Congestive Heart Failure Care Plan

• Past heart attacks from coronary heart disease  leading to scarring in the heart muscle. This is the most common cause for congestive heart failure.
• High blood pressure (hypertension).
• Heart valve disease  damaged heart valves may allow the blood to flow backwards or may obstruct forward flow.
• Congenital heart disease  heart abnormalities may be present from birth, such as defective valves or abnormal communications between heart chambers.
• Cardiomyopathy  this condition is characterised by enlargement of the heart muscle, where the left ventricle enlarges to compensate for poor contraction.
• Myocarditis viruses or other infections may damage the heart muscle.
• Heart arrhythmia rapid heartbeat with irregularity, over a long period of time, can also lead to inefficient contraction and heart failure.
• Thyroid disease the thyroid gland produces too much of its hormone, thyroxine; this increases the work of the heart and can lead to heart failure.⁽¹⁾

• Medications
• Addressing the underlying disorder  for example, treatment of high blood pressure.
• Lifestyle changes such as regular gentle exercise, losing excess body fat, stopping smoking, adhering to a low-fat and low-salt diet, restricting alcohol and having adequate rest.
• Surgery to replace narrowed or leaking heart valves.
• Coronary bypass surgery in some cases.
• Heart transplant in extreme cases.

• breathlessness (dyspnoea) when you're more active than usual or sometimes when you're resting
• extreme tiredness and weakness
• swelling in the legs, ankles and feet (oedema).

• being woken up in the middle of the night gasping for breath
• a cough that will not go away
• nausea (feeling sick)
• lack of appetite
• weight loss
• confusion or difficulties in concentrating.

• Heart attack and stroke: Because blood flow through the heart is slower in heart failure than in a normal heart, it's more likely you'll develop blood clots, which can increase your risk of having a heart attack or stroke
• Kidney damage or failure: Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. 
• Heart valve problems: The valves of your heart, which keep blood flowing in the proper direction through your heart, can become damaged from the blood and fluid build-up from heart failure.
• Liver damage: Heart failure can lead to a build-up of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.

• Chest pain 
• Extreme breathlessness
• Cough with/ without sputum (phlegm)
• Swelling of legs
• Extreme fatigue

• Take bed rest along with improved lifestyle and diet regulation. Restrict fluid and salt intake as prescribed by your doctor. 
• Do not stop any medications without doctor's consultations.
• Report to your doctor if your symptoms increases or you put on weight.
• Monitor your body weight every week.  

Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system
• Improve your circulation and help your body use oxygen better
• Improve your symptoms of congestive heart failure
• Increase energy levels so you can do more activities without becoming tired or short of breath
• Lower blood pressure
• Improve muscle tone and strength
• Improve balance and joint flexibility
• Strengthen bones
• Help reduce body fat and help you reach and stay at a healthy weight
• Help reduce stress, tension, anxiety, and depression
• Boost self-image and self-esteem
• Improve sleep
• Make you feel more relaxed and rested

What Type of Exercise Is Best?

Exercise while sitting

While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.

• Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
• Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
• Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
• Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
• Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
• Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
• Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
• Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
• Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Here are some questions you can think about before choosing a routine:
• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
• Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

General Workout Tips for People With Heart Failure

• Be sure any exercise is paced and balanced with rest.
• Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
• Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
• Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
• If your exercise program has been interrupted for more than a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Warning

Stop exercising and call your doctor if you have any of the following symptoms:

• Chest pain
• Weakness
• Dizziness or lightheadedness
• Unexplained weight gain or swelling
• Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern

If you have heart disease, your doctor may encourage you to participate in cardiac rehabilitation (rehab) program, which is designed to help you exercise safely and maintain a heart-healthy lifestyle. The program typically includes a tailored exercise program, education, and support in making lifestyle changes, like quitting smoking and adopting a healthier diet. Cardiac rehab programs also offer support groups to help you stay on track to maintain a healthier heart.

What Types of Exercises Are Included in a Cardiac Rehab Program?

Your cardiac rehab program may include exercises like cycling on a stationary bike, using a treadmill, low-impact aerobics, and swimming.