One of the best ways to take care of yourself is to keep a close eye on your symptoms and call your doctor if they should get worse. Everyone responds differently with heart failure. Some people have more problems with holding on to fluid and other people have more problems with not enough blood flowing to the body. Some people have trouble with both types of heart failure. Symptoms of fluid retention are shortness of breath, ankle swelling, fullness or bloating in the belly. Symptoms related to not enough blood flow to the body include fatigue, feeling dizzy, aches and pains, and anxiety.

Checking your weight is key to keeping an eye on your symptoms. Weight gain is one of the first signs of retaining fluid. Contact your doctor with weight gain or loss as directed. Changes in your weight may be a sign of fluid retention. Often increases in weight can be easily dealt with by changing your diuretic (water pill). Contact your health care team right away report weight gain. If you delay in calling your doctor you may need a hospital stay.

Purchase a bathroom scale if you don’t have one. Make sure you can see the numbers on the scale. Dial scales may be harder to read but more exact than digital scales. Do not be concerned if your weight on your home scale does not match your weight at your doctor’s office. Scales can vary by several pounds. Further, your weight will change during the day.

Place your scale in a handy location. Place the scale on a flat surface without carpet. If you have carpet, you may need to place a thin board under your scale. Make sure your scale is reading true by stepping on and off the scale three times. The scale should read your weight within one pound each time.

Use a calendar, notebook paper, or log to track your weights and keep it by your scale. Each morning step on the scale after you empty your bladder. Weigh before eating or drinking. Always weigh in the same clothing or no clothing. Record your weight every day. Weighing twice a day is not necessary. If you choose to weigh in the morning and evening make sure your doctor knows which weights you are talking about.

You will need to restrict the salt (sodium) in your diet. Be sure to read food labels and limit your salt intake to reduce HF symptoms. Your doctor may tell you to limit your daily fluid intake. Measuring the amount of fluid and salt you eat can help you keep track of your total daily intake. Read more about eating less salt below in section 9.

You may be started on a diuretic (water pill) if you have signs of holding on to fluid. Signs of excess fluid include swelling in your ankles, legs, or fullness in your belly. You may be told by your doctor to take more of your water pills if you gain weight. But you need to follow your doctor’s orders only and not do this on your own. Your doctor needs to know when you need extra water pills, how often you need them, and keep track of your blood levels that can be changed by water pills.

Learn to conserve your strength and pace yourself to prevent fatigue. If you have a good day, don’t do too much. Space out chores and plan ahead so you don’t have to rush. Do not try to keep up with others, but walk and work at your own pace. You may need to pause and catch your breath. Ask for help. Often others want to help but may not know what they can do the help you. Tell them how to best help you.

Your heart failure health care team may consist of a doctor and nurse who work with you to keep your symptoms stable. Talk with your health care team as soon as your start having symptoms to prevent a visit to the hospital. These could be feeling short of breath, dizzy, tired or having new or worse swelling. Also call your health care team if you have new symptoms such as racing heart beats, fainting, or chest pressure.

Side effects from your medications can cause faintness or dizzy spells. Call your doctor if your blood pressure is lower than your normal or if you get a flu or virus. Also tell your health care team of any newly prescribed medications, as some drugs can make fluid retention worse or work against medications you may be taking. Finally, ask before taking over-the-counter drugs.

Talk to your primary care doctor or heart doctor and ask if you should see a special doctor who has advanced training in caring for persons with HF. If you have symptoms at rest and are on all of the heart failure medications, you may be referred to a health care team that cares only for people with heart failure.¹ Heart failure doctors often work with someone who has had to come to the hospital many times because their symptoms are so bad. A heart failure team may include a doctor, nurse practitioner, nurse, dietitian, social worker, pharmacist, and exercise specialist. This team of health care providers cares for people who have severe heart failure symptoms. You may be worked up for advanced treatments such as heart transplant or a mechanical heart pump. You may be offered to be a part of a research study. You and your family’s goals will be discussed with the team. Then this team will work to manage your symptoms and discuss ways to improve your quality of life.

Be sure to bring a list of all medications and over-the-counter drugs, including herbal supplements with you. If you don’t have a current list, bring the actual pill bottles to review. Even if you have missed doses or stopped medications, include these drugs and discuss what you have and haven’t been taking. Only then can your health team make the best changes to your medications.

Also bring along any type of diary or log with your daily weight, blood pressure and pulse taken at different times of the day, including symptoms you may have felt since your last visit. Write down events like when you ate Mexican or Chinese food, had to go to the hospital, felt very stressed, or even just feeling great. Lastly, bring a list of questions for your doctor or nurse. Jot questions down when you think of them and bring them with your medications and log.

Just because you need to watch the sodium in your diet doesn’t mean you can’t enjoy food. Food is a part of every-day life, the center of social events and something that brings great pleasure. People with heart failure can enjoy good food that is also healthy. When thinking about food, think “What kind of food can I enjoy while staying healthy?” There are plenty of tasty low salt foods that can be part of your healthy diet.

The body holding on to extra fluid is a problem in persons with heart failure and very common. You may notice swelling in many parts of your body, such as in your legs. This swelling can build up anywhere in your body, including the space around your heart and lungs. This can make breathing hard and causes more strain on your heart. One way to prevent this is to limit the amount of salt you eat.

Fluid and salt are chemically attracted to each other, where one goes, the other follows. If you eat too much salt, your water or fluid pills may not work as well. Salt is found in most foods so you don’t need to add it to your food. Most people eat 7,000 to 12,000 mg of salt a day. But people with heart failure need to limit their salt to 1,500 to 2,000 mg per day.

The best way to limit salt is to choose foods in their natural state. If they have not been processed or cured, they will likely be low in salt. Check food labels for the amount of salt, or sodium, when shopping. Try to stay under 200 mg of sodium per serving.

If no salt, then what? There are some very tasty all-herb spices that can be used to add flavor to food such as Mrs. Dash and Lawry’s Salt-Free. Pure herbs and spices, such as garlic, onion and chili powder also are great choices (Hint: Make sure you don’t pick up garlic salt or onion salt by mistake). Buy spices in small amounts as they lose their flavor in a few months. Salt is added to many processed foods to keep them fresh for a longer shelf life.

Some foods to avoid include:

• “Salt Substitutes”- These can contain potassium, which can build up in your blood and cause an irregular heartbeat if you eat too much of the salt substitute.
• Seasonings that contain sodium or potassium in the ingredients.
• Any product that has “light salt” which may contain sodium or potassium.
• Seasoning salts, meat tenderizers, monosodium glutamate, baking soda, garlic and onion salt, Cajun seasoning, lemon pepper and bouillon cubes.
• Processed meats, such as corned beef, sausage, frankfurters and luncheon meats; smoked, cured or dried fish and meats, including bacon, salt pork, beef jerky and ham.
• Canned, frozen, or packaged dinners.
• Processed cheeses, blue cheese, Roquefort cheese, and creamed cottage cheese and cheddar cheese.
• Canned, preserved or convenience foods, such as canned vegetables, soups and broth, instant soups, rice mixes and macaroni and cheese mixes.
• Condiments such as catsup, mustard, soy sauce, light soy sauce and barbecue sauce.
• Salted snack foods, such as saltine crackers, rye krisp, salted snack chips, salted nuts, and pre-packaged popcorn.
• Pickles, olives, salsa and guacamole (unless made fresh without salt), sauerkraut and hominy.
• Buttermilk, tomato juice, vegetable juice and sport drinks
• Croissants, breads and other baked goods made with baking soda and baking powder, including biscuits, corn bread, muffins and cakes.

To calculate 1,500- 2000 mg of sodium for the day, each meal will consist of less than 500mg of sodium. If one meal is more than 700 mg, budget the sodium in your other meals so that you stay under 2,000 mg in a day. The following table will help you identify the lower sodium types of foods.

But I Don’t Cook!

Dining out can be a part of your lifestyle, but it doesn’t mean you can leave your diet at home! Here are some tips for eating out:

• Start by limiting your sodium for other meals on the day you dine out. Use about 400-500 mg for your other two meals to save about 1000 mg for dining out.
• Ask your server or chef what can be prepared without salt. (TIP: Dine out at a time that is not busy until you become used to the menu and the changes that can be made.)
• Hold sauces, gravies and salad dressings. Ask for oil and vinegar for your salad and fresh ground pepper, if available.
• Choose fresh fruit, whole grain cereals, milk, yogurt, juice and eggs (made to order).
• Try a grilled chicken breast sandwich with cheese, veggies, and oil and vinegar at a deli. Add a side of fresh fruit, if available. Leave off any deli meat, salty marinades or dressings.
• Try steamed rice, steamed vegetables or spring rolls.

To stay healthy, it is best to eat from all the food groups and choose foods with lots of color to ensure you get the nutrients you need. Here are low sodium options from every food group.

Starches

• Plain rices and pastas (instant mixes contain added salt)
• Dry cereals with less than 140 mg of sodium per serving (shredded wheat, puffed rice, puffed wheat)
• Regular cooked cereals, such as oatmeal and cream of wheat
• Air-popped popcorn (try low-sodium spray margarine to add flavor)
• Unsalted nuts and pretzels
• White, whole or cracked wheat, rye, French, Italian, pumpernickel breads, plain rolls and crackers (limit regular bread products to 4 per day). Ezekiel Bread is one brand that has very low sodium and is in the freezer section.
• Salt-free breads and crackers, melba toast, matzo crackers and bread sticks

Protein

• Unsalted fresh or frozen lean beef, pork, poultry, lamb, veal and fish
• Dried (legumes) beans, peas, lentils; soybeans, unsalted peanut butter, unsalted nuts, eggs
• Fresh seafood
• Milk and Dairy Products (2 servings per day)
• Skim or 1% milk
• Dry cottage cheese, natural cheeses (Swiss)
• Low-fat frozen yogurt and regular yogurt, ice-milk and sherbets

Vegetables and Fruits

• Fresh or frozen fruits or vegetables, no salt added
• Canned fruit, in its own juices
• Dried fruit
• Some canned tomato products, such as diced tomatoes, no salt added

Fats and Oils

• Salad dressings with less than 140 mg sodium per serving (1 tbsp)
• Salt-free margarine and butter (limit regular margarine and butter to 3 tsp per day)
• Canola, olive and peanut oils
• Warning: Special “diet” foods may contain less fat and fewer calories, but are usually higher in sodium

The above listed foods make good choices. Each shopping trip, read the food labels to identify the amount of sodium per serving.

• <140 mg sodium = low sodium food
• < 35 mg sodium = very low sodium food
• <5 mg sodium = sodium free