• Weigh yourself every morning after going to the bathroom but before eating, drinking or dressing. Keep a log of these numbers.
• Do your blood pressure and pulse readings three times per week and write these numbers down. If you don't have home machine you can go to your pharmacy and get it done free of charge.
• Make sure you have an active voicemail on your phone so we can reach you easily.

On the day of your appointment:

• Wear a loose fitting or stretchy top to assist with examination.
• Consider signing up for the Connected Care Patient Portal when you register at the front entrance of the hospital. The registration clerk can help with this.

• Bring all the medicine you are taking to each doctor's appointment. Medication is a very important part of your treatment so we want to make sure it is exactly right.
• Bring the logs of your daily weight, blood pressure and pulse readings along with any questions you may have for the team.
• We encourage you to bring anyone who supports you at home. There is a lot of information provided and having another person there can help.

• Your clinic appointment may take up to two hours depending on your needs or the needs of our other patient's.
• The distance to Ambulatory Care from the front entrance is quite long. There are wheelchairs available in the lobby for you to use and volunteers who can help.
• Once called in from the waiting room, you will have your weight and vital signs taken.
• The doctor/nurse will perform assessments of your neck, heart, lungs, feet and legs.
• A review of your medications, health history, symptoms, function and social habits will be done.
• The team will talk to you about your condition and discuss the treatment plan and follow up with you.
• There is a blood lab within the unit. We may have your blood tested after your appointment.

Heart Failure (or congestive heart failure - CHF) can happen to a person with a heart muscle problem. This problem can sometimes cause the heart to be unable to deal with the amount of blood the body expects it to pump. This makes the blood congest or “back-up” making people feel very tired and lightheaded. Often they develop swelling in their ankles, legs or stomach. Sometimes they can’t sleep or do their usual activities comfortably because they feel short of breath.

There are two types of heart muscle problems causing CHF:

• Diastolic heart failure: The heart muscle is stiff and has trouble relaxing to fill with blood (diastolic heart failure or heart failure with preserved ejection fraction HFpEF)

• Systolic heart failure: The heart muscle is weak and the heart is big and baggy (systolic heart failure or heart failure with reduced ejection fraction HFrEF)

You and your doctors may know from past tests if you have a stiff or weak heart. If not, an ultrasound test of your chest called an echocardiogram may be done. This test checks the heart to see if there is any problem with how it is pumping.

There are many conditions that can strain and damage your heart muscle. Some are sudden and others happen over time. Heart damage can be caused by fast heart rhythms, past heart attacks, high blood pressure, heart valve problems, alcohol abuse, infection from a virus or bacteria, or unknown reasons.

People with heart failure are at risk for hospitalizations because of fluid buildup. If blood is not pumped around your body well, it can back up causing fluid to collect in your lungs, stomach or legs. You may feel more easily breathless, more swollen or bloated, more tired or weaker than normal. The doctor will help you get rid of this extra fluid by giving you water pills called diuretics, usually furosemide (LasixTM). These pills make you pass more urine to get rid of the extra fluid so your heart can feel better and help your symptoms go away.

Not everyone has the same symptoms. It is important to know your own signs/symptoms. Think back to how you felt just before coming to the hospital. Did you have...

• Cough with white frothy sputum.
• Difficulty with lying down (need to be upright in bed or in a chair to sleep).
• Shortness of breath.
• Fatigue, tiredness.
• Nausea, loss of appetite.
• Stomach bloating, swelling of legs, feet, hands.
• Confusion or foggy brain, dizziness or lightheadedness.
• Rapid weight gain.

Research shows that a combination of “self-care behaviors” and medications help people with heart failure feel better, stay out of hospital, and live longer.

Self-care behaviors are actions you can take day-to-day to look after your heart and watch for problems.

• Daily weight: From now on, you will need to watch for signs of having too much fluid in your body. The best way to do this is to weigh yourself first thing every morning after going to the bathroom but before eating or dressing. This is called a dry weight.
• Write your dry weight down every day and look at what is happening over time along with the quality of your breathing, and amount of swelling in your legs and stomach. Normally, weight will go up and down by a pound or two. Be on the lookout for trends. Is it going up or down and how quickly?
• If your weight goes up or down quickly (a gain or loss of 3 pounds overnight or 5 pounds in 5 to 7 days for instance) you may need a water pill (called a diuretic, usually Furosemide or LasixTM ) medication added or the dose adjusted if you are already taking it.
• Sudden weight gain: If the doctor has prescribed Furosemide (LasixTM) for you to take when experiencing sudden weight gain, do as instructed until the extra weight and your symptoms go away. Contact your doctor or nurse if you are not sure. If you were not instructed by your doctor to take Furosemide (Lasix) for a sudden weight gain, call your family doctor right away for help.
• Sudden weight loss: If your weight has suddenly gone down and you do not feel well, call your doctor or nurse right away.

• Salt: One of the biggest reasons why fluid starts to build up is because of too much salt in food. Pre-packaged or restaurant foods are loaded with salt (sodium).
• Always read the nutrition label on everything you buy. In fact, go through your cupboards and fridge at home and take a look at how much sodium is in your food. You will be surprised at the amount of salt in some of them!
• Look for food with 200mg or less sodium per serving or 5% or less of total daily value on the label.
• Aim for no more than 1500mg a day of added sodium (don’t count natural sodium amounts in fresh foods).
• When you are shopping for groceries next time you can compare brand-to-brand and pick the brand with the lowest amount.

• Activity: If exercise came in a pill, everyone would be on it! It benefits your heart, body, and mind. Keeping active is a very important part of your treatment for heart failure.
• Aim for 30 minutes total of activity (like walking) every day. Start slow, and build up to this. Stop if you have chest pain, shortness of breath, nausea or dizziness.
• If you would like to join a structured program, call the University of Ottawa Heart Institute’s Cardiac Rehabilitation Center for more information. Their number is 613-696-7068.
• Smoking and too much alcohol: If you smoke, QUIT! Smoking reduces the oxygen in your blood, and makes your heart beat too fast. It also causes inflammation in your blood vessels making them harden and become smaller. Your heart muscle needs to get a good blood supply to work well. Smoking can starve the heart of the oxygen and nutrients it needs to work properly. 
• If you are a smoker, ask your health care provider for information and tools to help you quit. Call the University of Ottawa Heart Institute’s Quit Smoking Program for help at 613-696-7069.
• Drinking large amounts of alcohol is toxic to the heart and can cause or worsen heart failure. Talk to your doctor about your intake. Generally, the accepted amount is 2 drinks a week. More drinks means more risk. For more information and help with this or other addictions, please contact OAARS at 613-241-5202

• Recognizing signs of trouble: Contact your health care provider if you have a sudden or unexpected:
• Weight gain as fast as three pounds in 1 day or five pounds in 5 to 7 days.
• Worsening swelling in the feet, legs or bloated abdomen.
• Worsened breathing.
• Inability to do your usual activities.
• Cough with whitish frothy sputum.
• Unexpected weight loss as fast as three pounds in 1 day or five pounds in 5 to 7 days.
• Dizziness or lightheadedness.

Call 911 for:

• Sudden unrelieved or frequent chest pain, chest pressures or tightness.
• Extreme shortness of breath at rest.
• Passing out or feeling like you’re going to pass out.

Medications, along with the “self-care behaviors” listed above, are an important part of your treatment. If your heart is weak, they are used to help rest the heart and try to reverse some of the damage to the muscle. There are certain types of medications that are commonly used. These are:

• ACE inhibitors (ACEI) OR angiotensin receptor blockers (ARBs) OR angiotensin receptor-neprilysin inhibitor (ARNIs).
• Beta-blockers.
• Mineralocorticoid receptor antagonists (MRAs).
• Sodium-glucose co-transporter 2 inhibitors (SGLT2s).
• Diuretics or “water pills” that remove excess fluid from the body.

Not all of the medications listed above are used for every person. The medications and dosage chosen vary for each person. It is common to have medication and dosage changes during treatment to obtain the best results for each person. Many of the heart failure medications lower your blood pressure to protect your heart. Make sure to change positions slowly and wait for a few seconds before walking after you stand up. Contact your provider if you have a concern with your heart medication.

Potassium

Medications for heart failure can increase or decrease your potassium level. A low potassium level can cause extreme tiredness and weakness. A high potassium can cause your heart to beat irregularly. Your doctor will monitor your potassium level and you may be instructed to eat or avoid food that contains potassium and/or take a potassium supplement. Potassium-rich foods include:

• Fresh fruits (oranges, bananas, and melons.
• Coconut water.
• Fruit juices (most juices, orange, pineapple and grapefruit). Avoid tomato juice because it contains too much salt.
• Dried fruits (apricots, dates, prunes and raisins).
• Vegetables (potatoes, spinach, and sweet potatoes).
• Beans.
• Meat, fish, poultry.

Medications to avoid
Do not use non-steroidal anti-inflammatory (NSAID’s) medications like:

• Ibuprophen (AdvilTM)
• AleveTM
• MotrinTM
• VoltarenTM cream

These can make your heart failure worse. Products using acetaminophen (TylenolTM) should be used instead. Please talk to your pharmacist or doctor if you have regular pain.

You should advise your physician if you are currently pregnant or plan to become pregnant since some medicines may be harmful to an unborn child.