What is heart failure?

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Overview
Symptoms
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Heart failure: Overview

Heart failure occurs when your heart does not pump as much blood as the body needs. Failure does not mean that the heart has stopped pumping but rather that it is not pumping as well as it should. Over time, this causes fluid buildup in your lungs and other parts of your body. Fluid buildup can cause shortness of breath, fatigue, swollen ankles, and other problems. Heart failure is treated with medicines, a heart-healthy lifestyle, and the steps you take to check your symptoms. Treatment can slow the disease, help you feel better, and help keep you out of the hospital. Treatment may also help you live longer.

Heart failure

Heart failure means that your heart muscle doesn't pump as much blood as your body needs. In time, this causes fluid to build up in your body, and you have symptoms like swelling in the legs and feeling out of breath and weak.

Heart failure usually gets worse over time. But treatment can slow the disease, help you feel better, and help keep you out of the hospital. Treatment may also help you live longer.

What happens when you have heart failure?

Heart failure is a lifelong (chronic) disease.

Treatment may be able to slow the disease and help you feel better. But heart failure tends to get worse over time. Despite this, there are many steps you can take to feel better and stay healthy longer.

Early on, your symptoms may not be too bad. As heart failure gets worse, symptoms typically get worse, and you may need to limit your activities. Heart failure can also get worse suddenly. If this happens, you need emergency care. Then, after treatment, your symptoms may go back to being stable (which means they stay the same) for a long time.

Heart failure can lead to other health problems, such as heart rhythm problems. Over time, your treatment options may change, especially as your symptoms get worse. You may want to think about what kind of care you want at the end of your life.

What are the symptoms of heart failure?

Symptoms of heart failure start to happen when your heart can't pump enough blood to the rest of your body.

In the early stages of heart failure, you may:

Feel tired easily.
Be short of breath when you exert yourself.
Feel like your heart is pounding or racing (palpitations).
Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:

Feel short of breath even at rest.
Have swelling (edema), especially in your legs, ankles, and feet.
Gain weight. This may happen over just a day or two, or more slowly.
Cough or wheeze, especially when you lie down.
Feel bloated or sick to your stomach.

How is heart failure treated?

Heart failure is treated with medicines, a heart-healthy lifestyle, and the steps you take to check your symptoms. Treatment may also include a heart device, such as a pacemaker. Treatment can slow the disease, help you feel better, and help keep you out of the hospital. Treatment may also help you live longer.

How are heart devices used to treat heart failure?

A number of devices may be used for treatment when you have heart failure.

Pacemakers or implantable defibrillators (ICDs)

Cardiac resynchronization therapy (CRT) uses a biventricular pacemaker. It makes the heart's lower chambers (ventricles) pump together. This can help your heart pump blood better. This type of pacemaker can help you feel better so you can be more active. It also can help keep you out of the hospital and help you live longer.

ICDs can prevent sudden death from an abnormal heart rhythm and may help you live longer. An ICD checks the heart for very fast and deadly heart rhythms. If the heart goes into one of these rhythms, the ICD shocks it to stop the deadly rhythm and return the heart to a normal rhythm.

Pacemakers and ICDs may be used alone or together.

Ventricular assist devices (VADs)

VADs, also known as heart pumps, may be placed into the chest to help the heart pump more blood. VADs can keep people alive until a donor heart is available for transplant. In some cases, VADs may also be used instead of heart transplant for long-term treatment. VADs are used in people who have severe heart failure.

Intra-aortic balloon pump

An intra-aortic balloon pump is sometimes used to help the heart pump more blood during sudden heart failure.

Preventing heart failure

The best ways to help prevent heart failure are to have a heart-healthy lifestyle and manage existing health problems like high blood pressure and diabetes.

To reduce your risk for heart failure:

Don't smoke.

If you smoke, quit. Avoid secondhand smoke too. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Eat heart-healthy foods.

Eat fruits, vegetables, fish, lean meats, and whole grains. Choose foods that are low in saturated fat, and avoid trans fat. Limit sodium, alcohol, and sugar.
Be active.

Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
Stay at a healthy weight.

Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.
Manage other health problems.

Many health conditions can raise your risk for heart failure. These include heart attack, high blood pressure, and diabetes. You can help manage many health problems and stay as healthy as possible with a heart-healthy lifestyle and medicines. If you think you may have a problem with alcohol or drug use, talk to your doctor. Your doctor can help you figure out what type of treatment is best for you.

How is heart failure diagnosed?

To diagnose heart failure, your doctor will:

Ask about your medical history.: Your doctor will also review all the medicines you take, ask if you have heart disease in your family, and look for other risk factors, such as high blood pressure.
Do a physical exam.: Your doctor will check your blood pressure and heart rate, check your weight, listen to your lung and heart sounds, check your belly and legs for swelling, and look for swelling or bulging veins in your neck.

Your doctor may diagnose heart failure from your symptoms and the physical exam. But you will have more tests to find the cause and type of heart failure so that you can get the right treatment. Tests can show how well your left lower heart chamber (left ventricle) and the valves inside your heart are working. Common tests include:

Blood tests.

Routine blood tests can help your doctor identify the cause of heart failure, find out if your kidneys and liver have been affected, and know whether you have risk factors, such as diabetes.
A brain natriuretic peptide (BNP) test can help diagnose heart failure by checking the amount of a certain hormone in your blood.

Electrocardiogram (EKG or ECG).

An EKG is done to find any problems with your heart rhythm. It can also show signs of damage to the heart.

Chest X-ray.

A chest X-ray gives your doctor a picture of your heart, lungs, and major blood vessels.

Echocardiogram (echo).

This is an ultrasound exam of the heart. An echo can help show whether you have heart failure, what type it is, and what might be causing it.

Your doctor may order more imaging tests. These include:

Cardiac blood pool scan.: This test shows how well your heart pumps blood to the rest of your body.
Magnetic resonance imaging (MRI).: An MRI lets your doctor see the structure of your heart and check how well it is pumping.

Overcoming your problems with taking medicines for heart failure

When you have heart failure, medicines become a fact of life. It's also a fact that lots of people struggle with their medicines. Most people take several medicines, and more may be added over time. The dosages may change too.

Finding a way to make your medicines part of your daily routine could mean better days, with more energy for the things you love to do. Medicines can help your heart work better, help you feel better, and help keep you out of the hospital. They may also help you live longer. The following steps may help.

Identify what gets in your way.
If you have trouble taking your medicines as prescribed, you're not the only one. Here are some reasons people give for not taking their medicines every day.
- "I can't tell if the medicines help."
- "I don't understand how to take them."
- "I don't like the side effects."
- "I sometimes forget to take them."
- "It's hard to get motivated when I don't feel well."
- "I'm concerned about the cost."
These are some common barriers, but you may have others. If you like, take a minute and think about it. What makes it hard for you to take your medicines as prescribed?
Think about ways to solve your problem.
Consider some ways that you might get around the barriers to taking your medicines. For example:
- If side effects bother you, you could ask your doctor about giving you a different medicine.
- If you aren't sure that the medicine is helping, you could ask your doctor what each pill does. Knowing what they do for you may make taking them feel worth the effort.
- If it's hard to take different pills at different times, you might get a pill organizer. You might set an alarm to alert you when it's time for your next dose. Your pharmacist or doctor may be able to help you find ways to make your medicine routine easier.
- If you forget to take your medicines, try taking them when you do other routines like brushing your teeth.
- If it's hard to feel motivated, you might put your pillbox next to a photo of family or friends. This can remind you that the medicines are important because they're giving you more time with the people you love.
- If cost is a barrier for you, talk to your doctor about your options. There may be ways to lower the cost of your medicines, such as switching to generics.
These are just a few ideas. You may have others. Maybe you know someone who does a good job of managing a serious health condition. What strategies do they use that might help you?
Make a plan to get around your barriers.
You've thought about what's in your way, And you've seen some ideas that might help. Now take a little time to brainstorm how you'll overcome your barriers so you can get the benefits of your medicines. Ask yourself these questions:
- What's the main thing that makes it hard to take my medicines every day?
- What are some possible solutions?
- What are the pros and cons of each possible solution?
- Which solution do I think would work best?
- What would help me feel more confident that I can succeed? (For example, is there someone I could ask for help?)
- How will I get started?

Who can diagnose and treat heart failure?

People who can diagnose and treat heart failure include cardiologists, primary care providers, family doctors, internists, and physician assistants. Other health professionals who can help support your treatment include nurses, pharmacists, registered dietitians, and social workers.

How can you care for yourself when you have heart failure?

There are many steps you can take to feel better and live longer. These steps are an important part of treatment. They can help you stay active and enjoy life.

Taking your medicine properly

Take your medicine exactly as prescribed.: This gives the medicine the best chance of helping you. If you don't take it the right way, your heart failure may get worse, or you may get sudden heart failure.
Avoid medicines that can make your heart failure worse.: Talk to your doctor before you take any over-the-counter medicines. Some of them might make your symptoms worse. Others may keep your heart failure medicines from working right. This includes some pain relievers and cold medicines. And be sure your doctor knows all of the prescription medicines you take.

Checking your weight and your symptoms

Check your weight every day.: Record your weight. Call your doctor if you notice a sudden weight gain. It may mean that your heart failure is getting worse.
Keep a daily record of your symptoms.: Checking your symptoms helps you see what symptoms are normal for you and if they change or get worse.
Have a plan.: It's important to make a plan with your doctor so you know what to do if your symptoms get worse. With your plan, you will know when to call your doctor or call for emergency help.

Limiting sodium

Your doctor might recommend that you limit sodium. Your doctor can tell you how much sodium is right for you. An example is less than 3,000 mg a day. Limiting sodium helps keep fluid from building up in your body. It may help you feel better.

Being active and safe

Make an exercise plan with your doctor.: Do not start to exercise until you have talked with your doctor to make an exercise program that is safe for you. You might start to exercise in a cardiac rehabilitation program or on your own.
Exercise regularly.: Being active makes your heart stronger and can help you feel better. Try to be active throughout the week.
Don't exercise too hard.: If you exercise too much or too hard, you may put too much stress on your heart and make your symptoms worse. For some people, this stress can cause sudden heart failure.

Having a heart-healthy lifestyle

A healthy lifestyle is an important part of treatment. It can help slow down heart failure and help you feel better.

To be heart-healthy:

Do not smoke, and avoid secondhand smoke.
Eat heart-healthy foods.
Stay at a healthy weight. Lose weight if you need to.
Limit alcohol. Ask your doctor how much, if any, is safe.

Managing and preventing other health problems

Manage other health problems.

These include diabetes and high blood pressure.

Avoid infections.

Do as much as possible to avoid catching colds, COVID-19, the flu, and other respiratory infections. They can be more dangerous if you have heart failure.

Wash your hands often. Avoid touching your nose and eyes if possible. Germs can enter your body through these mucous membranes.
Get the flu vaccine every year. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor whether you need another dose. Stay up to date on your COVID-19 vaccines.
Encourage those you live with to also get recommended vaccines, so they won't get sick and then infect you.

Get support.

Support from friends and family can help you cope and enjoy life with heart failure. Cardiac rehab programs can also offer support for you and your family.

Get help for depression and anxiety.

Heart failure can be hard on your emotions. It's common for people to feel depressed or worry about their future. Talk to your doctor if you have symptoms of depression or are worried a lot.

Manage stress.

The challenges of living with heart failure can increase your stress. Explore ways to relax and manage stress to help your body, mind, and spirit.

Treat sleep problems.

Let your doctor know if you're having trouble sleeping. This problem is common with heart failure. Some people with heart failure have sleep apnea.

Get help for problems with alcohol or drugs.: If you think you may have a problem with alcohol or drug use, talk to your doctor. This includes prescription medicines (such as amphetamines and opioids) and illegal drugs (such as cocaine and methamphetamine). Your doctor can help you figure out what type of treatment is best for you.
Limit fluids if your doctor tells you to.: Limiting the amount of fluids you take in can help balance sodium levels in your body.

Trying other ways to relieve symptoms

Make breathing easier.: Doing certain things like propping yourself up with pillows at night may help relieve shortness of breath.
Try ways to save your energy.: Saving, or conserving, your energy means finding ways of doing daily activities with as little effort as possible.

Enjoying life

You can be active and enjoy life when you have heart failure. Many people with heart failure can be active, have sex, drive, and travel.

Working with your doctors

You are one of your doctor's most important partners.

Have all your tests, and go to all your appointments. Working together as a team can help you both manage your heart failure better. Together, you can create a treatment plan based on your goals and wishes.

How can you work through your feelings about heart failure?

Start by exploring your feelings about heart failure. Have they changed over time? Has heart failure changed how you see yourself? Has it changed your relationships? Then think about how taking good care of yourself might help your relationships and how you feel about your life.

How to overcome the challenges of heart failure

Living with heart failure—or any chronic condition—comes with some challenges. There's a lot to do to take good care of yourself. Working through those challenges can take time, patience, and a bit of courage. For many people, any change in routine is not easy.

One way to approach living with heart failure is to practice a three-step process to find solutions to your personal challenges.

Write down a problem or goal.

The first step is to write down a problem, issue, or goal that you want to work on but are having a hard time with. For example, maybe it's hard to eat a low-sodium diet because salt is everywhere. You may have a few ideas that come to mind. Go ahead and write them all down.
Think of a few possible solutions.

If you wrote down a few problems, take a minute to choose just one problem to focus on. Now think of a few possible solutions to that one problem. And then think of the pros and cons of each solution. For example, you might ask your partner to join you in eating low-sodium foods. A pro could be that you'll have someone to make the diet easier. A con might be that your partner may not want to eat with you.
Try one solution.
- First look at the pros and cons of each one. Which solution seems most doable? Which has the most pros?
- Pick one idea to try. That will help you focus your energy and build your confidence. Small, doable changes are less scary. They increase your chances of success. For example, you may want to ask your partner to join you in eating less salt after all.
- As you think about your solution, try to identify steps you could take that would help you feel more confident about putting your idea into action. Maybe your next step is to talk about it with your partner after dinner tomorrow. You can pick out recipes and remind each other each day why you're taking these steps for your health.

This process can help you feel more confident and in control. And that can help you feel better overall—so you can live your best life possible.

What increases your risk for heart failure?

Your risk of having heart failure is higher if you have certain risk factors. A risk factor is anything that increases your chance of having a certain problem.

Heart failure is usually caused by another health problem. So anything that increases your risk for one of those problems also increases your risk for heart failure. These problems include:

Coronary artery disease and heart attack. Risk factors include smoking, having high cholesterol or diabetes, and having a family history of heart disease.
High blood pressure. Risk factors include being overweight, being inactive, and having a family history of high blood pressure.
Heart valve disease. Risk factors include older age and an infection of the valves.

Your risk of heart failure also rises as you get older.

How can you track your activity when you have heart failure?

Tracking your activity can help you see what you're doing well and where you could improve. Seeing your progress can inspire you to keep doing the things that are working well.

Many people use a fitness app to track their activity. Many of the apps are free.

If you prefer, you can write down your activity in a notebook. Bring your tracker to doctor visits to talk about your progress and how you're feeling.

Some ideas for things you can track include:

Your daily activity.
How long you did the activity.
Your short-term exercise goals.
Benefits you may feel from being active, like feeling less out of breath or having more energy.
How you feel. It's okay to cut back on your activity if you're too tired or not feeling well.
Barriers or challenges you've faced—and dealt with.
Other thoughts or feelings about being active.

What medicines can make heart failure symptoms worse?

Some medicines can affect your heart and make your heart failure worse. Others may keep your heart failure medicines from working right. So it's important to be careful with medicines. These include NSAID pain relievers and medicines that speed up the heart rate.

Over-the-counter medicines that you may need to avoid include:

Pain relievers called NSAIDs. Examples are ibuprofen and naproxen.
Antacids or laxatives that have sodium in them.
Some cold, cough, flu, or sinus medicines. These include medicines that have aspirin, ibuprofen, pseudoephedrine, ephedrine, phenylephrine, or oxymetazoline in them.
Herbal supplements and vitamins. These include black cohosh, St. John's wort, and vitamin E.

Prescription medicines that you may need to avoid include:

Calcium channel blockers, a type of heart medicine.
Heart rhythm drugs that treat a fast or uneven heartbeat.
Prescription NSAID pain relievers.
Certain diabetes medicines.

How can you manage heart failure when you have other conditions?

If you're managing other conditions and heart failure, you might wonder how you can manage it all.

But there's good news: When you take care of your heart, you're also taking care of your other conditions. And if you're taking care of other conditions, you're already helping your heart.

It may feel like a lot to do. But remember your reason—why you're doing it. Maybe you want to enjoy time with friends and family, make fewer trips to the hospital, or be more independent.

You may have different reasons. So focus on what's important—and don't give up.

Some things that may help you manage heart failure along with other conditions include:

Being active. Be sure to talk to your doctor before you start any new exercise.
Checking your symptoms.
Limiting sodium.
Taking care of your emotional health.
Taking medicines as prescribed.
Losing weight, if needed.
Not smoking.
Limiting or avoiding alcohol.

When should you get help if you think your heart failure is getting worse?

Try to become familiar with signs that mean your heart failure is getting worse. If you need help, talk with your doctor about making a personal plan.

Here are some things to watch for as you practice your daily self-care. Call your doctor if:

You have sudden weight gain, such as more than 2 to 3 pounds in a day or 5 pounds in a week. (Your doctor may suggest a different range of weight gain.)
You have new or worse swelling in your feet, ankles, or legs.
Your breathing gets worse. Activities that did not make you short of breath before are hard for you now.
Your breathing when you lie down is worse than usual, or you wake up at night needing to catch your breath.

Be sure to make and go to all of your follow-up appointments. And it's always a good idea to call your doctor anytime you have a sudden change in symptoms.

Limiting sodium when you have heart failure: Overview

Sodium causes your body to hold on to extra water. This may cause your heart failure symptoms to get worse. Limiting sodium may help you feel better.

People get most of their sodium from processed foods. Fast food and restaurant meals also tend to be very high in sodium. Your doctor may suggest that you limit sodium. Your doctor can tell you how much sodium is right for you. An example is less than 3,000 mg a day. This includes all the salt you eat in cooked or packaged foods.

Heart failure zone check WTC

Check every day to see which zone you are in.

Green zone

You are doing well. This is where you want to be.

Your weight is stable. This means it is not going up or down.
You breathe easily.
You are sleeping well. You are able to lie flat without shortness of breath.
You can do your usual activities.

Yellow zone

Call your doctor. Your symptoms are changing.

You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You have sudden weight gain, such as more than 2 lb (0.9 kg) to 3 lb (1.4 kg) in a day or 5 lb (2.3 kg) in a week. (Your doctor may suggest a different range of weight gain.)
You have increased swelling in your legs, ankles, or feet.
You are so tired or weak that you cannot do your usual activities.
You are not sleeping well. Shortness of breath wakes you up at night. You need extra pillows.

Red zone

Call 911. This is an emergency.

You have symptoms of sudden heart failure, such as:
- Severe trouble breathing.
- A new fast or irregular heartbeat.
- Coughing up pink, foamy mucus.
You have symptoms of a heart attack. These may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Sweating.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.

If you have symptoms of a heart attack: After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Giving emotional support to someone with heart failure

Connecting to family, friends, and other people is good for a person who has heart failure. Sometimes living with heart failure can feel like too much for one person to handle. But you can help by providing emotional support. Here are some ways to help.

Offer encouragement.

It can be hard for people with heart failure to learn and do self-care, such as limiting sodium and watching their symptoms. You can encourage someone with heart failure to keep trying and to ask for help to do tasks. Encourage them to start slowly and gradually build up to an overall goal.
Help and encourage them to stay active.

Even though a person has heart failure, they can still try to stay as active as possible. Following their activity plan and doing simple tasks around the house can be safe. It can help them feel better both physically and mentally.
Ask if you can help with doctor visits.

You can offer support by sitting in on doctor visits and taking notes. This can help the person remember important instructions. They may also feel less alone.

By providing support, you may find that it brings you closer to each other. It can also make your relationship stronger.

What things can make your heart failure symptoms worse?

Triggers are things that make your heart failure symptoms worse. They can lead to sudden heart failure. Triggers include eating too much salt, missing a dose of medicine, and exercising too hard. Not all people are sensitive to or react to the same triggers.

Heart failure

Normal heart and an enlarged (dilated) heart.

Heart failure occurs when the heart muscle does not pump as much blood as the body needs. Failure does not mean that the heart has stopped pumping but rather that it is failing to pump as effectively as it should.

The body might try to compensate for the heart's reduced pumping ability by:

Holding on to (retaining) salt and water to increase the amount of blood in the bloodstream.
Increasing the heart rate.
Increasing the size of the heart.

Heart failure: Finding support from others

Connecting to your family, friends, and other people is good for you and your heart. But maybe you wonder who would want to help a person with heart failure?

As it turns out, a lot of people do. If you're not sure, just ask them. Chances are they've been hoping and waiting for you to ask.

Reach out to other people.

Reaching out to others may be outside your comfort zone. But you can do it. You might start by sharing your feelings with the people closest to you, like your partner, a family member, or a close friend. When you include others in your journey with heart failure, you may find that it makes your relationships stronger.
Be honest about how you feel.

When someone asks how you're doing, maybe you always say "Fine" and stop there. But what if you answered with a little more? For example, you might say, "I'm okay. I'm just more tired than usual."
Connect with others who have heart failure.

Support can also come from others who are dealing with the same things you are. Support groups may help you talk about what's going on in your life. They can show you that you're not alone with your feelings or frustrations. They may even give you new ideas for coping or solving a problem.
Explore what getting support means to you.
Think about the support you're getting now. On a scale of 0 to 10 (10 = very supported, 0 = no support at all), how supported do you feel right now?

Ask yourself a few questions, and write down your thoughts if it helps.
- What support are you getting now that made you think of that number?
- Now imagine you were one number higher than what you picked. What would it take to help you feel a little more supported?
- If you could meet with other people who have heart failure, how would your life be different?
- What small thing could your family do to help you right now?
- What would you like your care provider to do so you could feel more supported?

Did your answers surprise you? Maybe you're more supported than you thought. Or maybe you could use a little extra help. You've learned how having help and support can make a difference to you, and that's an important first step. Now, who could you reach out to today?

What causes heart failure?

Any problem that damages your heart or affects how well it works can lead to heart failure. This includes:

Problems that damage the heart muscle, such as high blood pressure, heart attack, coronary artery disease, and diabetes.
Diseases that damage the heart's valves.
Problems with the heart's electrical system, such as irregular heart rhythms.

What is heart failure?

Heart failure means that your heart muscle doesn't pump as much blood as your body needs. Failure doesn't mean that your heart has stopped. It means that your heart isn't pumping as well as it should.

Because your heart cannot pump well, your body tries to make up for it. To do this:

Your body holds on to salt and water. This increases the amount of blood in your bloodstream.
Your heart beats faster.
Your heart might get bigger.

Your body has an amazing ability to make up for heart failure. It may do such a good job that you don't know you have a disease. But at some point, your heart and body will no longer be able to keep up. Then fluid starts to build up in your lungs and other parts of your body.

This fluid buildup is called congestion. It's why some doctors call the disease congestive heart failure.

How are the stages of heart failure defined?

Heart failure stages are based on how it often progresses. Stage A means that a person is at risk for heart failure. In stage B, there are signs that the heart is not normal. Stage C means that a person has heart failure with symptoms. In stage D, a person has severe heart failure.

Tracking your fluids when you have heart failure

With heart failure, having too much fluid in your body can cause low sodium levels in the blood. If your doctor tells you to limit fluids, it can help maintain sodium levels in your body.

There are a number of ways you can track how many fluids you are drinking when you have heart failure. Find a method that works for you.

Write down each amount you drink.

You might simply write down how much you drink every time you drink. Be sure you know how much fluid your drinking glass or other container holds.
Use a separate container for tracking.
- Get an empty container that holds the amount of fluid you are allowed for the day.
- As you drink fluids, put an equal amount of water into the container until you reach your fluid limit. Be sure to include smaller amounts of fluids, such as teaspoons. Also include any food that will melt, that has a high water content, or that contains a lot of liquid. These foods include ice cream, gelatin, ice, juicy fruits, and soup.
- When the container is full, you have reached your fluid limit and should stop drinking fluids.

Heart failure: Preparing to talk to your doctor about your emotions

Your emotions affect your physical health, so your doctor needs to hear about how you're feeling. Feelings, especially negative ones like anxiety or depression, may be hard to talk about. But your doctor can help with your emotional health just like they have been treating your heart failure. The sooner you talk to your doctor about your emotions and your options for treatment, the sooner you can start to feel better.

Here are some ideas that can help you get ready to talk to your doctor.

Think about your emotions.

Take some time to think about how you're feeling. Try to picture how you deal with emotions in your daily life.

If you find it hard to think about emotions, that's okay. You could ask someone you trust and who knows you well to let you know what they may notice. Sometimes hearing another person's view can give you new insight.
Write about your emotions.
It may help you to write about your feelings. To get started, try asking yourself the following questions. Write down your answers and share them with your doctor. Having specific examples will help your doctor have a better idea of how to help you.
- What emotions are bothering me? (Examples: nervousness, worry, sadness, anger, or fear)
- When are these feelings worse? Who or what makes me feel that way?
- When do I feel a little bit better? What people and situations help make me feel okay?
- Am I having trouble sleeping?
- Am I having trouble concentrating?
- How long have I felt this way?
- Is there anything else I think my doctor should know?

Joan's story: Coping with depression and anxiety from heart failure

Joan, 52

Joan was only 52 when she had a heart attack. Learn how she coped with depression and anxiety.

"I would sit at my kitchen table and feel I was in this cloud of dread. I didn't feel like me. I felt like, 'I'm never going to be me again.' "

Joan figured she would need months to recover physically from the heart attack 2 years ago that led to her heart failure. She didn't realize she would need just as much time to recover emotionally.

"I was only 52 when I had the heart attack," she says. "Heart disease runs in my family, but I thought I'd been taking care of myself. It just hit me out of the blue. And then I got heart failure because of my heart attack. So now I had a health problem that wasn't going to go away."

Feeling like a "heart patient"

The heart attack and heart failure changed how Joan saw herself. For months, she wasn't able to take long walks in her neighborhood or meet her girlfriends for tennis dates.

"I went from being this really active person to barely being able to walk at first," she says. "After I got out of the hospital, it took me a long time to be able to even walk a short distance. I was so out of breath, I had to stop three times to sit on the curb while I was trying to go around the block."

Joan also felt down about being a "heart patient" and all the medicines she needed to take.

"I went into this terrible depression," she says. "I would sit at my kitchen table and feel I was in this cloud of dread. I didn't feel like me. I felt like, 'I'm never going to be me again.' "

On top of the depression, Joan was worried a lot. She had cardiac rehabilitation, so she was learning how to slowly be more active. But she was anxious that any activity would harm her heart.

"I felt like another heart attack was just waiting to happen," she said. "I could feel my heart pounding when I would walk up some stairs, even if I went slowly. I was convinced that I would drop dead right on the stairs. I knew I had to get some help. I couldn't keep being sad and afraid all the time."

Getting help

Joan talked to her partner and some of her close friends about her feelings. They told her that she was the same person they always loved. But Joan felt she needed more help. Her doctor recommended a counselor.

The counselor "helped me see that I was focusing on all the things I couldn't do anymore, instead of the things I could do. I may not be able to play singles tennis as intensely as I did before, but I can play doubles. I can still take walks and swim. I may have to take more breaks, but I can still do those activities."

One of the ways the counselor helped Joan was by showing her how to stop negative thoughts when they overwhelmed her. "She taught me how to recognize when I'm saying negative things to myself and how to stop it. Then I practice saying something positive instead."

Her doctor also prescribed an antidepressant, which Joan plans to take until she and her doctor feel she is ready to stop.

Joan has gotten a lot of her strength back. She knows that she will have good days when she has a lot of energy, and she'll have bad days when she feels tired.

"But I'm doing much better than I was when I was sitting on the curb outside my house and feeling sad. I enjoy my life again."

This story is based on information gathered from many people facing this health issue.

The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.

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