makes you feel. call 999 for an ambulance as you may be having a heart attack. and more in control. up your activities or work • someone to talk to – a family member. depression. family • a side effect of the medication you are taking Ask your doctor or nurse if the light-headedness or friends that they must call 999 immediately if or dizziness could be caused by your medication.

ask the person Palpitation is a word used to describe the feeling If you only get palpitations when you’re who does to go with you. frequently during the night. medication may have had an effect on your what’s best for you. medication you are taking. Poor sleep Weight loss can also be a symptom of depression. you should talk to your nurse or doctor. memory problems. has calories too. Being overweight can make it difficult for you to Ask your nurse or doctor for further information keep fit and active. phone 999 for an ambulance. Your weight may go down because your Tell your doctor about any slow weight loss. If you don’t do Palpitation worse. but still eating not snacking on unhealthy food. having trouble concentrating. does with you to see the dietitian. You birthdays. It can also be caused by stress or Sex may be the last thing on your mind. ask your doctor if You may find that you’re forgetting things. exercises on pages 68-69. anxiety or depression. Most boxes now come marked with the day that you should take them. Talk to your partner about how you feel. or have short-term information you need to remember a few times. He/she will refer you to a dietitian who will help Palpitation can often be due to stress or anxiety. worry. Your weight may go up slowly because you are Make sure that you are eating a healthy diet and not being very physically active. Have a milky drink before bedtime. slowly or irregularly. so try cutting down on your effect of any of the medication you are taking. your brain. you to absorb nutrients. or it may feel as If you get palpitations even when you are not if it is missing beats. anxiety or depression can also cause to discuss these issues with you and/or your Use a dosette box for your medication and a lack of interest in sex. should call and speak to your heart are frightened. life even if you’re not feeling ready for sexual you about things like hospital appointments. You can have an active sex Ask a family member or friend to remind sex life or desire for it. If so. appetite is poor and you are not eating enough. you to manage the problem with a high-calorie It may also be an arrhythmia (abnormal heart Your heart condition might make it difficult for diet and food supplements. you If the symptoms are very bad and you off to sleep. in dosette boxes. 16 British Heart Foundation An everyday guide to living with heart failure 17 . doctor’s appointments and so on. try the breathing and relaxation The heart may be beating at a normal rate. take the person who another reason for weight loss. The most common reasons for poor sleep are: • a lack of activity during the day Include a walk in the fresh air every day. If you don’t do the rhythm). Your might find it hard at first but they will want Check it every morning. or if they suddenly get Try the relaxation techniques on pages 68-69 failure nurse or doctor or your GP. intercourse. the cooking in your house. 5 Getting help  Important and information A warm bath with a few drops of lavender oil. • worry. ask if there is something else you can take instead. It will also make your heart and support. This is very common and can Use a diary or a calendar and write in it every Problems keeping sexually active happen when not enough oxygen is getting to day – for example. partner. and can make your symptoms to a dietitian for more help. feeling anxious. Your nurse or doctor will be able Worry. anxious. meetings. portion size. important events. and it can be made worse by some of the You might not have the energy for it. They may be able to refer you work harder. and that could be cooking and shopping.If you have this symptom… …here’s what you should do: You may also find it difficult to sleep well because Make sure that you have enough pillows to • you cough if you lie down support you in a comfortable position. or putting lavender oil on your pillow. worse. when you are in bed. see our tips on page 34. Memory problems or problems with • you have to go to the toilet frequently If you suffer from a cough or going to the toilet concentration in the night. you get when you are aware of your heartbeat. Slow weight loss 4 Living with heart failure quickly. Healthy food Ask your doctor if the problem could be a side the same amount of food. Try writing things down and re-reading any your medication may be causing the problem. Many pharmacists will arrange for your medication to be supplied See ‘Sex’ on page 77. can sometimes help you to relax and drop If any of these symptoms are new. Use Slow weight gain (over 3-6 months) the medication chart in the Personal record to of further problems 3 Reducing your risk help you.

depending on your medications you are taking • thinking about problems that stop you condition and symptoms. Remember never to run information. or see help with. 5 Getting help and information 18 British Heart Foundation An everyday guide to living with heart failure 19 . Controlling your blood pressure hardest things about living with heart Self-management involves: In the next few pages we look at three steps failure is keeping track of what their different Eating a healthy diet to organise your routine: • learning to recognise your symptoms medications are for and taking them properly. or • will treat other conditions you may have. dose and frequency – at a time. Ask them to explain anything that you been prescribed for someone else. and when you should ask for and any changes to your prescription. We suggest that you choose an action to help you understand what is safe for you to do yourself. Even one week. 4 Living with heart failure our booklet Living with heart failure for more be different. if what you are doing does not work. talk to your family and friends out of your medication. Also. Reducing your risk of further problems to feel more in charge. • thinking about what you normally do when Managing your fluid balance you get these symptoms. Facing severe illness (page 80) such as diabetes or arthritis. Many people have told us that one of the you need to take and avoid confusion. you may have to take a your pharmacist who will dispose of them safely. worry and anxiety • learning to recognise any changes in (page 64) • w ill help to control the symptoms of your medications are for of further problems 3 Reducing your risk your symptoms heart failure Managing the changing relationships • always talking to your doctor or nurse if you (page 74) • can help to treat the cause of your heart failure 3 Take your medications experience a symptom for the first time. This is what we mean combination of many different medications. – they may be able to help you stay on track.Self-management Managing your medication Understanding your condition and being Managing your medication (page 19) In order to treat your heart failure and keep If you have any old medications. Keeping active managing your symptoms – for example. your doctor and diagnosis. properly.  Never take medication that has at a time from the list on the right and do it for help. it may be easier to nurse know all the medication you are taking – Your doctor or heart failure nurse will be able try tackling adjustments to your lifestyle one including the name. the dose may don’t understand about your condition. Taking the right medication properly: 2 Understand what your lack of knowledge or physical ability Dealing with stress. It is important that you. knowing what Stopping smoking Your doctor may need to change the dose 1 Keep track of the works and why of your medication or give you a different • knowing when to seek help Limiting your alcohol one from time to time. Not everyone will feel overwhelmed by their Getting help and information (pages 91-105). return them to in control of your symptoms will help you it under control. But if you are. This will help you to stay on top of exactly what (pages 37-51) – this includes advice on: by self-management. Start with the one you most want if you think it is the same.

I am taking: This is a: I need to read page: Atenolol Beta-blocker 26 Bisoprolol 1 Keep track of the Here we have listed the most common types of Carvedilol medications you are taking medications that are used in treating heart failure and where you will find more information about Metoprolol them. that are not listed Eplerenone Aldosterone antagonist 27 below. It is important that you record these in the Personal record too. You can use the Personal record at the back Nebivolol to note down which ones you’re taking. Spironolactone Digoxin Cardiac glycoside 28 I am taking: This is a: I need to read page: Amiloride Diuretic (water pill) 23 Aspirin Antiplatelet 29 of further problems 3 Reducing your risk  endrofluazide B Clopidogrel (Bendroflumethiazide) Atorvastatin Statin or fibrate 30 Bumetanide (cholesterol-lowering drugs) Bezafibrate Chloralidone Clofibrate Furosemide (Frusemide) Pravastatin Metolazone Rosuvastatin Torasemide Simvastatin Captopril ACE inhibitor 24 4 Living with heart failure Warfarin Anticoagulant 31 Cilazapril Enalapril GTN spray Nitrate 32 Lisinopril Nitroglycerin tablets Perindopril Isosorbide dinitrate Ramipril Isosorbide mononitrate Trandolapril Hydralazine Vasodilator 32 Candesartan Angiotensin-II receptor 25 Kay-Cee-L Potassium chloride 33 antagonist 5 Getting help Irbesartan and information Slow-K Losartan Sando-K Valsartan 20 British Heart Foundation An everyday guide to living with heart failure 21 . Propranolol You may also be prescribed medications for other conditions that you may have.

if you already have gout. may interact • Passing much less urine than normal with the medication you have been get swelling of your feet. 22 British Heart Foundation An everyday guide to living with heart failure 23 . but it’s Diuretics are sometimes called ‘water tablets’. Bumetanide. salts that comes with your medication. frequently make changes to your medication packaging and names for the same If you have heart failure you should already be and doses. Some side effects (two other types of drugs) to work better. your doctor may Some manufacturers use different What are they for? or nurse about it. medication. What checks do I need? 5 Getting help Diuretics may raise your blood sugar. build up in the joints. Talk to your doctor before • Dizziness or light-headedness stomach? If so. but think about when it might to control any symptoms that you may have. ankles or • Constipation prescribed. and others may if you notice them for the first time. Furosemide (Frusemide). Dehydration is common in patients taking together. Side effects • lower blood pressure blood test results. (Bendroflumethiazide). not replace those information leaflets. problems. that it’s important for you to continue taking much worse. be best for you to take them and ask your doctor At the start of your treatment. early signs of weight are temporary and will go away after you have taken the medication for a while. or if their about this. • relieve shortness of breath potassium which may have an effect on your common side effects. If your fluid intake is restricted or dosage or change to a different medication to without first consulting your doctor – • Dizziness or light-headedness if you are unsure about your symptoms. make sure that you are drinking enough be because you are taking several medications but never stop taking your medication • G oing to the toilet more during the day fluid. speak reduce your side effects. and some check with your pharmacist. this could cause to check that your kidneys are working properly. Torasemide in the morning. of further problems 3 Reducing your risk Not everyone will experience side effects and • help ACE inhibitors and beta-blockers Tell your doctor about any side If conditions are hot or warm. and minerals in your body because they make Most types of heart failure medication will help Chloralidone. and information You should have a blood test every six months If you have diabetes. They can: page 42). or do you as vitamins and minerals. What are the main side effects? loss. Here we explain what not sure it is the right medication. This can be unsettling. to help you to deal with the side effects. so speak to your doctor Some people may have to have more frequent checks depending on their condition. dizziness and/or increased Side effects may be very unpleasant. But gout can be treated. you need to. 4 Living with heart failure medicines Alternative/complementary medicines Which side effects should I tell my such as homeopathic or herbal remedies. ask your doctor or nurse if or supplements. If the packaging is different on a low-salt diet (we say more about this on necessary for making sure that you’re taking They help your kidneys get rid of excess fluid to what you normally get and you are by making you pass more urine. you pass a lot of urine. the effects of the diuretics. fatigue. effects that you may get. and food supplements such doctor or nurse about?  Important • Any difficulty passing urine Do you get breathless. a diuretic. Bendrofluazide Diuretics can alter the balance of water. It’s also important • reduce swelling to avoid using salt substitutes as these contain the different types of medication do. increased thirst. especially experience any diarrhoea. or if you some may have very few. Diuretics the medication and will prescribe another one may cause gout or. They are normally taken to reduce the workload of your heart and help The information we provide here does Metolazone. Or he/she may decide doing so may make your symptoms • Gout (a condition where uric acid and salts to your doctor or nurse. Alternative/complementary make it worse. Your doctor may be able to adjust the and possibly at night water tablets. medication has changed. and you are not taking taking any of these medicines (if it’s a new symptom).2 Understand what your  Important Diuretics What else do I need to know? medications are for Always read the information leaflet Amiloride. causing pain). Having too much salt will counteract the appropriate amount of each medication to control your symptoms.

Avoid taking salt substitutes • Diarrhoea. • A severe rash or itching taking ACE inhibitors – unless you can’t • Sudden wheeziness or problems with breathing. What are they for? potassium in your blood. If you tend taking an ACE inhibitor. • Dizziness. Irbesartan. the workload of your heart. Which side effects should I tell my doctor or nurse about? Which side effects should I tell my If any of these side effects becomes severe. ACE inhibitors lighten the workload of your heart and make it easier for your heart to pump blood What else do I need to know? These medications relax the blood vessels What else do I need to know? to allow the blood to flow easily. specialist or even in hospital. and you should not take potassium of further problems 3 Reducing your risk Make sure you are on a low-salt diet • Dizziness supplements. 5 Getting help and information 24 British Heart Foundation An everyday guide to living with heart failure 25 . call your • Vomiting  Important 4 Living with heart failure doctor or go to an A&E department immediately: • Skin rash • Stomach pains • Swollen face. Cilazapril. and you should • Irritating cough not take potassium supplements. Lisinopril. They will reduce failure from getting worse and can also: dramatically. reducing around your body. you should be • Trouble breathing or swallowing. Trandolapril to check your kidneys are working properly and to check your kidneys are working properly Candesartan. They can prevent your heart ACE inhibitors can lower your blood pressure These medications are similar to ACE inhibitors. • Nausea If you get any of these side effects. Discuss this with your doctor or nurse. • A decrease in blood pressure What are the main side effects? (see page 42). try to avoid improving the blood flow to your heart muscle getting up too quickly. Losartan. (as most contain potassium). Enalapril. potassium). If you can’t take ACE inhibitors. You should have a blood test every six months antagonists You should have a blood test every six months Perindopril. doctor or nurse about? contact your doctor or nurse immediately: • Irritating cough. lips or mouth If you have heart failure. • help protect you from having a heart attack by to feel dizzy when you stand up. there are other medications you may be able to take instead. take them for some reason. What are the main side effects? Avoid taking salt substitutes (as most contain • help you be more active.ACE inhibitors What checks do I need? Angiotensin-II receptor What checks do I need? Captopril. Valsartan to make sure that you don’t have too much and to make sure that you don’t have too much What are they for? potassium in your blood. so you may be given your first Your doctor may give them to you if you develop your blood pressure and your risk of having dose under the supervision of your heart side effects such as a persistent cough from • help you to live longer a heart attack. Ramipril.

testicular taking beta-blockers and you may even feel that Beta-blockers help to prevent the heart from (which means that they help you to get rid of shrinkage and impotence. these drugs can affect the Nebivolol. Your nurse or doctor will tell you how often you need to do this – either by make your condition and symptoms much worse. or by the nurse. Metoprolol. as it can checked regularly.Beta-blockers What else do I need to know? Aldosterone antagonists What’s the down side? Atenolol. • If you have psoriasis. Spironolactone In some people. • Disturbed sleep Which side effects should I tell my If you have asthma. are often prescribed along with other diuretics to What checks do I need? help improve your symptoms. • control heart rhythm problems Other medication. You will be prescribed a low dose of beta-blocker Eplerenone. • Mood swings when you first start taking more frequently when you first start taking the beta-blockers beta-blockers. need to be changed when you start taking weeks to begin with. such as diuretics. They can: excess fluid by passing more urine). Bisoprolol. Carvedilol. usually only for the first few days of affect the way that you feel if you have low blood (feminisation) starting this medication or increasing its dose sugar. But in the long term. They help these feminising side effects. 5 Getting help yourself at home. What are the main side effects? three to six months. until the right dose is reached. It can take a few What are they for? Spironolactone can cause some men to develop What are they for? weeks or months to experience the benefits of These medications have a mild diuretic effect tender and slightly enlarged breasts. doctor or nurse about? • Shortness of breath • Extreme dizziness or fainting. beating too quickly and too forcefully. If you get this side effect. • Tender and slightly enlarged breasts in men. taking beta-blockers can • Tender and slightly enlarged breasts in men • T iredness. may also You will need blood tests every one to four • increase your chances of living longer. Check with your doctor before • Passing less water than usual • Impotence taking them. report it to your doctor immediately: 4 Living with heart failure Which side effects should I tell my • Diarrhoea. you may not be able to • Cold hands and feet take beta-blockers. and then once every beta-blockers. Propranolol to begin with. You may need to check your blood sugar • Reduced kidney function. as they may make your doctor or nurse about? • Diarrhoea asthma worse. What are the main side effects? • Diarrhoea of further problems 3 Reducing your risk If you have diabetes.  Important What checks do I need? You should not stop taking your beta-blockers suddenly without You will need to have your blood pressure speaking to your doctor. and information 26 British Heart Foundation An everyday guide to living with heart failure 27 . It may have to be increased slowly kidney function. beta-blockers may make this skin condition worse. taking beta-blockers helps to reduce the risk of your condition to control the potassium levels in your blood and • increase the amount of blood your heart pumps out getting worse. Eplerenone is free of your symptoms are getting worse to begin with.

don’t take extra aspirin as a painkiller in • Disturbed vision • Aspirin may worsen heart failure symptoms between doses. • control irregular heart rhythms report them immediately: • help your heart pump blood around your • make the blood less ‘sticky’ body more efficiently. • Nausea and vomiting What else do I need to know? You should not take an antacid (to settle • Diarrhoea or constipation heartburn or an upset stomach) or a fibre What are the main side effects? If you are prescribed aspirin. Antiplatelet drugs help to: If you get any of the following side effects. or if you take antiplatelets Always try and take your antiplatelet with Which side effects should I tell my 4 Living with heart failure with food. What are the main side effects? have a very slow heart rate or if you suffer • reduce your symptoms. experience some of these side effects if you take have asthma. or after food. This test is done six hours after taking What are they for? • Any signs of stomach bleeding.Digoxin What checks do I need? Antiplatelets Which side effects should I tell my You will have a blood test to check your Digoxin Aspirin. levels of digoxin being too high. Your doctor may reduce your dose and this will normally If you are prescribed aspirin. What else do I need to know? • reduce the risk of clots forming • Swelling of the face or eyelids • reduce the risk of having a heart attack • Difficulty breathing You may not be prescribed digoxin if you or stroke • An asthma attack. you are less likely to Aspirin may not be suitable for you if you result in the side effects disappearing. Clopidogrel doctor or nurse about? What is it for? level at regular intervals as required to ensure • Skin rash your dose is effective but does not cause side Digoxin slows down and strengthens your effects. doctor or nurse about? • Nausea • Disturbed vision • Poor appetite (if it’s a new symptom). • A slower or an irregular heartbeat • Enlarged breasts in men. 5 Getting help and information 28 British Heart Foundation An everyday guide to living with heart failure 29 . – patients with severe symptoms of heart Anti-inflammatory medication (such as those failure should discuss the need for aspirin with taken for arthritis) can also reduce the The side effects are usually caused by the blood their doctor. heartbeat. from heart block. effectiveness of aspirin. It can: your dose. you will normally • Dizziness or light-headedness of further problems 3 Reducing your risk supplement within two hours of taking • Indigestion have to take it for the rest of your life. If your • Rash your digoxin. • Nausea doctor prescribes both aspirin and warfarin for • Confusion • Vomiting you. enteric-coated aspirin (a preparation of aspirin with a special coating).

how much warfarin you need. although some people prefer not to have Statins and fibrates lower the level of cholesterol If you have an abnormal heart rhythm problem Ask your pharmacist or doctor before taking any at all. a heart attack or stroke. you should avoid Fibrates: Bezafibrate. eating grapefruit or drinking grapefruit juice. 5 Getting help and information 30 British Heart Foundation An everyday guide to living with heart failure 31 . Warfarin You need to carry an anticoagulant card with Statins: Atorvastatin. heavier bleeding during or nurse immediately. This is because atrial affect the way that warfarin works. in your blood. you to drink. take warfarin. What side effects should I tell my of further problems 3 Reducing your risk • Stomach upsets If you drink alcohol. You If you are taking simvastatin. you can have small bloodstream and reduces your risk of having Always tell a dentist or doctor that you are What are they for? amounts of grapefruit and grapefruit juice. and then What checks do I need? probably once a year. • reduce your risk of a heart attack and stroke. you at all times. These are normally done at your doctor’s surgery or at an anticoagulation clinic at a hospital. tell your doctor or nurse • Red or dark brown urine If you notice any signs of unusual 4 Living with heart failure immediately. bruising or bleeding. report them immediately: anticoagulation clinic how much is safe for • Muscle cramps and weakness (rare). Warfarin prevents clots from forming in your If you’re taking atorvastatin. Ask the nurse at the • Constipation bruising or bleeding.Statins and fibrates What else do I need to know? Anticoagulants What else do I need to know? (cholesterol-lowering drugs) Unless you have been told otherwise. taking warfarin. tell your doctor • Red or black stools • For women. Simvastatin What is it for? and how much warfarin you are taking. so your doctor will probably fibrillation increases the risk of having a stroke. They will also do a blood You will need to have regular blood tests to check test to check your liver function. or other vaginal bleeding. Your doctor will do a blood test to check your cholesterol levels after three months. Rosuvastatin. • Prolonged bleeding from cuts • Bleeding that does not stop by itself Which side effects should I tell my • Nose bleeds that last for more than doctor or nurse about? If you have any signs of unusual muscle pain. a few minutes • Bleeding gums  Important • Severe bruising cramps or weakness. Fluvastatin. They can: such as atrial fibrillation. you are likely to be any other medication as some medication can Some antibiotics such as erythromycin are prescribed warfarin. avoid excessive amounts • Nausea doctor or nurse about? or binge drinking as this will affect the way • Diarrhoea If you get any of the following signs of unusual that warfarin works. You should avoid cranberry juice if you tell you to stop taking the statin while you are What are the main side effects? taking antibiotics. What checks do I need? periods. you will need to take your statin at night. affected by statins. Clofibrate should also have a medic alert bracelet or tag. This records your blood tests Pravastatin.

making them widen you might possibly experience side effects such body loses too much potassium. But having too much or too little potassium can be dangerous. it can be overwhelming amount of potassium in your blood as too little What are they used for? may prescribe a combination of isosorbide and or too much can lead to serious arrhythmias. your doctor right time. Potassium and increasing the flow of blood). medication you’ve been prescribed at the workload of the heart. especially if you are also taking a diuretic. different times. Hydralazine is a vasodilator that lowers the What is it for? In order to keep your condition and symptoms This section also contains information on under control. What else do I need to know? 5 Getting help Potassium is an important substance in the blood and information that helps your heart function. pain). And you will need to continue having blood tests regularly while taking these medications. fever and blood chloride helps to prevent your potassium level prescribed for people who have angina (chest disorders. dosage … I have three boxes • Throbbing headache  Important divided into the days of the week • Flushing Which side effects should I tell my which anybody can buy from the Viagra (sildenafil/PDE-5 Inhibitor) • Dizziness interacts with vasodilators and can doctor or nurse about? pharmacist and I have found them • Fainting • Rapid heartbeat. Oral nitrates: Sometimes isosorbide dinitrate is used with Kay-Cee-L. memory. it’s important to take each blood pressure and therefore reduces the Potassium is one of the minerals that your body a vasodilator called hydralazine. isosorbide dinitrate another medication called hydralazine. terrible memory. incredibly bad taking Viagra or other PDE-5 inhibitors.” levels of potassium before being prescribed these medications.Nitrates What else should I know? Potassium chloride 3 Take your medications GTN spray. What are the main side effects? “My drug dosage is based on three • Diarrhoea applications a day: a morning. However. If you cannot take other needs. 32 British Heart Foundation An everyday guide to living with heart failure 33 . nitroglycerin tablets. You should not use salt substitutes as they may contain potassium and if you take them you may get more potassium than is safe for you. They also help to reduce the workload of Tell your doctor or nurse if you have had an of further problems 3 Reducing your risk the heart. Slow-K. So I … put all the 4 Living with heart failure What checks do I need? relevant tablets into the You will need a blood test to check your relevant boxes. getting too low. rapid heartbeat. make your condition or angina worse. They are often as headache. • Stomach pain most useful because … I have a • Nausea Always check with your doctor before • Chest or throat pain. if you’re having to take many medications at hydralazine instead. Sando-K properly Isosorbide mononitrate. unusual reaction to a vasodilator in the past. What side effects should I tell my • Nausea and vomiting a lunchtime and an evening doctor or nurse about? • Stomach pain. sometimes your in the blood vessel walls. It is important that you have the right medication such as an ACE inhibitor. When taking hydralazine. Nitrates are vasodilators (they relax the muscle When you are taking a diuretic.

counter medication that has not been prescribed for you. and when you take them. you think a medication is giving you Use your Personal record at the back of a problem. ahead and make sure you have plenty for when you go away and during 7 Don’t give your medication to other holiday periods when many pharmacies people. even if are closed. take it as soon as you remember. even if you 6 Always check with your pharmacist feel better. Show them the list 3 Don’t run out of medication. 3  Reducing your Here are some tips to help you 5 Tell your pharmacist or doctor if risk of further problems 1 Record all the different medications you take. talk to your doctor about it. are getting worse or if you get a new symptom. Stopping suddenly can be or doctor before taking any over-the- dangerous. 4 Never take a double dose. If you have missed taking a dose by a few hours. skip the one you missed and take the next dose 4 Living with heart failure at its scheduled time. Plan of medications that you are taking. They may harm them. 5 Getting help and information 34 British Heart Foundation . the other person also has heart failure. Use a dosette box available from pharmacies to help you organise your medication. If it is nearly time for your next dose. If you think your symptoms this guide to do so. 2 Don’t stop taking any medication without medical advice.

We look at each of these things in the following pages. including reducing or cutting out salt • managing your fluid intake Limiting your alcohol 49 • maintaining a healthy body weight Keeping active 50 • keeping your alcohol intake to the recommended limits • stopping smoking • keeping active. These things include: Stopping smoking 48 • eating a healthy balanced diet. 4 Living with heart failure 5 Getting help and information An everyday guide to living with heart failure 37 . or if it’s well controlled with medication. Even if you don’t have high blood pressure now. there Managing your fluid balance 42 are still things you can do to keep it under control. Controlling your blood pressure Controlling your blood pressure 37 Your heart failure may have been caused by high blood pressure. You can read about blood pressure in detail in our booklet Blood pressure Eating a healthy diet 38 (see page 102 for how to order this).

lentils and peas contain protein and fibre. • Beans. rice and yam. choose fruit canned in natural juice rather than syrup. trout. ghee.Eating a healthy diet Does a healthy diet help people If you’re a vegetarian… with heart failure? It’s important not to rely on cheese for your protein as it can be high in saturated fat. cereals. (Tinned tuna doesn’t count as an oily fish. Eat two or more portions of fish every week One portion equals: • In particular. palm oil or coconut. use unsaturated oils such as olive. plantain. Oily fish includes mackerel. • If you’re trying to lose weight. If you’re having canned produce. pasta. rapeseed or sunflower. rinse the fish well before eating it. are all examples of starchy foods that provide a slow release of energy. don’t add butter. To help keep your heart healthy Choose lean sources of protein • Go for lean cuts of meat and include fish a couple of times a week. • 1 cupful of small fruits (grapes. Aim for three balanced meals a day. or 2-3 if you have had a heart • 2 tablespoons of vegetables (raw. or in the form of pure are high in calories. cooked. See the Have small. • control your symptoms as they are high in saturated fat. dried or canned. It will as they are good low-fat sources of protein and fibre. peas and lentils (for example. • maintain a healthy weight If you are making curries or stews. herring. it will help you to feel better generally. 4 Living with heart failure juice. frozen or canned) attack. 2 kiwis or 3 apricots) • All types of fish are a good source of low-fat protein – unless you coat them • 1 slice of larger fruit (melon or pineapple) in batter or fry them! Fresh or frozen fish can be steamed. in dhal) things you can do to help you feel better. chapatis. grilled or baked.) • 2-3 whole pieces of smaller fruit (eg. but it’s still a good source • 1 whole fruit (apple or pear) of low-fat protein. frozen. If you can only find fish in brine. cucumber and onion) fresh tuna. Instead. Eat at least five portions of fruit and vegetables every day • Eggs can be eaten as part of a balanced diet. pilchards and • 1 cereal bowl of salad (eg. make sure you your 5 portions a day). Your diet is your body’s fuel. unsalted nuts and wholegrain cereals. pasta. Include starchy carbohydrates at each meal • Bread. look for fish in tomato sauce or water rather than brine. Make sure that you eat Eating a healthy balanced diet is one of the best a good mix of protein foods – include beans. as they contain more fibre. chapatis. have one portion of oily fish a week. with tomato. and choose vegetables canned in water without added salt. a rainbow’. • feel more energetic. • 1 small glass of fruit juice (only 1 glass a day can count towards which contains a lot of salt. 5 Getting help and information 38 British Heart Foundation An everyday guide to living with heart failure 39 . sardines. If you eat well. but take care not to add fat • Include a variety of fruit and vegetables of all different colours – think of ‘eating during cooking. eat nuts and seeds only occasionally. • Try to eat whole grain or wholemeal versions of bread. salmon. cherries or berries) • If you buy tinned fish. with healthy snacks in between if you’re hungry. Always choose unsalted nuts. as they • Fruit and vegetables can be fresh. are low in fat and can be used to bulk out meat dishes or as vegetarian alternatives to meat or fish. dhal. vitamins and minerals than the white versions. noodles. pasta and rice. potatoes. And balance your meals with help you to: a wide variety of fruit. and you may also miss out on some essential nutrients. regular meals advice on saturated fat and fish below.

Maintaining a healthy weight and shape will help are underweight or not able to put on weight. eat. • Replace fatty and sugary snacks such as cakes. Follow the advice on give you some advice on how to increase your of monounsaturated or polyunsaturated fats such as olive oil. vegetable sticks or low-fat yoghurt. Controlling how much you you need to talk to your doctor. sudden weight gain and oedema (collection of fluid in the ankles. choose lean meat. as we recommend that everyone eats a low-salt • check food labels when shopping. often put weight on over a few days if they • Cut down on salt are retaining fluid. Being Where can I find more information Remember that all fats are high in calories. I’ve been told to lose weight. See pages 46-47 See page 102 for information on ordering for more on managing your fluid intake. Remember that if you are not as active as you so read pages 42-46 of this guide. leading to your doctor or nurse about how you can do this. changing your diet may not be enough. ghee. coconut oil. or sunflower oil. • avoid adding extra salt to your food as even healthy food has calories. Try to use semi-skimmed Being underweight can be as much of a or skimmed milk instead of full-fat milk.Have less saturated fat and sugar Weight and your diet I’ve lost a lot of weight and • Avoid fatty meat and meat products like sausages or meat pies. • Many dairy products are high in saturated fat. but you booklets listed below. Because of your heart Have less salt should try to keep as active as you can. Your condition and symptoms may make it You will find much more information in our difficult for you to be physically active. you’ll have to be particularly careful Salt can increase the amount of fluid that you retain in your body. if you need to lose weight. will also help with recommend that you see a dietitian who will • Swap palm oil. you will still put on weight. However. Please note: People with heart failure can We say more about salt on pages 42-44. Choose low-fat yoghurts and limit Will eating a healthy diet help? problem as being overweight. It is important that you know • So you want to lose weight…for good what the reason is for your weight gain so that you can manage it properly. I can’t put it back on. 5 Getting help and information 40 British Heart Foundation An everyday guide to living with heart failure 41 . about healthy eating and weight loss? reduce your overall intake of fats. simply • Measure out oil with a spoon or use a spray and try a low-fat spread. to keep an eye on ‘hidden’ salt in foods. biscuits and chocolate with your symptoms. so if you’re trying to lose weight. physically active is a vital part of weight control. If you think you the amount of cheese you eat. This is not the same as the • Cut the saturated fat weight gain that happens over time if you’ve • Eating well 4 Living with heart failure been eating too much or not doing enough • Guide to food labelling physical activity. lard or butter with small amounts your weight management. He or she may with healthier alternatives such as fruit. Speak to failure. as well as what you eat. poultry or fish. weight safely. our publications. Instead. So it’s very important to: used to be and you are still eating the same the information in our other booklets should • cut down on the amount of salt and salty foods you eat amount as before. not conflict with the advice for heart failure. legs and lungs). and remove the skin from meat and poultry. corn oil pages 38-40. diet whether or not they have a heart condition. or try reduced-fat versions. However. about the amount of fluid and salt you have.

these foods and it can be difficult to know exactly to fluid if you put on 1-2 pounds in 2-3 days. This is usually shown as the amount of including soups. you should try and how much you are eating. Reduce the amount • If a food carries the label ‘Low salt’ it What about salt substitutes? should mean that a serving of the food of salt you eat contains 25% less salt than standard Be careful with these. Some salt substitutes versions of the same product.3 grams puts a strain on your heart.3 grams flavour your food instead. Salt is often ‘hidden’ in You can usually tell if your weight gain is due to 2. for reducing salt on the next page. • Use herbs and spices instead of salt If this is the case then you should tell your doctor keep your intake even lower than this – as The easiest way to find out how much salt there to flavour your food. The swelling can cause sudden too much salt? weight gain and make you breathless. • Rinse canned foods and avoid those cereals and pre-prepared meals. See the sample food labels on page 45. Try using herbs and spices to choose foods low in salt (0. Look for the salt or sodium To help you to control your fluid intake and avoid Most of the salt we eat isn’t what we add to content. is in my food? • Don’t have a salt mill on the table. in your feet. • weigh yourself every day at the same time • make sure you take your medication properly. is to check the nutrition information labels on • Avoid instant or flavoured snacks. could also still be high. If you have heart failure. Wherever possible. (This is equivalent from processed foods. salt or sodium per 100 grams. foods that • reduce the amount of salt you eat labels to keep an eye on your salt intake. As a simple guide. This leads to swelling I get ‘Meals on Wheels’. it could be because you are retaining too Experts recommend that adults should eat less About three-quarters of the salt we eat comes much fluid. This alone can reduce your salt than 6 grams of salt a day. Check the food try to go for low-salt foods – that is. in brine wherever possible – choose • watch the amount of fluid you drink contain 0. look at our tips or less per 100 grams).3 grams or less of salt per 100 grams. the sudden weight gain: food – it’s already present in foods such as bread. which low in salt should contain 0. sudden How much salt should I be eating? How do I know how much salt Tips for reducing salt weight gain and increased shortness of breath. the low-salt version and chloride. A product truly a balance of water in the body.) intake by up to a third. recommended for you. Also.5 grams – or 2. It would 4 Living with heart failure Salt is a combination of two substances: sodium be better just to try and gradually get used to is very high in salt. But How will eating less salt help my heart? can be very high in potassium and are not beware that if the standard version recommended if you have heart failure. But food tastes awful without salt! • Read the labels on packaged and Most people get used to the different taste within canned foods. Too much salt can make your body hold on to water. Eating less Meals on Wheels provide low-salt options salt or cutting it out altogether can help reduce for those who need them. per 100 grams.Managing your fluid balance If you have problems with swelling. ankles (oedema) and even your can I make sure I’m not eating stomach (ascites).500 milligrams – of sodium. those canned in water instead. Our bodies need salt to help keep the different taste of your food without salt. the amount of water your body holds on to. is. or heart failure nurse who will be able to advise low as possible or at the level your doctor has you on what steps you should take. Our bodies need some salt to stay healthy. a month or two. packets and cans. How of salt or less. 5 Getting help and information 42 British Heart Foundation An everyday guide to living with heart failure 43 .

3g 6. turkey or chicken everyday foods.2g 0.5g • Cheese • Instant sauces. Fibre 2g 6.3g Sodium 0.Low-salt or no-salt foods • P re-packed dinners (If you are having these.2g Protein 6. On the Typical values Per biscuit Per 100g Nutrition Information • Pre-packed sliced meats such as pre-packed next page there are sample labels from some Energy 700kj 2101kj Typical values Per portion (½can) Per 100g ham.2g your supermarket. ask your doctor to refer you to a dietitian for information on low-salt eating.8g instant drinks • Tinned soups and dry soup mixes.4g • Bacon. So which of these Carbohydrate: 21g 62. only one is below the • Processed meats such as sausages.056g and some breakfast cereals.7g Fat 0.0g 2.4g that some salt substitutes are very high in Of which sugars 1g 0.17g 0. you can see that it has only 0. do be careful to check whether these Protein 4g 1.3g 250g Sodium 0. Fibre 0g 0g How to find out how much Foods to limit or avoid sodium is in your food Chocolate digestive biscuit Nutrition Information Lentil and bacon soup • T inned meats such as spam.5g 2. 44 British Heart Foundation An everyday guide to living with heart failure 45 . Of hot noodles and instant pasta snacks the four foods above.1 grams per 100 grams.7g 0. Sodium 0. You can check the • Bread and rolls with salted tops Typical values Per portion (1 can) Per 100g Typical values Per serving (30g) Per 100g information on the products. Worcestershire Energy 120kcal 400kcal Energy 106kj 42.4kj supermarket what’s available. or ask at your • Sauces such as soy sauce.9g find fish in brine. corned beef Salt often appears as sodium on nutrition or chopped pork information labels (or food labels). you should choose Energy 167kcal 502kcal Energy 477kj 230kj • Tinned fish in brine (Try to buy fish canned foods that contain less than 0.4g Of which saturates 1.3g check the food labels) Carbohydrate: 1g 0.5g Of which sugars 2. or vacuum-packed. stock cubes or yeast extract Fibre 1.7g 1.1 grams of sodium per 100 grams) Nutrition Information Nutrition Information versions of many foods. kippers and smoked foods 4 Living with heart failure Carbohydrate: 16.3g • Cured. pies recommended limit of sodium – the low-sodium and burgers chicken broth.9g Energy 113kcal 55kcal in water.6g and some wholegrain cereals are better – Carbohydrate: 12g 40g products contain salt substitutes.14g 0.15g 0.1g 33.0g 0. rinse the fish thoroughly) foods would be OK? Of which sugars 11.5g 0. sauce or relishes • Cereals with a high sodium content (Porridge Protein 4g 13. which is below the recommended limit of 0.2g 7. Cereal Low-sodium chicken broth try to find ones with less than 0. and in sweet foods Of which saturates 0.8g • Crisps and salted snacks Sodium 0.7g Of which saturates 0.33g Of which saturates 4g 120g • Salted butter and margarine Fat 2.056 grams and information of sodium per 100 grams.3 grams of Most supermarkets have low-salt or no-salt salt or 0.5g potassium and are not recommended if you have heart failure.1 gram of Protein 2. pickled or salted foods such as pickled onions or olives Fat 8.2g If you can’t find the information or can’t get to such as cakes and biscuits. Remember Of which sugars 1g 3.3g Energy (kcal) 25kcal 10kcal However. On the nutrition information label 5 Getting help for this.3g Fibre 0. Ideally. Also be aware that salt can be ‘hidden’ in bread Fat 1g 3.4g • Ready-mixed spice blends or seasonings. If you can only sodium per 100 grams.5g 0.69g 0. instant A lot of everyday foods are high in salt.7g 1.

– Chew chewing gum or have an by 2-3 pounds (about 1 kilo) in a day. up suddenly? • Use reliable weighing scales. These changes may happen because your heart is • If you are going to see your doctor. swallow it. You everything you drink in a day into an – Have a bit of frozen fruit such Tips on weighing yourself may also notice more swelling in your ankles. gravy. take your weight chart with you. Why is this? up quite suddenly. sauces. If you notice a gain of more than 6 pounds (about 2. is in the morning. It is important to know exactly day? If you’re not sure. If this gain occasional boiled sweet. jelly. Tips for watching or restricting reasons we discussed on page 41. how much it has gone up by. time and put them on a firm flat things that you can do to manage any small 4 Living with heart failure water. dose of water tablets (diuretics). can use the Personal record in the back of the following: You might notice that your weight has gone up this guide. cream. Do this for a couple of days. ask a family member. ask your doctor or nurse. are drinking. if you notice a persistent cough or increased • Choose to weigh yourself either in shortness of breath. They may surface – preferably not on a carpet. Weight gain If you have difficulty with balancing on the scales your fluids due to fluid retention will usually happen over or reading the dial. Use the • When recording your fluids. regularly is a part of this. back of this guide. remember Ice may satisfy your thirst more same scales in the same place each Your doctor or nurse should have told you about to include foods that contain a lot of than water. orange or lemon. What should I do if my weight goes – Use ice cubes instead of fluids. continues for a few days. you should tell your doctor or nurse. it is probably because • Pour an amount of water equivalent to your body is holding on to too much water. canned fruit.Watch the amount Weigh yourself regularly How often should I weigh myself? of fluid you drink It’s best to weigh yourself every day. such as soups. – Rinse your mouth with water might feel tighter. The sour taste will quench suggest restricting your fluids and adjusting your • Keep a daily weight chart. 5 Getting help struggling to cope with the build-up of water in and information your body. phone your doctor or nurse immediately. without clothes You can then see just how much you or chilled mouthwash. these may be signs that fluid stones and pounds or in kilos and is building up in your lungs – so you should stick to that. friend • Keep a record of your daily fluids. You • When you get thirsty. Some people I’ve been told to weigh myself with heart failure find that their weight can go Do you know how much fluid you can have in a regularly. empty 2-litre bottle (or two 1-litre as grapes. 46 British Heart Foundation An everyday guide to living with heart failure 47 . Weighing yourself Managing your fluid intake is important to every day is the best and most accurate way to control your symptoms. your thirst more quickly. ice – Add a little lime juice or lemon juice weight gain because of fluid retention. or district nurse to help you whenever they visit. page 23 (Diuretics). Weighing yourself at the same time every day will tell you if you are retaining fluid or putting on weight for the I find it difficult to weigh myself. feet or abdomen. try some of a couple of days rather than weeks. Use the tomatoes. but don’t and after emptying your bladder. or tinned to water. and weighing yourself judge this. Also.5 kilos) over one in your Personal record at the Please note the advice given on three days. and your clothes or shoes • The best time to weight yourself bottles). • Helplines such as Quitline on 0800 00 22 00 But surely the odd cigarette won’t can provide advice and encouragement.Stopping smoking Limiting your alcohol Smoking increases the workload of your heart I want to stop smoking – where Can alcohol affect my heart? Should I stop drinking alcohol? and decreases the amount of oxygen that can can I get help? Drinking more than the recommended limits Unless your doctor has told you to give up be carried in your blood. cider • help you to sleep better or beer (for example. to speak to your doctor or anticoagulation clinic 1 unit of alcohol = • be one of the few things you enjoy • If you have access to the internet.nhs. 5 Getting help and information 48 British Heart Foundation An everyday guide to living with heart failure 49 . lozenges or inhalers – is failure worse – for example dizziness. • lead to weight gain (as it is high in calories). at www. • change your fluid balance (and increase • Our booklet Stop smoking offers more • m en should not regularly drink more than Smoking is a strong habit. • women should not regularly drink more • make you feel alert • Nicotine replacement therapy – in the form Alcohol may make some symptoms of heart than 2 to 3 units of alcohol a day. drink so long as you drink sensibly. practice nurses or pharmacists can provide • damage your heart muscle I’ve smoked for years and advice. information and tips on how • cause arrhythmias (problems with your heart Whether you drink every day. It can: to order this. • cause high blood pressure a modest amount – avoid binge-drinking. • cheer you up of patches. once or twice rhythm) a week. Nicotine acts like information – see page 102 for how swelling) 3 to 4 units of alcohol a day a drug and it’s addictive. Giving up smoking It can be hard to give up. you can enjoy having a is the single most important thing that you can right support will help you to succeed. Stopping smoking can: or • prevent further damage to your lungs • reduce your risk of having a heart attack or stroke half a pint (about 300ml) of 4 Living with heart failure • reduce your risk of lung diseases like cancer • increase your energy levels normal-strength lager. or just occasionally: I really enjoy it! to stop smoking. • G Ps. If you are taking warfarin you need • make you feel at ease and sociable your chances of success. tiredness • stop you feeling hungry available and has been found to almost double or fatigue. but getting the of alcohol may: alcohol completely. 3. That means do to help to protect your heart.5% ABV) • improve your circulation and the oxygen levels in your blood or • improve your symptoms • help you feel good about yourself. have a look about how much alcohol you can drink. at the moment. a pub measure (25ml) of spirits. a small glass (100ml) of wine make any difference to me now? (10% ABV [alcohol by volume]) Yes it will.

See page 79 for more details. they • it suits your level of heart failure can increase their level of activity while you • you do some every day. Making activity part of your daily routine also means you are more likely to remember to do it. This is because when exercise sessions as well as information sessions but in the long run it will mean that you are of your chair or not lying in bed all day can help you make a sudden. doing the fitness again. but resting all the time is not good for being with the children and doing things overactivity-rest cycle (see page 52). your on topics such as healthy eating and managing able to keep your condition and symptoms 4 Living with heart failure to improve your flexibility and mental wellbeing. you. control your symptoms such as squash or weightlifting. exhausted trying to keep up with • maintain and improve your fitness and stamina exercise or going to the gym. you need they enjoy too. What is and do it at home instead. It can be difficult to balance childcare and a You could work out a walk inside your home that social life on top of everything else. For some people This includes everyday activities like going to you have to build up to your previous level of Being active can: it might be a more modest activity such as the shops or walking down the street. What happens if I miss a day? as to how much you can do. • reduce your blood pressure regular activities we do on a daily basis that like snow. children or friends. But is it safe? motivated. Talk to your friends and family • help you sleep important is that: • keep your joints flexible and encourage them to do activities that you can • improve your general wellbeing. hard physical effort. You may feel cholesterol in your blood playing with children or grandchildren. care not to be competitive (either with others or Don’t be afraid to ask for help with looking with yourself!) as you might get carried away and But I’ve been told to rest. blood pressure goes up. How often should I be active? Ideally it should be every day. You also need to take your medication. It can be hard to force yourself strengthen your heart. to help and benefits that will enable you to look after your children. It includes specially tailored to rest. shortness of breath and fatigue but will still be helped by strengthening or around at home – is good for you as long as • improve the flow of oxygen around your body • raise your energy levels and reduce stress levels chair-based exercises. Even just getting out may not be good for you. such as walking the dog. rest or do something less strenuous. You may become It’s important to make sure you have regular rest of help so that you are not too tired to enjoy stiff and sore and will be getting into the periods. You may also be entitled to plan both rest and activity. If you want to keep fit and active. discouraged if you struggle to keep up with your • help to control your weight the car and doing the housework. Some people housework or even preparing a meal or making you are comfortable with – this may mean going • h elp reduce some of your symptoms such as may not be able to do these types of activities a cup of tea. and make you feel better. Make sure you start at a level that a gentle walk or a yoga class. However. physical If you are already quite fit. join in with. Or they may know of Don’t be tempted to overstretch yourself and Unless you have been told by your doctor to rest Is there anything I shouldn’t do? cardiac rehabilitation classes in your area.Keeping active Being active can be a challenge if you are limited What type of activity is best? I don’t feel I can do very much at all. Any activity – even just walking back a step or two. • the activity is regular I’m not very good at sticking to things. When it is time for you to rest. It is much easier 5 Getting help and information to get into the habit of doing something on a daily basis. particularly if you are feeling well. or when it is windy? • help to increase the protective type of involve being active. Ask your doctor or nurse about ‘exercise on prescription’. 50 British Heart Foundation An everyday guide to living with heart failure 51 . There are many What about when there is bad weather them – let alone with my friends. Not being active for a day or two can mean that activity is an excellent way to protect your heart. swimming or dancing is good. washing is the same distance as you usually walk outside. Vigorous activity of heart problems. Think about what you already do every day. (This try to keep up with everyone as this can make completely. after your family. and certainly accept offers end up doing more than is safe. you do it regularly and every day.) under control. brisk walking. You might want to join a class to help keep you watch. regular activity and exercise will help You may be advised to avoid hard physical sports is a class for people with lots of different types you feel worse. I have young children and I get and fatigue And physical activity isn’t limited to sports.

you decrease it. or do all the housework that’s been piling up The way to overcome this problem is to make List of weekly activities How many times a week • walk that bit further than you would an activity plan. This is known as the commitments and how well you are. the fact that you have to rest for a stick to your plan and stop when you have done whether that’s housework or a manual job do anything. rather than or grandchildren find that you have good and bad days of activity So even though you work really hard on one day continuing because you feel you can. • tackle all the gardening. to do it in a planned way and find a balance to do them. These could include: balancing your activity and rest effectively. you have do in a week.The ‘overactivity-rest cycle’ You may find that you then end up with bad Making an activity plan 1 Make a list of weekly activities days where you don’t want to get out of bed Jot down all the activities that you have to If you push yourself to a point of exhaustion and you feel tired and ill all day. • h ow often you have to do the shopping a result. As Many of us tend to overdo things when between doing too much and too little. instead of getting fitter or maintaining we’re feeling full of energy. for it afterwards. • try and do everything at once It’s also easier to become unfit than it is to be fit. You may be in an overactivity-rest cycle if you do what you know you can achieve. On these days you may: couple of days afterwards means that you don’t what you planned. Plan to • how often you have to look after your children overactivity-rest cycle. levels. do normally. You may be If you want to increase your fitness. you may find that you’re not so tired you can’t do anything for a few days. • the hours you spend at work. Daily walk 7 Shopping 3 Gardening 2 Overactivity Fitness Collecting children or grandchildren 1 The amount of activity you do Overactivity Fitness Going out with friends 1 Overactivity Fitness Yoga 1 Walk to work. and how many times you have on a regular basis. On good days you may feel that you can to get fitter. and may even make yourself feel worse. but we suffer Your plan will vary according to your or gardening your level of fitness. Learn to • the days when you have a heavy workload. stay fit. bus or train station 5 4 Living with heart failure Rest Rest Rest Days Weeks 5 Getting help and information 52 British Heart Foundation An everyday guide to living with heart failure 53 .

See ‘Setting realistic goals’ things you enjoy. and you’ll get over-tired and be back in or organising a birthday celebration or wedding. look after the grandchildren the next. going to • S et yourself realistic goals so that you don’t realistic goals so that you can do more of the one day. and only do that between activities each day. If you don’t. before. Activity plan M T W T F S S Daily walk x x x x x x x Shopping x x x 4 Living with heart failure Gardening x x Children x Work x x x Going out with friends x Yoga x 5 Getting help and information 54 British Heart Foundation An everyday guide to living with heart failure 55 . during and after the event. to start and finish with a less periods into the day. will not affect some people but for others it • Work out how much of each activity you can • B uild up your activity gradually and rest may require planning ahead. Unless you are feeling ill. strenuous activity. and try to build rest I would like to be able to: mix ones you enjoy with those that are more more slowly. Special events which can be tiring on page 56. reduce the amount of activity you do the day too many heavy ones on the same day. over-exert yourself. As you get amount in one go. you’ll end up doing too much in than you usually do – for example. and write them in.2 Write down when you need to 3 Stick to your plan What about the days when I have What would you like do your activities Use a weekly activity plan like the one below. and • You may find it helpful to do some things before and the day after. even if you don’t feel like it. The most important thing is to enjoy such occasions. the overactivity-rest cycle! or on a trip. and that your planning starts early so that you are not doing everything at the last minute. stick to that There are some days when you will do more more of. and reflect on how much or celebration. fitter you will be able to do more without If you think such events may affect you. do what you planned to do that day. If you something special like a birthday to do more of? Then plan all the other things you need or want have planned to do the shopping on one day and celebration or a wedding? Write a list of the things you would like to do to do in the week. then read on for our tips on setting plan. make sure you have enough help you are achieving. try to • Mix activities together so that you don’t have getting tired. If you are organising a party tedious. do fairly easily on each day.

you will to help your fitness levels every day. to fit some activity into each day. and Work out what part of your goal you can do fairly put yourself under undue pressure to do too Why not make a note of your progress? Perhaps advisable. What about holidays? walking more. Energy pockets The dotted line shows how fitness improves just right for you. Setting yourself realistic goals will help instead. Try walking every other day you are to begin with. for example You might have given up doing certain things day for a week. When you’re well enough to start again. If possible do it every Levels of fitness vary between different If you’re ill or recovering from illness. Week 1 Week 2 Week 3 Week 4 • Increase your activity gradually. You can set goals for more than do more things without becoming too breathless. Build up your strength slowly. Or make a chart and pin it on your chair-based exercise. Or so tired that you have to rest the next day. you must tell in the overactivity-rest cycle (see page 52) or your doctor. That way manage. your are generally. 56 British Heart Foundation An everyday guide to living with heart failure 57 . The diagram below shows you could keep a diary and show it to your doctor For instance. You’ll soon are going to change what you are doing. you should begin to notice a difference in a remember that you may not be able to start at 1 Choose a goal 3 Choose a new goal few weeks. with your doctor or nurse first. you could go on a walk or do your goal might be to do a 10-minute walk each you how you will be able to do more as your or nurse. add the next unwell. you must do as they say.” goal to work from as a baseline. day. don’t If your doctor or nurse has told you not to do 4 Living with heart failure 20 give up. It should be a level fitness increases. You’ll soon the ‘Things I would like to do more of’ list on page bit of your goal. Don’t worry if you aren’t able to there may be some things that you want to do baseline is too high. It will also depend on how fit for a few days. 15 minutes’ 20 minutes’ 25 minutes’ 30 minutes’ • Do what you planned. These are your goals. the same point that you were before you became Look back at the activities you have written in When this level becomes easy. Reduce your baseline so that it’s just certain things. check make progress again. and avoid the overactivity-rest cycle. or do the activity for longer. Number of minutes that you are unable to meet the goals that you of activity per day Fitness have set yourself. you may have to take it easy because you haven’t felt able to do them.Setting realistic goals 2 Reach the goal How long will it take me to get fit? What about times when I’m ill? Practise at your baseline. ” Iused to do so much and had so • Start each activity at a level that’s many life plans. are so slim [now] and I have learned to use pacing as much 5 Getting help and information Your heart failure nurse or cardiac rehabilitation nurse should be able to help you set a realistic as possible.) This is your baseline. many things at once. How can I tell if I’m improving? get back to where you were before. you are doing! Any other problems? What are the challenges? If you suddenly feel ill and tired for no reason. • Go slowly and build up gently. 55. or if your symptoms get worse or suddenly come on You may find that you are getting caught up 30 with less effort or more frequently. less tired and able to to start with – try something straightforward like to doing things. If you right for you and then carry on. Take this Everyday 10 guide with you and show them how you plan Remember the golden rules: to get back to being more active. if you chose walking. Pick one of those goals Goal-setting is the safest way for you to get back You should feel stronger. If any of this happens. Once you have found your baseline and you take things slowly and try to do something nurse’s advice on how much activity you can you to plan your activities at a manageable pace you have managed it for a fixed time. kitchen wall to remind yourself just how well that you can manage comfortably. and not what activity a day activity a day activity a day activity a day you feel like. (For example. one activity – just keep them realistic and don’t While you’re on holiday it is still possible. The main thing is that meet your baseline – follow your doctor’s or more of. If working at this level makes you people and are dependent on how well you with a cold or flu. easily now. have reached your goal.

• If you feel any pain or get exhausted. Do the ‘just right’ walk every day for one week. 58 British Heart Foundation . not what you feel hurt. example. Don’t do more. Let’s say you think that walking for ten minutes – activity or exercise. Or if it was closer to ‘too much’ or ‘too easy’. If you are (or have been) you’ve got to come back!) That’s your goal. ‘just right’?” if you plan to go for a walk. heart failure Example: Walking • Do your activities at the same time Think about an activity you want to do – for every day. This gives you time to see if you get the effects • Think of different activities. Ask yourself: “How far could I walk that would be somewhere in the middle like doing any activity. On day 1. stiffness them to keep yourself interested. 4 Living with heart failure Check if it was ‘just right’. keep to it as your • Be careful if you are doing activities baseline. (You don’t want to make yourself so stiff 5 Getting help and sore that you have to stop your activity and information altogether. with other people. line. and vary of too much exercise – muscle soreness. and go back. unwell. (Don’t forget that right for you. 4  How to use goal-setting to work out how much activity Tips on activity L iving with you can do • Check with your doctor or nurse that what you plan to do is safe for you. go back to a lower level of Step 2 Reach the goal.) Step 3 Choose a new goal. do the walk. ask yourself what would be ‘just right’ now. adjust your baseline in the appropriate way. It is also important to cool down towards the end of an Step 1 Choose a goal. If. “Is this still ‘just right’?” If not. and so on – which may only begin after a few days. walking. Make that your new goal. say down to the newsagent’s or the school gates • Start each activity at a level that’s just and back – would be just right. check on the stop. Imagine a line from ‘Too easy’ • Make sure you warm up first when to ‘Too much’. When you get back from the walk. Do what you planned. ask yourself again. you’re not likely like. A gradual increase you have chosen a walk that was too far. you feel that to keep them up. After a week. do the first few minutes at a slow pace and then Too easy Just right Too much go a little bit faster. activity until you feel better. as they may go too fast for you. even if you feel you should have chosen a longer • Build up slowly and gently so it doesn’t walk. before you reach your goal. stop works better. If activities hurt. If it was really ‘just right’. For example.

If you are not sure Having diabetes increases your risk of getting coronary heart disease. GP or diabetic nurse about what you can do to make Facing severe illness 80 Should I have flu and pneumonia jabs? sure your diabetes is controlled. Talk to your heart failure doctor. worry and anxiety 64 work shorter hours. because of the degree of your heart failure or your symptoms. Uncontrolled blood sugar Financial worries 79 about what you can do at work or feel unable to continue with your present job. I have diabetes. ask your doctor. Everyone who has heart failure should be immunised against pneumonia and flu. but the flu vaccine is different every year Most people with heart failure can continue to so you need to have it annually. when yours is due. levels can also make you feel tired and generally GP or nurse for advice. For example. at your surgery if you are not already on it. you might need to Many GP surgeries now have regular vaccination Dealing with stress. 5 Getting help and information An everyday guide to living with heart failure 61 . flu and lung infections because you may be at risk of developing complications related to your heart failure. Looking after yourself at home and at work Looking after yourself at home and at work 61 Is it all right to keep working? You only need one vaccine for pneumonia in your lifetime. However. airline pilots and HGV drivers there may be restrictions with regard to long-term illnesses. Is there anything Sex 77 You may decide that continuing to work is I need to do? not the best option for you. Ask to be put on the list Managing the changing relationships 74 In some employments such as the armed forces. you might need to make some adjustments your risk of getting flu and will also reduce the intensity of the infection. unwell. It is very important to protect yourself against Planning for the future 83 colds. Protecting yourself includes making sure that any visitors know not to visit you if they are unwell. or if you have a very physical dates for people over 65 or with long-term illnesses. and they will send you a reminder job you may need to consider reducing the workload or changing your job. This will reduce Getting out and about 63 work as long as they feel well enough.

encourage them to do so. For more information transport to your departure gate or ask to use see our booklet Inherited heart conditions: If you have heavy shopping or regularly lift heavy I’m worried about travelling. and limit the amount of time also be concerned about passing on your you may make in the future. try to walk about or plan stops every hour Helpline on 0300 330 3311 (similar cost to 01 independent and get on with your everyday life. condition to your children. or use a www. 5 Getting help and information 62 British Heart Foundation An everyday guide to living with heart failure 63 . Try and share the For more tips and information on travel. your doctor may advise that you failure. heavy things. or 02 numbers). your legs and reduce the risk of a DVT. Make sure there on your part by asking them to climb onto your caused by your pregnancy (post-partum dilated declare your condition to them. Around the home. to declare your condition to them. Take someone with you to help sure that you plan any journeys carefully and include plenty of breaks. physical contact is important and it has laid down regulations about when you have the aircraft and the cabin pressure is different and could make your condition worse. It may be better to organise for you spend carrying them. to take your shopping home. Not everyone to the air pressure on land. clot forms in one of the large veins in your Leave plenty of time to organise your travel for you and about methods of contraception. reduce the effort plans so that everything is ready for your journey If you have cardiomyopathy. pregnant. You may them about your condition may affect any claims at airports can be a 20-minute walk from the them up yourself. remember to watch how much you are doing You can also do ankle and foot exercises while and avoid getting into the overactivity-rest cycle you are sitting to keep the blood flowing around (described on page 52). Try to keep the driving if possible. usually the leg). Pushing or pulling heavy items will also increase important if you are or hour-and-a-half. If you want to travel for longer. your doctor may advise that your insurance company separately. Remember that departure gates or friend to pass you a child rather than picking you do not become pregnant again. Getting out and about What about pregnancy and Can I carry children or heavy items? Can I drive? A flight may also make you breathless and increase the risk of swelling in your ankles. especially if it was While the DVLA may not always require you to and you don’t have to rush. security gate. Or ask a partner cardiomyopathy). Is it safe? a wheelchair so that you are not rushing to get Dilated cardiomyopathy (see page 102 for how items. You should speak to your doctor about the risk to you. pushchair. please see our distance you need to move things to a minimum. contraception? If you have small children or care for them The Driver and Vehicle Licensing Agency (DVLA) This is because there is less oxygen on board Being pregnant puts extra strain on the heart regularly. or by air. This is particularly What about travel insurance? transfer the shopping from the trolley to the car. Talk to your doctor about what is best can make you feel breathless.dft. (A DVT is when a of a DVT. If your symptoms are a woman of childbearing age and have heart However. or a trolley to move Travelling can be tiring for everyone. so make to order this). try to use a shopping trolley with wheels to the aeroplane. the workload of your If your journey is for two to three hours in a train website bhf. Sitting still for long periods of time increase the risk of deep vein thrombosis (DVT) (like on a long-haul flight) can increase the risk in people with heart failure. you should tell is someone to help you to lift any heavy luggage lap rather than lifting them up. carrying children or other heavy items with heart failure will be affected by the are severe. Failing to tell at the check-in. including insurance. If your children can continue to drive or not from their website can or call our Heart While it’s important for you to remain or car. for at least five or ten minutes. What about HRT? it’s sensible to talk to your doctor or nurse Hormone replacement therapy (HRT) may beforehand. If you would be unrealistic to exclude carrying them. you may be advised against becoming will increase the workload of your heart and regulations. You can find out about whether you have oxygen available while you are on a flight.

The words themselves can be frightening. a terrible shock! should be doing to keep your heart as fit as However. For example. very little workload of your heart. hormone adrenaline is released into the blood. Some people may find that their life of the symptoms feel frightening. Your GP may be able to change your medication or arrange for you to see a counsellor. to help you deal with these feelings. Relaxing will help to regulate the flow of • eating more unhealthy foods or eating severe symptoms and need to adjust more. • being less active. Talk to your heart failure nurse or doctor or to your GP about what you be a positive challenge for someone else. changed.Dealing with stress. It is • indigestion of symptoms that can cause shortness of breath. Anxiety is a feeling of uncertainty. I’m afraid of doing anything in case Understanding your condition and knowing how to control your symptoms will help to relieve You may find that you develop unhealthy habits I get worse. as it means you can address the • drinking more alcohol worse and leads to dying early. both mentally and financially. it needs exercise to keep it healthy. able to work? What about your family or children? when you have more stress than you feel able • butterflies in the stomach such as a build-up of fluid. Then you can start to relax. like: Some people are scared of dying and do as Even watching TV seems pointless. more heavily. You may also experience other short or difficult. You will feel your heart something done on time. but you should still follow a plan that can make positive changes to any poor lifestyle Try to think about the positive things that you fits your lifestyle and symptoms. if you feel like this all the time. We need both in order to live • headaches one of the most frightening symptoms of heart You will have lots of questions about how you will a full and active life. Try the relaxation techniques • low spirits as possible. while others may have more worried. any situation that leaves you feeling Adrenaline helps to prepare our bodies for the Many people with heart failure say that it was possible. 64 British Heart Foundation An everyday guide to living with heart failure 65 . and some or frightened. some of the stress and anxiety that you feel. • becoming physically inactive. whole world has turned upside down. But worry. it may help to accept problem. or worrying about rate increase and may find that you are breathing failure. body. feeling this way. (See ‘Making an choices and prevent your symptoms getting have done and what you will try the next day. become short of breath. I can’t enjoy things any more. you and information disease. like all muscles in your that this is a day when you need to rest more. I can’t cope with my symptoms. The breathe more quickly when you are worried • restlessness control of it will help you to live as normal a life term heart failure sounds frightening.) This will help your heart worse as a result. which in turn can blood to your heart and lungs and reduce the increase your level of anxiety. to remain in the best condition possible. Poor lifestyle choices can also but don’t be too ambitious. unwell or unable to cope may be defined as fight or flight response when we are challenged a terrible shock to be told that they had heart stressful. activity plan’ on page 53. • difficulty concentrating problem early and treat it before it happens. We say more about depression on page 72. increase your risk of developing coronary heart 5 Getting help However. worrying about getting or in a position of danger. You may find that you • trouble sleeping understanding your condition and being in illness to be worried about their condition. But by learning to recognise the onset cope. they can increase your risk of having GP. Stress is the opposite of relaxation and it is a physical and emotional symptoms such as: dramatically. Most people find that being out of breath is natural part of life. or that it will have to change I get really frightened. Your medication may be the reason you are a heart attack. to time and what is stressful for one person may When you are under stress or are anxious. your heart rate increases and you fear. When this happen. your down. worry and anxiety What are stress and anxiety? What are the symptoms of stress Stress and heart failure Being afraid to do anything for fear of making We all experience stress and anxiety from time and anxiety? your symptoms worse can make you feel isolated. However. If you already have coronary heart may be depressed and need to speak to your disease. When you are on pages 68-69 if you feel a sense of panic or • feeling tired changes very little. Your It is important to understand how you cope Find someone you can talk to – they may physical ability or tolerance levels may have with feelings of stress and anxiety so that you help you to put your feelings into perspective. the Being told I have heart failure was stressed or depressed. Will you be would lose energy and feel demotivated. Without some stress you • tense shoulders and jaw failure. Knowing what triggers your stress and anxiety • smoking more little as possible in case it makes their symptoms We all have times when we feel worried and can also help. heart is a muscle and. They bring with them a feeling that life will be money or your children. It is normal for people with long-term something is wrong. you can spot the Who will look after you? You may feel that your to cope with that problems occur. fear and • dry mouth Being out of breath isn’t always a sign that • difficulty thinking clearly These are all common feelings and fears.

You might find it easier to break Emotion Eg. remain in control People are driving me mad. Allowing them to do things Relaxed are on holiday. it can have a huge impact on your life. and then do a bit more. • having a warm bath and daydreaming feel well enough to do the things you need to • sitting in your garden do. you might find you may be entitled to benefits to help you to very hard to accept. People who love you may be as upset and just being with others may be enough to make everyday tasks then you will feel in control. Impatient are waiting for or aggressive results. relaxing you enjoy – within the limits of what you find for you may also help them cope with their comfortable – will help you to keep stress and own anxiety. and in life. you may not be able to do the same stress.I’ve had to stop work and I feel that with. or the same number of hours. but going out and doing the things by your symptoms. They them – and you – happy. Talk to them honestly about difficult – such has bathing and getting to and level. will However your symptoms affect your life. Have a look at the emotions above. as before. worry or anxiety and will affect how you job. advice. Speak to your GP or nurse who may be able • sharing a quiet time with children or and information as looking after children. lifting heavy things to suggest how you can get someone else’s help grandchildren or carrying shopping. If this is not possible. Explain that you need to stay your carer for help with these things. to do what they think is best for you. confused by your diagnosis as you are. handing instead of your current job. Snappy or tense have lost something will want to protect you and in some cases It may help to save energy if you do some or are late for it can feel that you are being smothered or activities while sitting down – like preparing an appointment wrapped in cotton wool. but if it means that able to complete you are still able to do the things you want to. Where do you It may also help them to read our booklet Living think you are right now? See if you can find a way There may be some everyday tasks that you find to get your feelings back to the relaxed and calm with heart failure. some or all of this over to someone else can be If your symptoms are severe. you don’t have while accepting help from friends and family will anxious or fearful or receive bad news to do all the washing up at once. Even if you are really limited in what you can do. You may even feel that you it a little more difficult to do what you think are High cope (see page 79). Adrenaline level It will help to share this Everyday guide with them I have to get my carer to do things so that they understand your condition better. For example. It’s embarrassing. feel out of control a sense of fulfilment and enjoyment. stress. allow you to be in control and prevent you from feeling smothered. The best active to help keep your heart as healthy as • listening to some favourite music way to cope with this is to ask your carer how possible. Can you think of something that will help how you feel and what you are doing to manage from the toilet – but you may not want to ask you get there? What about: your symptoms. Or try finding a new purpose are of little use to anyone. I write a journal which their concern. worry and anxiety If you have had to stop work on your doctor’s Your role in the household may have changed. Your adrenaline level changes with your level of You may even feel that you’ve lost your purpose I’m so frustrated because I’m too weak For instance. • reading he or she feels about it and tell them how you 5 Getting help If there are things they can help you with. been the one who takes care of things. and accepting the help that’s offered. It may help to discuss other types of to do things and other people have to this may affect you financially. read the paper. employment that you might be able to do help me all the time. Do a bit. may feel that your condition has made you a burden on your family and friends or a nuisance. They won’t a rest. such feel. are not let me do anything. It may take longer that way. If you’ve always feel and behave. They are only trying the vegetables. or washing and drying yourself. I normally do. you Fighting back against my life is over. and reduce your level of anxiety. you may have to accept help family event or party Tell your family and friends that you appreciate from others so that you are not overwhelmed to me. when you… or hobby. have allow you to conserve energy. so that you without upsetting your carer. Low depression at bay. Being honest about the things you need help • stroking your cat or dog? 66 British Heart Foundation An everyday guide to living with heart failure 67 . simple tasks. between each one. or join a group – this may bring back jobs down into smaller steps and taking a rest But remember that balancing what you can do Rising panic. “I talk to the people who are close Pleasantly excited are attending a If you are very ill. helps to focus my feelings…” and calm reading. let them help.

How can I reduce my levels A couple of hours after a meal. meditation or this. tell them to shops. When you feel tired. For this technique to work. The more you avoid working. distracted – everyone does. It’s just the adrenaline that makes practice or more before deep relaxation starts at all. It is the country or even going on holiday. but by knowing what triggers these anxiety. Let your arms list’ method helps. this time crossing out noisy or going out with friends in case you can’t Keep doing this for ten minutes. starting with 1 for the most important. After a while. Let it go by itself. say the word things you can’t do anything about. the more adrenaline your body will right away. visiting your grandchildren in case they get too with them. This is where you have the symptoms of anxiety on your breathing. you may avoid worries into perspective or help you to deal thought will come back less often. saying the word avoid anything you feel may be dangerous person can help you put your concerns and of these thoughts it will get easier and the ‘Relaaax’ silently to yourself each time you or embarrassing. They can make life wretched. of every possible thing you feel worried about. It doesn’t matter only be things you can do something about fight stress. 68 British Heart Foundation An everyday guide to living with heart failure 69 . try one of the three all the things you can’t do anything about today. Make a list on a piece of paper You won’t always be able to avoid feeling stressed If you don’t fight back against stress. Just write a word or two to remind you what you feelings and what to do about them. Fill as many bits of paper as you need to. It usually takes six weeks’ – which it will do very quickly. breathe out.” If ever that thing comes Avoiding things • Talking to someone. but another worry pointlessly. That’s normal. • B eing organised and prepared for events such Next. go through the list.” Each time you say “Stop” to one mind back to your breathing. and information deeply and turning off stress. and how to control them. They can help get your adrenaline level • D on’t worry about whether you are succeeding. can help you to breath and fatigue. In time you will notice that you are becoming write the things down. down. worry and rest beside you. as weddings and celebrations. of practice to get good at this. Some people have found that the ‘Worry can take over your life breathing. This should the things you like and enjoy. If you worry about Now you have a plan. Don’t cross your legs. saying ‘Relaaax’ will make you feel calm. right down – in some cases lower than it is when • Don’t hold your breath. For the ‘Worry list’ method to work. Don’t force the air out. doing things. practise it for ten Tell yourself. “Stop. Go through the list again. The ‘Deep relaxation’ technique these rules: quite safe to leave all these things until tomorrow. When you get good at this at stopping worries in their tracks. “There’s no point in worrying about something I the symptoms of anxiety as well. or sit in a chair if it helps with your One of the effects of worry is feeling constantly anxious. Do this each day and you The ‘Relaaax’ technique more relaxed and the symptoms of stress trouble will soon start to gain control and become good 5 Getting help This is a simple but effective way of relaxing you less and less. stop. I will not 4 When thoughts distract you. Are you experiencing any of the following? control how they affect you. You have less fun and slowly lose control over Once you find something that works for you. Count them and then give them all a you feel like putting them off. Tell yourself. say in your head. it won’t work. you may feel relieved – but it then yoga can also get your adrenaline levels right • Don’t worry about how often you get Work through the items on your list in a calm and becomes even harder to do them the next time. ‘Relaaax’ silently to yourself as the air goes out. 3 Each time you breathe out. lie down The ‘Worry list’ method How stress. 2 Notice how your body relaxes slightly until you have written down everything you are General anxiety The following things should help you: every time you breathe out. Doing you sleep. and anxious. If you get angry. you can use it whenever you need to reduce the heart rate and have a number to get some peace and relief. You know what you have to produce at the thought of doing them. Find out if there are any in your area. it is better to make “Stop until tomorrow”. they can begin to take over your life. You might even put off doing things relaxation techniques below. That’s it! If you do feel overwhelmed. just bring your Part of the job of adrenaline is to make you own can make matters worse. you can 1 Let all of the tension drain out of your body. • Don’t worry if nothing seems to be happening number. do the things you’d like to do. It takes weeks controlled way. do and the order in which you have to do them. Trying to cope on your into your mind. can’t do anything about.” You can buy relaxation tapes in most good book As long as you’re sure that it’s safe for you to If they come back into your mind. Prop yourself up on pillows. them off. like going out. They may also help with shortness of • Don’t get angry when your mind wanders Then look at what is left on your list. it won’t work. It has been proved technique. keep up. “I promise I will start worrying about you enjoy. crossing out all the most of the time. It becomes even worse if you start to worry about • Knowing what makes your symptoms worse. yourself do them. just of other health benefits. your life. worry and anxiety of stress and anxiety? somewhere quiet and warm. For example. today. you need to practise it for 20 minutes every day. If you put Attending classes in relaxation. mean. going for a drive in minutes once or twice every day and follow them again tomorrow morning at 9 o’clock. even if you dread them. Concentrate worrying about.

” can be painful to be with people who seem to be happy and have no difficulties.” You think. I’m busy. Well then. Example: feels and if he’s sick of me. in the longer run. me.Panic attacks What can help? For instance. read the next few pages. 70 British Heart Foundation An everyday guide to living with heart failure 71 . effort and not a pleasure. give A setback happens. Time on your own What can help? Exaggerating the negative can be very helpful but. Does everyone ignore me? become negative and distorted. you can get caught up avoiding me. “He doesn’t want to speak to me anymore. “Your blood pressure has gone up a bit. It is natural to feel sad. thoughts One person does something. He can’t be Are you feeling really down? Most spells of low spirits go after a few months – bothered with me now I’m ill. generalising or exaggerating the negative. Is my carer busy? Yes. (See page 67. they are not harmful to the heart and So nothing new there then. You ask your carer to do something for you and refer you to someone who can help. Does he usually say Although panic attacks can be very frightening when you feel low and sad: You make a negative interpretation. If my blood pressure goes up. Did it go back down again? Yes. at the time. “That’s it. I’ll ask him how he don’t last long. Example: You see the nurse and she says. Very few people are left unmoved by serious illness. There you go then! people to leave me alone. He’s It is a natural part of being ill to withdraw from Without realising it. sorry for yourself and lonely at times. He doesn’t like others. even if they aren’t just now. You might even find that separate the fears from the facts. You think No. But if you’re concerned about • Plan something to look forward to every day. them. You may Someone you used to work with passes you in now I can’t be bothered. I’m getting him down. talk to your GP. It will help things are better or more manageable to put your negative thoughts into proper than you thought. If you are feeling Dealing with negative Over-generalising really down. Did that person just not see me when we passed in the street? Yes.” but only if you keep going. being Each time you have a negative thought.) All of the Sometimes it is better to smile and join in.” 5 Getting help and information Checking out the evidence will help you to perspective. I won’t survive that. angry. your thoughts can Example: doesn’t like me? No. No-one likes me.” You think “He’s you may well start to enjoy yourself again. He doesn’t love me any more. None of these medications are working. sick of me. Have I upset him? No. I just want find yourself jumping to conclusions. alone and giving up company can leave you yourself a ‘reality check’ by asking yourself: You imagine a disaster. Has my blood pressure been up before? Yes. When you are fed up or have a problem. it in a cycle of constant pessimism. Is there any evidence for that gloomy thought? maybe it will this time. even find yourself… if it doesn’t feel the same any more and it’s an symptoms of stress are at their maximum. feeling isolated and deprived of moral support. He or she may be able to • Make yourself do things that used to be fun. I’ve really upset him. the street without speaking to you. he says “I’ll do it later. Jumping to conclusions Some people feel like they’re going to collapse. it means I’ll have a heart attack. over. “Later” and then help me in his own time? Yes. You apply it to everyone. So is it true that he is avoiding me? No. If you keep going. The following things have been shown to help Something happens. if you Ask yourself: When your adrenaline level hits the top you experience panic. Is it true he I’ve always enjoyed company but When you are feeling low.

commit suicide. It can be difficult to recognise if you are Answer ‘Yes’ or ‘No’ to these questions. Or it can happen unexpectedly for no You have been making plans to suggests that you might benefit from getting you have done nothing wrong? apparent reason. then you may You may also feel that you should ‘pull yourself is an illness. pointless? Depression can affect anyone. but depression is not 3 Have you lost all interest in your appearance? in the brain. remember that your heart failure depressed. you may be depressed. experience depression at some time in our lives. or fun or another illness might cause some of these the way you see your life and everything around time. but if you talk to someone it can make you feel much better. you may be suffering from depression. your (However. It is not a sign of weakness any more something you have brought on yourself and Your thoughts. It that used to make you feel good? and you also notice the following. a full recovery. to try? If you feel you can’t. Depression is not just feeling sad or feeling low. How can you tell if you’re depressed? If you answered ‘Yes’ to most of these questions. What can help? 5  Have you been tearful all the time? It can happen as a result of serious illness or life You have a strong temptation to Depression is a common. treatable illness. 5 Getting help and information 72 British Heart Foundation An everyday guide to living with heart failure 73 . think that you might be depressed or if someone 7  Have you felt guilty about things even when crisis. speech and actions have than catching a cold is. You might feel worthless and believe that of your medication. please phone the 9 Have you felt subdued? Samaritans on 08457 90 90 90. It is often a slow process that affects mood never rises or you are tearful a lot of the 1  Have you lost your appetite for food. 10 Have you had trouble sleeping? You may not believe it now. caused by an imbalance of chemicals be in a major depression: together’ or ‘snap out of it’.Depression I just keep thinking there’s no point. help. speak to your GP or nurse who will know But depression can be successfully treated and the best way to help you. or seeing people? symptoms. thinking of something or doing something If you answered ‘Yes’ to most of these questions.) you don’t deserve help. 4  Have you felt that everything is hopeless or you are not to blame. If you 6 Have you thought life isn’t worth living? stresses such as a bereavement. all become very slowed down. Some can even be a side effect you. If you have constant negative thoughts. 8  Have you known you could manage to do If you ticked either of these last two the majority of people with depression will make something but thought it seemed too difficult symptoms you must speak to your GP. One in six of us will Almost all of your life seems unbearable. or that getting help is 2  Have you been unable to ‘cheer up’ by What is depression? pointless. job loss or family commit suicide.

They will enjoy used to. but sometimes I don’t want to be enjoy. it may help to ask for some I feel angry and frustrated that I am no relationship counselling.Managing the changing relationships You may find that your relationships with your You may feel guilty that you can’t do as much I often get annoyed with my partner. you may feel emotional support. I’ve never been mentioning my limits and needs and activities that don’t require as much physical See if you can manage reduced hours at work. or if there is another type of employment that reading stories or even taking them with you on you do rely on your wife a lot now. organisation Relate (see page 100 for their If you are no longer able to work. To manage the to feel this way. will help reassure them that they are still very are experiencing due to your condition. you need from them in terms of physical help or open and honest. makes a difference. See labelled the ill person. Your as you used to. Feeling that you have burdened family. It’s better to set realistic goals for giving older children responsibilities in the home.” a heart condition! I know they care your daily walk. one to rely on anybody as such but when even I have forgotten I have effort. Keep the lines of communication refer you for some counselling. are all activities that young children you can do. you do rely on your wife a “Some family members keep grandchildren. First understand any limitations or changes you frustration often arise because each of you is what you can achieve. You need If you feel that your relationship with your do and what do you need help with? You need to to know what your partner. Take much involved in your life and that their support help you to look realistically at your everyday life Living with a long-term condition requires time to talk to each other about your roles. it helps to be honest physical limitations of your condition. On the or video with you or playing cards. It may be that and realistic in your expectations – both of said on page 52. opposite side of the spectrum. and together work out the best way of carrying out your responsibilities I feel frustrated that I can’t play with your partner with earning the money as well as looking after you and the home can lead to and activities? my children or grandchildren as much feelings of depression and lack of self-worth. as I used to. This will unclear about what you need help with. so talk to them about it and explain You may sometimes feel angry and frustrated own role at home or at work may have changed others to do things for you. including advice on benefits and allowances. or if you feel that your partner is ‘fussing changing relationships. Talk to your partner about how you can take on Although you may not be able to play games a different role or responsibility. All this can be frustrating. Either ask your GP to expectations. carer and family lay down the ground rules and manage people’s are feeling and they need to know what you partner is suffering. yes. work colleagues and friends judge me on how well I look and occasionally expect too much!” 5 Getting help and information 74 British Heart Foundation An everyday guide to living with heart failure 75 . or because you have to rely on means. so that they can understand what are feeling. also ‘Financial worries’ on page 79. friends or colleagues have changed. I do now. As we have the attention you give them and appreciate over you’ or being over-protective. Why not use the goal-setting contact details). and responsibilities. For example. or phone the longer the breadwinner in the family. Being they just want to care for you and feel that they others. on’ you may end up in an ever-increasing cycle honest with them about your condition. Older children may enjoy watching a DVD contact your local Citizens Advice Bureau. there are a lot of other games help your self-esteem. It is perfectly normal why you may not always be able to do everything if your partner has to do more for you than they too. if you force yourself to ‘soldier the time that you do spend with them. and are doing something helpful. arts and crafts. lot. friends or carer. that you have lost your role as breadwinner in or activity plan methods (pages 53-56) with your the family. What can you continue to even stronger communication skills. This will ensure like football or tennis with your children or that you are still ‘pulling your weight’ and will “Oh yes. board games. and yourself. Confusion and of exhaustion. If you would like advice on finance. but it is important to accept the with them even if you’d like to. Children also need to know what your condition family.

once Talk to your partner about your concerns and condition and take an active role in to your partner about what you feel is most feelings. friends. These include: common in couples where one partner has a • I f you are no longer able to work. Listen to what you both need and try you have identified a routine for your treatment comfortable for you. you will be able to enjoy the your needs are and is able to work with you. • tiredness or fear of overexerting yourself • Learn to adapt and modify your if you manage your symptoms well. • Your family may appreciate you more and • a change in the way you express your feelings you may see more of them. If you have an ICD (implantable cardioverter are plenty of ways of sharing intimacy that don’t and friends. information see our booklet ICDs (implantable cardioverter defibrillators) and our booklets on • Discuss how you feel with your carer cardiomyopathies from the Inherited heart “I value the people in my life even and family.” they tell you how they children or grandchildren. See our • Include your carer as much as possible activity will initiate a shock. But there is no reason why you be able to spend more time with your partner rather than what you can’t. • If you feel you need to talk to others in the same situation. beta-blockers may cause impotence or carer. It is perfectly safe tips on ‘Sex and heart disease’ on our website relationships are strengthened and that you have a different perspective on life. and focus on what you can do • s ide effects caused by your medicines – in heart problem. Sex Focus on the positive Tips to help you cope with My partner and I never seem to get I just don’t have any desire for it the changing relationships round to making love any more. more than I used to. There time that you spend with your partner. There are many ways that you can be • mood swings or depression intimate without physical exertion if you don’t • resentment or anger towards your partner. 5 Getting help and information 76 British Heart Foundation An everyday guide to living with heart failure 77 . and everyday life. so that he or she knows what your to have sex if you have an ICD. see page 101. activities so that you can still take part Making love makes you feel good and brings as you get older – there may be less of a focus • Your relationship with your partner or carer in fulfilling activities with your family or you closer physically and emotionally to your on sexual intercourse may become stronger. Talk changes caused by your symptoms at first. and listen to them when conditions series (see pages 102-103). By focusing on the positive aspects of your life. friends. Although you may be frustrated about the • Learn as much as possible about your actually want to have sexual intercourse. should not have a normal sexual relationship particular. You might find that your different defibrillator) you may be worried that sexual necessarily involve sexual intercourse. you can begin to accept the changes • Recognise and accept that you may not You or your partner may be frightened that There may be many reasons why your desire for that happen: be able to do everything that you want an active sexual life may be harmful. For information on how to find one locally. partner. you may to. any more. family take some control of your situation. For further bhf. join a support group. This is sexual activity becomes affected. This will help you to different ways of showing your feelings.

family credit. Be sure to ask your doctor or GP first before you In Northern Ireland. Scotland and Wales: may be a reduced supply of blood to all parts keep an erection in the morning. rather erection is caused by large blood vessels in the than the blood supply or the Lancashire. nursery places. One clue that can help you decide whether I am worried about how I am going What is the carer’s allowance? the problem is caused by the medication or a to cope financially. instead of at night. Preston. you want to have sexual intercourse. your family down. This could be a spouse. (An informal carer is if you still have morning erections. We’ve already The carer’s allowance is a taxable benefit diminished blood supply or a result of anxiety. Another problem is a poor blood supply. Carer’s Allowance Unit. contact the Department for Work and Pensions (DWP). allowance from: Men have a rush of hormones in the early There are benefits in place that can help to penis hard. so you Phone: 0845 608 4321 anti-arrhythmic drugs can all have this effect. As you know. PR1 1HB with erections. Palatine House. Some types of medication can cause problems What state benefits are available? Lancaster Road. beta-blockers and Can I use Viagra? The benefits system can be complicated. pensions and so on – contact your local Social Security office. in heart failure there morning. You You can find out if you are eligible for the penis filling with blood. then it distressing. are facing financial problems. This is what makes the may be concerned about paying a mortgage. There can be many reasons for this. disability living and carers’ allowances. If you are not sure how to contact your local Social Security office. You can also find out information about benefits and allowances at your local Citizens Advice Bureau or from the www. it can be very and is not paid to do it. They will be able to advise you or put you in touch with relevant services. change available for informal carers. call the Benefits Your doctor or GP may be able to change these Remember that this includes entitlement to help take Viagra as it may not be safe for you to take Enquiry Line: 0800 220 674 to help. Financial worries I’m having problems with my erection. mentioned anxiety about your heart. housing benefit. but the If you have had to reduce your hours. Citizens Advice Bureau and other useful organisations can be found in ‘Financial help’ on page 100. Some benefits can be claimed quickly under ‘special rules’ by people who have been deemed 5 Getting help to be in the last six months of life – see page 81. but it is not your and information 78 British Heart Foundation An everyday guide to living with heart failure 79 .uk website. be a good time to have sex. in the house or childminding facilities as well as it with your other medication. For information on state benefits – income support. so this may of your body. Contact details for the Department for Work and Pensions. should get advice about what you are entitled to. If you have cause of the problem could also be worrying your job or give up work altogether and you is someone who provides care to another person morning erections but have problems when about the erection and your performance. In England. You might feel that you are letting a friend or a relative). Diuretics. Your is probably anxiety causing the problem. You may find it easier to get and support you and your family.

spiritual and social support. do so. Try to focus on useful organisations listed on pages 99-101. families and their friends aware of your preferences and offers them carers (see pages 99-101). under ‘Financial help’ on page 100. as well as to send in a short medical report called a DS1500 housing issues. discuss and plan for this report. alarm services which can be arranged in case It also includes support for their family and carers. talk to your doctor or says that you may be facing the last six months I can’t manage at home. It helps them to live as well Living Allowance under ‘special rules’. occasionally it can come on the issues that may arise when your condition is helps. because you have If you have difficulty cooking meals for yourself. their expert advice – especially if you have to the class of heart failure that you had before. applying for one these benefits you will need available in your area including home care. Ask your GP or nurse provide travel opportunities to help you stay care. see ‘Talking to your doctor. Although most people with heart failure Remember that you don’t have to manage alone. rather than just one aspect of care. mobility schemes (schemes that professionals specifically working in palliative form about your condition. heart failure is a progressive disease and tell your GP or nurse if you have care teams provide care and support in a hospice. If this happens. hospital. as well as suddenly and despite treatment there is little advanced. on things and worrying more. Your doctor may tell you • U se a wheelchair so that you can still that where you had. Ask about community as possible until they It includes the experience a gradual progression of their Here we explain how you can get support with Talking this through with family. • Watch your fluid levels very carefully complex symptoms or support needs. Palliative care is the holistic care of people with what you can do rather than what you can no longer do. support too. GPs and nurses have a limited time However. involvement of a specialist palliative care team for of being unwell. This 5 Getting help helps make sure your wishes are met and that Also.Facing severe illness You may find that there are times when your What about Meals on Wheels? My symptoms are so bad that I can’t Who provides palliative symptoms become severe. Coping • Ask your heart failure nurse or palliative work alongside your GP and/or nurse. and to die with dignity. Ask your GP or heart failure nurse any questions be difficult. quality of life possible. and you see your doctor so that he or she can assess ‘Meals on Wheels’. care home or your own home and will make the most of this time. are addressed right from when you are first failure is under control. By What about financial and other help? ‘holistic’ we mean it deals with the ‘whole’ person something happens. on page 91. emotional. Your GP and heart failure nurse. and your doctor to help you and your family achieve the best If you live on your own. When you recover from your period time to talk to me about everything oxygen if you get very breathless. or contact your local details for emergencies. you may find that you are dwelling You can also get further information from the What is palliative and end of life care? the services available in your area. class 2 heart failure. Palliative Most doctors. Decide on a plan for contacting someone breathlessness and discomfort. you may find that you return I want to know? • Have plenty of rest periods in the day. diagnosed. your GP or nurse might suggest the information). When this happens. information contact the organisations listed social services department at your local authority. for the last months. and so on. get out with your family and friends. you may be entitled to quickly How can I get help? want or need assistance at home on a regular End of life care is support for people who are claim an Attendance Allowance or Disability basis but it can be reassuring to have contact approaching death. GP or nurse’ with the effects of advanced heart failure can care team for tips on how to cope. or end of life care? caught a cold or become unwell for another your council can deliver ready-made meals to If it is no longer possible for you to get out and Your GP or heart failure nurse can meet many of reason. If you are unable to get about and you have about palliative and end of life care and do things. get out of the for that may help: should make sure that these aspects of your care your condition and make sure that your heart more information. This service is sometimes known as about on your own. if you feel you need help. say. can help you think about. When They will be able to advise on a range of services you should ever need help urgently. See www. independent). here are some suggestions your needs as you reach the end of your life. Its goal is improvement. there are a number of organisations that and information you receive the care you’d like and not treatments can offer practical and emotional support with you want to avoid. You might not of your life. We talk more about this in the ‘Planning for the future’ section. weeks and days of life. but you can and there may be a time when your condition swelling that you can’t control. it’s important that your home. 80 British Heart Foundation An everyday guide to living with heart failure 81 . they can spend with each patient. It helps make your family and end-of-life issues for patients. I’m scared of being on my own if an advanced illness which cannot be cured. you now have class 3 (see page 7 for more What if my doctor doesn’t have the • Ask your doctor for a prescription for However. friends or carers management of physical symptoms such as condition. For more Talk to your GP or nurse. nurse about home care For tips on how to gets worse despite your treatment.

What if I don’t want any When facing long-term or severe illness. Include them in your conversations and planning ahead lets you get on with living as • whether you would like to donate your organs conversations. Your wishes will then directives on page 84. If you decide you don’t want to receive particular situations that might arise and how you and treatments. it’s What kinds of decisions do I need to natural to look at the future and think ‘what if?’ Severe symptoms. you should write this down. This is a your are approaching the end of your life. so you need to of the worries or questions that are at the back • any specific treatments you’d like to refuse and nurse to help and visit www. with. that you over your treatment in the later stages of your unwell to let people know my wishes?’ or ‘what • where you would like to be cared for . 82 British Heart Foundation An everyday guide to living with heart failure 83 . If you’re finding it tricky discuss your wishes with your partner. first and then to your family or friends. or you may have been told. as it involves making an advance statement about matters such as your will. In your family or carer would like them to be dealt England and Wales the legal term for this is an with as soon as you feel comfortable doing this. The Mental Capacity Act 2005 (England and Wales) and the Adults with 5 Getting help Incapacity (Scotland) Act 2000 set out guidelines and information as to when a person may not be able to make a decision. make sure that they know your wishes so that well as you can for as long as you can. difficult decisions will help your relationship and When should I plan? deactivate its shock component to avoid understanding of each other. You might find or friends will also be more confident in knowing • if you have an implanted device such as an cope in the future and to give you peace of it easier to talk to your GP or nurse on your own exactly what you do and don’t want to happen. Once they’re out of the way. you can Northern Ireland currently has no legal help make sure that your wishes are taken into equivalent. You may have heard about a “living account. can be very frightening. ask your GP or There will be many options. Sharing when would be an appropriate time to ‘Planning for the future’. You may It is very important that you have some control like ‘what if my condition worsens and I am too You should start thinking about: believe. talking does help. you might ask yourself questions make? breathing. not only when you’re feeling unwell. decisions while you are relatively well.dyingmatters. particularly having difficulty more treatment? For example. We while you have the ability or “mental capacity” explain more about advance decisions and to make them for yourself. ICD (implantable cardioverter-defibrillator). anger or sadness. You should discuss the treatment you will happen to my family if I’m not around to care own home or somewhere else . making to make that decision in the future. and have these discussions when you’re feeling plans for the future and sorting out practical process known as advance care planning and If you can. advance decision to refuse treatment and in By having these conversations and making Scotland it is called an advance directive. mind. Your family to help someone after your death You can also make practical plans to help you they can help you in the future. stating your preferred place of care Planning for tomorrow can help address some to talk to your family or friends. and are designed to protect you in this situation. breathless or anxious. You should try Although it can seem difficult at first. family or of your mind. be clear if. try to talk to someone about your well. It’s a good idea to start thinking about the unnecessary discomfort. finances and sources feelings. It’s best that you make these decisions will” but this is not a recognised legal term. Planning for the future I’m frightened of dying.for example if you are no longer able to understand the information provided about your treatment. Although it might feel difficult to start can be difficult to make a decision when you’re your health and social care which can include of support can be a very positive thing to do. such as or heart failure nurse or doctor. how to make an advance decision about this for advice on how you can begin these friends. Hearing illness.and the sort this can cause you and your family and friends want or when you want to stop it with your GP for them?’ of care you would like if you become unable to experience many different emotions. at some time in the future. We look at this more in the next section. you lose the mental capacity to make these kinds of decisions .

In these after you. It is your right to refuse nominate who you would like to be consulted if infection or you may not want professionals to stops beating. Other course of action.It does not mean ‘do not treat’. heart prepared by a mentally competent adult that sets treatment for discomfort or pain. Remember you can make your wishes about treatment known and it risk. resuscitation and if you didn’t wish to take this still reflect what you want. you can kidneys would be damaged. transfusions. heart failure nurse and family and such as surgery. you will not be resuscitated. you would prefer to be allowed the option wishes and views yourself. However. This means that your family no realistic chance of successful recovery from or friends do not have to make difficult decisions An advance statement can help the professionals your heart or breathing stopping. about this in detail and others do not. while would only be used if you are too ill to speak for If your illness becomes very severe. your breathing and your heart. looking after you to understand what your wishes resuscitation would therefore not be offered and are. resuscitation treatment that would usually be someone else has to make a decision about your attempt to resuscitate your heart and lungs if It means only that if you stop breathing or your offered to you in these circumstances. successful and restore you to a reasonable quality a time when you are unable to express your future you don’t want certain treatments. try to talk to your GP or nurse and the treatments that could be useful for you first or visit www. yourself at the time.dyingmatters. Heart and lung on your behalf later on. then a DNAR order would be put in place. there may be you have the mental capacity to do this. You should review your advance of medical treatment in the event of serious also refuse those treatments through an advance circumstances. It can cover social and personal care they stop. and/or if it did. 5 Getting help and information 84 British Heart Foundation An everyday guide to living with heart failure 85 . It can also be used to example. your wishes would be sought on statements from time to time to make sure they illness and impending death.for example. but it does not bind them to a particular Preparing an advance decision or directive can a DNAR order would be put in place. It is intended to decision if you want to. should discuss your options with your GP. would also not be offered at this for help would be explained. heart stops beating. If you’re worried about having these stage and an overall discussion about your care conversations. There may come a time when your illness means as well as medical care. You may A ‘Do Not Attempt Resuscitation’ (DNAR) order is that an attempt at resuscitation would be and would not like in the future. You should let your team know if you want them to explain which treatments are not suitable for you at this stage.What is an advance statement? What is an advance decision? What is a ‘Do Not Attempt When might I have a DNAR order? An advance statement is a document that An advance decision specifically applies when Resuscitation’ order? You may feel that even if there is a good chance outlines your wishes about the care you would you want to refuse medical treatments. there would be a real risk that your brain or failure nurse or doctor and anyone else looking out their specific wish to refuse some or all forms dialysis or use of a ventilator. also be an opportunity to discuss difficult issues treatments without a realistic chance of success. Some people wish to talk and advice. you may not want antibiotics for a chest resuscitated if you stop breathing or your heart of natural death. You will still get other treatments if you need An advance decision (in England & Wales) or an that an attempt at resuscitation may not restart If you want to make an advance statement you advance directive (in Scotland) is a document them . treatment. in case there is decide that in some or all circumstances in the a specific kind of advance decision or directive. always change your mind if you want to. For It is an instruction that you are not to be of life. with your GP. treatment with antibiotics.

if appropriate. In case it is not. You can do it through a solicitor for a small • your signature aware of your advance statement or advance professionals to a particular course of action. such as the ‘out of hours’ and You’ll also need to think about financial issues • a clear statement of your wishes. address and phone number of a family or friends your preferences for cremation nominated person to be consulted if you are or burial and even planning the details. partner. in • the name and signature of a witness (this to help you do this. even if this puts your life at risk as a result their funeral. it is a good like insurance or pensions so you may wish to decisions is set out in the Mental Capacity Act treatment you wish to refuse and whether you idea to keep a copy of the document(s) to hand. not just those facing An advance statement covers the type of care An advance decision should be written down and decision is written? advanced illness. same way that refusing treatment would be if or anyone who stands to benefit from your will) teams involved in your care outside of normal you had mental capacity. but it is a good idea for you 101 for details of organisations who can help. If the treatment could Scotland.see page advance decision. They can explain the advantages and disadvantages of choosing or refusing certain treatments and the impact your wishes will have on the course of your illness.endoflifecareforadults. cost or. relative your hospital notes. you can • the date decision and an up-to-date copy should be kept do it yourself. You might want You don’t have to involve a solicitor in writing an to contact a funeral director for advice . Talking unable to make a decision about your to family and friends about this can ensure your treatment (optional). statement saying that you wish to refuse it Some people find it useful to talk about and plan comply with it. This might include telling your • t he name. but does not legally bind health putting-into-practice 5 Getting help and information 86 British Heart Foundation An everyday guide to living with heart failure 87 . It is legally binding in the person should not be a spouse. If you have made an advance decision. if it’s a very straightforward will. You can find a template advance decision document and supporting information at www.How is an advance statement different How do I make an advance decision What should I do once the Should I make a will? from an advance decision? to refuse treatment? advance statement or advance Everyone should have a will. heart failure nurse or doctor and other you would like to be cared for. include a aware of your advance statement or advance What about my funeral? your doctor and other health professionals must decision. It will be used to • your name and address your assets when you die. specifying the ambulance teams. Making a will is very relevant health professionals should be made inform your care. The law about advance GP surgery hours. funeral reflects your life and it can make a difficult time easier for your loved ones. There are plenty of guides available An advance decision applies specifically to in your medical records and. from organisations such as medical treatments. Making a will can bring you you would and wouldn’t like to receive and where include: peace of mind as you know what will happen to Your GP. Your GP or nurse will then be able to confirm that you were mentally competent at the time of writing the document. 2005 which covers England and Wales and the wish to refuse it in all or just certain You should also make your friends and family Adults with Incapacity (Scotland) Act 2000 in circumstances. seek independent financial advice. and your family to discuss your wishes with your GP or nurse. It should also be shared with the Citizens Advice Bureau and Age UK.nhs. potentially prolong your life.

Pick a couple and put them into practice. Talk with them openly and honestly about your feelings. there are plenty of things that can help you get the best of everyday life. • There are plenty of other relevant publications or DVDs available from the BHF or other organisations. especially the chapter ‘Help for carers’ on pages 92-98. We list some titles and details on how to obtain them on pages 102-103. 5  Looking forward. • And please remember that you. 88 British Heart Foundation . We list these on pages 99-101. Share this guide with them. Getting help and information right now: • Think about all the useful tips in this guide about taking positive action and managing your symptoms. and use the Personal record at the back to keep track of your symptoms and stay in control. Many of these are free of charge. never have to cope alone. and your family or carer. 5 Getting help and information Now please use the next section to help you get further help and support. there are many organisations that can offer valuable help and support. In addition to your GP. doctor and nurse. • Your family or carer can be an enormous source of practical and emotional support.

write down GPs and nurses expect to have to repeat things. or if understanding. What to do in an emergency 104 I don’t always understand what GP or nurse I’ve been told.” you get very nervous. GP or nurse. concern you. • Make notes on how you are feeling for about a week before your There never seems to be enough time appointment. be a very big problem. Before you go for your appointment. See our tips on the right. to know about. to talk about things. • Let them know that there are other things you want to talk about and “The Heart Failure Nurses have arrange when to discuss these. GP or Index 106 It is very important to understand what your doctor. An everyday guide to living with heart failure 91 . • Write down all of your concerns. don’t be shy to talk about. There never seems to be realistic and decide which ones are enough time to talk about all the things that the most pressing. Our tips below will help you keep track of what you’ve been told. take someone with you and ask them to write things down. ask your doctor or GP. and tell your doctor. a list of questions about all the things you want but you need to tell them which things. think about why you are going information can be complicated. If there’s something in at any one time. Doctors. GP or nurse 91 I would like more information from I often forget what I’ve been told. often been the most practical and • If you have trouble hearing. Talking to your doctor. GP or nurse is telling you. There is only so much we can take symptoms and treatment. It’s not unusual for us to forget what we have Help for carers 92 Information about your heart failure is essential if you are to understand how to manage your been told. GP or nurse Talking to your doctor. Before you visit your doctor. so if there’s to see them and what you would like anything you don’t understand. Tips on talking to your doctor. Medical nurse. especially if we are slightly nervous or worried. make notes of the answers or ask your doctor or GP to write things down for you. There are certain things that you GP or nurse about these right at the can do to make the most of your time with your doctor. beginning of your visit. my doctor or GP. to ask them to repeat it or to explain it in ‘layman’s terms’. Useful organisations 99 you don’t understand. Many people with heart failure say that this is If you end up with a long list. If you think you won’t remember Useful publications and DVDs 102 the answers.

relative. but being • reduce their feelings of being a burden or concerned that they are depressed. overactivity-rest cycle’ on page 52). have a good quality of life. Whether you are and support. you will make while the person is resting. It is natural to want to help the person with downs that you may face. There will be good and bad days They will be able to be objective and let you lost their self-confidence. If they are neglecting themselves. Read this in control of your lives. friend or carer of the person for them – and for you. them to live a normal life as possible will mean You will find more information in our booklet that both they and you will feel happier and more Living with heart failure (see page 102). Of course there will you tips and advice. (See page 72 for more information the guide. If you are worried. its causes and treatment. If you still have concerns. Finding the right balance for on depression. they are not able to share for themselves and for you. but also tell Give them time and space to adjust and get back While the nurse or GP may be happy to give on their feet. Gently encourage them to do things written to help you. however. 92 British Heart Foundation An everyday guide to living with heart failure 93 . Remember that you have “That’s one thing you have to if you’d like a greater understanding of the a life and other responsibilities too. • help them to feel positive about their situation There are times. talk to the heart failure nurse or GP for support recommend that you have a look at the rest of other about how you feel and what boundaries and advice. If you have time. Depression This guide has been designed to help the person overprotective may frustrate them or encourage dependent on you can be a serious condition. but once diagnosed with heart failure to manage their symptoms and them to be too dependent on you. try inviting someone around or suggesting an outing to share with you. Knowing to talk to your partner or the person you are how to do this without taking away their Try to focus on what is important and not on the caring for. Let them talk to you them an invalid eventually. Expectations At each stage of their condition. be very aware of – that you can condition.) they cope and what you can do to support them. Perhaps they have been the partner. You just make meals. It may be that the person you are caring for has to know what to do for the best. talk What if they don’t seem to want it affects everyone in the family and those it over and suggest other things that they can to do anything for themselves? involved in the care of that person.. Understanding the condition and how it affects I am worried that I am going – this can motivate them to make an effort with Making sure that the person you are caring their appearance. you when they need help. unwell recently or their symptoms have changed. • allow you to do something else while they it can be treated successfully. the person you do that aren’t so tiring. It may mean organising a few people on a rota basis to do the shopping. We all have good and bad days your partner or the person you are caring for. Striking the right balance If you think that they are doing too much. about what information about their Understanding heart failure independence can be tricky. who has been diagnosed. condition they are happy for the GP or nurse little things. this chapter has been to let them manage their condition.. when you may be heart failure as much as possible. we The key is to make sure that you talk to each are managing themselves. collect the children or stay with them them worse . Sometimes people be times when they are trying to do too much information about the patient unless they have are more encouraged if you ask them to do jobs and you might have to intervene (see ‘The permission from them to do so.Help for carers When someone is diagnosed with heart failure. will to be overprotective. and relationships will change and it can be hard are caring for will need different levels of care discuss them with the heart failure nurse or GP..” about what they want to do.. It will help you to understand how need to be set. You need to be able know if you are being overprotective. You should for you or other people. Ask them what they feel they can do and if actually make people worse by there are any areas that they particularly need running around after them and help with. for is in control of their life and condition can: help you to deal with the inevitable ups and and like things to look forward to. organise doing too much . too.

others in the same situation as them. Talk to your friends and family about your • Do some relaxation exercises. Talk to the nurse about Read though the guide together and work out arranging this. no-one seems to understand how You should not feel guilty about wanting a life under a lot of stress. There is plenty people find this very helpful as it enables Crossroads (see page 99) which may be able to of practical advice on: them to meet people in the same situation provide someone to sit in for you. with the demands of caring. contact an organisation called do what’s best for him or her. if you there is support and help for the person who a social life. let the housework go more responsibilities that your friends and hobbies will feel more relaxed and better able to cope than you would like to.) If you are unable to leave your partner or relative • getting the right amount of exercise (page 50) on his or her own for long. or talk to the nurse everything yourself. Sometimes talking with other people who are in the same situation can be very helpful. For some people that can be a very good idea. outside of caring for your partner. What can I do to help the person I’m • Speak to the person you are caring for If you need to go out but the person you are about what you need to do and how caring for needs someone with them. how you could help with putting this advice into practice. • eating healthily (see page 38) (See next page. you may make yourself ill. as them. Or. you may be able to • managing medications (page 19) arrange ‘respite care’ where they will be looked • recognising and managing symptoms after in a care home so that you can have a (page 12). Try to eat healthily and take regular exercise. Some phone. You are Looking after yourself is as important as caring the person you’re caring for. a support group. • Look after yourself. 94 British Heart Foundation An everyday guide to living with heart failure 95 . See page 101 for details of how to find a local support group. which can very therapeutic. and about the future. The symptoms are the same children or going to work. you feel. long run. You may have become so focused on your carer being selfish.Coping with stress What can I do about it? Having a social life It might also be a good idea for your partner to join a support group. longer break or holiday. Try the feelings and ask them for help. If you overdo things. have been ignored. which won’t help in the are caring for or your GP about going to local sessions. not a failure if you have to ask for help. By taking a break from caring you For example. You need a break and time to yourself. • Change your expectations for yourself. you could shop for healthy I am thinking about joining ingredients and help to prepare meals. for your partner or relative. factors can lead to you feeling very anxious and have other responsibilities like looking after is unwell. You may feel that. You will probably be worried about the health of • R ecognise that you can’t do everything. ask a friend caring for manage their symptoms? you can best allocate your time. Talk to your nurse who will have information on the support groups in your area. Feeling isolated is You may also be overwhelmed about the amount a common feeling. or relative to call round or be available on the The information in this guide will help you • Join a support group for carers. although I feel guilty about wanting to have • Try and anticipate when you might need of information you have to deal with. • Make sure you have time for yourself. Don’t try and do Helping the person you ones on pages 68-69. All these to ask for more help – for example. You’re not as the ones we described on page 64. For example. That way they can meet There are many things that you can do to cope Why do I feel stressed? with stress: I feel isolated.

your hobbies. These may be in the form of financial or practical a carer involves. • other commitments that you have. (An informal carer • H ow many hours a week do you spend caring. ankles or abdomen arrives. contact Heartstart. you can find their phone to the person you are caring for. not want measures taken to restart their heart receiving the carer’s allowance. They and is not paid to do it. see page 79. We to see if you are eligible (see below). Or. other • Memory problems or problems If you would like to do a free. a the house? If any of these symptoms are new. For more information about a DNR. If stops beating). a carer’s allowance? If the person you’re caring for has requested • Feeling helpless or fed up that in the event of their heart stopping they do you may qualify for a carer’s assessment. Read the section ‘What to do in an emergency’ For a week or so before the assessment. or chest information as possible about what your role as look after someone with a long-term illness. dial 999 for an ambulance What if he or she collapses suddenly? available for informal carers. carried out by social services to find out your How can I find out if I’m eligible for • Slow weight gain needs as a carer. Lancashire. To find out if The assessment looks at: (a ‘Do Not Resuscitate order’ or DNR). under the name of your local authority. contact: If any of these symptoms are new or have got in writing on their medical records. This helps them work out what • Difficulty in breathing. so that you know what to do. immediately. call 999 should begin basic emergency life support. Once you have called 999 you assessment from the social services department • How is your health. Preston.Warning signs to look If this symptom is new or has got worse. I should look out for? assistance. being a carer? for an ambulance: explain what to do on page 105. Palatine House. Are there any warning signs that pain. If you look after a friend or • Weight loss relative who cannot manage without your help. and this is you are eligible. phone Help with caring What happens in a carer’s assessment? out for 999 for an ambulance: There are benefits and services to help you A social worker will ask you to provide as much • A  heavy pressure across the chest. What is the carer’s allowance? be a good idea to keep a diary about what your role as a carer involves. Your GP or district nurse can contact them on your behalf. 96 British Heart Foundation An everyday guide to living with heart failure 97 . and how is it affected by they are very bad or suddenly get worse. In Northern Ireland. is unable to breathe properly. you must tell the doctor immediately: In England. if you want For more information on financial help available to contact them directly.) You will need to have an • Do you have any time for yourself? to the heart failure nurse or doctor or to the GP. or both. It can be a spouse. assistance you may be eligible for. call the Benefit You can ask your local social services department Enquiry Line: 0800 220 674 for a carer’s assessment. is someone who provides care to another person including at night time? Are you able to leave call 999 for an ambulance immediately. on page 104 now. A carer’s assessment is a free service that is You can find their contact details and course • Poor sleep information on page 100. or your sleep? with concentration emergency life support skills. Lancaster Road. We discuss some of them below. Scotland and Wales: should do is sit with them until the ambulance • what help you need to maintain your • Swelling of the feet. • Does your role as a carer impact on any other • Palpitation areas in your life – for example your job. There are quite a few conditions attached to • Problems keeping sexually active. own health Carer’s Allowance Unit. • Sudden weight gain see page 85. then all you • what help you need with caring worse. call and speak may have had a cardiac arrest (when the heart friend or a relative. PR1 1HB • Wheezing or coughing Phone: 0845 608 4321 • Light-headedness or dizziness How do I get a carer’s assessment? • Fatigue (feeling unusually tired and weak). For example: experiencing severe pains in the chest or has The carer’s allowance is a taxable benefit a blackout. If the person you’re caring for collapses suddenly. it might If the person you’re caring for is ever in severe distress. number in your local phone book. two-hour course in What is a carer’s assessment? relationships. Work British Heart Carers UK Foundation (BHF) 20 Dover Street Glasgow office person you’re caring for can work together out beforehand with the person you’re Greater London House London SE1 4LX Charles Oakley House to do this. Oak House counsellors and counselling High Street organisations throughout Britain. Chorley PR7 1DW 98 British Heart Foundation An everyday guide to living with heart failure 99 . Rugby offer speak to the Offers advice for carers and condition is Nottingham NG13 8EE counselling and support.bacp. It’s lovely. Both you. to be Northern office Has directories of individual Suite 6. Don’t be too Lakeside Victoria Buildings for Carers www.anticoagulationeurope. admin@BCPA. and write down the 0808 808 7777 London NW1 7AW Glasgow G2 2SD 0161 797 4484 15 Abbey Road babcp@babcp. but infochorley@carers. doctor. it’s like we’re Lutterworth LE17 4HB courting again.carersuk. admin@anticoagulationeurope. when people and health professionals on Cardiff CF5 1GZ to deal with it really 0844 800 4361 info@carers. • If you have any questions or concerns AntiCoagulation Europe infowales@carers. • Work out with the person you’re 0300 330 3311 www. may experience • For details of national organisations 020 8289 6875 to carers in the home. Bromley BR2 9WP to change. hard on yourself either – try to accept Doncaster DN4 5RA 9-13 Silver Street that change will involve some prevent it from getting worse. support failure around each other’s Bingham Offers relationship Relate British Association for had for years. plan with the person you are caring for one another. The person with heart Premier House Behavioural and Cognitive failure will need plenty of support Provides information for people Carolina Court Psychotherapies (BABCP) who use warfarin or other and encouragement. GP or heart 0845 450 0350 PO Box 405 • Recognise that it takes time to get used www. Woodford Green BACP House Essex IG8 8HD 15 St John’s Business Park I mean it’s great. accept the offer and suggest issues related to heart Provides information. information and time's valuable and try to do more resources for people with heart Southend Road Psychotherapy with my time. with my family… problems and their carers. but the • Participate in any hospital. Warwickshire CV21 2PN 02920 221 788 specific things that they can changes to daily life and to habits you’ve answers to any questions that are asked. British Cardiac Patients Bury BL9 0EU 0300 100 1234 Association especially at the beginning. Useful organisations Tips for carers Heart failure cannot be www. you’re caring for.bcpa. and the person Provides practical support and practical help to carers.relate. GP General information Carers 01257 234 070 symptoms can be controlled to help and nurse appointments or visits. Counselling services for carers. Don’t be afraid to Crossroads – Caring for Carers most concern you and plan how information service for the public Canton 10 Regent Place ask for London office British Association “I'm certainly more aware that Unit 14. And. Talk to each other about the caring for the main issues you would like 180 Hampstead Road 125 West Regent Street things you both need as individuals. Bourne Court for Counselling and Offers support. see next 0141 221 5066 caring for the everyday jobs that they • Learn about heart failure and how the (similar cost to 01 infoscotland@carers. Victoria House so that you can identify the things that Our Heart Helpline is an 250 Cowbridge Road East • Make time for yourself. Read through this or 02 numbers) can do and plan your weekly chores can put carers in touch with Wales office bhf. You and the don’t dominate the appointment. Provides information on how 01223 846845 The Princess Royal Trust to find a therapist in your 01455 883 300 is lovely…”

org.citizensadvice. Offers support and advice on of Funeral Directors resuscitation (CPR). for all people with life-threatening and life-limiting conditions. companionship Palliative care info@sexualadviceassociation.crusebereavementcare. visit The Ruby Care Foundation feelings of distress or despair. For between 8am and Provides contact www.rubycare. On an ELS course you will learn: more information about groups For information about UK people who have lost someone • how to recognise and deal England in your Richmond Myddelton House Cavendish Square Samaritans Surrey TW9 2RG 115-123 Pentonville Road 029 2043 1555 London W1G 9DR Runs support groups for 08457 90 90 90 London N1 9LZ enquiries@agecymru. Hospice House British Heart Foundation West Midlands B91 1AA people the simple skills needed in Heart Helpline 34-44 Britannia Street 0300 330 3311 a life-threatening emergency.dwp. bhf. benefits Dying Matters counselling for the Belfast BT7 1NR is listed in the phone directory. and international hospice to heart 020 7486 7262 and thinking about end-of-life 0131 554 6953 available in your arrest by performing 0845 125 9732 cardiopulmonary Promotes palliative care services information on the groups Hearty Voices A bereavement service for 028 9024 5729 counsellors in your Caxton House Age Concern and Help the Aged Suite For advice and information heartstart@bhf. 0300 330 3311 Bereavement Advice Centre and support. contact the For information on all aspects of Bereavement services for the are associated with the the terminally Northern Ireland London SW1H 9DA new charity called Age UK .uk with someone in a cardiac Edinburgh EH9 1PR www. www. heartstart-edin@bhf. • how to help someone 1-6 Tavistock Square who is choking London WC1H 9NA National Council for “Just a knowledgeable voice at • how to deal with serious Palliative Care bleeding 0800 169 87 87 The Fitzpatrick Building the end of the phone or on email Information and advice line open Our Helpline offers a with www. Age UK 020 7520 8222 In England and Wales there are 02 numbers) two-hour ELS course in your 0800 169 6565 For information and help for people who are experiencing and Pensions The Sexual Advice Association Edinburgh office and treatments that are National Association PO Box 800 counselling and support. 3 Lower Crescent www. Emblem House A BHF initiative that gives 0870 794 5353 Tothill Street have joined together to create a London Bridge Hospital Emergency life support individuals the skills. with a heart attack Tavis House and palliative care judgemental emotional support Department for Work 020 7554 0426 people of all 618 Warwick Road Support groups of benefits including disability Help the Hospices Solihull A BHF initiative which teaches British Heart Foundation living and carer’s dedicated to improving later life London SE1 2PR enquiries@dwp. death and Can provide contact details of Provides confidential For information about a free. A charity dedicated to the care of www.bcpa.” • how to deal with someone 188-194 York Way who is unconscious and Scotland London N7 9AS breathing normally Causewayside House 020 7697 1520 • how to recognise and deal 160 Causewayside Directgov A website to support people in (similar cost to 01 or on behalf of heart patients Heartstart for everyone. 100 British Heart Foundation An everyday guide to living with heart failure 101 . confidence info@rubycare. Citizens Advice 12 Chandos Street Cardiff CF24 5PJ www.Relate Financial help Wales Sexual problems British Cardiac Patients Cruse Bereavement Care 0300 100 1234 Tŷ John Pathy Association Central office Citizens Advice Bureau Institute of 13/14 Neptune Court 01223 846845 Cruse Bereavement Care Offers relationship Head office Psychosexual Medicine Vanguard Way people with heart problems 0844 477 9400 (24-hour helpline) 020 7580 0631 and their carers and can provide For information on a range how to manage practical and support and London office 0800 634 9494 Funeral services about the causes of bereavement service to support details of local funeral directors. Help for the older person 0300 330 3311 0845 230 1343 London WC1X 9JG internet@bhf. 27 Tooley Street (ELS) skills and knowledge to speak out is so financial Your local Citizens Advice Bureau in your about 300 heart groups which area. info@ageni. • Sudden arrhythmic death syndrome treatment and care people with heart failure Heart valve disease (HIS11) can expect. • A rrhythmogenic right • visit A booklet for people in the final stages of life.Useful publications and DVDs Resources from the BHF Heart Information Series (HIS) Diet and wellbeing: Publications from other The BHF produces a wide range of educational A series of booklets for people with different heart conditions.patients-association. or Having heart surgery (HIS12) • Dilated cardiomyopathy failure that the National Institute for Health • email orderline@bhf. In a Returning to work with a heart condition (HIS21) Urdu and Heart attack (HIS7) • Hypertrophic cardiomyopathy and Clinical Excellence (called NICE. To order. BHF health professionals answer Tests for heart conditions (HIS9) website www. End of life: The facts Produced by Marie Curie Cancer Care. felt about being told they had heart failure. Heart transplantation (HIS13) from bhf. Blood pressure (HIS4) • So you want to lose weight … for good and secondary care. for short) Heart rhythms (HIS14) You can also download many of our publications • Inherited heart rhythm disturbances has issued to the some of the questions that may be going or call their helpline on 0845 608 4455. Punjabi. Hindi. It features six Pacemakers (HIS15) Other languages: A guide to living wills people telling you in their own words how they Peripheral arterial disease (HIS16) • Heart failure Produced by The Patients Association. through your Our resources Angina (HIS6) • Cut the saturated fat Chronic heart diagnosed with heart failure. phone the Department of Health • Losing someone to heart disease (for adults) This DVD has been developed to help you and Living with heart failure (HIS8) Publications orderline on 0300 123 1002 or visit • The small creature (for children) your family and friends if you’ve just been Medicines for the heart (HIS17) guidance.mariecurie. 102 British Heart Foundation An everyday guide to living with heart failure 103 . or to find Caring for someone with a heart condition (HIS20) The Inherited Heart Conditions series: Published by the National Institute for Health out about our other resources: Coronary angioplasty (HIS10) and Clinical Management of are Diabetes and your heart (HIS22) ventricular cardiomyopathy This booklet describes the guidance on heart • call the BHF Orderline on 0870 600 6566. with their symptoms and live a fulfilling life. advance directive or ‘living will’.nice. how Physical activity and your heart (HIS1) • Taking medicines for your heart it affected their lives and families and the Primary angioplasty for a heart attack (HIS26) This booklet explains how to make an adjustments they’ve made to help them deal Reducing your blood cholesterol (HIS3) Available in and their carers. • Coping with stress organisations • Cut down on salt resources that may interest you. Cardiac rehabilitation (HIS23) To order the titles on this page. and their carers. family and friends. Gujarati. It tells you what help. One step at a time – living with heart failure ICDs (Implantable cardioverter defibrillators) (HIS19) Coping with bereavement: (DVD5) Keep your heart healthy (HIS25) To order a contact the Patients Association via their separate section. but a donation would enable us to help Atrial fibrillation (HIS24) • Eating well chronic heart failure in adults in primary more people with heart disease. Available to download from www.

‘Are you all right?’ your index finger and thumb and blow into the •5 if you get a pain in your arm. Look. less than two each second. a reason that you should not take it. neck. call 999 immediately. person’s mouth. gently shake him To do this. Action: Get help immediately. making sure that you. Keep doing the chest If the person is unconscious. breathing. or from hospital and there may be nobody else or her. 2 5Get the person to sit in a comfortable position. 15 Stop what you are doing. shout for help. 1 5Get help immediately. phone minute – until: of taking the GTN the second time. back or stomach. Only do this for up to 10 seconds. or C CPR •5 professional help arrives. If you are not able. what to do in a life-threatening emergency. To find •5 if you get a crushing pain. or heaviness About 70% of cardiac arrests happen away out if the person is conscious. If you have a If you think someone is back and lifting the chin. see page 100. and is either not compressions – at a rate of 100 times a 45 If the pain does not ease within a few minutes breathing or not breathing normally. Place the heel of your other hand on top arrives. A Airway 35 Continue CPR 25 Sit to rest. Circulation. around to help. or if you don’t know if you should Place the heel of one hand in the centre of their take it. C – Airway. •5 you become exhausted. skills. •5 the casualty starts breathing. If it doesn’t. B. sick. Breathing. or short of breath. immediately. person and anybody nearby are safe. suitable action. or Check should ease within a few minutes. call 999 999 for an ambulance. The pain •5 professional help arrives. or 55 If you’re not allergic to aspirin. You may be having a heart attack: Ideally. open the airway again by tilting the head back and lifting the chin.What to do in an emergency What to do if you think you What to do if someone has a If a person seems to be 25 Rescue breaths may be having a heart attack heart attack or cardiac arrest unconscious After 30 compressions. give chest compressions only. or are not willing. 104 British Heart Foundation An everyday guide to living with heart failure 105 . everyone should know what to do if •5 A  pproach with care. 3 5Phone 999 for an ambulance. pinch the person’s nostrils closed using or tightness in your chest. Open the person’s airway by tilting the head Keep doing the 30 chest compressions followed 35 Use your GTN spray or tablets. of your first hand and interlock your fingers. out and that the chest rises and falls with each •5 You may also sweat. throat. the These are called rescue breaths. by 2 rescue breaths until: GTN (glyceryl trinitrate) spray or tablets. and give two of your own breaths to the person. call 999 rescue breaths. someone has a heart attack or cardiac arrest. •5 If there is no response. and carer can learn simple and vital life-saving then 2 rescue breaths. Make sure that no air can leak jaw. just stay resting until the ambulance chest. and shout loudly. For more information on how you. next to you. or there isn’t Action: Cardiopulmonary resuscitation (CPR) •5 you become exhausted. Remember A. If you don’t have an aspirin Start chest compression. listen and feel for signs of normal take your GTN again. as described in step 1. your partner Then give another 30 chest compressions and This is what to do. or it as your doctor or nurse has told you. or feel light-headed. chew an adult aspirin tablet (300mg) if there is one 15 Chest compression easily available. Do this at a we have described above but you think you rate of about 100 times a minute – that’s a little are having a heart attack. to give If you do not have a GTN spray. Heartstart is a BHF initiative to teach the public •5 Y  ou will need to assess the casualty and take breath. use having a heart attack B Breathing •5 the casualty shows signs of life. Press Even if your symptoms do not match the ones down firmly and smoothly 30 times.

61 dosette box for medication 16 support groups 95. 47 anticoagulant card 31 14. 7. 16. 98 fluids 42. 105 insurance (for travel) 63 pressure in the chest 14 W see benefits cholesterol-lowering drugs 30 emotional support 74 protein 39 warfarin 29. 75 arrhythmias 15. 104. shortness of 5. 17 finance 79. 97 79. 97 valves 5. information for 92 vegetables 38 ejection fraction 8 implantable cardioverter physical activity 50 air travel 63 causes of heart failure 6. 69 ascites 11. 40. 104 dying 65. 12 driving 63 swelling 11. 33 cardiac arrest 96. 80 D self-management 18 making a will 87 doctor 91. 101 blood (BNP) tests 5 drinking (alcohol) 49 sweet foods 44 breath. 7. 38-41 palpitation 16 activity plan 53 carer’s allowance 79. 46 routine for taking 19. sex labels on foods 44-45 weighing 47 antagonists 25 congestion 11 fatigue 5. 46 medication 19 death 82 severe illness 80 work 61. 12. 57 104 angina 14 complementary medicine 22 relationships 74-76 L water tablets 23 angiotensin-II receptor concentration 16 F see also counselling. 66. 11-12 relaxation 68 length of life 7 weight 41 antacid 28 contraception 62 fats (in foods) 40 relaxation techniques 68-69 light-headedness 15 slow weight gain 17 antibiotics 30 coronary heart disease fibrates 30 resuscitation 105 living will 82 sudden weight gain 12. 104 Viagra 32. 33 flying alternative/complementary deep vein thrombosis 62-63 sex 17. 78 emergencies 104 income support 79 potassium chloride 33 aldosterone antagonists 27 children (caring for) 51. 97 lung function tests 5 salt 42-44 wheezing 12 antiplatelets 29 counselling 75 fish 39-40 salt substitutes 42 will anxiety 64. 82. 42 see air travel 22 defibrillator 77 shortness of breath 5. 100 activity (physical) 50 cardiomyopathy 6. 11. 49 alternative medicine 22 classes of heart failure 7 J employment 61. 100 V E palliative care 81. 29 funerals 87. 42 symptoms of heart failure 5. 104 oil 39. 40 thirst 15. 57 M saturated fats 40 living will 82 appointments with your flu jab 61 Meals on Wheels 42. 62 viral infection 6 emergency life support influenza 61 pregnancy 62 allowances cholesterol 50 100. 57 hospice care 81. 101 memory problems 16 diet 38 snacks 38. 95 scores 7 stress 64-69 blackouts 14 DNR (‘Do Not Resuscitate nitrates 32 sugar 40 blood pressure 15. 69 CPR 105 fitness 50. 77 worry 64. 43 atrial fibrillation 31 money 79 digoxin 28 G social services 80. 77 dizziness 15 guilt 74. 46 heart valves 5. 75 warning signs of heart attack anaemia 6 collapse (what to do if ) 96 jabs (for flu and pneumonia) 61 R exercise 50. 14-15. 104 food labels 44-45 list of 20 X depression 72 side effects of medication 22 assessment food supplements 22 over-the-counter 34 X-ray 5 diabetes 61 sleep 16-17 (carer’s assessment) 97 fruit 38-40. 81 goal-setting 56 negative thoughts 70 sodium 42-45 bereavement 101 diuretics 23 GTN 32. 31.Index H O T healthy eating 38 oedema 11 tests 5 heart attack 14. 12 aspirin 29. 62 HRT 62 vaccination 61 eating well 17. 11-17 syncope 14 106 British Heart Foundation An everyday guide to living with heart failure 107 . 97 B Disability Living Allowance general health 61 N see also benefits benefits 79. 11. 6 ECG 5 I panic attack 70 advance directive 84 carer’s assessment 97 vasodilators 32 echocardiogram 5 ICD 77 pessimism (dealing with) 70 advance statement 84 carers. 11 vegetarian diet 39 electrocardiogram 5 defibrillator 77 pneumonia 61 alcohol 49 chest pain 14. 26. 6 oily fish 39 thyroid gland disease 6 herbal remedies 22 organisations 99 tiredness 11 high blood pressure 6. 37 overactivity-rest cycle 52 travel 63 A C DS1500 form 81 holidays 57 overprotectiveness 92 U abnormal heart rhythms carbohydrates 39 DVT 62-63 see also travel over-the-counter medication 34 unconscious (if a person is) 105 (arrhythmias) 15. 33 diagnosis 5 smoking 48 asthma 26. 96. 16. 41 anticoagulants 31 cough 12. 66. 104 New York Heart Association statins 30 beta-blockers 23. 84-87 home care 80 P ACE inhibitors 24 cardiac rehabilitation 51. 64 fibre 39 low-salt foods 44 S weight loss 17. 52. 26. 81. 37 Order’) 85 suicide (thoughts about) 73 blood sugar 23. 7.

108 British Heart Foundation . Thank you. Our resources are free of or • post it to us at the address on the back cover. campaigning for change. Why not let us know what you think of this Everyday guide to living with heart failure? Contact us via the website patient care. but a donation would enable us to help more people who are living with a heart condition. If you would like to make a donation: • please call our donation hotline on 0300 330 or write to us at the address on the back cover. dedicated to saving lives through pioneering research. • visit bhf. Have your say We would welcome your comments to help us produce the best information for you.About the British Heart Foundation The British Heart Foundation (BHF) is the nation’s heart charity. and providing vital information.

dedicated to saving lives through pioneering research. registered charity in England and Wales (225971) and in Scotland (SC039426) G275U/0112 We are the nation’s heart charity. patient care. Phone lines open 9am to 5pm Monday to Heart Helpline British Heart Foundation Greater London House 0300 330 3311 180 Hampstead Road London NW1 7AW bhf. campaigning for change and by providing vital T 020 7554 0000 Information & support on anything F 020 7554 0100 heart-related. We rely on your donations of time and money to continue our life-saving work. But we urgently need your help. © British Heart Foundation 2012. bhf. Because together we can beat heart Similar cost to 01 or 02 numbers .