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You were brought to the hospital with severe breathlessness and swelling in your feet. After thorough examination the doctors have identified that you have got Congestive heart failure (CHF) which is normally present when the heart cannot pump enough blood to satisfy the needs of the body. Weakened chambers allow blood to pool inside the heart and nearby veins. This triggers fluid retention, particularly in the lungs, legs and abdomen. CHF is also known as chronic heart failure or congestive cardiac failure (CCF).
Congestive heart failure can be caused by several conditions, including:
Past heart attacks from coronary heart disease leading to scarring in the heart muscle. This is the most common cause for congestive heart failure.
High blood pressure (hypertension).
Heart valve disease damaged heart valves may allow the blood to flow backwards or may obstruct forward flow.
Congenital heart disease heart abnormalities may be present from birth, such as defective valves or abnormal communications between heart chambers.
Cardiomyopathy this condition is characterised by enlargement of the heart muscle, where the left ventricle enlarges to compensate for poor contraction.
Myocarditis viruses or other infections may damage the heart muscle.
Heart arrhythmia rapid heartbeat with irregularity, over a long period of time, can also lead to inefficient contraction and heart failure.
Thyroid disease the thyroid gland produces too much of its hormone, thyroxine; this increases the work of the heart and can lead to heart failure.(1)
Treatment may include:
Addressing the underlying disorder for example, treatment of high blood pressure.
Lifestyle changes such as regular gentle exercise, losing excess body fat, stopping smoking, adhering to a low-fat and low-salt diet, restricting alcohol and having adequate rest.
Surgery to replace narrowed or leaking heart valves.
Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight.
Weight gain, especially > 1.5 Kg over a day or two, can be a sign that your body is holding onto extra fluid and your heart failure is getting worse. Talk to your doctor about what you should do if your weight goes up or you develop more symptoms.
If you feel your heart is beating irregularly, or slowly, contact your doctor/ hospital immediately. If you feel any symptoms as mentioned above or your upper BP reading is < 100 mm Hg, contact your doctor.
Heart attack and stroke: Because blood flow through the heart is slower in heart failure than in a normal heart, it's more likely you'll develop blood clots, which can increase your risk of having a heart attack or stroke
Kidney damage or failure: Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated.
Heart valve problems: The valves of your heart, which keep blood flowing in the proper direction through your heart, can become damaged from the blood and fluid build-up from heart failure.
Liver damage: Heart failure can lead to a build-up of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.
Regular exercise, especially aerobic exercise, has many benefits. It can:
Strengthen your heart and cardiovascular system
Improve your circulation and help your body use oxygen better
Improve your symptoms of congestive heart failure
Increase energy levels so you can do more activities without becoming tired or short of breath
Lower blood pressure
Improve muscle tone and strength
Improve balance and joint flexibility
Help reduce body fat and help you reach and stay at a healthy weight
Help reduce stress, tension, anxiety, and depression
Boost self-image and self-esteem
Make you feel more relaxed and rested
What Type of Exercise Is Best?
Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help your blood pressure and improve your breathing (since your heart won't have to work as hard during exercise).
Strengthening exercises are repeated muscle contractions (tightening). They help tone muscles, improve strength, and increase your metabolism.
In general, to achieve maximum benefits, you should gradually work up to an aerobic session of at least 20 to 30 minutes, at least three to four times a week. Exercising every other day will help you start a regular aerobic exercise schedule. The American Heart Association recommends working up to exercising on most days of the week. While the more exercise you can do the better for your fitness, any amount of exercise is beneficial to your health.
Every exercise session should include a warm-up, a conditioning phase, and a cool-down.
Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature. The best warm-up includes dynamic stretching (as compared to the touch your toes stretches you did in high school) and the beginning of the activity at a low intensity level.
Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms.
Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.
Exercise while sitting
While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.
Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.
How Can I Stick With It?
Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Here are some questions you can think about before choosing a routine:
What physical activities do I enjoy?
Do I prefer group or individual activities?
What programs best fit my schedule?
Do I have physical conditions that limit my choice of exercise?
What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
Find an exercise "buddy." This will help you stay motivated.
Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.
General Workout Tips for People With Heart Failure
Be sure any exercise is paced and balanced with rest.
Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
If your exercise program has been interrupted for more than a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.
Stop exercising and call your doctor if you have any of the following symptoms:
Dizziness or lightheadedness
Unexplained weight gain or swelling
Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern
Quit! Tobacco and second-hand smoke are one of the primary risk factors and can lead to other cardiovascular diseases (CVD). Call - the Quit Line, 1800-22-77-87. For more-
It is best to completely avoid alcohol. Alcohol may interfere with medications and also affect heart health. Alcohol is calorie-rich and can increase blood pressure.
Lowering stress levels can help with recovery. Incorporate a daily routine to relax and rejuvenate try to listen to soothing music, chant, read a book or meditate.
Limit intake of tea, coffee, colas and chocolate to only 1 Cup a day. Lowered caffeine intake is known to induce a better sleep during the night.
Blood Pressure Management
Maintaining a normal blood pressure of lower than 120/80 is important to lower the risk of further cardiovascular complications. Exercise and heart healthy diet can help to maintaining normal blood pressure.
Blood Glucose Management
Diabetic patients are at a risk of developing complications. Keep your blood sugar in constant check by maintaining a balanced diet and a prudent lifestyle.
Other important changes to make in your lifestyle:
- Stay active. Walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for you. DO NOT exercise on days when your weight has gone up from fluid or you are not feeling well.
- Lose weight if you are overweight.
- Lower your cholesterol by changing your lifestyle.
- Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest too.(3)
If you have heart disease, your doctor may encourage you to participate in cardiac rehabilitation (rehab) program, which is designed to help you exercise safely and maintain a heart-healthy lifestyle. The program typically includes a tailored exercise program, education, and support in making lifestyle changes, like quitting smoking and adopting a healthier diet. Cardiac rehab programs also offer support groups to help you stay on track to maintain a healthier heart.
What Types of Exercises Are Included in a Cardiac Rehab Program?
Your cardiac rehab program may include exercises like cycling on a stationary bike, using a treadmill, low-impact aerobics, and swimming.
It is important to eat the right kind of food for a healthy heart, mind and body. For a speedy and long lasting recovery, combine positive dietary and lifestyle changes with the medical care.
Typically, food items can be classified into six major groups as shown in the Healthy Heart pyramid.(6)
Immediate Diet Plan
1. Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables.
2. Add plenty of Whole Grains (whole wheat flour, brown rice, whole beans).
3. Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish, walnuts, flaxseeds.
4. Include food sources rich in Potassium to increase heart health.The main source of potassium in our food is fruits and vegetables. Dairy products, whole grains, meat, and fish also provide potassium.
5. Keep track of your fluid intake as recommended by your doctor.
1. Say NO to all Sugary and Refined foods (cakes, pastries) and do not add any sugar to beverages
2. Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanaspati.
3. No Carbonated, Caffeinated and Alcoholic beverages.
4. Curb Salt intake, as it can increase blood pressure. Don't add salt while cooking and reduce packaged food consumption.
Refer to DASH diet(7)
Sample Diet Plan (patient recovering from Congestive Heart Failure)
Check portion sizes for each food by going to these links.(8),(9). Do not add SALT or SUGAR while cooking or as seasoning. For cooking, use only Olive oil or Peanut oil.
- 1 Cup (250ml) lukewarm water with 1 Tbsp. freshly squeezed lemon juice and 1/2 tsp. honey
- 1 Ragi Dosa (Recipe) OR 1 Moong Dal Dosa (Recipe) - 1 medium Apple OR 1 medium Orange
Early Morning Snack
- 1/2 Cup boiled Sweet potatoes, sprinkled with lemon juice OR Brown rice Poha - 1 Cup Coconut water (discard the malai")
- 2 dried Figs and 1 whole Walnut
- 1 large bowl of tossed Salad (carrots, cucumbers, beets, tomatoes and onions) (Dressing - mix Olive oil, lemon juice and pepper) - 1 Multigrain phulka OR Jowari Roti - 1 Cup Palak/Plain Dal OR 1 Cup Rajma - 1 Cup Buttermilk
Mid Afternoon Snack
- 1/2 Cup Mixed sprouts OR Chole salad (Recipe) - 1 Cup Green Tea (no milk
Early Dinner Snack
- 2 Ragi Biscuits - 1/2 Cup cubed Papaya OR Musk melon
- 1/2 Cup Brown rice with 1 Cup Mixed vegetable sambar OR 1 Cup Brown rice Khichadi with 1 small bowl of Raita made with low fat yoghurt
- 1 Cup of Cabbage curry OR Bottle gourd (Lauki)curry - 1 Cup Buttermilk
Late Night Snack
- 1/2Cup Skim milk infused with Saffron
Life Long Instructions
It is never too late to adapt a healthy lifestyle.
Maintain a balanced diet and perform regular physical activity. Eat foods that are low in saturated fats and cholesterol. Avoid foods high sodium content. If overweight or obese, loose the extra kilos and maintain a healthy weight. Quit smoking and say no to alcohol. Check your blood pressure and blood glucose regularly.
Eat Right and Exercise your way to a Healthy Heart.