Cardiomyopathy or congestive heart failure (CHF) is the result of the heart's inability to effectively pump blood to meet the body's needs. It may be a consequence of heart muscle weakness, such as after a series of heart attacks, valvular disease like rheumatic aortic stenosis, or toxic injury such as alcohol poisoning. Symptoms frequently include shortness of breath, particularly while lying down (orthopnea), leg swelling (edema), and awakening from sleep gasping for air (paroxysmal nocturnal dyspnea). CHF is a cause for serious concern.
The outlook for patients with CHF continues to improve. There are several groups of medications that have been shown to prolong life and reduce hospitalizations in patients with CHF. The New England Heart Institute participates in nationwide clinical research trials to help assess whether other treatments may further protect the patient with CHF. The optimal treatment for patients with CHF involves considerably more than prescribing the right medicine. It requires the full support of the patient to work with the health care team in managing his or her heart failure. It has been well established that the main reason for re-hospitalization is the discontinuation of prescribed medications, dietary indiscretions, and the failure to identify early signs of worsening heart failure. It is therefore the goal of the Cardiomyopathy Clinic to not only provide the patient with the best medical treatment possible, but also to educate the patient regarding diet, medications, exercise, and most importantly, symptoms to report before a trip to the hospital becomes necessary.
Upon referral to the clinic, the patient undergoes an initial consultation by a trained heart failure nurse and a nurse practitioner. The nurse provides education and collects information that will help guide the patient’s management. The nurse practitioner works with the patient through office appointments and telephone follow-up to monitor symptoms, titrate medications as needed, and educate the patient about the disease process and medical management. After a six-minute walk test, a graduated exercise program is reviewed with the patient. Moderate exercise conditions body muscles to help take the best advantage of the heart's output. This has been shown to reduce heart failure symptoms. A six-minute walk test can be repeated to gauge the patient’s progress through this program. Follow-up visits with the cardiologist are incorporated and we take a team approach to the patient’s care, reviewing individual cases and creating a plan.
A keen dietary awareness is essential - even moderate amounts of hidden salt intake can tip a patient with CHF out of control. Patients enrolled in the program have the option to meet with a dietitian to control their salt intake (in a palatable fashion!) and monitor their weight carefully to help assess their volume status. All other dietary modifications, such as those recommended for diabetic patients, are incorporated into dietary instructions. Tips regarding holiday eating, food shopping, dining out, and new ways to season foods are discussed with the patient and family members.
Since the goal of the program is to ultimately improve the quality of life for patients with heart failure, the patient is requested to complete the Minnesota Living with Heart Failure questionnaire at the beginning and at six-month intervals during the program.
At the Cardiomyopathy Clinic, we believe a well-informed patient is more likely to make successful and effective choices, whether it be about his/her diet, medications, or getting help. By providing a network of supporting physicians, nurse practitioners, nurses, dietitians and exercise specialists, in collaboration with the primary care physician, the Cardiomyopathy Clinic is poised to partner with patients to best control heart failure.
For more information, call ASK-A-NURSE® at 603.626.2626.