Heart Failure

Heart Failure Facts

Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body’s other organs. The heart keeps pumping, but not as efficiently as a healthy heart. This occurs due to a weakened muscle. The heart attempts to compensate for this change by pumping faster and harder. In doing so, it becomes enlarged and stretched, thereby increasing its muscle mass. This works in the short term, but, eventually, the heart cannot keep up with its increased demands. Usually, the loss in the heart’s pumping action is a symptom of an underlying heart problem.

Nearly 5.7 million Americans are living with heart failure, and 670,000 new cases are diagnosed each year.

Heart failure is a progressive and chronic condition which can occur on either the left or right side of the heart. The left ventricle is the largest of the heart’s chambers and supplies most of the heart’s pumping power. This is referred to as ejection fraction. When the left side of the heart is compromised, the blood backs up to the lungs and shortness of breath may occur.

Types of Heart Failure

Left-sided heart failure:

  • Systolic heart failure is characterized by a decrease in strength to the left ventricle.
  • Diastolic heart failure occurs when the heart muscle is stiff and inflexible.

Right-sided heart failure:

  • When the right side of the heart becomes overloaded, the blood backs up into the veins of the body. This is where patients may experience an increased swelling in the abdomen or legs.

Causes of Heart Failure

What causes heart failure?

Heart failure may result from any/all of the following:

  • Cardiac arrhythmias (irregular heartbeats) cause the heart to beat inefficiently
  • Cardiomyopathy or another primary disease of the heart muscle
  • Chronic lung disease and pulmonary embolism
  • Congenital heart disease/defects (present at birth)
  • Coronary artery disease: narrowed arteries that supply blood to the heart muscle
  • Diabetes
  • Drug-induced heart failure
  • Excessive sodium intake
  • Heart valve disease caused by past rheumatic fever or other infections, or by normal degeneration of the valve—changes in the valve affect blood flow to the heart
  • Hemorrhage and anemia
  • High blood pressure (hypertension) causes the heart muscle walls to thicken and become stiff
  • Infections of the heart valves and/or heart muscle (i.e., endocarditis)
  • Pregnancy
  • Previous heart attack or attacks (myocardial infarction): scar tissue from previous attacks may interfere with the heart muscle’s ability to work normally
  • Viral illness

Tacking Symptoms

Heart Failure SymptomsIf you have congestive heart failure (CHF), knowing your body can help you manage your condition. Here are some common symptoms of CHF. Talk to your doctor if you experience the following:

  • Weight gain - Weigh yourself daily at the same time, and call your doctor if you suddenly gain three pounds or more. This is an early sign of fluid retention.
  • Swelling - Blood flow backing up from the heart can lead to swelling in your ankles, legs and abdomen. The kidneys cannot compensate for the extra fluid. Your shoes may be difficult to get on and clothes may fit more tightly around your stomach.
  • Shortness of breath or coughing - Your heart can’t pump as efficiently as it should, so fluid can back up into your lungs. You may be breathless, which can cause you to wake up at night.
  • Increased nighttime urination - Your kidneys get more blood flow when you are at rest.
  • Trouble sleeping - If you find yourself needing to use more pillows or sleep in a chair rather than a bed to avoid trouble breathing, let your doctor know right away.
  • Fatigue - Blood flow to the muscles may be reduced. This may make you feel tired during the day. Take time to rest.
  • Nausea or loss of appetite - Not enough blood in your digestive system can make you feel full or sick to your stomach. Too much fluid in your abdominal cavity can cause bloating.
  • Disorientation or confusion - Changing amounts of sodium in your blood can cause confusion. If you or someone else notices this, talk to your doctor at once.
  • Dizziness or lightheadedness - Decreased blood flow to the brain or low blood pressure may contribute to this. Try to change positions slowly.

Diagnosing Heart Failure

Diagnosing Heart Failure - CardiogramIn addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any one or a combination of the following:

Chest X-ray: A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film. Echocardiogram: A non-invasive test that uses sound waves to produce a study of the motion of the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.

Electrocardiogram (ECG or EKG): A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias) and detects heart muscle damage.

BNP testing: B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. The higher the BNP levels, the worse the heart failure.

Muga scan: A nuclear test to see how the heart wall moves and how much blood is expelled with each heartbeat, while the patient is at rest.

Myocardial perfusion scans:

  • Resting SPECT thallium scan - A nuclear scan given while the patient is at rest that may reveal areas of the heart muscle that are not getting enough blood.
  • Exercise thallium scan - A nuclear scan given while the patient is exercising that may reveal areas of the heart muscle that are not getting enough blood.
  • Adenosine or persantine thallium scan - A nuclear scan given to a patient who is unable to exercise to reveal areas of the heart muscle that are not getting enough blood. Special medications which stress the heart, like exercise, may be given.

Magnetic resonance imaging (MRI) of the heart: A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI of the heart may be used to evaluate the heart valves and major vessels, detect coronary artery disease and the extent of damage it has caused, detect the presence of plaque causing blockages of the coronary arteries, evaluate congenital defects and detect the presence of tumors or other abnormalities. The cardiac MRI may be used prior to other cardiac procedures such as angioplasty or stenting of the coronary arteries and cardiac or vascular surgery.

Magnetic resonance angiography (MRA) of the heart: A specialized type of MRI procedure used to evaluate blood vessels in the heart.

Cardiac catheterization (also called coronary angiogram): A test in which a small catheter (hollow tube) is guided through a vein or artery into the heart. Dye is given through the catheter, and moving X-ray pictures are made as the dye travels through the heart. This comprehensive test shows narrowings in the arteries, outside heart size, inside chamber size, pumping ability of the heart, ability of the valves to open and close, as well as a measurement of the pressures within the heart chambers and arteries.

Heart Failure Medication

Heart Failure MedicationTypes of Heart Failure Medication:

  • Aldosterone blockers: Block the effects of aldosterone which causes sodium and water retention.
  • Angiotensin converting enzyme (ACE) inhibitors: Decrease the pressure inside the blood vessels and reduce the resistance against which the heart pumps.
  • Angiotensin receptor blockers (ARB): Alternative medication for reducing workload on the heart if ACE inhibitors are not tolerated.
  • Antiarrhythmic medications: Keep the rhythm regular and prevent sudden cardiac death.
  • Beta-blockers: Reduce the heart’s tendency to beat faster and reduce workload by blocking specific receptors on the cells that make up the heart.
  • Digitalis: Increase heart strength and control rhythm problems.
  • Diuretics: Reduce the amount of fluid in the body.
  • Inotropes: Increase the pumping action of the heart.
  • Vasodilators: Dilate the blood vessels and reduce workload on the heart.

Medication Management Tips

Medication ManagementHow many different medicines do you take? Most people with heart failure or other cardiovascular illnesses take several. It’s no wonder you may become puzzled over which medicines to take and when, how much to take, or what symptoms the drugs treat.

To prevent missed or double doses, side effects, and drug interactions, keep your medications organized. Try following these tips to avoid problems:

Write it down

Keep an up-to-date list of every medication you take. You can make your own, get a form from your health care provider or pharmacist, download one from the Internet or keep a list on a free website that you can access from any computer anytime. Make a note of the basics about each of your medicines.

Here’s what to record:

  • Medicine name (generic and brand name)
  • What you use it for (such as “heart failure” or “cholesterol”)
  • When to take it (morning, bedtime or at dinner)
  • How much to take (number of tablets or milligrams)
  • How to take it (by mouth, injection, inhaled and with or without food)
  • Which side effects to report to your health care provider
  • How long to take it

Make sure you note whether to avoid mixing the medicine with any others or with any foods or drinks.

Share the information

Tell your health care providers which medicines you take. This includes all prescriptions and any over-thecounter drugs, nutritional supplements, herbs and other remedies. Keep an up-to-date list of everything you take. Bring it whenever you see your health care provider. If you do not have a list handy, bring all your pill bottles to your appointment in a large bag. (Your health care provider will not be bothered by this; she or he would much rather go through the bottles than not know exactly what you are taking.) Ask whether any of the items can cause problems when combined.

If your health care provider makes changes in your medications, update your list immediately whether you are at the provider’s office or in the hospital.

Use a weekly pillbox

These boxes have seven compartments, one for each day of the week. Some have additional slots for different times of day, such as morning, midday and bedtime. If you fill your pillbox at the beginning of the week, then all week long it’s easy to tell whether you’ve taken a dose instead of trying to remember. You also can plan to take your medicine with another routine activity, such as brushing your teeth or having breakfast, so you get used to taking it regularly.

Watch for side effects

Ask your health care provider what side effects may occur with each of your medicines and learn what you can do to avoid them. Learn which side effects you should report to your health care provider so he or she may be able to adjust your dose or schedule, or substitute another drug if side effects bother you.

Measuring Your Heart Beat

Measuring Your Heart BeatWhy is My Ejection Fraction So Important?

Ejection fraction (EF) is a measurement of how much blood your heart pushes out when it beats. This measurement helps with the diagnosis and treatment of heart failure.

When your heart beats, the right ventricle pumps blood to your lungs and the left ventriclepumps blood to the rest of your body. The EF is the percentage of blood that is pumped out of aventricle with each heartbeat. Even in a healthy heart, some blood stays behind in the ventricles.

EFs between 55 and 75 percent are considered normal for the left ventricle, which is the main pumping chamber of the heart. In heart failure caused by a weak heart muscle, the EF number can become very small. An EF of 20 percent means 80 percent of the blood stays in the ventricle and therefore the heart is not providing all the blood the body needs.

Doctors can use an echocardiogram, or other techniques, such as cardiac MRI, cardiaccatheterization, or nuclear imaging, to measure EF and see how well your heart is working.

Although the EF is very important and is one of the most commonly used methods of expressing overall heart function, it is important to note that some people have heart failure symptoms despite a normal-range EF. Also—although a low EF is never normal—with treatment, some people can lead a fairly normal, active life, despite a dcreased EF.

Smoking and Cardiovascular Disease

Smoking Facts & Risks

Smoking FactsAccording to the American Heart Association (AHA), diseases caused by smoking kill more than 440,000 people in the United States each year; of that number, more than 135,000 deaths are cardiovascular related.

Even with antismoking campaigns and medical disclaimers in place, many people continue to smoke or start smoking every year. According to the American Cancer Society, 90 percent of new smokers are children and teenagers, in many cases, replacing the smokers who quit or died prematurely from a smoking related disease.

Smokers not only have increased risk for lung disease, including lung cancer and emphysema, but also have increased risk for heart disease, stroke, and oral cancer.

Facts about smoking and cardiovascular disease:

  • One out of every five smoking-related deaths is caused by cardiovascular disease.
  • Cigarette smoking produces a greater risk for coronary heart disease in people younger than age 50.
  • Women older than age 35 who smoke and take oral contraceptives are at much greater risk of developing a cardiovascular disease or stroke than women who do not smoke while taking oral contraceptives.
  • Cigarette smokers are two to four times more likely to develop coronary heart disease (CHD) than nonsmokers.
  • Cigarette smoking doubles a person’s risk for stroke.
  • Cigarette smokers are more than ten times as likely as nonsmokers to develop peripheral vascular disease (PVD).

How does smoking affect the cardiovascular system?

In posing health risks on the body’s cardiovascular system, smoking:

  • causes immediate and long-term increases in blood pressure
  • causes immediate and long-term increases in heart rate
  • reduces cardiac output and coronary blood flow
  • reduces the amount of oxygen that reaches the body’s tissues
  • changes the properties of blood vessels and blood cells–allowing cholesterol and other fatty substances to build up
  • contributes to higher blood pressure and increased risk for blood clot formation
  • damages blood vessels
  • doubles the risk of ischemic stroke(reduced blood flow to the brain)
  • stimulates the blood clotting process

In addition, smoking has been associated with depression and psychological distress.

Quit Smoking Tips

Quit Smoking TipsYou’ve done your homework, made your plan, tossed out all your cigarettes and now the big day is here: Day One of your plan to quit smoking. You’ve probably heard that nicotine withdrawal is unpleasant and that most people need to quit several times before they reach their goal.

But the good news is that, if you can make it through this first day and this first week, when nicotine withdrawal symptoms are at their worst, you will be on your way to success.

One of the most important things you can do right now is remind the people around you that today is the day you are quitting cigarettes and ask for their help. This might mean asking some people not to smoke around you, so that you aren’t tempted to give in to a craving.

How you might feel today

You may experience a range of nicotine withdrawal symptoms today or during this first week. It’s not unusual to have four or more of these reactions:

  • cravings for cigarettes
  • anger
  • frustration
  • irritability
  • depression
  • anxiety
  • weight gain
  • increased appetite

If your doctor has prescribed nicotine replacement products, such as nicotine patches, be sure to use them as directed to help relieve symptoms. If he or she suggested antidepressants, which are sometimes helpful, make sure you understand how and when exactly to take them.

Here are no- or low-cost strategies for meeting today’s challenges:

Plan a new morning ritual. If smoking was a big part of how you started every day, create new positive habits, like making a healthy breakfast from scratch. Ideally the activity should last an hour or more and keep you busy and distracted.

Plan activities. Schedule activities that you enjoy (but that you don’t associate with smoking) to stay occupied and avoid feelings of boredom or frustration. It’s okay to bribe yourself a little bit,too—reward yourself after you get through the afternoon without a cigarette by going to the movies or getting a manicure.

Lean on others for support. Ask friends and family to help motivate you, and reach out to support groups available both in person and online. Don’t be afraid to contact them—you want to create a network of cheerleaders who will keep you on track.

Drive differently. If you smoked in your car—on your way to work or just the supermarket,for example—you might need to change your route, listen to new music or find another way to drive without smoking. You might even consider joining a carpool or taking a train to shake up your daily commute.

Get physical. Taking a walk or jog or engaging in any kind of physical activity that you really like can reduce feelings of anxiety, anger, frustration and stress that are often part of nicotine withdrawal.

Fiddle. If you enjoyed the feeling of a cigarette in your hand, find a small object, such as a paperclip, pencil, or even a squishy stress ball, that you can play with instead.

Keep your mouth busy. Try chewing sugar-free gum, sucking on hard candy or chomping on fruits and veggies whenever you get a craving—have all these choices handy at all times.

Take a deep breath. Do deep breathing exercises as often as you need them to relieve stress, and every time you exhale, remind yourself that the urge to smoke will pass.

Seek out smoke-free distractions. Take advantage of public smoking bans by enjoying smoke-free places in your community. Savor the fresh air filling your lungs.

Create a plan to manage triggers. You probably have favorite times and places to smoke or certain stressful (but predictable) events that cause you to want to light up. Plan your day so that you avoid as many of your trigger situations as possible; have an alternative activity you can do when a trigger is unavoidable, such as drinking a glass of water rather than smoking during scheduled coffee breaks.

Cut back on alcohol. Not only does alcohol weaken your resolve to follow a number of healthy lifestyle options, it also often acts as a trigger for smoking. In particular, avoid any specific drinks you used to enjoy with a cigarette.

Distract yourself. If you find you have time on your hands, keep those hands busy with an interesting book or magazine to read or a puzzle to solve.

Know key contacts. If you have a weak moment, call a friend, a loved one, the American Lung Association helpline (800-548-8252), or the National Cancer Institute helpline (877-448-7848) for encouragement so that you do not reach for a cigarette.

Nicotine Replacement Products:

Nicotine replacement products continue to give smokers nicotine to meet their nicotine craving without the tars and poisonous gases that cigarettes emit.

Nicotine chewing gum. An over-the-counter chewing gum that releases small amounts of nicotine to help reduce nicotine withdrawal symptoms. Nicotine patch. An over-the-counter patch applied to the upper body once a day that releases a steady dosage of nicotine to help reduce the urge to smoke.

Nicotine inhaler or nasal spray. A prescription nicotine replacement product that releases nicotine to help reduce withdrawal symptoms (requires a physician’s approval before use).

Non-nicotine options to quit smoking:

Zyban (Bupropion). A non-nicotine alternative to help people stop smoking approved by the U.S. Food and Drug Administration (FDA). Offered in pill form to smokers who want to quit, Zyban, has been shown to alter mood transmitters in the brain that are linked to addiction. Zyban must be prescribed by a health care provider and may not be appropriate for everyone. Consult your health care provider for more information.

Chantix (Varenicline). Also a non-nicotine pill to help in smoking cessation. It was approved recently by the FDA. It targets the nicotine receptors in the brain. Chantix attaches to the receptors and blocks nicotine from reaching them, decreasing the desire for nicotine. Chantix may not be appropriate for everyone and you should consult your health care provider.

Benefits of Quitting

Short-term benefits

About 20 minutes after your last cigarette, your body already has begun to respond to your decision to quit smoking:

  • Your blood pressure goes down
  • Your pulse rate slows
  • The temperature of your hands and feet increases

Eight hours after you quit smoking, your blood has begun to recover from the effects of smoking. The levels of both carbon monoxide and oxygen in your bloodstream return to normal.

Within 24 hours, your chance of a heart attack has already decreased as your system repairs itself.

About 48 hours after you quit smoking, nerve endings deadened by the habit have begun to regenerate and your sense of taste and smell has already improved.

A few weeks after you quit smoking, your circulation has improved and your lungs have begun to function better. Walking and exercising become much easier.

Within the first few months, your phlegm production has decreased and you won’t find yourself coughing or wheezing as much.

Long-term benefits

The benefits of your decision to quit smoking continue long after the immediate impact. You might not feel these benefits the way you felt the quick improvement in your lung function and overall health, but you’ll still enjoy them:

1 Year: Your excess risk of suffering coronary heart disease has decreased to half the risk of a continuing smoker.

5 Years: Your risk of having a stroke has decreased compared to continuing smokers, and will continue to decrease over time.

10 Years: A decade after you quit smoking, your risk of lung cancer is now half that of people who keep smoking. You’ve also experienced a decrease in your risk of ulcers and other cancers, including cancer of the mouth, throat, esophagus, pancreas, kidneys, and bladder.

15 Years: Your risk of coronary heart disease is now comparable to that of people who never smoked a single cigarette. Your risk of dying is also nearly back to the same level as that of non-smokers.

SOURCE: Everyday Health, Dennis Thompson Jr.; medically reviewed by Cynthia Haines, MD


Exercise Ideas

Exercise IdeasFinding ways to get exercise as you get older is a smart and easy way to stay fit and improve your health. Exercise is just as important in your older years as when you were younger.

Research shows that an exercise regimen offers a wealth of health benefits. One study found that adults ages 75 and older who exercised lived longer than older adults who didn’t exercise. Another study discovered that older women who squeezed in resistance, or strength, training workouts each week improved their cognitive function.

It’s also well known that regular exercise can help to boost heart health, maintain a healthy body weight, keep joints flexible and healthy, and improve balance to minimize falls.

Exercise is not as time-consuming as you may think. For general health benefits, older adults need about 2½ hours of aerobic (walking, running, and other activities that get the heart pumping faster) activity per week, combined with muscle-strengthening activities at least two days per week.

Balance and strengthen count, too

To help prevent falls, you also want to practice exercises that improve your balance. Yoga and tai chi fit the bill—and they will also help you manage stress, feel more relaxed, and improve muscle tone. Yoga or tai chi classes are widely available in many areas, from senior centers to the Y.

Taking some time to stretch every day can also help keep your joints flexible and keep you moving well. It’s also important to lift some light weights—canned goods from your cupboard are a fine substitute—or use a resistance band to tone your muscles.

Work out while you work

Add a little “elbow grease” when doing chores and these regular activities will count as a workout:

  • Cleaning the house
  • Raking leaves in the yard
  • Gardening
  • Mowing the lawn
  • Sweeping and dusting

Remember that getting older doesn’t mean slowing down. You’ve got to keep moving to stay young at heart…as well as in mind, body and spirit.

Easy Ways to Exercise

Exercise actually comes in many forms, including activities that feel more like fun than hard work:

Dance. Sign up for a dance class with your spouse or a friend or carve out some dance time at home.

Go bowling. Join a bowling league or make a weekly date with some of your friends. If you have grandchildren, bring them along.

Rediscover a favorite sport. Whether you love the elegance of golf or the challenge of tennis, make time for these leisure activities. If possible, vary your activities over the course of each week to work different muscle groups.

Enjoy the great outdoors. When the weather cooperates, ride your bike, visit a local park for a hike, or simply go for a walk. These are all great exercises that get you outside and into the fresh air.

Jump right in. Swimming is an excellent exercise choice, particularly if you have arthritis joint pain. Join a local fitness center with a pool and work in regular swims to meet your cardiovascular needs without straining your joints.

Healthy Eating

Healthy Eating Facts

Health Eating FactsThe Facts on Fat: What a Healthy Diet Should Include

Surprise: Fat’s not all bad. You just have to know how to maximize the healthy fats and minimize the unhealthy fats. Unhealthy fats contribute to hardening of the arteries and can lead to heart disease and stroke. The following fat facts and tips can help you understand how fat should fit in your healthy eating habits.

Change your fat mix

Fact: Monounsaturated fats like canola oil and olive oil can improve blood-cholesterol levels and reduce the risk for heart disease.

Tip: Substitute monounsaturated fats for the saturated fat and some polyunsaturated fat in recipes and meal planning.

Trim your total fat

Fact: It’s essential to eat some fat because hormones and your nervous system depend on it to function properly. Some fats are healthier than others. Monounsaturated fat, omega-3 fatty acids and polyunsaturated fats are healthier than saturated fats and trans fats.

Tip: Limit fat intake to no more than 20 to 35 percent of your total daily calories.

Beware of trans-fats

Fact: Stick margarine, shortening, processed pastries, cookies and crackers, French fries and other deep-fried fast foods tend to have plenty of hydrogenated trans-fatty acids, a riskier type of fat.

Tip: Trans-fats should make up no more than one percent of your total daily calories. Cut down on trans-fats by eating fewer processed snacks and avoiding deep-fried fast foods.

Fat-free vs. low-calorie

Fact: Just because a food product is labeled “fat-free” or “low-fat” doesn’t mean it’s good for you. When a food manufacturer removes the fat, something has to take its place. Usually that’s sugar. Fat-free and low-fat foods can have just as many calories as the regular version and cause weight gain if you eat too much of them.

Tip: A better approach, if you’re craving something in particular, is to have just a couple of bites of the real thing, then push it aside.

Tips to reduce your fat intake:

  • Increase your intake of fruits, vegetables, legumes and whole grains
  • Use fat-free salad dressing and mayonnaise. If you cannot tolerate the taste, try the low-fat versions of these.
  • Skip the butter or margarine on your toast, baked potato, cooked carrots or other vegetables.
  • Avoid pastries, pies, cookies, muffins and most commercial snack foods
  • Reduce your cheese intake or switch to low-fat varieties
  • Select fat-free or low-fat dairy products such as skim or 1 percent milk, nonfat yogurt and low-fat cottage cheese. Avoid flavored yogurts, as they have added sugar and a lot more calories.
  • Remove all visible fat from lean meat before cooking. Remember to select meats that are relatively low in saturated fats, such as chicken, turkey and fish.
  • Purchase low-fat or fat-free hot dogs, sausages and processed meats.
  • Avoid fast foods
  • When in doubt about a food, read the nutrition label. If more than 30 percent of the calories are from fat, skip it.

Remember that even one positive change a day can help you move toward a healthy eating pattern. Select one of the tips and give it a try today!

Emotional Eating

Emotional EatingIf you raid the fridge when you’re stressed or upset, that’s called emotional eating. Emotional eating affects most everyone from time to time, but regularly letting your feelings guide your food intake can affect your health. Sadness, boredom and other negative emotions can drive emotional eating—such as polishing off a container of ice cream after a romantic breakup or devouring a bag of potato chips when you’re home alone on a Saturday night. But happy events can lead to it, too. Many people overeat at joyous occasions like parties and weddings.

More serious conditions can be linked to emotional eating. One is binge eating disorder, characterized by eating dramatically large amounts of food well after you reach the point of fullness.

Eating more food than your body needs can have dangerous consequences. People who eat for emotional reasons often gain too much weight, which puts them at greater risk for type 2 diabetes, high blood pressure, obesity and cancer. Excessive eating has emotional consequences as well, such as feeling guilty or embarrassed afterward.

Strategies to deal with emotional eating:

Here are steps you can take to stop emotional eating episodes and break the cycle:

Learn to recognize hunger. Next time you reach for a snack, ask yourself what’s driving it. If you are truly hungry, you’ll notice physical symptoms, such as a growling stomach. Other, less-obvious hunger cues include irritability and difficulty concentrating. If those signs are absent, you probably don’t need to eat right then.

Keep a journal. Take the time to create a “mood and food” journal. Write down what you eat each day, along with the emotions you were experiencing at the time and whether you were truly hungry. You may find that specific feelings, such anger or sadness, lead to your overeating. Once you recognize these triggers, you can learn healthier ways to deal with them. For example, if you experience stress, instead of trying to relieve it with a candy bar, take a walk around the block.

Build a support network. Surrounding yourself with friends and family who support your efforts to change your eating habits can improve your chances of success. It may also be helpful to join a support group, such as the 12-step program Overeaters Anonymous, through which you will meet other people with similar problems and learn better ways of coping.

Cultivate other interests. Finding an activity that you enjoy, such as yoga, playing a musical instrument or painting, can increase self-confidence, which is often poor in emotional eaters. If you find that your eating is driven by boredom, a new passion can fill your hours and make you less likely to look to food for emotional satisfaction.

Get help if necessary. If you can’t control emotional eating on your own, consider getting professional help to change your behavior. A form of psychotherapy called cognitive behavioral therapy can teach you to change your eating habits and deal with unpleasant emotions in a better way. Medication, including antidepressants and appetite suppressants, may also help. Talk with your health care provider to learn about more treatment options.

Shop Smart, Cook Smart

Shop SmartFrom the grocery aisles to your dinner table, here are some tips for reducing the amount of sodium that finds its way into your body.

Avoid processed, prepared and pre-packaged foods. Americans consume up to 75 percent of their sodium from these food sources. Examples include soups, tomato sauce, condiments, canned goods, preserved meats and prepared mixes.

Choose lower-sodium foods or low-sodium versions of your favorites. Although it may take some time for your taste buds to adjust to a lower sodium diet, there are delicious options for very flavorful, low-sodium meals. Once the adjustment to healthier dining is made, many people report they would not choose to go back to the highly processed sodium rich foods.

Read your food labels. When buying pre-packaged foods, read the labels. Many different sodium compounds are added to foods, and they are listed on food labels. Watch for the words “soda” and “sodium” and the symbol “Na” on labels, which warn you that these products contain sodium compounds. Many canned and frozen food labels help the consumer by printing “low-salt” or “low-sodium” boldly on the packaging.

Eat more fruits and vegetables. When buying canned or frozen varieties, be sure to choose the no-salt added versions, and look for the choices without added sauces.

Use fruit and raw vegetables as snacks. These are a heart-healthy alternative to chips and salted nuts.

Select unsalted nuts or seeds, dried beans, peas and lentils.

Select unsalted or low-sodium fat-free broths, bouillons or soups.

Avoid adding salt and canned vegetables with added salt to homemade dishes.

Don’t use salt during cooking. Certain salt substitutes contain a large amount of potassium and very little sodium. They are not expensive and may be used freely by most people, except those with kidney disease. Talk with your healthcare professional about whether a salt substitute is right for you.

Learn to use spices and herbs to enhance the natural flavor of food. Ditch salt for healthier, delicious salt-free seasoning alternatives. Don’t salt food before you taste it; enjoy the natural taste of food.

Take the salt shaker off the table. Adding more salt at the table adds to your daily sodium intake without adding much to the flavor of your food.

Eat less salted potato and corn chips, lunchmeat, hot dogs, salt pork, ham hocks, dill pickles and many canned foods. All of these foods have a lot of salt. SOURCE: American Heart Association

Low-Sodium Diet

Low-Sodium DietA 2,000 milligram (mg) low-sodium diet is used to treat various medical conditions including congestive heart failure, kidney disease and liver disease. People with these conditions may experience problems with fluid retention when too much sodium is consumed.

Most Americans usually consume more than 4,000 mg of sodium a day. Some of this sodium comes from salt added at the table. Commercially prepared, processed food is also a major source of sodium.

Getting Started:

Read food labels. This should be done to learn about sodium in the foods you eat. Avoid buying packaged foods with more than 200 mg of sodium per serving.

Do not use salt at the table. Instead, use herbs, spices, vinegar, and fresh lemon or lime to add flavor to foods. Try salt-free seasoning mixes such as Mrs. Dash or Salt-Free 17 at the table. Check with your doctor before using salt substitutes like “No Salt” which contain potassium chloride.

Use more fresh, non-processed foods. These foods can be flavorful and inherently have less salt.

Pack your lunch instead of eating out. If possible, limit restaurant dining to once or twice a week.

Try setting a sodium intake goal of less than 600 mg per meal. If you must eat out often or depend on processed foods regularly, sodium intake goals per meal will need to vary. Your dietitian can help.

Dining Out

When dining out, it is best to choose an owner-operated “steak and seafood” restaurant that can prepare fresh, non-processed foods.

Ask for nutrition information at your favorite fast food restaurant (or check their website). Even with careful selections, assume this meal will have at lease 1,000 to 1,200 mg of sodium. Plan other meals accordingly to avoid exceeding 2,000 mg of sodium for the day.

Ask detailed questions about how foods are prepared. Explain that it is important for your food to be prepared without added salt.

The fresh-catch broiled or grilled fish, a non-marinated steak, or a plain hamburger usually has the lowest sodium content for an entree selection.

Unsalted fries, baked sweet or white potatoes, corn on the cob, fruit and lettuce salads with vinegar and oil dressing are usually the best low-sodium side items.

A small dish of ice cream or sherbet is often the best choice for dessert.

Limit bread items, sauces, dressings, condiments and other toppings. These can be high in sodium. Ask that they be served “on the side” and use sparingly.

Low-Sodium - Food Guidelines

Food GuidelinesThe sodium amounts listed below represent a suggested maximum amount of sodium that a serving should have. It is important to note that when following these guides, it is best to keep your sodium intake well below the suggested maximum amounts. Your daily sodium intake should be less than 2,000 mg.

Grains: 6-11 servings per day

  • Breads: regular or salt-free white, wheat, or other breads and rolls - less than 140 mg per serving
  • Cereals: regular cooked and cold low sodium cereals - less than 75 mg per serving
  • Crackers and snack foods: all low sodium crackers and chips - less than 75 mg per serving
  • Pasta, rice and potatoes: all salt-free pastas, potatoes and rice - less than 35 mg per serving

Veggies: 3-5 servings per day

  • All fresh, frozen or canned salt-free vegetable products - less than 35 mg per serving

Fruits: 2-4 servings per day

  • All fresh, frozen or canned fruits and fruit juices - less than 25 mg per serving

Protein: 2-3 servings per day

  • Fresh or frozen meat, poultry, fish, low-sodium canned meat and fish, dried beans and peas, low-sodium peanut butter, eggs, unsalted nuts, low sodium soups - less than 250 mg per serving

Dairy: 2 servings per day

  • Milk, yogurt, low-sodium cottage cheese, low-sodium cheese - less than 130 mg per serving

Fats/Oils: use sparingly

  • Regular butter, margarine or mayonnaise (limited to 4 tsp./day), Unsalted butter, margarine, cooking oils or shortenings, low-sodium gravy, cream sauces and salad dressing - less than 100 mg per serving

Sweets: use sparingly

  • Sugar, honey, syrup, jam, candy - less than 35 mg per serving desserts: Cake and other baked goods within sodium allowance, sherbet, gelatin, ice cream and cooked puddings - less than 35 mg per serving

Miscellaneous: in moderation

  • Herbs, spices, low-sodium seasoning mixes, vinegar, low-sodium ketchup, regular or decaffeinated coffee and tea, Kool-Aid, most soda, low-sodium bouillon, non-dairy creamer - less than 35 mg per serving

Low-Sodium Alternatives

When choosing low-sodium alternatives it is important to follow certain guidelines. Remember to buy fresh, unprocessed foods, prepare plain grains, dress your salads lightly and pay careful attention to the sodium content of foods before purchasing.

Use These (Sodium Levels) Instead of These (Sodium Levels)
  • 1/2 cup fresh of frozen vegetables (<35)
  • 1 oz fresh cucumber slices in vinegar (1)
  • 1 oz fresh meat, poultry or fish (15-25)
  • 1/2 cup canned or frozen veggies w/sauce (140-160)
  • 1 oz bread and butter pickles (170) 1 oz canned meat, poultry or fish (90-250)
  • 1 oz processed luncheon meats (200-675)
  • 1 oz frozen meat or poultry processed and injected with broth (70-235)
  • 1/2 cup pasta, cooked without salt (<5)
  • 1/2 cup rice, cooked without salt (<5);
  • 1/2 cup macaroni and cheese (650-1200)
  • 1/2 cup Near East Pilaf (450) 1/2 cup Old El Paso spanish rice (400)
  • 1 tbsp oil and vinegar (2-6)
  • 1 tbsp plain yogurt (10)
  • 1 tbsp salad dressing (120-320)
  • 1 tbsp light or regular mayonnaise (100-120)
  • 1 cup Campbell’s low-sodium chicken broth (65)
  • 1 cup Pritikin fat free chicken broth (290)
  • 1 cup Campbell’s chicken broth, reconstituted (770)
  • 1 cup Swanson chicken broth (1000)
  • 1 cup popcorn, no salt added (trace)
  • 5 low-sodium Triscuits (75)
  • 1 cup microwave popcorn (200-450)
  • 5 regular Triscuits (290)
  • Quaker puffed wheat/rice, per serving (0)
  • 1 oz. Quaker Old-Fashioned Oatmeal (<5)
  • Salt-free bakery bread (10)
  • Most ready-to-eat cereals, per serving (100-360)
  • 1 packet Quaker Instant Oatmeal (270)
  • Most regular white and wheat bread (100-200)
  • 1 cup fresh tomatoes (16)
  • 1/2 cup no-salt-added canned tomatoes (50)
  • 1 tbsp Heinz low-sodium ketchup (3)
  • 1 cup Del Monte diced tomatoes (320)
  • 1/2 cup Prego spaghetti sauce (700)
  • 1 tbsp regular ketchup (190)
  • Swiss cheese (60)
  • Unsalted butter or margarine (Fleisehmann’s) (0)
  • Ore-Ida potato wedges (25)
  • Colby cheese (180)
  • Regular butter or margarine (90-120)
  • Ore-Ida steak fries (360)/td>


Reading Food Labels

Food LabelTo limit sodium to less than 2,000 mg per day, sources of sodium beyond what is added at the table must be identified. Understanding food labels is essential to regulating a low-sodium diet.

In this example, there are 4 servings per container.

  • The sodium in the entire container of this food item: 1,200mg
  • The sodium in one serving of this food item: 300mg

Understand these food label terms:

  • Sodium-free: 5 mg or less sodium per serving
  • Very low sodium: 35 mg or less per serving
  • Low sodium: 140 mg or less per serving
  • Reduced sodium: 25% less sodium than regular
  • Unsalted: No salt added during processing

Sample Menu


  • Oatmeal with brown sugar, raisins and cinnamon, 5mg
  • Skim milk, 120 mg
  • Orange juice, 5 mg


  • Healthy Choice deli roasted beef on Roman Meal wheat bread with lettuce, tomato and light mayo, 750 mg
  • Fruit salad, 5 mg
  • Diet soda, 35 mg


  • Chicken breast sautéed with fresh mushrooms in olive oil, garlic and 1/4 tsp. Prudhomme’s Poultry Magic Seasoning, 220 mg
  • Baked potato with margarine, light sour cream and chives, 150 mg
  • Fresh green beans with margarine, 120 mg


  • Low-sodium Ritz cracker with Alpine Lace swiss cheese and 1 tsp spicy brown mustard, 130 mg
  • Small frozen yogurt cone, 100 mg

Alternatives to Salt

Alternatives to SaltThere is a rich world of creative and flavorful alternatives to salt. Get started with this guide to spices, herbs and flavorings and the food items with which they are a particularly good flavor match. Then get creative and experiment!

Here are some seasonings to add variety:

Allspice: Lean ground meats, stews, tomatoes, peaches, applesauce, cranberry sauce, gravies, lean meat

Almond extract: Puddings, fruits

Basil: Fish, lamb, lean ground meats, stews, salads, soups, sauces, fish cocktails

Bay leaves: Lean meats, stews, poultry, soups, tomatoes

Caraway seeds: Lean meats, stews, soups, salads, breads, cabbage, asparagus, noodles

Chives: Salads, sauces, soups, lean meat dishes, vegetables

Cider vinegar: Salads, vegetables, sauces

Cinnamon: Fruits (especially apples), breads, pie crusts

Curry powder: Lean meats (especially lamb), veal, chicken, fish, tomatoes, tomato soup, mayonnaise

Dill: Fish sauces, soups, tomatoes, cabbages, carrots, cauliflower, green beans, cucumbers, potatoes, salads, macaroni, lean beef, lamb, chicken, fish

Garlic (not garlic salt): Lean meats, fish, soups, salads, vegetables, tomatoes, potatoes

Ginger: Chicken, fruits

Lemon juice: Lean meats, fish, poultry, salads, vegetables

Mace: Hot breads, apples, fruit salads, carrots, cauliflower, squash, potatoes, veal, lamb

Mustard (dry): Lean ground meats, lean meats, chicken, fish, salads, asparagus, broccoli, Brussels sprouts, cabbage, mayonnaise, sauces

Nutmeg: Fruits, pie crust, lemonade, potatoes, chicken, fish, lean meat loaf, toast, veal, pudding

Onion powder (not onion salt): Lean meats, stews, vegetables, salads, soups

Paprika: Lean meats, fish, soups, salads, sauces, vegetables

Parsley: Lean meats, fish, soups, salads, sauces, vegetables

Peppermint extract: Puddings, fruits

Pimiento: Salads, vegetables, casserole dishes

Rosemary: Chicken, veal, lean meat loaf, lean beef, lean pork, sauces, stuffings, potatoes, peas, lima beans

Sage: Lean meats, stews, biscuits, tomatoes, green beans, fish, lima beans, onions, lean pork

Savory: Salads, lean pork, lean ground meats, soups, green beans, squash, tomatoes, lima beans, peas

Thyme: Lean meats (especially veal and lean pork), sauces, soups, onions, peas, tomatoes, salads

Turmeric: Lean meats, fish, sauces, rice

SOURCE: American Heart Association

Fluid Intake

Fluid IntakeRestricing Your Fluid Intake

Fluid restriction is important in the management of heart failure. When too much fluid is taken in, the heart has to work very hard to pump the excess fluid volume which can increase your risk for heart failure and cause shortness of breath, weight gain, swelling of the feet or legs and bloating.

Your doctor may recommend that your daily intake of fluids be limited to 11/2 to 2 quarts (6 to 8 cups) per day.

Daily fluid guide

Keeping track of fluid intake:

  • Use a container large enough to hold the total amount of daily fluid your doctor has recommended. Fill the container with that much water. A standard household measuring cup is needed for exact measuring.
  • Every time fluid is consumed, measure that much water out of the container. For example, if you are drinking a 1/2 cup of milk, measure a 1/2 cup of water from the container.
  • You will have used your daily fluid allowance when the container is empty.

What do I track?

  • Count all fluids that you consume. This includes water, coffee, tea, juice, milk, soft drinks, ice cubes, etc.
  • Count the fluid in all foods that become liquid at room temperature. Examples include Jell-O, sherbet, ice cream, ice milk, fruit ice, Popsicles and frozen yogurt.

What can I do about a dry mouth?

Suck on hard, sugar-free candy, a lemon wedge, frozen orange sections, frozen grapes or chew on gum to moisten your mouth. Brushing your teeth often will also help.

Measurement Guide

1 cup = 8 ounces
4 cups= 32 ounces = 1 quart
6 cups = 48 ounces= 11/2 quarts
8 cups = 64 ounces= 2 quarts

Remember, do not exceed your recommended daily fluid allowance.