A diagnosis of heart disease is much more than a medical problem. It also requires

sufferers to cope with changes in their day-to-day living and to come to grips with the realities of a chronic life-threatening illness.

Among the heart problems that can present the greatest challenges are heart failure (inadequate pumping action of the heart) and heart rhythm problems, such as ventricular tachycardia and ventricular fibrillation, which are typically treated with an implantable cardioverter defibrillator (ICD).

If people with heart failure and ICD wearers adopt the right habits, they can have a dramatic influence on how they feel—and perhaps even extend their lives.

Heart Failure

About five million Americans have heart failure. The older you are, the more likely you are to have the condition (it affects 10% of people age 70 and older). Symptoms include fatigue... shortness of breath and swelling, especially in the ankles, or weight gain (both can be due to water retention).

How people with heart failure can stay as healthy as possible…

  • Cut down on salt to counter your body's tendency to retain water. The goal is generally no more than 2,000 mg of sodium per day—about half what the average American consumes. Most salt comes from processed foods-not the shaker. Read labels. Avoid processed foods and never add salt to your food. Your taste buds will adjust to a salt-free diet much more quickly than you might expect.
  • Limit fluids. Follow your doctor's advice about fluid intake. Consuming even a little extra fluid can lead to undue heart strain. Be aware that foods with a high liquid content, such as Jell-O and ice cream, count as fluids.
  • Weigh yourself daily. If you gain more than three pounds in a day or five in a week, call the doctor. You're probably retaining water.
  • Avoid caffeine and alcohol. Caffeine in coffee, tea and cola makes your already overworked heart beat more rapidly, increases the amount of oxygen it needs and may disrupt your heart rhythm. Alcohol can weaken the heart muscle. Ask your doctor if you need to cut back or eliminate alcohol- and caffeine-containing beverages and foods.
  • Take your medications. Many people with heart failure will need to take medications such as diuretics (to help the body excrete excess fluid)...beta-blockers (to reduce the force of the heart's contractions)...and anticoagulants (to help prevent blood clots from forming in the heart chambers) for the rest of their lives. Failure to take medicines as prescribed is a leading cause of hospitalization.
  • Balance rest and activity. Heart failure limits how much your body can do. To reduce fatigue, get sufficient sleep (including an afternoon nap if you need one)...and spread your tasks throughout the day.

At the same time, regular exercise has been shown to increase energy in people with heart failure and sometimes even help them live longer. The challenge is to find an exercise level that will strengthen not overtax-your heart.

Most important: Start slowly...to reduce strain on your heart, use leg rather than arm muscles (walking generally is the best exercise for heart failure patients)...and stop immediately if you become dizzy or short of breath or have chest pain.

Best option: Enlist your doctor's help in designing an exercise plan and/or enroll in a cardiac rehabilitation program. To find one near you, consult the American Association of Cardiovascular and Pulmonary Rehabilitation, 312321-5146, www.aacupr.org.

  • Tend to your relationships. In a recent study, University of Pennsylvania researchers found that heart failure patients who got along well with their spouses were significantly more likely to be alive at a four-year follow-up point than those who had less harmonious relationships.

Living With An ICD

An ICD is an electronic device about the size of a deck of cards that automatically delivers a shock when the heart rate accelerates to the point where life-threatening fibrillation (dangerously fast heart rate) may be imminent (Similar electronic devices, known as pacemakers, signal the heart to beat when the heartbeat is too slow.)

Even though ICDs can be lifesavers, most people who wear one of the devices worry about getting a shock at the wrong time or not receiving a shock when one is needed. What you can do to adjust to wearing an ICD…

  • Don't limit your activities unnecessarily. Normal activity-including sex, exercise, job stress, arguments or excitement at a movie or ball game-will not accelerate your heart rate enough to trigger the ICD. The best way to reduce the number of shocks you receive is to take your heart medication regularly.
  • Take sensible precautions. Electromagnetic interference (EMD) can disrupt ICD operation or trigger an inappropriate shock. For that reason, ICD patients cannot have a magnetic resonance imaging (MRI) scan, which creates a large, powerful magnetic field.

ICD wearers can talk on cell phones but should keep them more than six inches from the implant site (use a belt holster instead of your shirt pocket).

Although the ICD may set off metal detecting devices used at public places, such as airports, walking through one is generally safe if you don't linger. The hand-held wand used by security personnel can disrupt ICD operation, so ask to be "patted down" instead. (When you receive an ICD, you should be given a card that identifies you as an ICD wearer.)

Electric shavers, remotes, televisions and microwave ovens typically present no risk for those who wear ICDs.

  • Remain calm if you have an ICD"storm." If you receive more than one shock in 24 hours, go to a hospital emergency room. The ICD device could need an adjustment or your heart medications may need to be modified.

An estimated 16% of people with ICDs have such "storms," which can cause wearers to fear that they are suffering a potentially fatal heart rhythm disturbance or that the device is running amok. To put the trauma behind you, talk about it with supportive people, such as loved ones and your health-care providers.

Even Heart Attack Survivors Don't Recognize Heart Attack Symptoms

When quizzed about the signs of heart attack, 46% of those questioned answered less than 70% of questions correctly.

Surprising: All the participants had either survived a heart attack or been treated for blocked arteries. Women, people younger than 60 and those who were seeing a cardiologist rather than an internist or a general practitioner tended to answer more of the questions correctly.

Problem: Quickly recognizing the signs of a heart attack significantly improves the likelihood of survival. Common symptoms include discomfort in the chest and/or upper body, shortness of breath, cold sweat, nausea and light-headedness.

Never Ignore Chest Pain

When health information for 1.957 patients was reviewed one year after the patients had suffered a heart attack, nearly 20% of them reported suffering chest pain (angina), a treatable condition that indicates significant heart disease. These patients were more likely to be depressed or smoke than those in the study who did not have angina.

If you have had a heart attack: See your doctor if you suffer any chest pain or depression symptoms-or need help quitting smoking.

Mild Thyroid Problems Linked to Serious Heart Failure

In a 12-year study of 3,065 adults, those with untreated subclinical hypothyroidism (a mildly underactive thyroid) were twice as likely to develop congestive heart failure inadequate pumping action of the heart) as those with normal thyroid function.

Theory: Subclinical hypothyroidism results in less-efficient heart contractions.

If you have an underactive thyroid: Ask your doctor if you should take thyroid medication and/or be monitored for heart problems.

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