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Be sure to ask
your doctor any questions that are on your mind! Here is a list of commonly
asked questions by heart failure patients. Only your doctor can give you the
answers that fit your personal case. Click on any of the questions below for an
answer.
Some potentially difficult questions that are usually not asked but that should be:
When can I go back to work?
Most patients are able to perform sedentary work which involves lifting a 10 pound maximum and occasionally lifting or carrying small items (files, small tools, etc.). Some patients with mild heart failure may be able to perform jobs that require considerable walking or standing and involve lifting 20 pounds maximum. An exercise stress test may be helpful in assessing the capacity for activity. top
When can I return to hobbies and activities (such as sports)?
An exercise test can assess exercise capacity and the likelihood of arrhythmias caused by physical activity. A cardiac rehabilitation specialist or exercise physiologist can prescribe a personalized fitness regimen for patients. Patients with an ejection
fraction (EF) of less than 35% may be at an increased risk for arrhythmias or pulmonary congestion. top
What activities should I avoid?
Any activity that
causes patients to become short of breath, light-headed, or seriously fatigued
should be avoided. Endurance sports should be avoided, as should activities that
involve lifting heavy objects. top
What
foods should I limit?
Patients should
avoid foods high in sodium;
salt should not be added to food. Patients should eat fresh food (like fruits
and vegetables) and avoid processed foods. In addition to these guidelines,
alcohol consumption should be limited to no more than one drink per day, if not
omitted altogether. top
How much salt can I have?
The answer to this
depends on the patient's heart failure severity. The Recommended Dietary
Allowance of sodium
is 2400 milligrams, but patients with Class III-IV heart failure should limit
their intake to 2000 milligrams or less. top
Is it safe for me to drive?
Patients who have
a history of loss of consciousness due to an arrhythmia in general should not
drive. Those who have had symptomatic ventricular arrhythmias should be event
free for six months before driving. Patients who have had an Automatic
Implantable Cardioverter Defibrillator (AICD)
to prevent sudden death may drive. top
What are the side effects of my medications?
Side effects
depend on the type and dosage of the medications. For more information on the
types of drugs and their various side effects, click
here. top
What happens if I miss a dose?
Patients should never compensate for a missed dose by doubling the next dose. Take the next dose as scheduled. Only a medical professional should reduce or increase the amount or dose of a drug being taken. top
What tests are being done and why?
Patients with new onset or suspected heart failure should have a history and physical exam, lab tests (chemistry panel, CBC, Urinalysis),
electrocardiogram (ECG) and chest x-ray. These will determine if the
presentation fits the diagnosis of heart failure. An echocardiogram
will assess left ventricular function and is important for finding the cause and
severity of heart failure. Additional tests may follow as necessary. top
How do I become involved in a support group?
Support groups are
often formed in hospitals for heart failure patients and can be joined by
contacting the group coordinator. If the hospital doesn't provide this service,
chances are a nearby hospital will. It is also advisable to meet with a
counselor who specializes in cardiac rehabilitation. Patients can also find heart
failure forums and chat rooms on the internet. top
How long am I going to live?
This is often a patient's most important question, and also the most difficult for doctors to answer. In part, medical professionals may be reluctant to discuss statistical information with a patient, regarding a topic as serious as mortality. Also, with adherence to medications and lifestyle recommendations, a patient's prognosis is often better than average.
Even so, some visitors have requested some type
of statistical information on mortality of heart failure. It is VERY IMPORTANT for you to recognize that the following information applies to large groups. Individual
prognosis should be discussed with your doctor.
Mortality has been shown in clinical trials to correspond to their clinically defined New York Heart Association (NYHA) status, where classes are defined on a scale of one to four (four being the worst functional status). Estimates of mortality rate per year for patient subgroups are as follows:
- Class II = 5-15%
- Class III = 20-50%
- Class IV = 30-70%
New York Heart Association (NYHA) Functional Class
- Class I: No limitation of functional activity
- Class II: Slight limitation of activity. Dyspnea and fatigue with moderate physical activity
- Class III: Marked limitation of activity. Dyspnea with minimal activity
- Class IV: Severe limitation of activity. Symptoms are present even at rest
The information listed is from a review article by Massie BM et al Am Heart J
1997; 133: 703-712.
Again, it is necessary for
you and your family to discuss your prognosis with your doctor to plan for
appropriate medical options and life activities.
How am I going to pay for medications/procedures?
Insurance
companies pay for many medications and procedures for heart failure patients.
Some pharmaceutical companies have patient medication assistance programs in
cases of financial hardship. Ask your doctor about the use of cheaper generic
diuretics (for example, furosemide) when effective. top
Is the procedure going to hurt?
Patients should
feel assured that the history and physical exam are painless. Virtually all
patients will tolerate a small amount of blood being drawn for laboratory
testing. Echocardiograms and electrocardiograms are non-invasive and should
likewise not cause any real discomfort. Discuss procedures like cardiac
catheterization or major surgery (for example, coronary artery bypass grafts)
with the doctors performing the procedure so they can assess this on an
individual basis. top
How long will I be in the hospital?
Hospital stays
differ widely between patients and depend on the reason for hospitalization.
Patients with heart failure should be discharged from the hospital when:
- Symptoms of heart failure have been adequately controlled
- Reversible causes of morbidity have been treated or stabilized
- Patients and caregivers have been educated about medications, diet, activity and exercise recommendations, and symptoms of worsening heart failure
- Adequate outpatient support and follow-up care have been arranged top
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