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CARDIOPULMONARY SERVICES
Table of Contents
Signs and Symptoms of Cardiovascular Disease. . . . . . . . . . . . . . . . . . . . . . . . . 3
Weight Diary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medications List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Blood Pressure and Cholesterol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Coronary Artery Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Angina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Myocardial Infarction (Heart Attack). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Heart Failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Testing your Heart.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Treatments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
CABG (Open Heart Surgery). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Heart Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Blood Pressure.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Smoking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Diabetes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Cholesterol and Triglycerides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Exercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Daily Activity Log. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Community Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
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Early treatment for a heart attack can prevent or limit damage to the heart muscle.
Signs and Symptoms of Cardiovascular Diseases
If you are experiencing any of these signs or symptoms, call 9-1-1!
Heart Attack
It’s important to remember that everyone is different,
and just because what is listed is common, it is by
no means an absolute rule. If you even think you are
having a heart attack, call 9-1-1. Remember, time lost
is heart muscle lost.
Women:
• Shortness of breath. May occur with or without
chest discomfort
• Nausea and light-headedness
• Flu-like symptoms, including chills and
cold sweats
• Heart palpitations
• Chest discomfort (angina): pain, tightness or
pressure in the center of the chest that lasts
more than a few minutes, or that goes away and
then returns
• Discomfort in other areas, including pain or
discomfort in one or both arms (especially the
left arm), the back, between the shoulder blades,
neck, jaw, teeth, or stomach
• Heartburn or indigestion
• Extreme fatigue
Men:
• Crushing, squeezing, or burning pain, pressure, or
fullness in the center of the chest that may radiate
to the neck, one or both arms, the shoulders, or
the jaw, with chest discomfort that lasts more than
a few minutes or goes away and then returns
• Shortness of breath, dizziness, nausea, chills,
sweating or weak pulse
• Cold and clammy skin, gray pallor or a severe
appearance of illness
• Fainting (rare)
Source: American Heart Association
Stroke
Learn the warning signs that someone is having a
stroke: F.A.S.T.
• FACE—Ask the person to smile. Does one side
droop? (This is caused by numbness or weakness
of the facial muscles.)
• ARMS—Ask the person to raise both arms. Does
one arm drift downward? (This is caused by
numbness or weakness of the muscles on one
side of the body.)
3
• SPEECH—Ask the person to repeat a simple sentence
(“It is sunny today.”). Are the words slurred?
Can the person repeat the sentence correctly?
• TIME—If the person shows ANY symptoms, time
is important. Call 9-1-1 immediately.
Some other symptoms of a stroke are:
• Sudden confusion, trouble speaking or trouble
understanding what others are saying
• Sudden problems seeing out of one or both eyes
• Sudden dizziness, sometimes accompanied
by a loss of balance and/or trouble walking or
weakness in the legs
• Sudden headache of unknown cause
Source: American Stroke Association
Blood Pressure and Cholesterol
High blood pressure and high cholesterol usually have
no symptoms.
Peripheral Artery Disease (PAD)
One out of three people with P.A.D. experience the
following common signs (which are typically late
warning signs):
• Claudication (fatigue, tiredness or pain in your legs
that occurs with walking and goes away with rest)
• Pain in your thighs or buttocks, which also occurs
with walking and subsides at rest
• Foot or toe pain that often disturbs your sleep
• Slow-to-heal wounds on your feet
• Changes in color or temperature of lower
extremities
If you have any of these symptoms, talk to your
clinician at your next health care visit.
DVT
Symptoms can include leg pain or tenderness in one
leg, swelling in one leg, increased warmth in one leg
and changes in skin color (the appearance of redness)
in one leg.
Signs and Symptoms of Cardiovascular Diseases continued from page 3
Diabetes
Stress
Diabetes often goes undiagnosed because many of its
symptoms seem harmless. Diabetes symptoms include:
• Frequent urination
• Unusual weight loss
• Excessive thirst
• Increased fatigue
• Extreme hunger
• Blurry vision
• Irritability
The signs and symptoms of stress overload can be
almost anything. Stress affects the mind, body and
behavior in many ways, and everyone experiences
stress differently.
Patient’s Take Home Daily Weight Diary
Name: ___________________________________________________________________________
Weigh yourself first thing in the morning after urinating, wearing the same amount of clothing, and using the same scale.
Reason: Rapid weight gain can be a sign of retaining fluid.
Date
Weight
Date
Weight
Please use the additional chart on the next page when this one is completed.
Please notify your physician if you have a sudden weight gain (3 or more pounds in one day; 5 or more pounds
in one week; or whatever amount you told to report).
If your physician has placed you on a fluid restriction, use the following guidelines:
• Count all the fluids you eat or drink.
• Items such as ice cream, jello, and soup are considered liquids.
CC or mL
Ounces
30
1
Cups
Other
2 Tbsp
120
4
½
240
8
1
½ pint
1000
33
4
1 quart
1200
40
5
1500
50
6
1800
60
7½
• Please see your teaching materials regarding dietary restrictions.
1½ quarts
4
Weight Chart
Document your weight every morning. Use the same scale and the same amount of clothing. Use the bathroom
first, then stand on the scale. Bring this to the doctor’s office for your appointment.
Date
5
Weight
Date
Weight
Medications List to Take to the Doctor
Write ALL medications you use on this list, including vitamins, herbals and over-the-counter medicines. Take this
list with you to all health care provider appointments. Cross out any medications that your health care provider
has stopped or discontinued. Do not take ANY prescription or over-the-counter medications without discussing
them with your health care provider. If you run out of a medication, check with your doctor about the need to
renew the prescription.
Medication
When to take
Why to take
Side effects/special instructions
6
Blood Pressure and Cholesterol
Blood Pressure Record
Date/Time
Numbers
Blood Pressure Record
Date/Time
Numbers
Date/Time
Numbers
Date/Time
Numbers
Cholesterol Record
Date
7
Total
HDL
LDL
Triglyceride
Let’s Talk About Coronary Artery Disease,
and Acute Coronary Syndrome
Coronary artery disease, or CAD, is a serious health
problem in which the arteries that carry blood to your
heart muscle become narrowed or blocked. This can
lead to acute coronary syndrome (ACS), angina and/
or heart attacks. (See the following sections on angina
and heart attacks, or myocardial infarction.)
What are the risk factors for CAD/ACS?
Some of the risk factors are:
• abnormal blood cholesterol/lipids;
• high blood pressure;
• smoking and other tobacco use; exposure to
second-hand smoke
• diabetes;
• being overweight;
• being physically inactive;
• poor diet
• increasing age;
• family history of heart disease;
• stress; and
• male gender.
Common signs and symptoms of CAD/ACS IN
WOMEN include:
• shortness of breath—may occur with or without
chest discomfort
• nausea and lightheadedness
• flu-like symptoms, including chills and cold sweats
• heart palpitations
• chest discomfort: pain, tightness or pressure in
the center of the chest that lasts more than a few
minutes, or that goes away and comes back
• discomfort in other areas, including pain or
discomfort in one or both arms (especially the
left arm), the back, between the shoulder blades,
neck, jaw, teeth or stomach
• heartburn or indigestion
• extreme fatigue
Coronary artery disease affects the arteries that wrap
around the surface of the heart and supply the heart
muscle with oxygen. Healthy arteries have smooth,
flexible walls that can provide the needed blood flow
to the heart. When a healthy artery becomes damaged
by smoking or high cholesterol, for example, plaque
(a fatty material made up of cholesterol or other
particles) builds up on the artery wall. The buildup
makes the artery narrower and less flexible, so that
the needed blood cannot get through.
Common signs and symptoms of CAD/ACS
IN MEN include:
• crushing, squeezing or burning pain, pressure, or
fullness in the center of the chest that may radiate
to the neck, one or both arms, the shoulders, or
the jaw, with chest discomfort that lasts more than
a few minutes or can go away and return
• shortness of breath, dizziness, nausea, chills,
sweating or weak pulse
• cold and clammy skin, gray pallor, or a severe
appearance of illness
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What tests are done for CAD/ACS?
What medicines are available for CAD/ACS?
You may have one or more of the following tests:
You may need one or more of the following medicines:
12-lead ECG: This test, also called an EKG, helps
caregivers look for damage or problems in different
areas of the heart.
ACE inhibitors: These are medicines that keep your
blood vessels relaxed and open.
Blood tests: Your doctor will order blood tests to look
for signs of damage to your heart muscle. These tests
will be done more than once.
Cardiac catheterization: This is a test to see if there is
any blockage in your heart arteries.
Echocardiogram: This test is also called an echo. It
is a type of ultrasound, using sound waves to show
pictures of the size and shape of your heart. An echo
also looks at how your heart moves when it is beating.
Exercise stress test: A stress test helps caregivers see the
changes that take place in your heart during exercise.
Stress test with medicine: If you cannot walk or
exercise, you may be given medicine that causes your
heart to work harder.
Coronary CT angiography: This test is a non-invasive
way to detect blockage in coronary arteries through
the use of a CT scanner.
How are acute coronary syndromes treated?
You may have one or more of the following treatments
depending on what your tests show.
Angioplasty: Angioplasty is a treatment that may be
needed to open up an artery (blood vessel) blocked by
plaque by inflating a balloon against the wall of the artery.
Coronary intravascular stent placement: A stent is
a hollow tube made of wire mesh that is put into a
coronary artery to keep the artery open.
Coronary artery bypass surgery: Coronary artery
bypass surgery (CABG) is open-heart surgery. A graft
taken from a blood vessel in another part of your body
is used to bypass a blocked vessel in the heart to
reconnect blood flow to your heart muscle.
Cardiac rehabilitation: Cardiac rehabilitation
is a comprehensive program which includes
information about cardiac disease, medicines, and
lifestyle changes. It also focuses on establishing a
personal exercise program which may be done in a
rehabilitation center or at home.
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Anticoagulants: This medicine helps keep the blood
from clotting and closing partly blocked arteries.
Antiplatelet medicines: Anti-platelet medicines, such
as aspirin, keep platelets from sticking to a damaged
part of your artery.
Beta-blockers: Beta-blockers help reduce the workload
on your heart by decreasing the rate and and force of
heart contractions, and reducing blood pressure.
Blood pressure medicine: This medicine may be given
to lower your blood pressure.
Diabetes medicine: If you are diabetic, medicine may
be given to control the amount of glucose in your
blood. It helps your body move the glucose from the
blood to your cells, where it is needed for energy.
Diuretics: These are medications that increase
urination, helping to prevent fluids building up in
the body.
Lipid lowering medicines: These medicines may
help to lower cholesterol and triglycerides that cause
coronary (heart) artery disease.
Nitroglycerin/Nitrates: This medicine opens the
arteries to your heart so the heart gets more oxygen.
Let’s Talk About Angina
Angina is the chest pain or discomfort that occurs
when your heart doesn’t get as much blood and
oxygen as it needs. Over time, the coronary arteries
that supply blood to your heart can become clogged
from a buildup of fats, cholesterol and other
substances. This buildup is called plaque. If one
or more arteries are partly clogged, not enough
blood can flow through, and you feel chest pain or
discomfort.
Angina is common. More than 6 million people in the
United States have it. And while angina may not cause
long-term heart damage, it’s a sign of heart disease.
What does angina feel like?
Angina usually only lasts just a few minutes. Some
people say that:
• their chest feels tight or heavy;
• they feel pressure, squeezing or burning in chest;
• they feel discomfort that may spread to the arm,
back, neck, jaw or stomach;
• they experience numbness or tingling in
shoulders, arms or wrists;
• they feel short of breath; or
• they feel sick to the stomach, or have indigestion
or heartburn.
What can I do about angina?
Don’t give in to it! You can change your way of life and
lower your chance of having angina attacks.
A few simple steps can help you feel more
comfortable every day:
• Stop smoking, and avoid other people’s
tobacco smoke.
• Eat healthy meals low in saturated fat, cholesterol
and salt.
• Control high blood pressure and blood
cholesterol/lipid levels.
• Avoid extreme temperatures.
• Avoid strenuous activities.
• Learn to relax and manage stress.
• Call your doctor if your angina changes. For ex
ample, if you get angina while resting, or if it ever
gets worse.
When will I get angina?
You may get angina when you:
• climb stairs or carry groceries;
• feel angry or upset;
• work in very hot or cold weather;
• have sex;
• have emotional stress; or
• exercise.
How is angina treated?
Your doctor may give you nitroglycerin, a medicine
to relieve the discomfort. Nitroglycerin comes as tiny
tablets or spray you put under your tongue. It also
comes in capsules, skin patches or ointments. It is
safe and not habit-forming.
Be sure to ask your doctor, nurse or pharmacist about
what to do if you get angina, and how to use your ???
If you are having chest pain, sit down and take
nitroglycerin as instructed by your health care provider.
10
Let’s Talk About Myocardial Infarction
(Heart Attack)
What is a myocardial infarction?
Sometimes one or more of the coronary arteries
become too narrowed, completely blocked, or spasm
(tighten). This causes part of the heart muscle to not
get enough oxygen-rich blood that it needs to do its
work. If the muscle goes too long without oxygen, it
starts to die. This is called a myocardial (meye-ohKAR-dee-al) infarction (in-FARK-shun), which is also
called an MI or a heart attack.
Spasm: Sometimes a coronary artery can spasm
(suddenly tighten) and cause blood flow to be cut
off to part of the heart muscle. Most people with
coronary artery spasms have fatty deposits as well.
It is not known what causes most coronary artery
spasms. Some things are known to cause coronary
artery spasms, such as cocaine use.
Other causes: Other conditions, such as certain heart
valve problems, can cause blood clots that may lead
to an MI. Sudden and severe (very bad) stress can
trigger a heart attack as well. Talk to your caregiver if
you have questions about what caused your MI.
Why do some people have heart disease and others
do not?
What is the difference between angina and a
myocardial infarction?
Angina is chest pain, tightness, or discomfort that
comes and goes. It is your heart muscle’s way of
telling you that it is not getting enough oxygen.
Angina can be relieved (helped) with rest, oxygen,
or special medicine. Angina does not cause the heart
muscle to die, like an MI does. However, angina can be
a warning sign that you may be at risk for an MI.
What causes a myocardial infarction?
Blockage: The most common cause of an MI is fatty
deposits (plaque) inside one or more of the coronary
arteries. The disease that causes fatty deposits to
narrow arteries in your heart and elsewhere in the
body is called atherosclerosis. Atherosclerosis is also
called “hardening of the arteries.” The fatty deposits
may cause your blood vessels to become too narrow,
which can cause an MI. However, most MIs happen
when a blood clot forms on the rough fatty deposits in
a coronary artery, blocking it even more.
11
Certain things can increase your chance of having
atherosclerosis and heart disease. You are able to
change some of these risk factors. You are not able to
change other risk factors. These factors may cause a
greater risk of heart disease and having an MI:
• a family history of heart problems;
• atherosclerosis in other areas of the body
(For example, you may have poor circulation
[blood flow] in your legs, or carotid [neck] artery
disease. You may have had a stroke in the past.);
• being overweight;
• being a female who smokes and takes birth
control pills;
• being a female who has gone through menopause;
• cocaine use;
• diabetes;
• high blood pressure;
• high blood cholesterol/lipids or having too much
fat in your diet;
• lack of exercise;
• being male;
• older age (over 55);
• smoking now or in the past, or being exposed to
cigarette smoke regularly; and
• stress.
What are the signs and symptoms of a
myocardial infarction?
The signs and symptoms of an MI may start slowly,
or they may happen suddenly. The most common
sign of an MI is chest pain, tightness, or pressure.
The discomfort may feel crushing, tight, or heavy. The
discomfort may range from mild to severe (very bad).
It may spread to the neck, jaw, shoulders, back, or left
arm. You may feel like you are having indigestion or
burning under the breast bone in your upper chest.
Other signs may include sweating, nausea (feeling
sick to your stomach), vomiting (throwing up), or
trouble breathing. Your skin may be pale, cool, or
“clammy”. You may feel lightheaded or weak.
Some people may not have typical chest pain
or pressure. Those most likely to have unusual
symptoms when having an MI are women, and people
who have diabetes. Their discomfort may be in an
unusual place, such as the right arm or lower back.
Sometimes symptoms like sweating, shortness of
breath, dizziness, or nausea may be the only sign of a
problem. Some people who are having an MI have no
obvious symptoms at all. This is called a “silent” MI.
A common problem with some people having an MI
is not recognizing the symptoms. This is when the
person does not admit to themselves or others that
they are having symptoms of an MI. Unfortunately,
this may cause the person to put off seeking medical
help. This delay in treatment can be dangerous, even
life-threatening.
What should I do if I think I may be having a
myocardial infarction?
Call 9-1-1 or 0 for an ambulance at the first signs of
an MI. In most areas, you can receive life-saving care
much earlier by calling an ambulance to take you
to the hospital. Most ambulances carry medicines,
oxygen, and other equipment so that your treatment
can start right away. Quick treatment of an MI can
save your life. Every minute you wait to be treated
may cause an increase in permanent (life-long)
damage to your heart. Never try to drive yourself
to the hospital if you think you are having a heart
problem. People having heart problems may pass out
(faint) without warning, making it dangerous to drive.
How is a myocardial infarction diagnosed?
Sometimes it is hard to tell the difference between
an MI and other causes of chest discomfort. You will
need to be seen by a health care provider for tests
to know for sure if you are having an MI or not. Your
caregiver will review your medical history and the
symptoms you are having. A test called an ECG may
be done to look for problems or damage in different
areas of the heart. Your caregiver may do tests on
your blood to get important information about your
health. You may need a chest x-ray to check your
heart and your lungs. You may also need an ultrasound of your heart called an echocardiogram.
You may need a more detailed test called a cardiac
catheterization, or “heart cath.” This procedure uses
dye and a special x-ray to check the blood flow in
your coronary arteries. A heart cath can help your
caregiver decide how your heart problem should be
treated. Sometimes blockages in the coronary arteries
can be treated during a heart catheterization.
How is a myocardial infarction treated?
• CPR: CPR is when caregivers or a speciallytrained bystander gives you breaths and chest
compressions. This may help your body get
oxygen and some blood flow.
• Emergency treatment: You may develop
arrhythmias (ah-RITH-mee-ahs), or irregular
heartbeats. You will be hooked up to a heart
monitor so that caregivers can watch for
arrhythmias. Emergency arrhythmia treatment
may include CPR defibrillation. This procedure
uses an electric shock that is given to the heart
through paddles or sticky patches placed on your
chest or back. The shock may help your heart
return to a normal beat.
• Medicines and oxygen: You may need extra
oxygen until your heart is getting better blood
flow. You will be given aspirin, unless you have a
contraindication or already took an aspirin before
you arrived at the hospital. You will be given
other medications to treat your heart attack.
Tell your caregiver about all medicines that
you use because it is dangerous to use certain
medicines together.
• Angioplasty, coronary stents or other cardiac
catheterization lab procedures: These may be
needed to help increase the blood flow quickly.
• Coronary artery bypass graft (CABG) surgery:
If your coronary artery disease is significant,
surgery may be recommended.
• Control of risk factors: Risk factors may include
high blood pressure, high cholesterol/lipids,
diabetes, being overweight and smoking. If
you have any of these medical conditions, ask
caregivers for help to control them. Smoking can
further damage your heart, as well as your blood
and lungs. With time, this can cause a stroke or
another MI. It is very important to stop smoking.
12
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Let’s Talk About Heart Failure
• weakness or tiredness with little effort;
• problems breathing when lying flat, or the need to
sleep in a recliner or propped on many pillows;
• waking up at night coughing or short of breath;
• rapid weight gain;
• swelling in the abdomen, ankles or feet;
• confusion or trouble concentrating;
• a racing or skipping heart; or
• dizziness or fainting.
You may have many of these symptoms, or only a few.
When the heart can’t pump enough blood, certain
body chemicals (hormones) are sent to make the
heart work harder. Some of these make the heart grow
larger. Others make it pump faster. This will help at
first, but the heart can’t keep up with these demands.
Over time, the extra work causes more damage.
13
Heart failure can be treated with medicine and
lifestyle changes. Your health care provider will
develop a treatment plan for you to relieve some of
you symptoms and help make you more comfortable.
Heart failure symptoms may sometimes become so
severe that you need to go to the hospital for a few
days. You may be able to prevent trips to the hospital
by keeping your symptoms under control and taking
an active role in your care.
How can I take care of myself at home?
• Take your medicines as directed by your
health provider.
• Control your hypertension or diabetes as directed
by your health care provider.
• Eat low salt and low fat foods.
• Monitor your weight daily.
• Avoid or limit drinks that contain alcohol.
• Rest when you need it.
• Exercise if your health care provider says to.
• Quit smoking/use of illicit substances.
• Avoid or limit drinks and foods that contain caffeine.
• Stay indoors if the weather is either very hot or
very cold.
• Talk to your health care provider if you have any
questions, or are worried about your medicine
or care.
• You should always be aware of any changes in
your body. Your health care provider needs to
know if your symptoms are not under control. He
or she may need to change your treatments or
medications if your symptoms ger worse or you
develop new symptoms. Evaluate yourself daily
by following the zone chart (next page). You may
consider hanging in on the refrigerator or another
location that you visit daily.
Heart Failure Zones
Which Heart Failure Zone are you today?
Green, Yellow or Red?
Green Zone
All Clear—This zone is your goal.
Your symptoms are under control. You have:
• No shortness of breath.
• No weight gain more than 2 pounds (or what
you were told to report).
• No swelling of your feet, ankles, legs or
stomach.
• No chest pain.
Yellow Zone
Caution—This zone is a warning.
Call your doctor’s office if:
• You have a weight gain of 3 lbs. in 1 day or a
weight gain of 5 lbs. or more in a week.
• More shortness of breath.
• More swelling of your feet, ankles, legs or
stomach.
• Feeling more tired. No energy.
• Dry hacky cough.
• Dizziness.
• Feeling uneasy, you know something is
not right.
• It is harder for you to breath when lying
down. You are needing to sleep sitting up
in a chair.
Red Zone
Emergency—Go to the emergency room or call
9-1-1 if you have any of the following:
• Struggling to breathe. Unrelieved shortness
of breath while sitting still.
• Have chest pain.
• Have confusion or can’t think clearly.
14
Let’s Talk About Testing Your Heart
There are several different kinds of tests to help
your doctor find out how well your heart is working.
Before doing any testing, you should tell your doctor
about any medications you take, including herbs,
supplements and over-the-counter medicines. Women
need to let the doctor know if you may be pregnant.
He or she also needs to know if you are allergic to any
medications, iodine or shellfish.
The heart also produces electrical patterns. These can
be recorded by an electrocardiogram (also called an
ECG or EKG). A monitor is attached to your arms, legs
and chest with wires. This can be done while you are
sitting or lying down to show the resting electrical
activity. A stress ECG is done while you are walking
on a treadmill to find out how your heart works
during exercise.
Imaging tests
Cardiac catheterization is done to find or treat
blockages in the coronary arteries. Angiography
is done during cardiac catheterization to show the
doctor detailed pictures of any blockages. You will go
to a special catheterization lab for these procedures.
You will be awake, but will be given a sedative to keep
you comfortable. The doctor will insert a flexible tube,
or catheter, into the arteries to the heart. He or she will
then put an X-ray dye into the arteries and take X-rays,
called angiograms, to see exactly where blockages
have occurred. X-ray cameras and monitors are in
the room so that the doctor can see exactly what is
happening. You will probably be able to go home
within a few hours of angiography if no significant
disease is found.
These tests use pictures to show the doctor how well
your heart is working. Sometimes, you will be asked
to exercise before the imaging so that the doctor can
see how the heart works when it is under stress. The
technician may also give you medicine to make your
heart work harder.
An echocardiogram uses sound waves to produce
pictures of the heart. You will lie on a table and the
technician will use a small hand-held scanner to
record the pictures.
Nuclear imaging is done with a small amount of weak
radioactive material given by an injection. The blood flow
is then visible through the heart with a scanning camera.
15
Talk About Treatments
ing the angiograms, the doctor may decide
You may need to stay in the hospital overnight after
Let’s Talk About
Treatments
Let’s
Talk
About
Treatments
need a treatment
such Talk
as angioplasty
orTreatments
a
angioplasty or stenting. The sheath that was used to
Let’s
About
After seeing the angiograms, the doctor may decide
You may need to stay in the hospital overnight after
mprove the blood
or shethatmay
decide
insert
catheter
will
removed.
You will
you
a treatment
such asthe
angioplasty
or ato
Afterflow.
seeing He
the angiograms,
the need
doctor
may decide
stenting.
Theneed
sheath to
that was used to
You
may need
stay be
inangioplasty
the
hospitalorovernight
after
Coronary artery bypass surgery graft is usually done
After seeing the angiograms, the doctor may decide
stent
toangioplasty
improve
the blood
Heangioplasty
or
she mayone
decide
that you
need a after
treatment
such
as
angioplasty
orlie
a flow.
insert
the
will
removed.
You
will need to
or
stenting.
The
sheath
that was
used
tomonie of these
right
the
angiogradown
quietly
for
a few
hours.
You
will
be
because
or
more
of
thecatheter
arteries
inbe
your
heart
are
thatprocedures
you need
a treatment
such
as
or
to do
oneHe
of or
these
after the
stent to improve the blood
flow.
sheprocedures
may deciderightinsert
lie removed.
down quietly
for aneed
few hours.
You will be monithe angiogracatheter will be
You will
to
blocked. You may hear this surgery referred to as
a stent to improve the blood flow. He or she may
le you are
still indothe
caththese
lab. procedures
He or she right
may after the
tored closely
to she
bemay
sure that“cabbage”)
everything
is normal.surgery.
orbe
open-heart
decide to to
phy, while
still
in the cath lab.
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doone
oneof
of these procedures
rightyou
afterarethe
angiogratored
closely
be
sure
that everything is normal.
lieCABG
down
quietly
for a few
hours.
Youtowill
moniParts
of
your
heart
do
not
get
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bloodafter
if an
angiography,
while
you
are
still
in
the
cath
lab.
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or
at coronary artery
isthethe
much
afterfeelthese
procedures,
think
thatbest
coronary
bypasspeople
surgery
isfeel
the to
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phy,bypass
while yousurgery
are still in
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lab. He orartery
sheMany
may
Many
people
better
these procedures,
tored closely
be sure better
that
everything
is much
normal.
she may think that coronary artery bypass surgery
artery is blocked. An artery is a blood vessel (tube)
option.
Iffor
so,
that
will
be
scheduled
thinklikely
that coronary
artery
bypass
surgery
is themost
bestlikely
and
their
symptoms
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peoplefor
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procedures,
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and
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that
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likely
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time. be scheduled for a
option. If so, that will most
You will
be able
tobypass
goquickly.
homethe
when
your condition is
and
their symptoms
heart
disease
goto
away
During
surgery, of
a graft
is used
blocked
scheduled for a later time.
You
will
be
able
to
go
home
when
your
condition
is
later time.
stable.
You
will be
able
to go home
whenflow
your to
condition
is
vessel
to
reconnect
blood
your heart
muscle.
Balloon
angioBalloon angioplasty is a
The graft
is a piece of a blood vessel from somewhere
stable. stable.
plasty
is a proceBalloon angioBalloon angioprocedure in which a very
else in your body.
dure in which a
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plasty is a procevery small balloon
dure in which a
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a small balloon is inserted through
to the place where the dure in which very
artery is blocked. It is
the catheter to the
is inserted through
very small balloon
inflated and presses the
place where the
the catheter to the
plaque against the artery
is inserted through
artery is blocked.
place where the
walls to open the artery,
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the catheter toartery
the is blocked.
then deflated and removed.
presses the plaque
againstand
the artery walls to open the
It is inflated
where
the
A stent may be neededplace
to help
keep
the
artery
open.
artery,
then deflated
presses the plaque against
the artery
walls to and
openremoved.
the
A stent is a tiny wire mesh tube. It is collapsed and put
artery
blocked.
artery, then deflated
andAis
removed.
stentatmay
needed to help
onto a balloon. When it is in place
thebeblockage,
the keep the artery open.
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tobe
open
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then
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stent
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stent may
needed
to
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the
artery
open.
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isup
inflated
and removed,
leaving
the
stent
in
the
artery
to
hold
onto It
a balloon.
When
A stent is a tiny wire mesh
tube.
is collapsed
andit is in place at the blockhe plaque
against
the artery
wallsisput
to
open
the
it open.
Another
angiogram
then
taken
to
see
if the
Coronary artery bypass surgery graft is usually
age,it the
inflated
to open up the stent, then
put onto a balloon. When
is inballoon
place atisthe
blockstent
is
holding
the
blockage
open
and
restored
the
done
because
oneisorusually
more of the arteries in your heart
Coronary
surgery
graft
hen deflated andage,
removed.
deflated
andupremoved,
leaving
in theartery
artery bypass
the balloon is inflated
to open
the stent,
then the stent
blood flow.
are
blocked.
You
may
hear
this surgery referred to as
done because one or more of the arteries in your
heart
to holdthe
it open.
deflated and removed, leaving
stent in the artery
may be You
needed
help keep
the artery
open.
CABG
“cabbage”)
are blocked. You may hear
this (pronounced
surgery referred
to as or open-heart surmay to
need
Another angiogram
to holdtoit stay
open.in
hospital
overnight
gery. Parts
your heartsurdo not get enough blood if
CABG (pronounced “cabbage”)
orof
open-heart
s a tinythe
wire
mesh
tube.
It is collapsed
and to see
is then taken
Another
angiogram
after angioplasty or
is blocked.
An artery
gery. Parts of your heartan
doartery
not get
enough blood
if is a blood vessel (tube)
the stent is holding
is thenistaken
to see atifthe
a balloon.
When
in place
blockstenting.
Theitsheath
that
carries
blood vessel
with oxygen
an artery is blocked. Anthat
artery
is a blood
(tube) through your body.
stent the
is holding the blockage open
used iftothe
insert
Coronary
artery
bypass
surgery
graft
is
usually
balloonwas
is
inflated
to
open
up
the
stent,
then
Duringthrough
surgery, your
a graft
is used to bypass the blocked
that carries blood with oxygen
body.
and restored the
the blockage
open
catheter will
be removed.
vessel
totoreconnect
your heart muscle.
During surgery,
graft is
used
bypass
theblood
blocked
done because
one ora more
of the
arteries
in flow
yourto heart
You will leaving
need
to lie
and restored
the
and removed,
thedown
stent inblood
theflow.
artery
graft
is a piece
a blood vessel from somewhere
vessel to reconnect bloodThe
to your
heartofmuscle.
quietly forblood
a few
hours. You will be monitored closely
flow.
You may hearflow
this
surgery
referred
to as
t open. to be sure that everything is normal. Many peopleare blocked.
in vessel
your body.
The graft is a piece of a else
blood
from somewhere
feel much better after these procedures, and their
CABG else
(pronounced
in your body. “cabbage”) or open-heart surangiogram
symptoms of heart disease go away quickly. You will
aken tobe
seeable to go home when your condition is stable.gery. Parts of your heart do not get enough blood if
e.
nt is holding
kage open
ored the
ow.
an artery is blocked. An artery is a blood vessel (tube)
that carries blood with oxygen through your body.
2
During surgery, a graft is used to bypass the blocked
vessel to reconnect blood flow to your heart muscle.
The graft is a piece of a blood vessel from somewhere
else in your body.
16
Let’s Talk About Coronary Artery Bypass Graft,
or Open Heart Surgery
Before your surgery
After surgery
Surgery may take place very soon after your tests. If
time permits, you will meet with your doctor a few
days before. He or she will tell you how to prepare.
It’s okay to be nervous. Don’t be afraid to share your
feelings with your doctor, family and friends. Doing so
can help you get ready emotionally.
You are taken to the recovery room or an intensive
care unit (ICU) where health care providers will watch
you very closely. A protective cover will be over your
incision. You will have several tubes in place and they
may make it hard for you to move. All of these tubes
are important to help caregivers watch you closely for
any problems. You may have:
Before surgery, your blood and urine may be tested
• a line in your wrist and chest to monitor blood
cines for general anesthesia. This will put you comBeforethe
your
surgery You may
for problems that could affect
surgery.
pressure and other pressures in your heart;
pletely to sleep.
also have a chest x-ray. An
anesthesiologist
may
Surgery
may take place very
soontalk
after your tests.
• Ifan IV to provide medications and fluid;
to you before your surgery.
This
is
the
caregiver
who
After
surgery
time permits, you will meet with your doctor a few
• drainage
tubes
to drain fluid from your chest;
gives you medicine before
and
during
surgery
so
that
• a catheter
totaken
drain
days before. He or she will tell you how to prepare.
You are
to
you do not feel or remember the surgery.
urine; the
or recovery room
It’s okay to be nervous. Don’t be afraid to share your
• an intraaortic balloon
feelings with
youryou
doctor,
family and friends. Doing
Bring your personal belongings
with
to the
or an intensive care
pump
to take over
so
can
help
you
get
ready
emotionally.
hospital. These include your bathrobe, tooth brush,
unit (ICU) where
of the heart’s
denture cup (if needed), Before
hair brush,
and blood
slippers.
Do may be testedsome
healthcare providers
surgery, your
and urine
for
pumping
function
not wear any jewelry or bring
money
or affect
important
will watch you very
problems
that could
the surgery. You may also
(if
needed).
This lets
personal papers to the hospital. Do not wear contact
closely.
A protective
have a chest x-ray. An anesthesiologist may talk to the
you heart
relax
and
lenses the day of surgery. You may wear your glasses.
cover
will
be
before your surgery. This is the caregiver who givesrecover.
You willover
your
incision. You
you medicine
before
and during
surgery so that youlikely be sedated
until
Try to get a full night’s sleep
the night
before
surgery.
have several
this is will
removed.
do not
feel midnight,
or remember not
the surgery.
Don’t eat or drink anything
after
even
tubes in place and
water. Shower the night Bring
before
the morning
of you to the hospiyourand
personal
belongings with
Managing
pain
they
may make it
surgery. You may be asked
to use
special
tal. These
include
your soap.
bathrobe, tooth brush,You’ll
denturereceive medication to control pain. People
hard for you to move. All of these tubes are important
(if needed),
hair brush,
and slippers. Do not
wear faster from surgery if pain is kept under
recover
After you are checked incup
at the
hospital,
hair from
to help caregivers watch you closely for any problems.
any
jewelry
or
bring
money
or
important
personal
control. So be honest about how much pain you feel.
your chest or other incision sites will be clipped if
You may have:
papers to the through
hospital. Doan
notIVwear
contact lenses
Andthe
don’t be afraid to ask for pain medication if you
needed. You’ll receive medication
that
• a line in your wrist and chest to monitor blood presdayhelp
of surgery.
You mayLines
wear your
will make you groggy and
you relax.
willglasses.
be
need it. Tell your nurse if the medications don’t reduce
suresuddenly
and other pressures
in your heart;
connected to your finger,Try
wrist,
These
or if you
feel worse.
to getarm
a full and
night’schest.
sleep the
night before pain
surgery.
• an IV to provide medications and fluid;
are attached to machines that monitor your oxygen
Don’t eat or drink anything after midnight, not even
Preventing
lung problems
• drainage
tubes to drain fluid from your chest;
levels, heart rate, blood pressure and pressures in
water. Shower the night before and the morning
of the breathing tube has been removed, a
After
• a catheter to drain urine; or
your veins. You’ll also have a tube to help you breathe.
surgery. You may be asked to use special soap.respiratory therapist or nurse will help you with deep
• an intraaortic balloon pump to take over some
When it’s time for surgery,
you
be given
breathing and
coughing
exercises.
help
prevent
After
youwill
are checked
in at the hospital, hair from
of the
heart’s pumping
functionThese
(if needed).
This
medicines for general anesthesia.
This
will
put
you
pneumonia.
Your
healing
breastbone
incision
may
your chest or other incision sites will be clipped if
lets the heart relax and recover. You will likely be
completely to sleep.
breathing and coughing painful. Still, it’s
needed. You’ll receive medication through an make
IV thatdeep sedated
until this is removed.
very
will make you groggy and help you relax. Lines
will important to do the exercises. You’ll be taught
how to doManaging
them in apain
way that lessens the pain.
Let’s Talk About Coronary Artery Bypass
Graft, or Open Heart Surgery
be connected to your finger, wrist, arm and chest.
You’ll receive medication to control pain. People reThese are attached to machines that monitor Reducing
your
swelling
from surgery
if pain
is kept under
control. if
oxygen levels, heart rate, blood pressure and presYour legs cover
mayfaster
be swollen
after
surgery,
especially
So
be
honest
about
how
much
pain
you
feel.
And
sures in your veins. You’ll also have a tube to help
you were taken from them. Raising the foot of your
grafts
don’treduce
be afraidswelling.
to ask for pain
medication
if youhelp
need with
breathe.
bed can help
Your
nurse will
it.
Tell
your
nurse
if
the
medications
don’t
reduce
pain
this. You may also be taught to do exercises in bed.
When it’s time for surgery, you will be given medior if you suddenly feel worse.
• Start with your toes pointed. Flex your foot at the
1
ankle and count to 5. Then relax.
• Repeat 10 times with each foot.
17
Getting out of bed
A health care provider will help you out of bed, maybe
within the same day of surgery. Moving around
improves circulation and helps prevent blood clots
and pneumonia. You may sit on the edge of the bed
with your legs dangling over, or have help getting into
a chair. When you’re well enough, a staff member will
help you walk. Keep in mind that being active, even this
soon after surgery, helps move your recovery along.
Protecting your breastbone
Your breastbone was divided to reach the heart
during surgery. The bone will take six to eight weeks
to heal. While in the hospital and then at home, you
need to take special care of your breastbone. This
will reduce pain and aid healing. Avoid motions that
strain your arms or chest. This means no pushing,
pulling or lifting heavy objects. Also, avoid reaching
behind you or high above your head. You’ll be shown
ways to move to protect your breastbone, such as the
following method for standing.
• Scoot to the very front edge of the chair.
• Rock yourself onto the balls of your feet. Slowly
rise to a standing position.
• Use the same method to get out of bed. Don’t
push your arms against the mattress.
It’s ok to use your arms for balance, but don’t use
them to push!
After you leave the hospital
• Watch for bleeding from your gums or nose, or in
your urine or bowel movements.
• Use a soft toothbrush to brush your teeth. Doing
this can keep your skin and gums from bleeding.
• Tell your dentist and other caregivers before
dental cleanings or other procedures that you take
blood thinning medicine.
• If you shave, use an electric shaver.
• Do not play contact sports since you may bleed or
bruise easier.
• If you are taking medicine that makes you drowsy,
do not drive or use heavy equipment.
You will have a follow-up visit with your surgeon.
Write down questions you have about your CABG
or valve surgery. This way you will remember to ask
these questions during your next visit.
You may have one or more of the following problems
after surgery. Most of these side effects disappear
over 4 to 6 weeks, but it may take several months for
you to completely recover. Tell your caregivers if you
are having:
• constipation;
• fatigue;
• loss of appetite;
• mild disorientation;
• mood swings and feeling depressed;
• muscle pain or tightness in the shoulders and
upper back;
• short-term memory loss;
• sleeping problems;
• swelling in the area where the piece of blood
vessel was removed; or
• trouble concentrating.
Other ways to take care of yourself
• Do not take a bath or go swimming until the
incision is healed (no scab). Until then, shower
and carefully wash the stitches/staples with soap
and water. Caregivers may want you to leave the
incision open to air.
• Stay away from people who have an infection
such as colds. Also try to stay away from large
groups of people. This decreases your chance
of getting sick. The medicines and treatments
you are getting can decrease your ability to fight
infection. You may need to get shots to avoid
getting the flu and pneumonia.
• Some people have a poor appetite after heart
surgery. Try eating small meals 5 to 6 times each
day. This will help you get enough calories and
energy so that you can heal better.
• Drink six to eight cups of healthy liquids each day.
Follow your caregiver’s advice if you must change
the amount of liquid you drink. For most people,
healthy liquids to drink are water, juices, and milk.
Limit the amount of caffeine in your diet. Caffeine
may make you urinate too much and lose too
much body fluid. Caffeine also may increase blood
pressure and heart rate. Caffeine may be found in
coffee, tea, soda pop, sports drinks, and foods. Try
to drink enough liquid each day, and not just when
you feel thirsty.
• Do not cross your ankles or legs for long periods
of time. This can cause circulation problems.
• Try to stand and walk every 1 to 2 hours when you
travel and are sitting for a long time.
• Do not wear tight garters or girdles. Do not wear
pants that are too tight.
• Do not put ice or heat over your surgery area
without first talking with your caregiver.
18
• You may have shoulder and neck pain after
surgery. You may put a heating pad (turned
on low) or a hot water bottle on your neck or
shoulders. Heat brings blood to the area and helps
it feel better. Do this for 15 to 20 minutes out of
every hour as long as you need it. Do not sleep on
the heating pad or hot water bottle.
• You may feel like resting more after surgery.
Slowly start to do more each day. Rest when
you feel it is needed. Do not take more than 1 or
2 short naps during the day. This may help you
sleep better at night.
• Avoid straining or bending over with your
head down.
• You may have sex when you are able to walk up
two flights of stairs without shortness of breath or
pain. Stop if it causes pain. Do not have sex after
a heavy meal or if you are tired. Do not bear any
weight on your upper chest or arms. Talk to your
caregiver if you have questions or concerns.
• Your ankles may swell at different times during
the day. Try not to sit in one position for more than
one hour. To decrease swelling, put your legs up
on pillows so that your feet are higher than your
heart. Do this for 15 to 20 minutes 3 to 4 times a
day. Walking also helps decrease ankle swelling.
• Some people have frightening dreams and have
trouble sleeping after heart surgery. Use two
to three pillows under your back and head if
you have trouble lying flat in bed. Taking pain
medicine before going to bed may help you sleep
through the night. If you wake during the night
and cannot get back to sleep, get out of bed. Read
a soothing book or watch some relaxing TV for a
short time.
• Weigh yourself daily before breakfast. Weight gain
can be a sign of extra fluid in your lungs or body.
Call your caregiver if you have gained two to three
pounds in a day.
Proper Stair Techniques After Surgery
• One step at a time.
• DO NOT use your arms to pull up on the railing of
stairway.
• Lead up with your “good” leg and down with
your operative leg. The leg without incision is
considered your “good” leg. If you have incisions
on both legs, use your strongest leg.
• Pause on each step, up and down. A good
suggestion is to count to 3000 by thousands,
saying to yourself 1000—2000—3000.
• Explanation: It requires more oxygen or work for
your heart to do stairs. It’s important to give time
for your heart to heal.
• We encourage you not to do more than four stairs
for the first two weeks.
19
Signs and Symptoms to Report to Surgeon’s Office
Call your surgeon if you:
• have any shortness of breath or dizziness or chest
pain like you had before surgery;
• have chills, sweating, or fever greater than 101
degrees, coughing up anything other than white or
clear sputum;
• have nausea, vomiting, or loss of appetite lasting
more than 24 hours;
• feel very tired for more than two to three days;
• experience a fast heart rate over 120 beats per
minute or slow heart rate less than 60 beats per
minute;
• experience skipping or irregular heart beats;
• notice swelling that stays in the legs, extreme calf
pain, or tenderness in the legs;
• see new drainage from incisions, especially the
chest, or lots of movement of the chest;
• have drainage that changes to green, yellow
or brown;
• have an increase in leg swelling that is
uncomfortable, or comes with shortness of breath;
• bruise or start bleeding for no reason, or have
bleeding that is not stopped with holding pressure
for 10 minutes;
• gain two to three pounds in one day, or five to six
pounds in one week;
• are unable to sleep for two to four hours at a time;
• notice redness or swelling in the skin around your
incision, or pus coming from the incision; or
• have trouble breathing or have itchy, swollen skin
or a rash, which may mean you are allergic to
your medicine.
Do’s and Don’ts
Do:
• Do take a shower or sponge bath daily.
• Do use two washcloths to bathe. One for the
incision and the other for the rest of the body
• Do use mild liquid soap from a pump dispenser
to bathe.
• Do pat your incision dry with a clean towel.
• Do keep the incision without a dressing if there is
no drainage.
• If the incision is draining or your clothing irritates
the incision, put a dressing on the area and
change the dressing every day.
• Do look at the incisions every day and look for
spreading pink areas around the incision and
drainage color that changes to yellow, green
or brown.
• Do limit visitors for the first two weeks.
• Do continue the exercise program from cardiac
rehab. Do stop activities that cause you dizziness,
shortness of breath, discomfort or pain.
• Do limit stair use.
• Do take a 20 to 30 minute rest break at least twice
a day. Do sit with your legs up.
• Do wait 1½ hours after eating a meal before doing
your exercises.
• Do wear your seat belt. Put the heart pillow
between you and the seat belt.
• Do follow the diet discussed with you in the hospital.
Dont’s
• Don’t take a tub bath for one month.
• Don’t shower when alone in the house for the first
2 to 3 times and avoid HOT water; use warm water.
• Don’t use powder around or on your incision.
• Don’t use spray deodorants.
• Don’t put creams or lotions on your incision.
• Don’t use deodorant or perfumed soaps on
your incision.
• Don’t put a heating pad on the incision on the
chest or the leg.
• Don’t cross your legs or ankles when sitting.
• Don’t pull or push with your arms when getting in
and out of chairs, the bed or the car.
• Don’t lift more than 10 pounds for 6 weeks.
• Don’t drive until after the appointment with
the surgeon.
• DON’T SMOKE or drink any alcohol.
Weeks 2 through 6
Do:
• Do return to light recreational activities.
• Do avoid long trips (over 25 miles) until week 4.
• Do get out of the car every hour or so to walk and
stretch your legs if traveling a distance.
• Do wear your seat belt when in the car. Put the
heart pillow between the belt and you for comfort.
• Do stop activities that make you short of breath,
dizzy or cause you pain or discomfort.
• Do use stairs if you feel up to it.
• Do gradually increase your activity.
• Do listen to your body, and rest when you need to.
• Do avoid outdoor activities if the temperature
is below 32 degrees or above 80 degrees. This
includes the wind chill and heat index. Avoid
outdoor activity in humid weather.
• Do continue your exercise program.
• Do use a stationary bike or treadmill without the
moveable arm activity after you have been to the
surgeon’s office for an appointment.
• Do follow the diet discussed with you in the
hospital and rehab.
Dont’s
• Don’t Smoke!
• Don’t drive the car until after you have been to the
appointment at the office with the surgeon.
• Don’t progress your activity level quickly.
• Don’t use arm weights.
• Don’t lift anything over 10 pounds.
• Don’t drink alcohol until you have talked to your
doctor about your medications.
• Don’t sit with your legs or ankles crossed.
Beyond 6 Weeks
• After three months you may participate in heavier
housework. Still remember to stop activities that
cause you shortness of breath, dizziness, discomfort,
or pain and notify your health care provider.
• You may increase your weight restriction from
the 10-pound limit. Do increase this gradually up
to 25 pounds through 12 weeks. If you have any
shortness of breath, dizziness, discomfort, or
pain stop the activity and notify your health care
provider. After 12 weeks the weight limit is lifted.
• Continue to follow the low fat, low cholesterol diet.
• Discuss the life changes with your health care
provider and ask for the assistance that you need to
continue your good work.
• Continue cardiac rehabilitation until you are
discharged from the program. After discharge
from the cardiac rehab program continue with an
exercise program. Ask cardiac rehab to help you
plan an exercise program that will work for you for
the rest of your life.
• Consider progressing to the Phase 3 part of the
cardiac rehab program.
20
Let’s Talk About Heart Medications
Medications to help your heart
Taking your medications
Your health care provider will work with you to find a
combination of medications that works best for you.
Some medications will improve the way your heart
pumps. Others are to help relieve your symptoms.
Follow all your health care provider’s instructions
to be sure you do not take too much or too little
medicine. Do not stop taking medicine or take a
different amount unless your doctor tells you to. Do
not allow your prescriptions to run out. Call your
doctor to find out if you need to renew a prescription
before it runs out. It is important to keep track of your
medications. Here are some tips to help you.
Most people with heart failure or other heart
problems take medications. These are some of the
most common medications:
• ACE inhibitors lower blood pressure and decrease
strain on the heart. Angiotensin receptor blockers
(ARB’s) have similar effects. These are prescribed
for some patients instead of ACE inhibitors.
• Beta blockers help lower blood pressure and slow
your heart rate. This lessens the work your heart
has to do. They may also improve the heart’s
pumping action over time.
• Diuretics help get rid of excess water in your
body and reduce swelling. Having less fluid to
pump means your heart doesn’t have to work as
hard. Some diuretics might make your body lose
potassium, a mineral. You may need to take a
supplement or eat more foods high in potassium.
• Digoxin helps your heart pump with more
strength. Your heart will pump more blood with
each beat, taking more oxygen-rich blood to the
rest of the body.
Your health care provider may want you to take some
medicines for other problems. Controlling other
problems helps keep heart failure and other risk
factors under control.
• Antihypertensives lower high blood pressure.
• Statins lower cholesterol/lipid levels.
• Anticoagulants/aspirin prevent blood clots.
• Antiarrhythmics keep the heartbeat steady.
• Nitroglycerin/Nitrates open the arteries to your
heart so the heart gets more oxygen.
21
• Follow a routine. Having a regular routine for
taking your medications will help you remember
to take them. It may be helpful to have a pill
box marked with the days of the week. Fill it at
the beginning of each week with each kind of
medicine. Then you just open a section every day
and take all your medications in that section.
• It helps to take your pills at the same time each
day. It may help to take them when you are doing
something else, such as brushing your teeth or
eating breakfast. Be sure to ask your health care
provider or pharmacist which medications can be
taken with meals.
More About Medications
Your medications will work correctly if you take them
exactly as directed. Order more medication when
you still have a two-week supply left, so you are sure
not to run out. Carry your medications and extra
prescriptions with you when you travel. Always keep a
list with you of all the medicine you take. Show the list
to every health care provider who treats you.
Some medications may have side effects. These may
include, nausea, dry cough, dizziness, muscle cramps
or changes in heart rhythm. Talk to your doctor or
pharmacist if you have any of these side effects. They
may be able to tell you how to lessen these effects.
Over-the-counter medications may cause problems
with the medications your doctor has prescribed.
You should show the list of medicine you take to
your pharmacist when buying over-the-counter
medications to be sure they will not cause problems
when taken together.
You may want to try taking herbs and other
supplements you have heard about. Not all of these
alternative remedies are safe, and they may not work
well with your other medicines. Always ask your
doctor before taking any herbs or supplements.
Some things to watch for
Most antacids contain sodium, which can cause you
to retain water. Some of these are Maalox, Mylanta II,
Basagel, Riopan and Milk of Magnesia. Some people
use baking soda as an antacid, which also contains
sodium. Any type of effervescent or dispersable tablet,
like Alka-Seltzer, contains sodium. Talk to your doctor
or pharmacist before taking any of these products.
Many herbs interact with prescribed medicines and
keep them from working the way they should. Herbs
may also produce unwanted side effects when taken
with some prescribed medications. These are a few of
the reactions that herbs may cause:
• Aspirin/Ginko—may make platelets less likely
to clot
• Digoxin/St. John’s Wort—decreases digoxin
• Warfarin/Danshen—increases prothombin & INR*
• Warfarin/Dong Quai—increases prothombin & INR
• Warfarin/Garlic—raises INR
• Warfarin/Ginko—raises INR
• Warfarin/Ginsing—lowers INR
*International normalized ratio: A standardized system,
commonly called the INR, for reporting the results
of blood coagulation (clotting) tests. For example, a
person taking the blood thinner warfarin (Coumadin)
might maintain a “prothrombin time” (a “pro time” or
PT) of 2 to 3 INR. No matter what laboratory checks
the prothrombin time, the result should be the same.
Aspirin/anticoagulants, such as warfarin (Coumadin),
clopidogrel (Plavix), ticlopidine (Ticlid) and
dipyridamole (Persantine), prevent blood clots and
may react with these herbs and vitamins:
• Black cohash—increased chance for bleeding
• Chamomile—increased chance for bleeding
• Fish oil—increased chance for bleeding
• Vitamin E—increased chance for bleeding
• Ginger—increased chance for bleeding
• Goldenseal—decreases anticoagulation effect.
Antihypertensives (blood pressure medicine) may
react with these herbs:
• Ephedra—may elevate blood pressure
• Goldenseal—may raise or lower blood pressure
• Black cohash—increases peripheral vasodilation
(flushed face)
• Licorice—may raise blood pressure
Digoxin may react with the following:
• Aloe—increased risk of toxicity
• Licorice—increased risk of toxicity
• Hawthorn—raise or lower cardiac effects
• Goldenseal—raise or lower cardiac effects
22
Let’s Talk About Managing Risk Factors
Risk factors are health problems and lifestyle choices
that increase your chances of developing heart disease.
If your heart disease has been treated, you can help
keep your heart healthy by making changes in some
of the risk factors that you can control.
The American Heart Association has identified several
risk factors. Some of them can be modified, treated
or controlled, and some can’t. The more risk factors
you have, the greater your chance of developing heart
disease. Also, the greater the level of each risk factor,
the greater the risk. For example, a person with a
total cholesterol of 300 mg/dL has a greater risk than
someone with a total cholesterol of 245 mg/dL, even
though everyone with a total cholesterol greater than
240 is considered high-risk.
What are the major risk factors that can’t
be changed?
Increasing age—Over 83 percent of people who die of
coronary heart disease are 65 or older. At older ages,
women who have heart attacks are more likely than
men are to die from them within a few weeks.
Male sex (gender)—Men have a greater risk of heart
attack than women do, and they have attacks earlier in
life. Even after menopause, when women’s death rate
from heart disease increases, it’s not as great
as men’s.
Heredity (including race)—Children of parents
with heart disease are more likely to develop it
themselves. African Americans have more severe
high blood pressure than Caucasians and a higher
risk of heart disease. Heart disease risk is also higher
among Mexican Americans, American Indians, native
Hawaiians and some Asian Americans. This is partly
due to higher rates of obesity and diabetes. Most
people with a strong family history of heart disease
have one or more other risk factors. Just as you can’t
control your age, sex and race, you can’t control your
family history. Therefore, it’s even more important to
treat and control any other risk factors you have.
23
What are the major risk factors you can modify,
treat or control by changing your lifestyle or
taking medicine?
Tobacco smoke—Smokers’ risk of developing
coronary heart disease is 2–4 times that of
nonsmokers. Cigarette smoking is a powerful
independent risk factor for sudden cardiac death
in patients with coronary heart disease; smokers
have about twice the risk of non-smokers. Cigarette
smoking also acts with other risk factors to greatly
increase the risk for coronary heart disease. People
who smoke cigars or pipes seem to have a higher risk
of death from coronary heart disease (and possibly
stroke) but their risk isn’t as great as cigarette
smokers’. Exposure to other people’s smoke increases
the risk of heart disease even for nonsmokers.
High blood cholesterol—As blood cholesterol rises,
so does risk of coronary heart disease. When other
risk factors (such as high blood pressure and tobacco
smoke) are present, this risk increases even more.
A person’s cholesterol level is also affected by age,
sex, heredity and diet.
High blood pressure—High blood pressure increases
the heart’s workload, causing the heart to thicken and
become stiffer. It also increases your risk of stroke,
heart attack, kidney failure and congestive heart
failure. When high blood pressure exists with obesity,
smoking, high blood cholesterol levels or diabetes, the
risk of heart attack or stroke increases several times.
Physical inactivity—An inactive lifestyle is a risk
factor for coronary heart disease. Regular, moderate
to vigorous physical activity helps prevent heart and
blood vessel disease. The more vigorous the activity,
the greater your benefits. However, even moderate
intensity activities help if done regularly and long
term. Exercise can help control blood cholesterol,
diabetes and obesity, as well as help lower blood
pressure in some people.
Obesity and overweight—People who have excess
body fat—especially if a lot of it is at the waist—are
more likely to develop heart disease and stroke even
if they have no other risk factors. Excess weight
increases the heart’s work. It also raises blood
pressure and blood cholesterol and triglyceride levels,
and lowers HDL (“good”) cholesterol levels. It can also
make diabetes more likely to develop. Many obese
and overweight people may have difficulty losing
weight. But by losing even as few as 10 pounds, you
can lower your heart disease risk.
Diabetes mellitus—Diabetes seriously increases your
risk of developing cardiovascular disease. Even when
glucose levels are under control, diabetes in creases
the risk of heart disease and stroke, but the risks are
even greater if blood sugar is not well controlled.
About three-quarters of people with diabetes die of
some form of heart or blood vessel disease. If you
have diabetes, it’s extremely important to work with
your health care provider to manage it and control any
other risk factors you can.
What other factors contribute to heart disease risk?
Stress—Individual response to stress may be a
contributing factor. Some scientists have noted a
relationship between coronary heart disease risk
and stress in a person’s life, their health behaviors
and socioeconomic status. These factors may affect
established risk factors. For example, people under
stress may overeat, start smoking or smoke more
than usual.
Alcohol—Drinking too much alcohol can raise blood
pressure, cause heart failure and lead to stroke.
It can contribute to high triglycerides, cancer and
other diseases, and produce irregular heartbeats.
It contributes to obesity, alcoholism, suicide and
accidents. The risk of heart disease in people who
drink moderate amounts of alcohol (an average of
one drink for women or two drinks for men per day)
is lower than in nondrinkers. One drink is defined as
1 ½ fluid ounces (fl oz) of 80-proof spirits (such as
bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof
spirits, 4 fl oz of wine or 12 fl oz of beer. It’s not
recommended that nondrinkers start using alcohol or
that drinkers increase the amount they drink.
The following pages will help you learn to manage some of the most common risk factors.
Let’s Talk About High Blood Pressure
High blood pressure means the pressure in your
arteries is elevated. Another name for high blood
pressure is hypertension. Blood pressure is the force
of blood pushing against blood vessel walls. It’s
written as two numbers, such as 112/78 mm Hg. The
top, or systolic, number is the pressure when the
heart beats. The bottom, or diastolic, number is the
pressure when the heart rests between beats. Normal
blood pressure is below 120/80. If you are an adult and
your systolic pressure is 120 to 139, or your diastolic
pressure is 80 to 89, you have “prehypertension.”High
blood pressure is a pressure of 140 systolic or higher
and/or 90 diastolic or higher that stays high over time.
No one knows exactly what causes high blood pressure.
It usually can’t be cured, but it can be controlled. High
blood pressure often has no symptoms. It can truly be a
“silent killer.” You may not have any symptoms unless
you have another illness, such as kidney disease. Some
of the signs and symptoms of high blood pressure are
blurred vision or headache, sleepiness or confusion,
nosebleeds or coughing up blood, numbness or tingling
in the hands or feet, and shortness of breath.
About 50 million Americans, or one in four adults
have it, and many don’t even know they have it. Not
treating high blood pressure is dangerous. High blood
pressure increases the risk of heart attack and stroke.
Who is at risk for high blood pressure?
• People with close relatives who have high
blood pressure;
• African Americans;
• people over age 35;
• overweight people;
• people who aren’t physically active;
• people who use too much salt;
• people who drink too much alcohol;
• people with diabetes, gout and kidney disease;
• pregnant women;
• people with a great deal of stress; and
• women who take birth control pills who are
overweight, had high blood pressure during
pregnancy, have a family history of high blood
pressure or have mild kidney disease.
24
How can I tell if I have it?
You usually can’t tell. Many people have it and don’t
know it. The only way to know if your blood pressure
is high is to get it checked regularly by a doctor. It is
important to find out if you have high blood pressure
because it can lead to:
• stroke;
• heart attack;
• vision loss;
• poor circulation;
• heart failure; and
• kidney failure.
What can I do about high blood pressure?
By treating high blood pressure, you can help prevent
a stroke, heart attack, heart failure or kidney failure.
Here are some things you can do now.
• Lose weight if you are overweight. If you are
overweight, you put too much strain on your heart.
You should talk with your health care provider
about a healthy eating plan. When you lose
weight, your blood pressure often goes down.
• Eat a healthy diet low in saturated fat, cholesterol
and salt. By eating a low saturated fat, low
cholesterol diet, you’ll help avoid heart attack and
stroke. Eating a lot of salt (sodium) adds to high
blood pressure in some people. It holds excess
fluid in your body and puts an added burden on
your heart. Your health care provider may tell you
to cut down on the salt you use in cooking and
not add salt to food. He or she may tell you to
eat no salt at all. Try to read food labels so you’ll
know which foods are high in sodium. Learn to
use herbs or salt substitutes instead. You’ll find
helpful information in the Healthy Diet section of
this book.
• Be more physically active. Regular physical
activity helps to reduce blood pressure, control
weight and reduce stress. It’s best to start slowly
and do something you enjoy, like taking walks or
riding a bicycle. Talk to your health care provider
about a good plan for you.
• Limit alcohol to no more than one drink per day
for women or two drinks a day for men. Ask your
doctor to be sure you are allowed to drink alcohol,
and if so, how much. If you drink more than two
ounces a day (about two beers, glasses of wine or
mixed drinks), it may add to high blood pressure.
If cutting back on alcohol is hard to do on your
own, ask about community groups that can help.
• Take medicine the way your doctor tells you. There
25
are different kinds of medicine your doctor may
prescribe for you. Don’t be discouraged if you
need to take medicine. What is important is that
you take your medicine the way your doctor tells
you to. Never stop treatment on your own. If you
have problems or side effects, talk to your doctor.
• Know what your blood pressure should be and
work to keep it at that level. Your health care
provider will tell you what your blood pressure
should be and how to monitor it.
How can medicine help?
Blood pressure can be controlled with different types
of medication. Some medicines, such as vasodilators,
help relax and open up your blood vessels so blood
can flow through better. A diuretic can help keep your
body from holding too much water and salt.
These tips will help with your medication:
• Keep a written list of the medicine you are taking
and when you take them. Bring the list or your
pill bottles when you see any of your health
care providers. Ask for information about your
medicine and learn why you take each one.
• Do not take any over-the-counter medicine without
talking to your health care provider. Some of these
medicines may raise your blood pressure.
• Some providers may want you to take aspirin
daily. Aspirin helps to thin your blood. Do not take
acetaminophen or ibuprofen instead of aspirin!
• If you take medicine that makes you drowsy, do
not drive or use machinery.
Some special things you need to know about blood
pressure medicine:
• You may get dizzy when you change from a lying
to a sitting position. Get up slowly. If you feel faint,
lie down right away.
• Your medicine may make your nose stuffy, weaken
you or cause you to lose your appetite.
• You may need to have your medicine or the dose
changed many times before it is right for you. It
may take weeks for your body to adjust to your
blood pressure medicine. Be patient and do not
stop taking your medicine, even if you have side
effects. Let your health care provider know about
any side effects you have.
• Some men may have a decrease in sexual ability
when taking certain medicines. If you experience
this side effect, do not stop taking your medicine.
Call your health care provider. He or she may be
able to change your medicine or the dose.
• Do not skip doses of your blood pressure
medicine or take extra doses. If you miss a dose,
call your health care provider. Always follow his or
her directions.
• High blood pressure is a long term health
problem. You may need to take blood pressure
medicine for the rest of your life. Your blood
pressure will probably go back up if you stop
taking your medicine. If you do not take your
medicine, you may have serious medical
problems. With time, your health care provider
may be able to lower the amount of blood
pressure medicine that you take.
• Call your health care provider if you have
any of these side effects from your blood
pressure medicine:
–– bloating (feeling of fullness)
–– constipation
–– depression
–– diarrhea
–– dizziness
–– dry mouth
–– dry cough that will not go away
–– headaches
–– hives or other rashes
–– impotence
–– itchy skin
–– problems staying awake
–– trouble going to sleep or staying asleep, or
sleeping too much
–– vomiting
Let’s Talk About Quitting Smoking
Why should I quit smoking?
Smoking cigarettes tops the list of major risk factors
of our No. 1 killer—heart and blood vessel disease.
In fact, almost one-fifth of deaths from heart disease
are caused by smoking. Buildup of fatty substances in
the arteries is a chief contributor to the high number
of deaths from smoking. Smoking increases blood
pressure, decreases exercise tolerance and increases
the tendency for blood to clot. The long list of diseases
and deaths due to smoking is frightening. Smoking also
harms thousands of nonsmokers who are exposed to
cigarette smoke, including infants and children.
If you smoke, you have good reason to worry about its
effect on your health, your loved ones and others. You
could become one of the more than 430,000 smokingrelated deaths every year. When you quit, you reduce
that risk tremendously!
Is it too late to quit?
No matter how much or how long you’ve smoked,
when you quit smoking, your risk of heart disease and
stroke starts to drop. In time, your risk will be about
the same as if you’d never smoked!
How do I quit?
Step One
• List your reasons to quit and read them several
times a day
• Wrap your cigarette pack with paper and rubber
bands. Each time you smoke, write down the time
of day, how you feel, and how important that
cigarette is to you on a scale of 1 to 5.
• Rewrap the pack.
Step Two
• Keep reading your list of reasons and add to it.
• Don’t carry matches, and keep your cigarettes out
of easy reach.
• Each day, try to smoke fewer cigarettes, and try
not to smoke the ones that aren’t most important.
Step Three
• Continue with Step Two. Set a target date to quit.
• Don’t buy a new pack until you finish the one
you’re smoking.
• Change brands twice during the week, each time
for a brand lower in tar and nicotine.
• Try to stop for 48 hours at one time.
Step Four
• Quit smoking completely. Throw out all cigarettes
and matches. Hide lighters and ashtrays.
• Stay busy! Go to the movies, exercise, take long
walks, go bike riding.
• Avoid situations and “triggers” you relate to
smoking.
• Find healthy substitutes for smoking. Carry
sugarless gum or artificially sweetened mints.
Munch carrots or celery sticks. Try doing crafts or
other things with your hands.
• Do deep breathing exercises when you get
the urge.
26
What if I smoke after quitting?
It’s hard to stay a nonsmoker once you’ve had a
cigarette, so do everything you can to avoid that “one.”
The urge to smoke will pass. The first 2 to 5 minutes
will be the toughest. If you do smoke after quitting:
• This doesn’t mean you’re a smoker again—do
something now to get back on track.
• Don’t punish or blame yourself—tell yourself
you’re still a nonsmoker.
• Think about why you smoked and decide what to
do the next time it comes up.
• Sign a contract to stay a nonsmoker.
What happens after I quit?
• Your senses of smell and taste come back.
• Smoker’s cough goes away.
• You will digest normally.
• You feel alive and full of energy.
• You breathe much easier.
• It’s easier to climb stairs.
• You’re free from the mess, smell and burns in clothing.
• You feel free of “needing” cigarettes.
• You’ll live longer and have less chance of heart
disease, stroke, lung disease and cancer.
How can I handle the stress of not smoking?
No one says that quitting smoking is easy. But
everyone says it’s worth it! Quitting will drastically
reduce your risk of developing heart and blood
vessel diseases—diseases that kill someone every
34 seconds. It will also lower your chance of having
lung disease and cancer. Most of all, quitting can save
your life and the lives of nonsmokers around you.
No matter how much or how long you’ve smoked,
when you quit smoking, your risk of heart disease and
stroke starts to drop. In time your risk will be about
the same as if you’d never smoked!
How can I cope with the urge?
• Write down the reasons why you quit and look at
the list often.
• Don’t talk yourself into smoking again. When you
feel an urge to have “just one,” stop yourself.
Think of what triggered you, and find a different
way to handle it. For example, if you feel nervous
and think you need a cigarette, realize that you
could take a walk to calm down instead.
• Be prepared for times when you’ll get the urge. If
you smoke when drinking, cut down on alcohol so
you don’t weaken your promise to yourself.
• Change your habits. Instead of having a cigarette
after dinner, brush your teeth or walk the dog.
• Go where smoking isn’t allowed. In restaurants
ask to be seated in the nonsmoking section.
• Stick around people who don’t smoke. Ask for
support and find a buddy you can call when you
27
feel weak. Tell others they can help you by not
giving you a cigarette and by being supportive.
• Reward yourself each time you get through a
day or week without smoking. Treat yourself to
a movie. Or figure out how much money you’ve
saved and buy yourself something special.
How can I relax?
• Try deep breathing. Take a long, deep breath,
count to 10 and release it. Repeat five times and
you’ll feel much more relaxed.
• Allow 20 minutes a day to let go of tension this
way: Close your eyes, relax your muscles and
think hard about one word, like “calm.” Say it until
you reach a state of relaxation.
• Think positive thoughts! Focus on how great it
is that you’ve stopped smoking, how food tastes
better and how nice it is not to wake up coughing.
Remind yourself how smoking stinks, stains your
teeth and gives you bad breath.
• Listen to relaxation audiotapes.
How can exercise help?
• Walking and other exercise releases stress and
calms you.
• It can improve your mood.
• It keeps your mind off cigarettes.
• It can help control your appetite.
• It can help you lose weight if you’re overweight, or
stay at a normal weight.
• It can lower your blood pressure level.
• It can lower your “bad” blood lipid level.
• It can help reduce your risk of developing heart
disease and stroke.
What can I do instead of smoking?
• Play with a pencil, paper clip or marbles.
• Keep your hands busy—wash the car, garden, knit,
do crossword puzzles, write letters, cook.
• Munch on carrots, apples, celery and sugarless gum.
• Brush your teeth often and keep a fresh taste in
your mouth.
• Get plenty of rest and exercise.
• Try a new sport.
How can I avoid weight gain when I stop smoking?
Quitting smoking doesn’t mean you’ll automatically
gain weight. And even if you do gain a couple pounds,
that’s not as important as saving your life…and the
lives of others.
When people gain weight, it’s usually because they
start to eat more once they quit smoking. If you watch
what you eat and stay physically active, you may not
gain at all!
What should I eat?
• Plenty of fruits and vegetables (at least 5 servings
a day).
• Read food labels and choose healthful foods low
in saturated fat and cholesterol.
• Whole-grain cereals, pastas and breads.
• Cut back on alcohol and drinks with caffeine
(coffee, tea and soft drinks).
• Fat-free or low-fat snacks like pretzels.
• Sugar-free hard candy.
• Drink lots and lots of water!
What are good activities to help keep weight off?
Becoming more active can help you reduce or
maintain your weight. Try any of the following. Check
with your doctor first if you’ve been inactive a long
time or have medical problems, you’re middle-aged or
older, and you plan a vigorous exercise program.
• Walk in your neighborhood or at indoor
shopping malls.
• Do gardening or yardwork.
• Take stairs instead of escalators and elevators.
• Park farther from stores and walk.
• Learn a new dance.
• Ride a bicycle.
• Try aerobic dance classes or use a videotape
at home.
What else can I do?
• Try relaxation techniques like deep breathing
or meditation.
• Spend time with other nonsmokers.
• Go where there’s no smoking, like stores, movies,
churches and libraries.
• Think positive thoughts! Feel proud about quitting.
• Write down why you’re quitting and read it.
• Reward yourself every day or week that you stay a
nonsmoker. Don’t use food as a reward.
28
Let’s Talk About Diabetes
Diabetes dramatically increases a person’s risk for
heart disease and stroke and often is associated with
other cardiovascular risk factors, such as high blood
pressure, cholesterol disorders, obesity and insulin
resistance. Unfortunately, most people with diabetes
are not aware of these risks.
Cardiovascular disease is the leading cause of
diabetes-related death. People with diabetes are
two to four times more likely to develop
cardiovascular disease.
When you have diabetes, your body either doesn’t
make enough insulin or can’t use its own insulin as
well as it should, or both. This causes sugars to build
up too high in your blood. Most of the food we eat is
turned into glucose, or sugar, for our bodies to use for
energy. Insulin is a hormone needed to convert sugar
and other food into energy and to help glucose get
into our bodies’ cells.
What types of diabetes are there?
This disease has two main forms: type 1 and type 2.
Type 2 is the most common. About 90 to 95 percent
(17 million) of Americans diagnosed with diabetes
have type 2 diabetes. It most often develops in
middle-aged and older adults. It’s often linked with
obesity and physical inactivity. Type 2 diabetes
develops when the body doesn’t make enough
insulin and doesn’t efficiently use the insulin it makes
(insulin resistance).
Type 1 usually starts early in life. It results from the
body’s failure to produce insulin. People with it must
take insulin each day to regulate levels of blood
glucose (sugar).
29
Am I at risk?
Diabetes is increasing. This is because more people
are obese, don’t get enough physical activity and
are getting older. However, many younger people
are developing diabetes at an alarming rate. This is
probably because obesity and lack of physical activity
are increasing problems for this group, too.
People in several ethnic groups seem to be more likely
to develop type 2 diabetes:
• Hispanics
• African Americans
• Native Americans
• Asians (especially South Asians)
How can I control my risk for heart disease
and stroke?
Diabetes is a major risk factor for stroke and heart
disease. That means it can be as serious as smoking,
high blood cholesterol, high blood pressure, physical
inactivity or obesity.
If you have diabetes, it’s very important to have
regular check-ups. Work closely with your health care
provider to manage your diabetes and reduce any
other risk factors:
• Control your weight and blood cholesterol with a
low-saturated-fat, low-cholesterol diet.
• Be physically active for at least 30 minutes on
most or all days of the week.
• If you drink alcohol, don’t have more than one
drink per day for women or two per day for men.
• Lower your blood pressure, if it’s too high. Don’t
smoke, and avoid other people’s tobacco smoke.
• Specific medicines may help you control your
blood pressure, cholesterol and blood glucose.
Your doctor will advise you if one is right for you.
If you take medicine, take it exactly as directed.
If you have questions about the dosage or side
effects, ask your doctor or pharmacist.
Let’s Talk About Cholesterol and Triglycerides
Most heart disease and many strokes are caused by a
buildup of fat, cholesterol and other substances called
plaque in the inner walls of your arteries. The arteries
can become clogged and narrow, and blood flow is
reduced. If a blood clot forms and blocks blood flow to
your heart, it causes a heart attack. If a blood clot blocks
an artery leading to or in the brain, a stroke results.
What is Cholesterol?
Cholesterol is a fat-like substance always present
in the human body. It is essential for normal body
functioning. The human body obtains cholesterol
from two sources—from the cholesterol it
manufactures and from foods eaten. Cholesterol is
found only in foods of animal origin. The cholesterol
level of your blood is affected by the cholesterol your
body produces and the amount of saturated fat and
cholesterol in your diet.
Cholesterol travels in the blood in packages called
lipoproteins. All lipoproteins are formed in the liver
and carry cholesterol through the body.
High blood cholesterol
The saturated fats, trans fats and cholesterol you
eat may raise your blood cholesterol level. Having
too much cholesterol in your blood may lead to
increased risk for heart disease and stroke. About half
of American adults have levels that are too high (200
mg/dL or higher) and about 1 in 5 has a level in the
high-risk zone (240 mg/dL or higher). The good news
is that you can take steps to control your cholesterol.
What should I eat?
Focus on low-saturated-fat, low-cholesterol foods
such as these:
• A variety of fruits and vegetables (choose 5 or
more servings per day)
• A variety of grain products like bread, cereal, rice
and pasta, including whole grains (choose 6 or
more servings per day)
• Fat-free and low-fat milk products (2 to 4 servings
per day)
• Lean meats and poultry without skin (choose up to
6 total ounces per day)
• Fatty fish (enjoy at least 2 servings baked or
grilled each week)
• Beans and peas
• Nuts and seeds in limited amounts
• Unsaturated vegetable oils like canola, corn, olive,
safflower and soybean oils (but a limited amount
of margarines and spreads made from them)
What should I limit?
• Whole milk, cream and ice cream
• Butter, egg yolks and cheese—and foods made
with them
• Organ meats like liver, kidney and brain
• Sweetbreads
• High-fat processed meats like sausage, bologna,
salami and hot dogs
• Fatty meats that aren’t trimmed
• Duck and goose meat (raised for market)
• Bakery goods made with egg yolks and
saturated fats
• Saturated oils like coconut oil, palm oil and palm
kernel oil
• Solid fats like shortening, partially hydrogenated
margarine and lard
• Fried foods
What are triglycerides?
Triglycerides are the most common type of fat in your
body. They’re also a major energy source. They come
from food, and your body also makes them. High
levels of blood triglycerides are often found in people
who have high cholesterol levels, heart problems, are
overweight or have diabetes.
What is Fat?
Fat is one of the three nutrients that supply calories to
the body. Fat provides nine calories per gram (protein
and carbohydrate each provide four calories per
gram). Small amounts of fat are necessary for normal
body functioning. Dependent on their chemical
structure, fats are primarily labeled as saturated,
unsaturated or trans fats.
Saturated Fat: A type of fat which is usually hard at
room temperature. It is found in greatest amounts in
foods from animals, such as meat, poultry, and whole
milk dairy products. Examples of saturated fat include
butter and the marbling in meat and lard. Other sources
include hard vegetable shortening (hydrogenated
vegetable oil). A few vegetable oils—coconut oil, palm
oil, palm kernel oil and cocoa butter—are also high in
saturated fat. Saturated fat raises blood cholesterol
levels more than anything else in the diet.
Trans Fat: A type of fat made through a process
called hydrogenation. This process takes a healthy fat
(soybean oil) and makes it into a solid form. Trans fats
are known to affect blood cholesterol levels similar
to saturated fats. Some common foods that contain
trans fats are crackers, stick margarine, fried foods
and potato chips.
30
Unsaturated Fat: A type of fat that is usually liquid
at room temperature. Polyunsaturated fat and
monounsaturated fat are two kinds of unsaturated fat.
When substituted for saturated fat, unsaturated fat
helps reduce blood cholesterol levels.
Polyunsaturated Fat: An unsaturated fat that is found
in greatest amounts in foods from plants such as
safflower, sunflower, corn, soybean, sesame and
cottonseed oils. Another type of polyunsaturated fat
is found in the oils of seafood; this is referred to as
fish oil or omega-3 fatty acids.
Monounsaturated Fat: An unsaturated fat that is
found in the greatest amounts in foods from plants
such as olive oil and canola (rapeseed) oil.
Measuring my cholesterol and triglycerides
High blood cholesterol signals a higher risk of heart
attack and stroke. That’s why it’s important to have
your cholesterol levels checked regularly and discuss
them with your doctor. A “lipoprotein profile” is a
test to find out your blood cholesterol numbers. It
gives information about total cholesterol, LDL (bad)
cholesterol and HDL (good) cholesterol, as well as
triglycerides (blood fats).
What should my total cholesterol level be?
Total Blood Cholesterol Levels:
Less than 200 mg/dL = Desirable (lower risk)
200 to 239 mg/dL = Borderline high (higher risk)
240 mg/dL and above = High blood cholesterol (more
than twice the risk as desirable level)
What should my HDL and LDL cholesterol levels be?
HDL stands for high-density lipoprotein. HDLs carry
cholesterol back to the liver for processing or removal
from the blood, preventing the accumulation of
cholesterol in the walls of the arteries. Thus they are
often referred to as “good cholesterol.”
LDL stands for low-density lipoprotein. LDLs carry
most of the cholesterol in the blood and if not
removed from the blood, they can build up in the
arteries, contributing to atherosclerosis or “hardening
of the arteries.” A high level of LDL cholesterol means
there’s a higher risk of heart disease and stroke.
You can raise your HDL by quitting smoking, losing
excess weight and being more active.
31
HDL Cholesterol Levels:
Your HDL cholesterol level should be 40-60mg/dL or
what your physician has recommended for you.
LDL Cholesterol Levels:
LDL stands for low-density lipoprotein. This is the
main carrier of harmful cholesterol in your blood.
A high level of LDL cholesterol means there’s a
higher risk of heart disease and stroke. Less than 100
mg/dL is optimal for people with heart disease or
diabetes (your doctor may recommend a goal of less
than 70 mg/dL).
What should my triglyceride level be?
Many people who have heart disease or diabetes
have high fasting triglyceride levels. Some studies
have shown that people with above-normal fasting
triglyceride levels (150 mg/dL or higher) have a higher
risk of heart disease and stroke.
Triglyceride Levels:
• Less than 150 mg/dL = Normal
• 150 to 199 mg/dL = Borderline High
• 200-499 mg/dL = High
• 500 mg/dL and above = Very High
What should I know about medicine?
Your doctor will decide which medicine is best for
you. Often you’ll be asked to take more than one.
Always follow your doctor’s orders carefully, and let
them know if you have any side effects. Never stop
taking your medicine on your own!
Niacin is a B vitamin. It’s also called nicotinic acid.
Take this only if your doctor has prescribed it. It can
lower total cholesterol, LDL (“bad”) cholesterol and
triglyceride (blood fat) levels. It can also raise HDL
(“good”) cholesterol levels. It may cause flushing and
itching. It could also upset your stomach and cause
other side effects your doctor can describe.
HMG-CoA reductase inhibitors, or “statin”
drugs, stimulate the body to process and break
down cholesterol. Some names are “lovastatin,”
“pravastatin” and “simvastatin.” Possible side effects
include constipation, stomach pain, cramps or gas.
A few patients experience muscle pain, weakness or
brown urine.
Bile acid binders help rid the body of cholesterol.
Some names are “cholestyramine” and “cholestipol.”
These often come in a powder that you mix with
water or juice. Side effects may include constipation,
bloating, nausea and gas. To reduce these effects, eat
more fiber and drink more fluids.
Gemfibrozil is a fibric acid. It’s especially good for
lowering triglyceride (blood fat) levels. A few patients
have stomach problems when they take it.
Fenofibrate is taken once a day with a meal. A few
patients have stomach problems when they take it.
How do I know if it’s working?
Your doctor will test your blood cholesterol level when
needed. Together with your doctor, set a goal and ask
how long it may take to reach that goal. Follow up
with your doctor after reaching your goal. Don’t stop
medication unless your doctor tells you to.
How do I remember to take my medicine?
Sometimes it’s hard to keep track of your medicine.
To be safe, you must take it properly.
• Take your medicine at the same time each day
along with meals or other daily events, like
brushing your teeth.
• Use a weekly pill box with separate compartments
for each day or time of day.
• Ask family and friends to help remind you.
• Use a pill calendar or drug reminder chart.
• Leave notes to remind yourself.
• Try an e-mail reminder or beeper service.
• Wear a wristwatch with an alarm.
General Diet Guidelines: Low Sodium, Low Fat
Your nutrition is an important aspect of your
recovery and continued health.
The following guidelines are designed to get you
started on a healthier way of eating.
• Immediately after treatment, you may not have
much of an appetite. It is important that you
gradually increase your intake towards regular
balanced meals. Include foods and snacks that
appeal to you between meals during this time to
boost your intake to promote healing.
• Reducing the amount of sodium in your diet is
very important to help prevent fluid from building
up in your body. This may cause your heart to
work much harder to remove the fluid.
• Maintain your weight if you are at a normal
weight. If you need to lose weight, a slow steady
weight loss is recommended. Wait for a few weeks
after surgery before embarking on any low calorie
weight loss regimen.
• Limit cholesterol to 200 mg or less per day. Limit
sodium to 2000 – 3000 mg or less per day. If
you have been diagnosed with congestive heart
failure, sodium intake should be 2000 mg or less.
You’ll find more specific information on the next
few pages.
• Limit egg yolks to 3 or 4 per week, including
those used in cooking. Egg substitutes may be
used instead.
• Broil, bake, grill, or steam foods. Limit fried foods,
cream sauces, soups, and gravies.
• Limit sausage, bacon, ribs, and high fat luncheon
meats. Choose lean cuts of meat (i.e. turkey, fish,
lean beef etc.) and limit to 6 oz. per day or less.
Keep meat portions realistic—about the size of a
deck of cards.
• Trim all visible fat and remove skin from poultry
before cooking.
• Compare labels to choose lower fat cheeses.
Select low-fat or fat-free cheese when possible.
• Make the switch to skim or 1% milk.
• Do not use salt at the table or in cooking.
• Limit convenience foods such as pizza, frozen
dinners, canned and boxed foods.
• Limit processed, cured, pickled and smoked
foods such as ham, sausage, bacon, corned beef,
luncheon meats, pickles, olives, sauerkraut, etc.
• Eat 5–7 servings of fruits and vegetables each day.
• Include at least 6 servings of bread, grains, pasta
or cereals each day. At least half of your servings
should be whole grain.
32
Sodium
Americans tend to consume about 4000 to 6000
milligrams (mg) of sodium per day, which is
significantly more than the human body needs. A high
sodium intake may be associated with hypertension
(high blood pressure). Hypertension can increase the
risk of heart attack, stroke and kidney disease. The
desire for highly salted foods is an acquired taste.
Because of this, with some effort, you can change
your desire for salty foods.
What Is Sodium?
Sodium helps regulate blood pressure and blood
volume; it also helps nerves and muscles function
properly. Sodium occurs naturally in almost all foods,
but it is also added to many foods during processing.
The terms “sodium” and “salt” are often used
interchangeably, but they are not the same. Salt is a
combination of two minerals: sodium and chloride.
Table salt is 40 percent sodium and 60 percent
chloride. Sodium is usually listed in milligrams
(abbreviated as “mg”) on Nutrition Facts labels. One
teaspoon of salt contains about 2000 mg of sodium.
33
Checklist for Lowering Your Sodium Intake
• Don’t use salt during cooking, including table salt,
sea salt, garlic salt, onion salt, celery salt, MSG
(monosodium glutamate) or seasoned salt. (Try a
salt-free seasoning substitute.)
• Substitute herbs and spices as food flavoring.
• Eat less salted potato and corn chips, lunchmeat
and hot dogs, bacon, salt pork, ham hocks, dill
pickles, sauerkraut and many canned foods. All of
these have a lot of salt.
• Eat more fresh fruits and vegetables and less
canned or frozen ones. Limit canned, boxed and
frozen dinner items.
• Use fresh fruit and raw vegetables as snacks
instead of chips or salted nuts.
• Look at food labels—many canned and frozen
foods say “low salt” or “low sodium.”
• Select unsalted nuts or seeds, dried beans, peas
and lentils.
• Avoid adding salt and canned vegetables to
homemade dishes unless “low sodium” canned
vegetables are used.
• Select unsalted, fat-free broths, bouillons
or soups.
• Select fat-free (“skim”) milk or low-fat milk, lowsodium, low-fat cheeses, as well as low-fat yogurt.
• When dining out, be specific about what you want
and how you want it prepared. Request your dish
be prepared without salt.
• Learn to use spices and herbs to enhance the taste
of your food.
• Salt substitutes may be used if it is all right with
your physician. Make sure that it is sodium-free
and not just sodium-restricted.
• Find recipes for low-sodium foods.
Seasoning Without Salt
Herbs and spices do not contain salt and can be
used to season foods. Read the labels of all blends to
ensure that they are salt free.
Listed below are seasoning suggestions to start you
out—onions, garlic, and pepper enhance the flavor of
most foods.
• Beef and Veal: bay leaf, sage, thyme
• Chicken: lemon, paprika, poultry seasoning, sage
• Fish: bay leaf, lemon juice, paprika
• Lamb: garlic, mint, mint jelly, rosemary
• Pork: apple, garlic, onion, sage
• Pasta, Rice, Potatoes: garlic, oregano, paprika
• Rice: chives, onion, parsley
• Asparagus: garlic, lemon juice, vinegar
• Broccoli: lemon juice, garlic
• Cucumbers: chives, dill, garlic, onion, vinegar
• Green Beans: dill, lemon juice
• Greens: onion, pepper, vinegar, lemon
• Peas: parsley, onion
• Squash: brown sugar, cinnamon, nutmeg, ginger
• Tomatoes: basil, onion, oregano
Spice Alternatives to Using Salt
• Begin by using no more than one or two herbs or
spices at a time.
• Start with small amounts of herbs. Add 1
teaspoon of chopped fresh herbs to soups/stews
during the last few minutes of cooking.
(Adding any sooner will destroy the flavor).
Add ¼ teaspoon of dried herbs earlier in cooking.
• Add herbs/spices in cold dressings, dips or
marinades several hours before serving to “blend”
the flavors.
• Use ½ teaspoon of dried herbs for every four
servings of food.
• Use 3–4 times as much of the fresh herb as the
dried herb.
Basic Herb Blend
• 2 T. Parsley
• 2 T. Chives, chopped
• 1 T. Dill Weed
• 1 T. Oregano
• 1 tsp. Rosemary
• 1 tsp. Thyme
Greek Blend
• 2 T. Garlic Powder
• 1 T. Lemon Peel
• 1 T. Oregano
• 1 tsp. Ground
Black Pepper
Italian Blend
• 2 T. Basil
• 2 T. Marjoram
• 1 T. Garlic Powder
• ½ tsp. Crushed
Red Pepper
Onion Mixture
• 1 tsp. Mustard Powder
• 1 tsp. Garlic Powder
• 3 tsp. Onion Powder
• 1 ½ tsp. White Pepper
• ¼ tsp. Basil
Vegetable Blend/Red
• 2 T. Marjoram
• 2 T. Basil
• 2 T. Chervil
• 2 T. Oregano
• 1 T. Tarragon
• 1 T. Celery Seed
Spice Mixture
• 1 tsp. Onion Powder
• ½ tsp. White Pepper
• 1 tsp. Mustard Powder
• 1 tsp. Paprika
34
Heart-Healthy Eating: Foods to Include
Fiber Tips
Sterol and Stanol Tips
There are two types of fiber in food: soluble and
insoluble. Soluble fiber is especially helpful in
lowering LDL cholesterol. Try to eat 10 grams (g) to
25 g of soluble fiber per day. Work toward this goal
gradually, and be sure to drink enough fluids. This will
help you limit problems with gas.
Eating foods with plant sterols and stanols may lower
your LDL cholesterol. To benefit, you should have 2
grams (g) plant stanols and sterols every day. For the
most benefit, have the sterol or stanol foods at mealtimes or with other foods.
Way to Add Fiber to Your Eating Plan
To get at least 2 g plant sterols or stanols daily:
• Have 2–3 tablespoons of margarine spread made
with esterified plant sterols or stanols. OR
• Eat several foods fortified with stanols or sterols
For example, you could have 6 oz yogurt with plant
sterols, 8 oz orange juice with plant sterols, and
1 tablespoon margarine spread with plant sterols.
• Add fiber to foods you already eat:
–– Sprinkle oat bran or rice bran on cereal.
–– Add almonds to salad.
–– Include dried beans in soup.
–– Mix ground flaxseed into muffins.
• Eat whole fruit rather than drinking juice.
• Select vegetables with lots of soluble fiber, such
as brussel sprouts, acorn squash, lima beans,
broccoli, okra, and eggplant.
• Look for whole grain products, especially those
with oats and barley.
• Add vegetables to sandwiches, or eat a peanut
butter sandwich on whole grain bread.
• Have bean dip or hummus for snacks.
Fiber-Rich Foods
The chart shows ho much soluble fiber is in one
serving of some foods.
Food
• 1/2 cup kidney beans
• 1/2 cup black beans
• 1/2 cup oatmeal, regular
before cooking
• 1 medium orange
• 1/4 cup oat bran
• 1 packet instant oatmeal
• 1/2 cup cooked broccoli
• 2 tablespoons flaxseed meal
• 1 medium apple
• 1 small baked potato with skin
• 1 medium banana
Soluble fiber
• 2.8 g
• 2.2 g
• 2.0 g
• 1.8 g
• 1.7 g
• 1.4 g
• 1.4 g
• .1 g
• 1.0 g
• 0.9 g
• 0.7 g
Ways to Add Sterols and Stanols to your Eating Plan
Take care that you don’t add unwanted calories to
your eating plan:
• If you substitute margarine with sterols for regular
margarine, you will the same amout of calories
as usual.
• If you add sterol margarine to your eating plan,
you will add calories. You can make up for these
calories by eating less of some other food.
Omega-3’s
Eating fats that provide omega-3 fatty acids may
reduce risk of heart disease.
Tips for Adding Omega-3 Fatty Acids to your
Meal Plan
• Select oils that provide omega-3 fat, such as
canola oil or soybean oil.
• Add flaxseed oil, which is very high in omega-3
fat, to foods. If you use flaxseed , be sure it is
ground up. Your body cannot digest the beneficial
fat if the seeds are left whole.
• Enjoy walnuts. The walnut is the only common
nut with alpha linolenic acid. Try walnut oil in
salad dressings.
• Have two 115-gram portions of fatty fish weekly.
Enjoy salmon, albacore tuna, mackerel or sardines
• Try new ways to cook fish. Remember that fish
cooks quickly. Try poaching it in an orange juice
and herb mixture. Or bake fish with vegetables
wrapped in foil.
• Read the labels on egg cartons and choose eggs
that are high in omega-3 fats than regular eggs
because of the type of feed given to the chickens
that lay them. Remember, however, that all egg
yolks contain cholesterol.
Source: American Dietic Association
35
Ideas for a Healthy Diet
Food
Choose
Decrease
Beverages* (limit dairy
products to 2 servings
each day if you have CHF)
•Coffee, decaffeinated coffee, tea, soft drinks
•Low sodium tomato juice or vegetable juice
•1% or skim milk
•Low sodium carbonated beverages
•Milk shakes, chocolate milk
•Regular vegetable or tomato juice
•Sports drinks
•Limit buttermilk to 1 cup each week
•2% or whole milk
Low fat dairy products
•Low fat yogurt
•Low sodium cheese, low sodium/low fat cottage
•cheese, rinsed cottage cheese
•Low fat cheese
•Low fat coffee creamer
•Regular (hard) cheese, regular cottage cheese
•Processed cheese, cheese spreads, cheese sauces
(American, Velveeta)
•Whole milk yogurt
Breads and cereals
•Crackers, bread, rolls (unsalted tops)
•Muffins, French toast, cornbread
•Cooked cereals prepared without salt
•Puffed wheat, shredded wheat, puffed rice cereals
•Ready to eat cereals
•Crackers, bread, rolls with salted top
•Pancakes, biscuits, pastries, muffins, waffles
•Commercial bread crumbs
•Instant hot cereal
•Cereals containing coconut, hydrogenated vegetable fat,
animal fat
Desserts (Limit to 1 choice
a day)
•All low fat desserts, such as low fat ice cream,
low fat cookies, popsicles, sherbet (count in milk
allowance if made with milk)
•Sweets—sugar, syrup, honey, jam, preserves
•Fruit flavored gelatin
•Angel food cake
•Fig and other fruit bars
•Cake mixes
•Instant pudding mixes
•Donuts, commercially-made pies
•Ice cream and frozen treats made with ice cream, egg
yolk, cheese, sour cream, whole milk
Fats and oils (less than
or equal to 6 teaspoons
per day)
•Low fat salad dressings (1 tablespoon per day)
•Tub margarine
•Low sodium salad dressings
•Low fat sour cream, low fat cream cheese
•Unsaturated oils ( canola, olive, peanut, safflower,
corn, soybean, cottonseed)
•Salad dressings made with bacon bits
•Bacon fat, salt pork
•Stick margarine, butter, lard shortening
•Sour cream, cream cheese
Vegetables and fruits
(at least 5 servings a day)
•Fresh or frozen vegetables
•Low sodium canned vegetables
•Fresh, frozen, canned, dried fruits
•Fruit juice–fresh, frozen, canned
•Regular canned vegetables
•Sauerkraut
•Pickled vegetables
•Vegetables cooked with salted meats or salted fats
•Vegetables fried or prepared with butter, cheese, cream
•Dried fruits made with sodium sulfite
•Fried fruit or fruit served with butter or cream sauce
Meat, fish, poultry, eggs
dry beans and peas
•Fresh or frozen poultry, game, meats, fish
and shellfish
•Canned tuna and salmon, rinsed
•Tofu, dried beans and peas
•Low sodium canned tuna, salmon
•Canned dry beans, and peas if drained
•Low sodium canned dry beans
•Natural peanut butter
•Eggs & egg substitutes (limit to 3–4 egg yolks/
week, includes eggs used in cooking or baking)
•Salted or canned meats or poultry
•Canadian bacon, bacon
•Deli meats, ham, corned beef, pastrami
•Beef jerky
•Hot dogs, sausages
•Kosher-prepared meats
•Frozen prepared dinners if more than 500 mg sodium
•Fried meats, or meats with skin or breading (fried
chicken, fried shrimp)
Potatoes and substitutes
•White or sweet potato
•Homemade bread stuffing
•Macaroni, spaghetti, noodles, and rice cooked in
unsalted water
•Dried beans and peas
•Noodle, rice, potato and stuffing mixes
•Chow mein noodles
•Pasta or rice prepared with whole
•eggs, cream sauce or high fat cheese
Soups*
•Homemade soups made without salt
•Low sodium or low fat soups and bouillon (1 cup)
•Count soups made with milk as part of milk
allowance if you have CHF
•Regular canned, frozen or dehydrated soups and bouillon
•Homemade soups made with salted meats and salted fats
36
Ideas for a Healthy Diet...continued
Food
Choose
Decrease
Snacks
•Unsalted snack foods
•Homemade salsa
•Unsalted nuts & seeds
•Low fat crackers and snacks, graham crackers,
low salt saltines, bread sticks
•Salted snack foods
•Limit salsa in a jar (2 tablespoons at most)
•Salted nuts & seeds
•High fat or salted crackers–cheese crackers, butter
crackers, saltines
Fast food
•Plain hamburgers, plain grilled chicken
•Unsalted French fries
•Plain salads (1 tablespoon regular salad
dressing allowed)
•Any fast food with bacon, sausage, or ham
•Any fast food with breading, pickles, cheese sauces
Flavorings
•Herbs & spices
•Vinegar, lemon juice
•Barbecue sauce, catsup, prepared mustard, chili
sauce, (1 tablespoon per day)
•Low sodium soy sauce (1 teaspoon per day)
•Onion powder, garlic powder, seasonings
without salt
•Cocoa powder
•Seasoning salts (onion salt, garlic salt), monosodium
glutamate (MSG)
•Bottled sauces (soy sauce, Worcestershire sauce
•Pickles, olives, relishes
•Gravy mixes
•Coconut, milk chocolate
•Ask your doctor about using a salt substitute
Healthy Cooking Tips
Often minor changes in how favorite foods and
recipes are prepared can make a big difference.
If you usually add salt while cooking, simply put the
salt shaker out of reach. Don’t season meats and
vegetables with prepackaged mixes, which often
contain a lot of salt. Don’t fry foods in oil, which adds
unwanted fat and calories. Instead, try some of these
healthier techniques:
Stir-fry. Use a wok to cook vegetables, poultry and
seafood in low-sodium vegetable stock, wine or a
small amount of oil. Avoid high-sodium seasonings
like teriyaki and soy sauce.
Microwave. This is a good alternative because it’s fast
and doesn’t add fat or calories.
Roast. Put a rack in the pan so the meat or poultry
doesn’t sit in its own fat drippings. Instead of basting
the meat with pan drippings, use fat-free liquids like
wine, low-sodium tomato juice or lemon juice. When
making gravy from the drippings, use a gravy strainer
or skim ladle to remove the fat.
Grill or broil. Always use a rack so fat drips away from
the food.
Bake. Bake foods in covered cookware with a little
extra liquid.
Poach. Cook chicken or fish by immersing it in
simmering liquid.
37
Sauté. A pan made with nonstick metal or coated with
a nonstick surface is a terrific investment, because it
lets you use little or no oil without having food stick.
You also can use a nonstick vegetable spray, a small
amount of low-sodium broth or wine, or a tiny bit of
oil rubbed onto the pan with a paper towel. When
necessary, use liquid vegetable oils that have no more
than 2 g of saturated fat per tablespoon.
Steam. Steam vegetables in a basket over simmering
water. They’ll retain more flavor and won’t need salt.
Make favorite recipes healthier by substituting
ingredients to cut down on the content of fat
(particularly saturated fat). You and your family
probably won’t even notice a difference in taste. This
table can help you get started.
When your recipe says...
Try this instead
Whole milk (1 cup)
1 cup fat-free milk
Heavy cream (1 cup)
1 cup evaporated skim milk
Sour cream
Low-fat cottage cheese plus low-fat
or nonfat yogurt (fat-free sour cream
is also available)
Cream cheese
1 ounce of Neufchatel or light
cream cheese
Butter (for baking)
Butter blend stick, applesauce, or
fat-free plain yogurt
Egg (1)
2 egg whites or 1/4 cup commerciallymade, cholesterol-free egg substitute
What You Need to Know About Food Labels
How much will you be eating?
Remember, if you eat more than the amount listed,
you get more fat and calories!
Nutrition Facts
Serving Size 1 cup (228g)
Servings per container 2
How many of the calories come from fat?
The bigger the difference between Calories and
Calories from Fat, the better.
Amount per serving
Calories 260 Calories from fat 120
% Daily Value
Total Fat 13g
Saturated Fat 5g
20%
25%
Trans Fat 2g
Cholesterol 30mg
10%
Sodium 660mg
28%
Total Carbohydrate 31g
10%
Dietary Fiber 0g
0%
Sugars 5g
Protein 5g
% Daily Values are based on a 2000-calorie diet. Since
most people are unsure of calorie intake, it is better
to look less at % Daily Values and more at the total
grams (fat) and mgs (sodium). Five percent or less is
considered low, 20% or more is high.
Is it a lower-fat food?
Use this number to find out. Your total fat should be
35 to 70 grams/day, saturated fat should be 9 to 16
grams/day.
How much of the fat is saturated or trans fats?
The bigger the difference between Total Fat and
Saturated Fat and Trans Fat, the better.
Is it high in cholesterol?
You should eat less than 200mg of cholesterol per day.
Remember, you should limit sodium to 2000–3000mg
per day.
It is important to keep carbohydrates in mind if you
are a diabetic.
Nutrition Labeling Definitions
Serving Size: Listed by weight and household
measurement per serving
Sodium: The word to look for when you are limiting
salt intake.
Fat: The total weight refers to all fatty acids—
saturated, trans, polyunsaturated, and
monounsaturated (which may not be listed
individually on labels).
Polyunsaturated fats: Found mostly in vegetable
products like corn oil, it can help reduce blood cholesterol
as part of a total low-fat, low-cholesterol diet.
Saturated fats: Found mostly in animal products. It
is also found in large amounts in some vegetable oils
(palm, palm kernel, and coconut) and tends to raise
blood cholesterol.
Trans fats: Made from partially hydrogenated oil and
can raise cholesterol. Examples are stick margarine,
donuts, cookies and some snack foods.
Cholesterol: A fat-like substance found in meat, eggs,
and dairy products but not in foods of vegetable
origin. It may raise blood cholesterol.
38
Fast Food Facts
For most people, the occasional meal eaten at a fast
food restaurant will not upset an otherwise wellbalanced diet. With a carefully selected menu, you
can select a variety of foods to fit into your meal plan.
The bad news is that many of the food items are also
high in calories, fat, sugar and salt, while missing
many other nutrients. The good news is that many
fast food restaurants are helping us out by offering
salad bars, leaner meats, low calorie dressings, soups,
baked potatoes, low-fat milk and diet soft drinks. With
the ideas listed below, you should be able to equip
yourself with enough ideas to fit your appetite and
your meal plan!
Strategies
• Eat only at meal time. Try to balance a fast food
meal by choosing lower fat, lower salt the rest of
the day.
• Try to look for restaurants that cook with
vegetable oil, not animal fats.
• Choose grilled, or broiled—not fried, breaded, or
extra-crispy.
• Buy small! The words “super,” “giant,” “extralarge” and “deluxe” are red flag words.
• Think healthy, top smartly, use low-calorie salad
dressings, go “extra” on the veggies! Skip the
sauces and “hold the mayo!”
39
Instead of:
Choose:
Batter fried chicken or fish
sandwich
Grilled or broiled chicken breast
sandwich
Large roast beef or beef &
cheese sandwich
Regular roast beef sandwich
Burgers with the works
Plain quarter-pound hamburger with
lettuce, tomato and onion; and choose
from ketchup, mustard or pickle.
Deli or submarine
sandwiches with cold cuts,
sausage and cheeses
Deli sandwich with sliced turkey,
chicken, lean roast beef or ham on
whole grain bun. (Hold the cheese
and mayo)
Pan-style pizza with
pepperoni, sausage, or
double cheese
Order thin crust or vegetable pizza.
Go heavy on the veggies! No extra
cheese! Choose ham or Canadian
bacon for a lean meat topping.
French fries
Side salad with reduced calorie
dressing, or split small french fries
with a friend.
Baked potatoes with
toppings
Plain baked potato with lots of
vegetables and a small amount of
sour cream, margarine, or yogurt.
Salad bar with the works
with bacon, cheese,
pepperoni, sunflower seeds,
croutons, mixed salads,
regular salad dressings
Variety of raw vegetables, low-fat
cottage cheese or lean meats. Use
reduced-calorie salad dressings. Use
creamy dressings sparingly!
Breakfast sandwich with
bacon or sausage on a
croissant or biscuit
English muffin or bagel breakfast
sandwich with egg and ham or
scrambled egg plus English muffin
or toast with a small amount
of margarine.
Danish or donut
English muffin or bagel with jelly or
jam; or pancakes
Healthy Eating Away from Home
Because of travel associated with work or busy
schedules, many of us eat two of our daily meals away
from home. At the same time we are trying to reduce
the fat, cholesterol, calories, and sodium in our diets
to improve health and maintain optimal weight. One
option to meet both of these needs is to “brown bag”
breakfast and lunch.
Breakfast is the meal least often eaten outside the
home, but mainly because it is the meal most often
skipped. Mom’s admonition that breakfast is the most
important meal of the day seems to be true, according
to recent research. Breakfast “breaks the fast” and
signals the body to speed up its metabolism for the
day’s activities. Those who skip breakfast or cram
their day’s calories into a few meals tend to overeat
later in the day.
Healthy Brown-Bag Breakfasts
• Homemade whole grain muffins (commercially
prepared muffins are often high in fat, calories,
sodium and cholesterol). Lower fat muffins are
becoming available commercially.
• Whole wheat bread products
• Bagels (avoid egg bagels to reduce cholesterol)
• Hot or cold single-serve whole-grain cereals. Bran
flakes and shredded wheat are high in insoluble
fiber; oatmeal or oatbran cereals are high in
soluble fiber. Vary your selections to get some of
each. Cold cereals and instant hot cereal packets
can contain 200–400 mg sodium per serving, so
check the sodium content of your selections.
• English muffins
• Fresh fruit (higher in fiber than juice and tends to
promote a sense of fullness)
• Dried fruit (raisins, dates, apricots, apples, prunes
and figs)
• Low-fat yogurt (fruited and plain)
• Low-fat toppings for muffins and bread products
include the new all-fruit (low-sugar) jams and 1%
cottage cheese
• People who dislike traditional “breakfast foods”
oftenprefer healthy dinner leftovers such as
homemade vegetarian pizza (lots of vegetables,
light on cheese and minus the sausage and
pepperoni) or rice or pasta dishes (with small
amounts of fish or chicken and vegetables mixed).
Healthy Brown-Bag Lunches
• Low-fat turkey lunchmeats (use baked or
roasted fresh turkey or chicken without skin to
reduce sodium.)
• Tuna or salmon salad (packed in water, not oil;
use low-fat, low-calorie dressings; low sodium
products available)
• Sardines packed in mustard or tomato sauce (high
in sodium)
• Low-fat plain and fruit yogurts
• 1% or fat-free cottage cheese
(great mixed with vegetables
and seasonings and stuffed
into whole-wheat pita
pockets)
• Whole-grain breads and
crackers (low-salt products
available)
• Fresh and dried fruits
• Individually packaged juices
(if you are watching calories
stick with low-calorie sodas
or sparkling waters)
• Fresh vegetables, cut into
finger-size pieces or shredded into
sandwich filings
• Salad with vegetables, pasta, and lentils topped
with a low-calorie, low-fat dressing
• Microwavable baked potatoes topped with low-fat
plain yogurt flavored with seasonings or stuffed
with vegetables
• Healthier, homemade versions of the
microwavable single-serving pasta and vegetable
dishes available in the supermarkets
• Pretzels or air-popped popcorn are a good low-fat
lunch alternative to high-fat potato, corn or tortilla
chips (minus the salt, they are low in sodium)
• Mustard, ketchup and horseradish are good lowfat alternatives to mayonnaise sandwich spreads
(high in sodium)
• Homemade low-fat soups or chili during the winter
40
Suggestions for Heart-Healthy Dining
Recognize that you can choose healthy foods when
eating out in the same way that you do at home.
Eating out is an opportunity to enjoy the company of
friends, provides, a relaxing environment, and allows
the enjoyment of new foods that do not have to be out
of step with a good healthy diet.
It is wise to avoid situations in which you cannot
make healthy food choices (fried fish and chips type
restaurants) or where the tendency to overeat is
overwhelming (all-you-can-eat buffets).
Do not feel shy about asking questions concerning
preparation of foods or making special requests.
Special requests are common these days because
people are more concerned with good nutrition.
Most places see this as a way to ensure your
continued patronage.
Special requests to consider:
• “Could I substitute a baked potato for french fries?”
• “Could you leave the potato chips off the plate?”
• “Could you serve the salad dressing, gravy or
sauce on the side?”
• “Could you bring skim milk instead of cream for
our coffee?”
• “Could I have the fish broiled without butter
or margarine?”
Be alert to high-fat food preparation methods
such as frying and sauteing, as well as cream or
cheese sauces, deep-fried, and breaded items.
Better selections are steamed, poached, blackened,
mesquite-grilled, and stir-fried (request a vegetable oil
and light on the soy sauce).
Portions in restaurants are huge. Simply decide on a
reasonable amount to eat and then ask for a doggy
bag. An alternative is to share an appetizer, entrée or
dessert with a spouse or friend.
If you tend to eat very quickly, consider the fact that
your brain does not recognize signals of fullness from
your stomach until 20 minutes after you have eaten.
Slow down, sip on a beverage, chat with friends, and
enjoy the moment. You will have a better sense of
when you are full and will avoid overeating.
41
How Much Sodium is in Your Food?
Serving
Amount
Sodium
(mg)
8 oz
8
Potassium Calories
(mg)
Beverages
Apple Juice
Serving
Amount
Shredded Wheat
296
Toasted Oats
116
Sodium
(mg)
Potassium Calories
(mg)
2 biscuits
3
196
156
1 cup
284
89
110
Cinnamon Roll
Beer
Regular
12 oz
18
89
146
Refrigerated (1)
1 oz
236
18
103
Light
12 oz
11
64
99
Dinner Roll
1 oz
148
38
85
Club Soda
12 oz
75
7
0
228
58
242
8 oz
5
128
5
Doughnut, Cake,
Plain
2 oz
Coffee, brewed
Regular
12 oz
15
4
152
Diet
12 oz
21
0
4
Cranberry Juice
Cocktail
8 oz
5
46
Grapefruit Juice,
Unsweetened
8 oz
3
378
Cola
*Muffin, Mix
Apple Cinnamon
1
210
40
170
Banana Nut
1
230
35
170
144
Chocolate Chip
1
210
40
170
1
210
25
160
94
English (1)
2 oz
265
75
134
Orange Juice,
frozen
Corn
Macaroni, Cooked
½ cup
1
21
99
Noodles, Egg,
Cooked
½ cup
5
23
106
One 4”
192
76
83
½ cup
5
42
108
Reconstituted
8 oz
3
473
112
*Pancakes, Mix
Pineapple Juice
8 oz
3
335
140
Rice, Cooked
Prune Juice
8 oz
10
707
182
Tea
8 oz
7
88
2
White
½ cup
1
28
103
Tomato Juice
8 oz
877
535
41
Spaghetti, Cooked
½ cup
0
21
99
Tonic Water
12 oz
15
0
124
Tortilla, Flour
One 7”
234
64
159
Vegetable Juice
Cocktail
8 oz
653
467
46
Waffle, Frozen
One 4”
260
42
87
Water, Bottled
8 oz
2
0
Wheat Germ
2 Tbsp
0
140
50
Red
5 oz
7
164
106
Condiments and Spreads
White
5 oz
7
121
100
Barbecue Sauce
1 Tbsp
127
27
12
Butter
1 Tbsp
117
4
102
Catsup
1 Tbsp
178
72
16
0
Wine
All juices are canned or bottled unless indicated otherwise.
Breads, Cereals
Brown
*Prepared according to package instructions.
Bagel (1)
2 oz
304
58
157
Gravy, Chicken,
Canned
¼ cup
343
64
47
Biscuit (1)
1 oz
341
45
98
Jam
1 Tbsp
6
15
56
Margarine
1 Tbsp
132
6
102
Pita (1 piece)
1 oz
150
34
77
Rye (1 slice)
1 oz
187
47
74
Dijon
1 tsp
120
10
5
White (1 slice)
1 oz
148
71
69
Yellow, Prepared
1 tsp
56
8
3
Bran Flakes
¾ cup
226
175
95
Corn Flakes
1 cup
298
26
Crisp Rice
1 cup
206
Oatmeal, Cooked
¾ cup
Puffed Rice
Bread
Cereals
Mustard
Pancake Syrup
1 Tbsp
12
1
53
2 Tbsp
156
239
188
102
Peanut Butter,
Chunky
27
111
Pickles
1
98
104
Dill
1 spear
385
35
5
1 cup
0
16
56
Sweet Relish
1 Tbsp
122
4
20
Puffed Wheat
1 cup
0
42
44
Raisin Bran
1 cup
354
437
186
42
Serving
Amount
Sodium
(mg)
Potassium Calories
(mg)
Condiments and Spreads
Desserts
Salad Dressing
*Brownie – Mix
Sodium
(mg)
Potassium Calories
(mg)
1 square
110
183
170
Blue Cheese
2 Tbsp
334
12
154
French
2 Tbsp
428
24
134
Angel Food
1/12 cake
255
68
129
Italian
2 Tbsp
232
4
138
Devil’s Food
1/12 cake
360
160
290
Yellow
1/12 cake
290
48
250
1.55 oz
36
169
226
1/8 cake
377
209
271
*Chocolate
Mousse Pie, Mix
1/8 pie
437
270
247
Chocolate Syrup
2 Tbsp
25
50
100
Mayonnaise
2 Tbsp
156
10
198
Ranch
2 Tbsp
287
14
148
Salad Dressing
2 Tbsp
210
2
114
Thousand Island
2 Tbsp
218
36
118
Steak Sauce
1 Tbsp
280
50
15
Soy Sauce
1 Tbsp
871
64
9
Worcestershire
Sauce
1 Tbsp
210
30
15
Cheese
American,
Processed
Blue, Crumbled
Cheddar
*Cake – Mix
Candy Bar
Milk Chocolate
(1 bar)
*Cheesecake
Mix, No-Bake
Cookies
(packaged)
Dairy Products
108
28
123
406
46
106
Animal
Crackers (11)
1 oz
1 oz
88
28
135
471
87
119
Chocolate
Chip (1 lg)
1 oz
¼ cup
Chocolate
Sandwich
3
181
53
142
1 oz
107
66
110
5
92
32
142
1 oz
176
28
114
½ cup
457
95
117
Low Fat
½ cup
459
97
82
Cream Cheese
2 Tbsp
86
35
101
Mozzarella
1 oz
150
27
79
Parmesan,
Grated
1 Tbsp
93
5
23
Regular
½ cup
57
1
80
Sugar-Free
½ cup
56
0
8
1 oz
74
31
107
Frosting – Canned
Cream,
Half & Half
1 Tbsp
6
19
20
Chocolate
2 Tbsp
65
69
139
Vanilla
2 Tbsp
30
13
142
Cream, Heavy
1 Tbsp
6
11
52
Sour Cream
1 Tbsp
6
17
26
Ice Cream,
Vanilla (10% fat)
½ cup
53
131
133
*Pudding,
Instant – Mix
(2% Milk)
Chocolate
½ cup
247
417
150
Vanilla
½ cup
407
185
147
Buttermilk
1 cup
257
371
99
*Prepared according to package instructions.
Lowfat (2%)
1 cup
122
377
121
Nonfat
1 cup
126
406
86
Whole
1 cup
119
369
157
Orange
½ cup
34
71
102
8 oz
190
580
150
Cottage Regular,
Small Curd
Swiss
Oatmeal Raisin (1)
Vanilla Wafer
Flavored
Gelatin – Mix
Milk
Sherbet
Yogurt Lowfat,
Plain
Fish and Seafood
Apple, Raw
1
0
159
81
Applesauce
Canned,
Sweetened
½ cup
4
78
97
Apricots
Raw
Canned
Avocado
Banana
Blueberries, Raw
43
Serving
Amount
3
1
312
51
½ cup
4
202
59
½
10
602
162
1
1
467
109
½ cup
5
65
41
Cantaloupe,
Cubed
Serving
Amount
Sodium
(mg)
½ cup
7
Potassium Calories
(mg)
247
28
Serving
Amount
Sodium
(mg)
Frankfurter, Beef
1 oz
458
77
143
Salami, Beef
and Pork
1 oz
302
56
71
Leg Roast
3 oz
58
287
162
Loin Chop
3 oz
71
320
184
Cherries
Raw, Sweet
½ cup
1
163
52
Canned
½ cup
4
164
68
Dates, Pitted
5
0
240
120
Fruit Cocktail,
Canned
½ cup
5
128
55
½
0
178
41
½ cup
2
148
57
Kiwifruit
1
4
252
46
Orange
1
1
257
62
Grapefruit
Grapes, Raw
Peaches
Raw
Canned
1
0
193
42
½ cup
5
159
55
Lamb
Pork
Bacon
3 slices
303
92
109
Sausage
3 links
504
141
144
Ham
3 oz
1275
348
151
Rib Chops
3 oz
55
357
173
Spare Ribs
3 oz
79
272
337
Veal
Cutlet
3 oz
57
329
173
Loin Chop
3 oz
71
252
192
Rib Roast
3 oz
82
264
150
2.5 oz
357
98
117
Fried, Flour
Coated
3 oz
62
201
231
Pears
Raw
Potassium Calories
(mg)
1
0
208
98
½ cup
5
119
62
Raw
½ cup
1
88
38
Canned
½ cup
1
152
75
Roasted,
Dark Meat
3 oz
79
204
174
1
0
114
36
3 oz
66
210
147
½ cup
2
194
73
Roasted,
White Meat
Prunes
5
2
313
100
Raisins
¼ cup
190
580
150
2 slices
368
58
68
Raspberries
½ cup
0
94
30
3 oz
88
221
193
Strawberries
Raw, Sliced
½ cup
1
138
25
Ham
1 oz
316
81
32
Roasted
3 oz
57
223
127
1
1
132
40
1 cup
6
332
96
Canned
Chicken
Canned
Pineapple
Plums
Raw
Canned
Tangerine
Watermelon,
Diced
*All canned fruit is packed in juice. All raw fruit are medium size, unless
otherwise indicated.
Ground Turkey
Eggs
Fried
1 large
163
61
92
Hard-Boiled
1 large
62
63
78
Scrambled
1 large
171
84
101
Prepared Entrees and Side Dishes
Beef
Beef Stew,
Canned
1 cup
1187
388
192
213
*Beef
Stroganoff, Mix
1 cup
760
110
320
297
238
Chicken Pot Pie
200
137
Frozen (1 pot pie)
7.6 oz
857
256
484
318
195
1336
934
287
359
162
Chili with Beans
Canned
1 cup
54
56
343
166
*Lasagna, Frozen
1 cup
720
410
370
88
Macaroni and
Cheese
1 cup
990
210
320
Chuck Blade Roast
3 oz
60
224
213
Corned Beef
Brisket
3 oz
964
123
Ground Beef, Lean
3 oz
76
Liver
3 oz
60
Rib Roast
3 oz
61
Round Steak
3 oz
Sirloin Steak
3 oz
Cold Cuts
1 oz
Bacon
*All values are for cooked, lean, trimmed, boneless and shelled weights.
Meat, Poultry and Eggs
Bologna, Beef
1 slice
Turkey
378
45
Frozen
44
Serving
Amount
Sodium
(mg)
Potassium Calories
(mg)
Prepared Entrees and Side Dishes
Fresh
147
59
132
20
Fresh, baked
1
8
610
145
Fresh, peeled,
boiled
½ cup
4
256
67
French Fries,
frozen, ovenheated
10
15
209
100
½ cup
246
352
83
1
11
397
117
5
4
52
5
½ cup
470
121
14
Raw, chopped
1 cup
24
167
7
Canned
½ cup
29
370
25
Winter, fresh,
baked
½ cup
1
448
40
Zucchini, sliced
½ cup
3
228
16
389
Pepper, Green,
raw
Pork and Beans
Canned
½ cup
557
380
124
Potatoes
Ravioli, Canned
1 cup
1174
354
229
Veggie Burger
1 patty
411
432
137
425
60
4 spears
7
96
14
Canned (S/L)
½ cup
347
210
18
Beans, Lima, fresh
½ cup
15
485
105
Canned (S/L)
½ cup
313
353
88
Beans Sprouts,
Mung
Radishes, raw
Sauerkraut
Spinach
Squash
Raw
½ cup
3
78
16
Canned
½ cup
88
17
8
Beets, fresh
½ cup
66
259
38
Broccoli, fresh
½ cup
20
228
22
½ cup
12
143
12
Brussel Sprouts,
fresh
½ cup
16
247
30
Cabbage, raw,
shredded
½ cup
7
86
9
Raw
Mashed,
instant mix
Sweet, baked
Asparagus
67
2
315
216
Vegetables’
217
214
248
855
Fresh
3
½ cup
456
5 oz
114
½ cup
Potassium Calories
(mg)
½ cup
5 oz
Pepperoni
(1 slice)
*Prepared according to package directions.
Tomatoes
1
11
273
26
Canned, whole,
(S/L)
Raw
½ cup
178
265
23
Paste
½ cup
1035
1228
107
Sauce
½ cup
741
455
37
½ cup
39
106
17
½ cup
6
83
35
1 cup
850
108
175
Turnips, fresh
Carrots
Fresh, sliced
½ cup
52
177
35
Water Chestnuts
Canned
½ cup
177
131
19
Canned, (S/L)
Cauliflower, fresh
½ cup
9
88
14
Celery, raw
1 stalk
35
115
6
Fresh
½ cup
14
204
89
Canned,
whole kernel
½ cup
176
160
67
Canned,
ready to serve
Chicken Noodle
Canned, creamed
½ cup
365
172
92
1 cup
1001
384
134
Cucumber, raw,
sliced
½ cup
1
75
7
Clam Chowder,
Manhattan
Vegetable
1 cup
1010
396
122
Eggplant, fresh,
cubed
½ cup
2
123
14
Lettuce, Iceberg
1 cup
5
87
7
Cream of Chicken
1 cup
1047
273
191
Raw
½ cup
1
130
8
Cream of
Mushroom
1 cup
918
270
203
Canned
½ cup
332
101
19
Tomato
1 cup
744
449
161
Corn
Mushrooms
45
Canned
Cheese (1 slice)
1
Sodium
(mg)
Peas
Pizza, Frozen
Artichoke, Globe,
raw
Serving
Amount
Soups
Soups,
Condensed,
prepared with milk
Serving
Amount
Sodium
(mg)
Potassium Calories
(mg)
Snacks
Serving
Amount
Sodium
(mg)
Potassium Calories
(mg)
1 oz
168
361
152
Potato Chips
627
169
Plain
Beef Jerky
1 oz
116
Cheese Balls
1 oz
300
30
160
Corn Chips
1 oz
179
40
153
Cheese flavored
Pretzel Twists
1 oz
225
433
141
5 twists
515
44
115
Tortilla Chips
Crackers
Cheddar Cheese
1 oz
280
41
140
Plain
1 oz
110
70
140
Graham (4)
1 oz
170
38
120
Nacho cheese
1 oz
190
65
140
Saltines (5)
½ oz
182
18
61
Wheat (5)
½ oz
113
26
67
1 oz
120
180
170
Baking Powder
1 tsp
363
0
2
1 cup
86
761
827
Dry Roasted
1 oz
231
187
166
Brown Sugar,
(packed)
Oil Roasted
1 oz
123
193
165
Flour, all purpose
1 cup
3
134
455
Powdered Coffee
Cream
1 tsp
4
16
11
1 oz
0
111
203
Vegetable Oil
1 Tbsp
0
0
120
Vinegar, Cider
1 Tbsp
0
15
2
Oil-popped
3 cups
291
75
165
Cheese flavored
1 cup
98
29
58
Nuts
Cashews
Peanuts–Salted
Pecans, oil roasted
Unsalted
Popcorn
Miscellaneous
Let’s Talk About Fluids
Your daily fluid allowance is ______________________ cc
or __________________ ounces
or____________________ cups
cc
ounces
30
1
cups
other
2 tbsp
120
4
½
240
8
1
½ pint
1000
33
4
1 quart
1200
40
5
1500
50
6
1800
60
7½
1 ½ quarts
One pint of fluid equals one pound.
What counts as fluid?
Water
Ice (1 cup = 180cc)
Soft Drinks
Broth/bouillon
Ice cream (½ cup = 90cc)
Fruit ice (4 oz = 120cc)
Coffee and tea
Soups (¾ cup = 180cc)
Popsicles (2 sticks = 65cc)
Jello (½ cup = 120cc)
Sherbet (½ cup = 90cc)
Milk
Beverages used to take your medicine
Measure your daily allowance
It may be helpful to keep a container near your sink to
keep track of how much fluid you have each day. Start
each day with an empty container, marked with your
daily limit. Every time you have liquid, pour an equal
amount of water into the container. This makes it easy
to see how much fluid you have for each day.
How to control thirst without fluid
• Avoid foods high in salt or sodium.
• Moisten mouth with chewing gum, hard candy or
slices of cold fruit.
• Frozen grapes are great and can help moisten
your mouth.
• Rinse your mouth with water, then spit it out.
• In winter moisten air by using a humidifier.
Tips:
• Measure how much your coffee cup, drinking
glass or soup bowl holds. Then you won’t need to
measure every time you use them.
• Drain liquid from canned fruits and vegetables.
• Try to spread your fluid allowance evenly over the day.
• When taking medications, set aside the amount of
fluid you will need to take them.
• Weigh yourself every morning after going to the
bathroom. If you gain two pounds overnight, you
may be retaining fluid, and you should tell your
doctor immediately.
How long do I need to restrict my fluids?
This varies with each person. Ask your physician if
you have questions about fluids.
46
Let’s
Let’sTalk
TalkAbout
AboutExercise
Exercise
sa hcus seitivitca ciboreA .krow ti pleh ot esicrexe sdeen elcsu
Staying
activeyour
will help
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heart.
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ying active
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such
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oto
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it
walking
help exercise
theyour
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fewer
king help
exercise
the
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When
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may
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and
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walking
help
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and
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symptoms.
walking
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traeh ruoy dna flesruoy t
Let’s
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walking
help
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the
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you
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you
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And
staying
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can
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you When
feelExercise
better
yourself
And
staying
active
can
help
you
feel
better
about
yourself
and
your
heart.
d staying
active
can
help
you
feel
better
about
yourself
and
your
heart.
And staying
staying active
active can
can help
help you
you feel
feel better
better about
about yourself
yourself and
and your
your heart.
heart.
And
rm Up Exercises
Staying active will help your heart. Your heart muscle needs exercise to help it work. Aerobic activities such as
walking helpLeg
exercise
tired and have fewer symptoms.
Liftsthe heart. When you stay active, you may also
Sitfeel
& less
March
And staying active can help you feel better about yourself and your heart.
Warm
Up
Exercises
Warm
Up
Exercises
Warm
Up
Exercises
Warm Up Exercises
Sitting in a chair, lift one leg
Lifts it straight.
at a time,Leg
keeping
Leg Lifts
Sitting
in a chair, lift one leg
Leg
Lifts
Perform this
exercise
10 times
Leg
Lifts
Leg
Lifts
at a
time,
keeping it straight.
Sitting
in
a
chair,
lift one leg
Sitting
one
legleg
on Leg
eachLifts
leg.
Perform
exercise
10
times
Sittinginthis
ina chair,
chair,liftlift
lift
one
Sitting
in
aa chair,
one
leg
a time,
onat
each
leg. keeping
it straight.
it itstraight.
ata atime,
time,keeping
keeping
straight.
Sitting atinat
liftexercise
one
aa chair,
time,
keeping
it leg
straight.
Perform
this
10 times
Perform
this
exercise
1010times
Perform
this
exercise
times
Perform
this
exercise
10 times
at a time,onkeeping
each leg.it straight.
ononeach
eachleg.
leg.
leg.
Perform on
thiseach
exercise
10 times
on each leg.
Ankle Roll
Sitting in a chair,
and
lift oneSitleg
atMarch
a time.
hcraM
tiS leg at a
SitSitting
& March
in a chair,
lift&one
SitSit
&&
March
Repeat
this
exercise
10
March
Sittime.
& March
Repeat
iahcthis
a niexercise
gnittiS 10 times
Sitting
in a,rchair,
Sit
&
March
on
leg.
Sitting
chair,
times
onineach
each
Sitting
in
chair,
.aem
tleg.
a ta gel eno tfil
Sitting
in
aa ichair,
gel en
.thgia
semit 0
lift one leg at a time.
liftliftone
one
leg
at
time.
0leg
eaatsichair,
caexercise
retime.
siht10taepeR
Sitting
in1this
lift
one
leg
at
aaxetime.
Repeat
Repeat
this
exercise
Repeat
this
exercise
10
.at
gexercise
elaleg.
htime.
cae10n10
o semit
this
liftRepeat
one on
leg
times
each
times
ononeach
leg.
times
each
leg.
times on
leg. 10
Repeat
thiseach
exercise
times on each leg.
lloR el kn A
SittingAnkle
or standing,
roll ankles in
Roll
Ankle
Roll
Ankle
Roll
Ankle Roll
nicircle.
seankles
l kna Rellin
or ,gnidnats ro gnittiS
one direction
Sitting or making
standing, aroll
Sitting
ororstanding,
roll
ankles
in
Sitting
standing,
roll
ankles
in
-roll
eRa .circle.
elccompletric aReor standing,
ankles
ingnikam noitcerid eno
one
direction
making
peatone
inSitting
the
other
direction,
direction
making
a
circle.
Reone
direction
making
a
circle.
ReAnkle
Roll
-telpm
c ,ncompletoiRetcerid rehto eht ni taep
one
direction
making
a ocircle.
peat
in in
theeach
other
direction,
ing 10
rolls
direction.
peat
ininthe
other
direction,
completpeat
the
other
direction,
completaises
.noicomplettcerid hcae ni sllor 01 gni
peat
in rolls
the other
direction,
ing 10
in each
direction.
Sitting
or
standing,
roll
ankles
in
Arm Raises
ing
10
rolls
in
each
direction.
ing
10
rolls
in
each
direction.
Arm
Raises
ing
10
rolls
in
each
direction.
Arm
Raises
Arm
Raises
or standing,
raise
both arms
shoul-to shoul- one Ankle
direction
Arm
Raises
Rollmaking a circle. ReSitting
or standing,
raise forward
both armsto
forward
Sitting
or
standing,
raise
both
arms
forward
to
shoulSitting
orstanding,
standing,
raise
both
armslower
forward
to shoulshoul- peatSitting
Sitting
oror
both
arms
forward
standing,
roll ankles
in one
ght, or point
of
discomfort,
and
then
Sitting
standing,
raise
both
arms
forward
to
in theorother
direction,
completder
height,
or pointraise
of
discomfort,
and
then to
lower
der
height,
or
point
of
discomfort,
and
then
lower
shoulder
height,
or
point
of
discomfort,
and
then
direction
making
a
circle.
Repeat
in
der height,
height,
or 10
point
of discomfort,
discomfort, and
and then
then lower
lower
der
or
point
of
them.
Repeat
times.
Repeat them.
10
times.
ing
10
rolls
in
each
direction.
lower
them.
Repeat
10
times.
the
other
direction,
completing
10
Repeat 10 times.
m Raises
them. Repeat
Repeat 10
10 times.
times.
them.
ing or standing, raise both arms
forward to shoulShoulder Rolls
Shoulder
Rolls
Shoulder
Rolls
height, or pointShoulder
of discomfort,
andRolls
then lower
Shoulder
Rolls
Sitting orRolls
standing, roll
Shoulder
Sitting
ororstanding,
roll
Sitting
standing,
rollyour
m. Repeat 10 times.
Sitting or standing,
roll
Sitting
or
standing,
roll
Sitting
or
standing,
roll
your shoulders
forward
10
your
shoulders
forward
1010 and
your
shoulders
forward
shoulders
forward
10 times,
your
shoulders
forward
10
your shoulders
forward
10backward
times,
and then
times,
and
then
backward
then
backward
10backward
times.
times,
and
then
times,
and then backward
10 times.
times,
and10then
backward
Shoulder
Rolls
times.
10
times.
10 times.
10 times.
Sitting or standing, roll
your shoulders forward 10
times, and then backward
10 times.
-luoh
re
rolls in each direction.
sesiaR leeH
Heel Raises
Heel
Raises
Heel
Raises
ehtRaises
ffor
o sstanding,
leeh htob lift
tfil both
,gnidheels
nats roff
o gnthe
ittiS
HeelHeel
Raises
Sitting
Sitting
or
standing,
lift
both
heels
off
the
Sitting
orWhen
standing,
lift
both
heels
off
the
-pusSitting
ot tnaw
ystanding,
am ustanding,
oy ,glift
nidboth
nayou
ts nheels
eh Woff
.dnthe
uto
orgsupor
ground.
may
want
ground.
When
standing,
you
may
want
to
Sitting
or
standing,
lift
both
heels
off
the
When
standing,
you
may
want
to
sup.sground.
eground.
mit yourself
01 tWhen
aepeagainst
R standing,
.llaw aa wall.
tsnyou
iagRepeat
amay
flesrwant
u10
oy times.
trto
osuppsupport
port
yourself
against
a
wall.
Repeat
10
times.
port When
yourselfstanding,
against aa wall.
wall.
Repeat
10 times.
times.
ground.
youRepeat
may want
to support
yourself
against
10
Heel Raises
port
yourself
against a wall. Repeat 10 times.
Heel
Raises
Sitting
or standing, lift both heels off the ground.
hcraM
& dnatS
When&standing,
you may want to support
yourself
Stand
March
Sitting
or
standing,
lift
both
heels
off
the
Stand
&
March
Stand
&
March
against
a wall. Repeat 10 times.
Stand
er&
ehMarch
T
emitplace,
a ta glift
el enone
o tfleg
il ,eatcaalptime.
eno nThere
i gnidnatS
Standing
in .When
one
ground.
standing,
you
may
want
to supStanding
in
one
place,
lift
one
leg
at
a
time.
There
Standing
in
one
place,
lift
one
leg
ateArms
time.
There
desu ebbeyin
aam
smplace,
rA
.eenlift
k ethe
ht nknee.
i dnat
baa ttime.
hgilmay
s There
a ebbedused
luohs
Standing
one
one
leg
should
slight
bend
in
Stand
&
March
port
yourself
against
a
wall.
Repeat
10
times.
should
be
a
slight
bend
in
the
knee.
Arms
may
be
used
should
be aa.gslight
slight
bend
inemthe
the
knee.
Arms
may
be
used
el hRepeat
cabend
e no 10
sin
it 0knee.
1 on
taepeach
eR .eleg.
smay
icrexbe
e siused
h t ni
should
be
Arms
in
this exercise.
times
inin
exercise.
Repeat
10
times
on
each
leg.
1this
this
exercise.
Repeat
10one
times
onateach
each
leg. There 1
Standing
inexercise.
one place,
lift10
legon
a time.
in this
Repeat
times
leg.
1
1
1
should be a slight bend in the knee. Arms may be used
Standing in one place, lift one leg at a time. There
Stand & March
should be a slight bend in the knee. Arms may be in this exercise. Repeat 10 times on each leg.
1
used in this exercise. Repeat 10 times on each leg. Standing in one place, lift one leg at a time. There
47
should be a slight bend in the knee. Arms may be used
Stand and March
Let’s Talk About Exercise....continued
Home Exercise Program I
To be followed until you begin Phase II (outpatient) Cardiac Rehabilitation
Begin your exercise program by walking as follows:
Level
Duration
Frequency
Level I
5 – 10 mins
3 times/day (7 days/week)
Level II
10 – 15 mins
2 times/day (7 days/week)
Level III
15 – 30 mins
2 times/day (3–5 days/week)
If you had open heart surgery, read
this section about exercise carefully!
Things to Remember:
• Always perform warm-up stretches (as shown to
you in the hospital during Phase I Cardiac Rehab)
before you begin your exercise regime.
• Increase your exercise time gradually, adding one
minute every day (or every other day) as long as
you have no symptoms (i.e.: shortness of breath,
pain, dizziness, etc.).
• Stay within each “level” for at least one week
before advancing to the next.
• End your exercise session with 5 minutes of cooldown stretches (same as warm-up).
• Plan rest periods before and after exercise and
when you feel tired.
• Wait 1½ hours after eating before beginning your
exercise session.
• No lifting more than 10 pounds or using arm weights.
• Do not exceed your exercise program because you
“feel good.”
Note: You may find it helpful to keep track of your
daily exercise activity. An activity log is included in
this book for your convenience.
48
Let’s Talk About Exercise....continued
Home Exercise Program II
As part of your lifestyle changes, you should consider
participating in an aerobic exercise program.
Aerobic exercise is very important for cardiovascular
fitness and decreasing your risk factors for further
complications related to your heart. Aerobic exercise
can help to maintain a healthy weight, decrease
cholesterol levels, decrease blood pressure, maintain
normal blood glucose levels and decrease stress.
Generally speaking, any activity that is continuous in
nature and lasts for 20 minutes or more is aerobic.
Walking, cycling, jogging, swimming, dancing,
and rowing are examples of aerobic activities. We
recommend that you start with walking. You are not
expected to exercise for 20 minutes when first starting a
walking or exercise program. Please refer to the following
chart for a starting point and progression schedule.
In addition to the times provided on this chart, include
a stretching routine before your walk to help increase
your heart rate gradually and after your walk to begin
to reduce your heart rate gradually. Stretching also
help to increase flexibility and avoid injury.
49
When you have easily completed one step at least 3
times, and you feel able to increase your walk time,
you may progress to the next step. The rate at which
you progress depends on your level of fitness and
how well you are able to adapt to exercise. When
reaching step 15, you may continue at a maintenance
level of 30 to 60 minutes of exercise daily if tolerated.
To avoid placing too much stress on your heart, you
will need to monitor your heart rate (HR) as you
begin your home exercise program. Your HR should
not exceed 20 beats per minute above your resting
HR. This means you should check your HR before
you begin and then once again approximately 3 to
5 minutes after you have begun. For example, if
your HR is 70 before walking, it should not exceed
90 during the walk. If it is, you will need to slow
down or stop until your HR decreases. You may not
always be restricted by this HR limit, but your doctor
will be responsible for setting a new HR limit when
appropriate. If you are not sure how to check your
pulse, ask your nurse or a member of the rehab staff
to assist you.
Step
Time
Frequency
Total time/day
1
3 – 5 minutes
2 – 3 times daily
6 – 15 minutes
2
4 – 6 minutes
2 – 3 times daily
8 – 18 minutes
3
5 – 7 minutes
2 – 3 times daily
10 – 21 minutes
4
6 – 8 minutes
2 – 3 times daily
12 – 24 minutes
5
7 – 9 minutes
2 – 3 times daily
14 – 27 minutes
6
8 – 10 minutes
3 times daily
24 – 30 minutes
7
9 – 11 minutes
3 times daily
27 – 33 minutes
8
10 – 12 minutes
3 times daily
30 – 36 minutes
9
11 – 12 minutes
3 times daily
32 – 36 minutes
10
16 – 17 minutes
2 times daily
32 – 36 minutes
11
16 – 18 minutes
2 times daily
32 – 36 minutes
12
18 – 20 minutes
2 times daily
36 – 40 minutes
13
20 – 22 minutes
2 times daily
40 – 44 minutes
14
20 – 25 minutes
2 times daily
40 – 50 minutes
15
30 – 45 minutes
1 – 2 times daily
30 – 90 minutes
Intensity of Exercise
The following scale is called the Rating of Perceived
Exertion (RPE) Scale. It is a subjective way to
determine how hard to exercise.
0 = Nothing at all
1 = Very, very easy
2 = Very Easy
3 = Moderate
4 = Somewhat hard
5 = Hard
6=
7 = Very hard
8=
9=
10 = Very, very hard
Note: Difficulty of exercise should fall into the
moderate (3) to somewhat hard (4) range. You must
truly evaluate how you feel while exercising for this
chart to be effective. Take into account: shortness
of breath, leg fatigue and overall fatigue when
evaluating difficulty.
Exercise Precautions
• Discontinue exercise if you experience chest
discomfort (pain, pressure, burning), unusual
shortness of breath, light-headedness, dizziness,
frequent skips in your heartbeat or unusual
fatigue. Contact your doctor if you experience any
suspicious symptoms.
• Wait one hour after eating before you exercise.
• Avoid exercising in extreme temperatures (less
than 32 degrees or over 85 degrees).
• Avoid very humid conditions as well. Both
conditions place extra stress on your heart
with the potential to increase heart rate and
blood pressure.
• Avoid exercising during periods of illness.
Wait for all signs and symptoms of colds, flu,
etc to disappear before restarting your exercise
program. Do not exercise if you have a fever.
• If you have an injury, rest and treat the injury.
Further exercise may complicate an injury.
The Home Exercise Program is designed with your
safety in mind. Please do not exceed the guidelines
presented to you unless directed by your physician.
You may want to ask your physician if you are a
candidate for outpatient cardiac rehabilitation. This is
an exercise program designed specifically for persons
who have suffered a heart attack, had bypass surgery,
a stent or balloon angioplasty, or other related
problems. The rehab program involves wearing a
small heart monitor while you exercise. The rehab
staff will monitor your heart rhythm, heart rate, and
blood pressure.
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Daily Activity Log
Day
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Activity
Time
Community Resources
This sheet includes listings of available resources for
continued care following your hospitalization for heart
disease. You will also find additional patient education
and other resources on Advocate Health Care’s
website: advocatehealth.com.
Cardiopulmonary Rehabilitation
Visit their website at www.diabetes.org.
Cardiac Rehab is an 8–12 week program for people
who have had a heart attack, coronary artery bypass
surgery, balloon angioplasty or stenting, or angina.
At times other heart conditions are considered
for cardiac rehab. It includes monitored activity
progression and risk reduction education. For more
information, call 309.268.5493.
American Heart Association
Community Wellness Center
American Diabetes Association
Call 1.800.AHA.USA1 (1.800.242.8721) or visit
the American Heart Association web site at
americanheart.org to learn more about heart disease.
American Stroke Association
For more information on stroke, call 1.888.4.STROKE
(1.888.478.7653) or visit the American Stroke
Association online at strokeassociation.org.
Bloomington/Normal Chapter of Mended Hearts
The Mended Hearts is a national support and
educational group for those with heart disease.
The organization is affiliated with the American
Heart Association. For more information, call
1.800.AHA.USA1.
Community Wellness at Advocate BroMenn Medical
Center offers classes on the following:
• “Freedom from Smoking”
• Stress Reduction
• Nutrition and Weight Management
• Cardiopulmonary Resuscitation (CPR)
Please call 309.268.5900 for more information and
times for these classes or you may go online to
advocatehealth.com/bromenn.
Smoking Cessation
Smoking cessation resources are also available
through the American Lung Association at
www.lungusa.org and the Tobacco Quit Hotline at
1.866.QUIT.YES (1.866.784.8937).
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