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Heather Mosley APRN,NP-C

Bryan Heart Improvement Program

Lincoln, NE

What Do You Mean I Have Heart Failure?

Objectives� To better understand the 2 different types of

heart failure.� To understand why you take the medications

you do. � To empower you to be able to identify signs

and symptoms of an acute exacerbation of heart failure

� To empower you to know what to do when an exacerbation arises

� Help you to identify foods that would be good choices and those that will not

What Do You Mean There is Something Wrong with my Heart?

Weak HeartStiff heartSystolic DysfunctionDiastolic Dysfunction ALL EQUAL HEART Water in my lungs FAILUREFluid around my heartCongestive Heart FailureCHF

If you belong to the Bryan Heart Improvement Program,

YOU HAVE HEART FAILURE!

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Types of Heart Failure…

What Can I Do To Help My Heart?

#1 Know your medications!!

KNOW YOUR MEDICATIONS

� Bring them to every appointment� At least a CURRENT list (include vitamins)

� Know what they are for� Heart, blood pressure, blood thinner, etc

� Know when you should take them� With food, without food, etc

Unless you are specifically asked to “fast” before your appointment, take your medications as usual before each visit

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Beta Blockers� Carvedilol (Coreg)� Bisoprolol (Zetia)� Metoprolol Succinate (Toprol)� Nebivolol (Bystolic)

What do they do?� Slows down my heart rate� Lowers my blood pressure and� It can even improve my pump function!!

BUT…..They can also make you tired!

Angiotensin Converting Enzyme (ACE Inhibitor)

� Lisinopril

� Benazapril

� Captopril

What do they do?� Lowers blood pressure� Can help improve heart strength� Protects my kidneys� BUT…..

• It makes me cough

Angiotension Receptor Blocker (ARB)

� Valsartan (Diovan)� Losartan (Cozaar)� Irbesartan (Avapro)� Olmesartan (Edarbi)

What do they do for me?� Lowers blood pressure� Protects the kidneys� Improves pump function� Psstt…..and no cough!!

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Angiotensin Receptor NeprilysinInhibitor (ARNI)

Combination of Sacubitril/Valsartan

What does this do for me?

� There is only One:� Entresto

� Used IN ADDITION to your current heart failure medications

� There are special instructions when you start Entresto….

• Lowers blood pressure• Decreases mortality• Decreases hospital

admissions• Shown to improve

symptoms of fatigue and shortness of breath

• Shown to improve ejection fraction in some patients

Diuretics

AKA: “The Water Pill”� Furosemide (Lasix)

� Torsemide (Demadex)

� Bumetanide (Bumex)

� Metolazone (The Power Pee Pill)

Aldosterone AntagonistAldosterone antagonists are drugs that block

harmful effects on the heart and blood vessels caused by the hormone aldosterone.

� Spironolactone (aldactone)� Eplerenone (Inspra)� Amiloride (Midamor)

#1-LESS or NO Potassium Supplement � Decreases Blood Pressure� Works as a wimpy water pill

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What Can I Do To Help My Heart?

#1-Know your medications

#2- Limit your fluid intake

What goes in…must come out!

Fluid Restriction� 1500ml per day=48 ounces per day

� 6 8 ounce glasses of fluid per day� Anything pourable

� ie. Milk, Juice, Water, Soda, Tea, etc

DON’T DRIVE YOURSELF CRAZY!!

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But my other Doctor says I need to drink lots of water….it’s good for my kidneys!

Not with heart failure…..� Too much water results in swelling, shortness of

breath, cough, dizziness, confusion because a weak pump can’t handle more fluid

What Can I Do To Help My Heart?

#1-Know your medications

#2- Limit your fluid intake

#3 Limit your Sodium Intake

Sodium Restrictions

1500mg of sodium per day� 1tsp of table salt contains 2325mg of sodium

No More Salt Shaker

Read Your Labels� Salt = Sodium (THEY ARE THE SAME THING)

Hidden Salt� Cottage Cheese

� 1 cup of cottage cheese = __________mg of sodium.

What’s the big deal??

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Where there is Salt….There is water!

What Can I use???

Reduced Sodium

When you see "reduced sodium" on a food label, you may think you're being served up a lot less salt.

� However, this FDA-regulated term means that a food has only 25% less sodium than the original product.

Better labels to look for are:� "low sodium" ( 140 mg of sodium or less per serving) � "very low sodium" (35 mg of sodium or less).

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Lower Sodium Options Use lower-sodium options like pita bread, whole grain mustard instead of pickles, fresh veggies, Swiss cheese (it contains a fraction of the sodium of provolone), and low-sodium deli turkey or—better yet—pieces of freshly carved turkey.

I’ll eat Chicken!! It’s healthy….. right?

� Raw chicken breasts harbor a secret: they're often injected with a high-sodium flavoring solution to perk up the taste. To avoid it, buy chicken with the words "non-enhanced" on the label, avoid brands that list salt on the ingredients label, or go for an organic variety. Try the brand called Smart Chicken.

A cup ofcottage

cheese withsome fresh

fruit

An applewith peanut

butter

Trail Mix Freshvegetableswith dip

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Which of the following would NOT be a good snack for someone watching their sodium intake?

A. A cup of cottage cheese with some fresh fruit

B. An apple with peanut butter

C. Trail Mix

D. Fresh vegetables with dip

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Answer

A. A cup of cottage cheese with some fresh fruit

THIS IS HARD…..

WE GET IT!!

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What Can I Do To Help My Heart?

#1-Know your medications

#2- Limit your fluid intake

#3-Limit your sodium intake

#4-Weigh yourselfEVERY DAY!

Daily Weights

� Be Consistent

� Once a day is plenty

� How much weight is too much ?� 3 pounds for 2 consecutive days

� 5 pounds in any given week

� When do I call?� Above weight increase

� Worsening symptoms

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It’s the best….for nowWe now know that your weight changes just days

before you become sick enough to be hospitalized…..This is why you must call!!

NEW TECHNOLOGY� Cardiomems� Lets us see changes almost 30 days before your

weight actually changes� Currently implanting

Cardiomems Heart Failure System

2 pounds inany givenweek

5 pounds inany givenweek

7 pounds inany givenweek

Any weight gain is too much…I’ll just call.

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How much weight gain in 1 week is too much, therefore I should call BHIP!

A. 2 pounds in any given week

B. 5 pounds in any given week

C. 7 pounds in any given week

D. Any weight gain is too much…I’ll just call.

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Answer

B. 5 pounds in any given week

What Can I Do To Help My Heart?

#1-Know your medications

#2- Limit your fluid intake

#3-Limit your sodium intake

#4-Weigh yourself every day

#5- Exercise

Exercise

30 minutes most days of the week� Walking

� Stairs instead of the elevator

� Resistance bands

� Chair exercises

� Ask if you qualify for

cardiac rehab!

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Symptoms to Watch out for…

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What symptoms may I experience when I have too much fluid on board?

A. Swelling in the legs or abdomen

B. Cough, especially when you lay down

C. Loss of appetite

D. Confusion or memory loss

E. Dizziness

F. All of the above

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Answer

F. All of the above

Scary Facts about Heart Failure

Heart Failure is a progressive disease that contributes to approximately 287,000 deaths a year.

About half of people who develop heart failure die within 5 years of diagnosis.

HELP ME… HELP YOU!!

� Tell me how you feel….

� Tell me what’s different…..

� Tell me what you miss doing…..

� If there was one thing you could change about how you feel, what would it be?

� Tell me when you have had enough….

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Don’t Come to Appointments when…

QUESTIONS

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YOUR Bryan Heart Improvement Providers

Heather Mosley, APRN

Dr. John Steuter Dr. Matt Baker

Starrlet Klute, APRN