Lifestyle changes and self-management

Monitoring your daily weight 

It is important to weigh yourself every day after you have been to the toilet and before you get dressed and have breakfast.  If, over a period of 3 days, you notice a persistent weight gain that results in an increase of around 4lbs / 2 kgs or more,please speak to your heart failure nurse or GP, as this may be a sign that your body is retaining excess fluid.  This in turn can cause you to become short of breath, or more short of breath than usual.

What to do if you are breathless 

You may feel frightened when you become breathless, so it is important to try to control your breathing.

Practice the following exercise regularly and use when you become breathless

  • Get comfortable, close your eyes and focus on your breathing
  • Place one hand on your tummy, just above your belly button
  • Breathe in and out through your nose, if you are able to do so. If not, breathe through your mouth
  • If you are breathing through your mouth, then purse your lips – like blowing out a candle
  • As you bring in gently, feel your tummy rise under your hand. Your upper chest and shoulders should remain relaxed
  • Breathe out and feel your tummy fall beneath your hand

Other options to try

  • Cool your face using a hand-held or standing fan or use cool water (with a damp cloth).
  • Distract yourself if you become anxious. This works by taking the focus away from your breathing. Try counting backwards from 100, or trying to remember people’s birthdays in each calendar month
  • Visualise a relaxing scene – your favourite place, the garden or the beach
  • Relax your shoulders as these can tense up when you are breathless and wastes energy and oxygen.
  • Support your arms and shoulders by resting forward on your forearms
  • Lean forward slightly, maybe over the back of an upright chair
  • If you are in bed, then sit yourself upright using pillows for support

If you remain breathless, please refer to the advice on page 6. 

Fluid intake  

As previously mentioned, excess fluid can accumulate in the body in heart failure, and diuretics are given to treat this.  In order to get the best relief from your symptoms it is important that you limit how much fluid you take in (from hot and cold drinks and also foods with high fluid content, for example soup or ice-cream). Your doctor may have asked you to restrict your fluid intake, if not, you should still generally limit yourself to a maximum of 1.5 – 2 litres within 24 hours.

Alcohol 

Your doctor may have advised you to stop drinking alcohol completely, in which case you should follow their advice.  If you have not been told to stop completely and you wish to drink alcohol, you can do so as long as you stay within the recommended guidelines (below).  It is important that you observe the daily as well as weekly guidelines and remember that alcohol counts towards your daily fluid intake. 

New alcohol advice, drawn up by the Chief Medical Officer, was issued in January 2018

  • Maximum safe level of alcohol is 14 units a week – 14 units is equivalent to a bottle and a half of wine or five pints of export-type lager (5% abv) over the course of a week.
  • The advice is the same for men and women.
  • If you do drink as much as 14 units per week, it is best to spread this evenly over three days or more.

 

Activity levels / cardiac rehabilitation 

Moderate exercise is beneficial and if carried out regularly can contribute to a feeling of wellbeing.  Going for a walk every day is useful as it is a safe and convenient form of exercise; your heart failure nurse can provide further information regarding exercise limits. In general, you should always be able to talk whilst exercising and you must always STOP if you experience undue shortness of breath or chest pain.

Cardiac rehabilitation

The research and evidence tell us that cardiac rehabilitation leads to improvements in your exercise tolerance and quality of life.  This can include: being able to walk further with less breathlessness, improve energy levels, strength and stamina and help to make day to day activities such as shopping, walking upstairs and even getting dressed easier.

It is easy to be frightened by your symptoms, but after you have completed your course of cardiac rehabilitation, you should be able to manage this better and have more control and confidence over your symptoms.

Cardiac rehabilitation courses

The cardiac rehabilitation courses on offer in Oxfordshire include:

  • An 8 week supervised individually designed physical activity programme which is adapted for your own needs.
  • Information and support on heart failure and coping with your condition
  • A friend or family member can attend the information session with you.
  • A friendly social supportive atmosphere.

You will have the support of trained health professionals such as nurses and exercise physiologists who will advise you how to carefully increase your activities and cope with your symptoms. These health professionals have close links to your lead health professional i.e. Community heart failure nurse, Consultant cardiologist and GP. 

Cardiac rehabilitation is about supporting you to manage your condition. It is not a cure, but it will help you feel better and more in control. Following the exercise sessions we provide information sessions on the following topics: healthy eating, salt and fluids, medications, symptom management, thoughts and feelings, referral to psychological service and physical activity. Your community heart failure nurse normally visits the sessions once a month to review you.

This will take place after your activity programme. A member of your family or a friend can attend the information sessions with you.

Where does cardiac rehabilitation take place?

  • Horton Hospital in Banbury, Mondays 1-3 pm
  • White Horse Leisure Centre, Abingdon, Tuesdays 2-4 pm
  • Windrush Leisure Centre, Witney, Wednesdays 2-4 pm
  • The Leys Leisure Centre, Blackbird Leys, Thursdays 2-4 pm

After your course has ended you will be advised on what physical activity programmes are available to you whether this is gym, supervised class or home based. 

How can I start cardiac rehabilitation?

Speak to your community heart failure nurse.  They will be able to talk to you about the cardiac rehabilitation programme and refer you to your nearest course.

Heart failure cardiac rehabilitation is safe, enjoyable, social and good for you.

Smoking 

If you smoke and you have heart failure, you have probably been advised to stop. Smoking causes many health problems and it reduces the amount of oxygen that can be carried by the blood, thereby adding to the impact of heart failure.  Your heart failure nurse will be pleased to help and support you if you are trying to quit.  Free specialist advice and support is available from the smoking cessation advisor at your GP practice.  There is a local helpline on 01865-238036.  We can also provide some booklets that you may find helpful.

Losing weight 

Being overweight can put extra strain on the heart so losing any excess weight may help to reduce breathlessness and fatigue.  You may be able to get professional advice and support for sensible weight loss through your practice nurse or local pharmacist.

Over the counter (OTC) medicines 

Some medicines that can be bought over the counter may make heart failure worse and should be avoided.  These include the group of drugs known as non-steroidal anti-inflammatory drugs, which are used to relieve pain, stiffness and inflammation.  You may know them more commonly as ibuprofen and they come under various names such as arthrofen, brufen, ebufac, ibufac, ibugel, ibuleve, inoven, motrin and nurofen.

Some herbal remedies including St John’s Wort should be avoided as they can interfere with prescribed medications. 

Be cautious about taking cold and flu remedies as these often contain compounds that should be avoided.

Driving  

Group 1: (Private cars)

Generally, you may drive if you have heart failure, as long as you are not having symptoms that may distract your attention.  You do not need to inform the DVLA about your heart failure, but it is wise to let your insurance company know.

Group 2: LGV (Large Goods Vehicles); PCV (Passenger Carrying Vehicles); C1 (Medium Goods); D1 (Minibus). 

You can drive if your ejection fraction is at least 40%, but you must notify the DVLA.  If you are symptomatic then your license may be refused or revoked. 

Travel 

There is no reason why you cannot travel or go on holiday abroad, but it may be best to avoid high altitudes as well as hot and humid places.  If your heart failure is severe, long haul flights can cause problems, so if you are planning a holiday ask for advice from your GP or heart failure nurse.  Some insurance companies are reluctant to insure people with certain medical conditions.  The British Heart Foundation has a list of travel insurance companies that are sympathetic to people with heart conditions.  The website address is https://www.bhf.org.uk/informationsupport/support/practical-support/travel-insurance or telephone the Heart Helpline on 0300 330 3311.

Pumping Marvellous produce an information booklet called ‘Travelling with Heart Failure’.  The website address is: https://pumpingmarvellous.org/wp-content/uploads/2014/03/Travelling-with-heart-failure.pdf

What to do during a heatwave 

General advice includes:

  • to stay in the coolest areas of your house,
  • wear loose clothing,
  • limit your trips outside,
  • try not to go out between the hours of 11.00 and 15.00,
  • consider having an extra glass of fluid,
  • avoid tea, coffee and alcohol.

You may feel as though you are a little more breathless than usual and your ankles are more puffy at the end of the day – if this reduces overnight in the cool this is OK, if it remains increased with a persistent weight gain you may need a review.

If the heatwave is more than a few days you may need to reduce your diuretic therapy and have your kidney function reviewed, please discuss this with your GP or nurse as appropriate.

Useful website for more information is http://www.nhs.uk/Livewell/Summerhealth/Pages/Heatwaveredalert.aspx

Vaccinations    

Please liaise with your GP surgery about:

  • Yearly flu jab
  • One off pneumonia jab
  • One off shingles jab

Sexual activity  

Many people with heart disease avoid sexual intercourse because they believe it is dangerous – there are certainly lots of myths and misconceptions about this.  As far as heart failure is concerned it is difficult to be specific as everybody is different and the things that affect one person with heart failure may not necessarily affect the next person.  Some people with heart failure lose interest in sex and this can be distressing.  For those whose condition is severe, they may find that they cannot tolerate sexual intercourse at all because it causes them to become very short of breath.  If you have any worries or difficulties, do mention them to your heart failure nurse or GP.