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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 2 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 8 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. 9 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 to cardiomyopathy. It occurs when the heart muscle is weak and has trouble pumping out blood (systolic dysfunction). It also occurs when the heart muscle Let’s Talk About Heart Failure will no longer relax (diastolic dysfunction). Fluid colHeartHeart failure also beor referred totoasasof CHF also be referred CHF itit isbecause lectsfailure inmay themay lungs other parts theifif body is considered congestive heart failure. It may be considered congestive failure. may related the heart doesheart not pump asItwell asbe itthe should. related to cardiomyopathy. It occurs when heart (The muscle is weak and has trouble outmuscle blood to cardiomyopathy. It occurs when the isheart common measurement for pumping this called ejection frac(systolic dysfunction). It also occurs when the heart is weak and has trouble pumping out blood (systolic refer tion. Youno may hear your healthcare provider muscle will longer relax (diastolic dysfunction). Fluid collects in the lungs or other parts of the body dysfunction). also occurs the heart muscle to this.)It This causes when your body to not get enough because the heart does not pump as well as it should. (The common for you this is called ejection will no longer relaxmeasurement (diastolic dysfunction). Fluid col- failure oxygen-rich blood to keep healthy. Heart fraction. You may hear your health care provider refer lects in the or and other parts oftothe because slowly gets worse over time. tostarts this.)lungs This causes your body notbody get enough oxygen-rich to keep youas healthy. Heart(The failure the heart does notblood pump as well it should. Heart failure be caused by a heart attack, heart starts slowly and may gets worse over time. common measurement for this is called ejection fracdisease, ormay high may also Heart failure beblood causedpressure. by a heartItattack, heartbe caused tion. disease, You may hear your healthcare provider refer or high blood pressure. It may also be caused by heart valve problems, heart muscle disease or diaby heart valve problems, heart muscle disease or to this.) This causes your body to not get enough diabetes. Narrowed arteries supplying blood to theto heart betes. Narrowed arteries supplying blood the heart muscle blood can cause heart you failure. Some medicines and oxygen-rich to keep healthy. Heart failure muscle can cause heart failure. Some and lung or thyroid disease may also cause heartmedicines failure. starts slowly and gets worse over time. lung or thyroid disease may also cause heart failure. Heart failure may be caused by a heart attack, heart disease, or high blood pressure. It may also be caused by heart valve problems, heart muscle disease or diaWhat does Heart Failure feel like? betes. Narrowed arteries supplying blood to the heart The symptoms of heart failure include: muscle can cause heart failure. Some medicines and • shortness of breath, wheezing or coughing when you exert yourself; lung or thyroid disease may also cause heart failure. 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. He or(pronounced 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 enough bloodafter if an angiography, while you are still in the cath lab. He or at coronary artery isthethe much afterfeelthese procedures, think thatbest coronary bypasspeople surgery isfeel the to best phy,bypass while yousurgery are still in cath 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 of heartquickly. disease go away quickly. Many peoplefor feela much better after thesego procedures, f so, that willbest most be that scheduled a be and their symptoms of heart disease away that carries blood with oxygen through your body. is the option. If so, will most likely later likely 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 plasty is a procesmall balloon is inserted plasty is a procevery small balloon dure in which a through the catheter 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, It is inflated and 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. balloon isAinflated tobe open stent, then deflated Athe stent is and a tiny wire mesh tube. It is collapsed and stent may needed to help keep the artery open. It 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 yourYour heart. Yourmuscle heart muscle needs exercise to helpititwork. work. Aerobic Aerobic activities such as as ying active willactive help heart. heart needs exercise to help activities such Staying will your heart. Your muscle needs exercise help Staying active willhelp help your heart. 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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. 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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. 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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. 50 Daily Activity Log Day 51 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). 52 53