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Module 8: Managing Other Chronic Conditions

Heart Failure is a chronic medical condition, that is, one that usually requires life-long treatment. Many people with heart failure also have other chronic medical conditions. Other chronic medical conditions may require that you take medicines or make lifestyle changes in addition to taking the medicines prescribed as part of your heart failure treatment plan. To help your doctors and nurses better manage your care, be sure to tell them about all of your chronic medical conditions including any medicines you are taking to treat these other conditions. Trying to manage several medical conditions at the same time may be confusing.

This module will provide information on:

  • Other chronic medical conditions commonly experienced by people with heart failure.
  • The impact of these other chronic medical conditions on heart failure and its treatment.
  • Lifestyle changes that may be required to manage your overall health when dealing with more than one chronic medical condition.

It will help you:

  • Understand how some common chronic medical conditions can impact your heart failure treatment plan.
  • Learn about the medicines and lifestyle changes used to treat these other chronic medical conditions.
  • Learn how to better manage all of your chronic medical conditions including heart failure.
Common Chronic Medical Conditions

The most common chronic conditions that people with heart failure have are:

  • Diabetes.
  • Lung disease.
  • High blood pressure.
  • High cholesterol.
  • Decreased kidney function.
  • Arthritis, muscle and joint pain.

About one-third of people with heart failure also have diabetes. Having diabetes and heart failure can worsen your health if the diabetes is not controlled. Because you have heart failure, it is particularly important to control your blood sugar to help prevent further complications.

If you have diabetes, you should ask your doctor or nurse about any possible side effects of your diabetes medicines on your heart failure.

Lung Disease

Both heart failure and lung (also called pulmonary) diseases such as chronic obstructive pulmonary disease or asthma can cause you to experience shortness of breath. If you begin to have shortness of breath or trouble breathing and are not sure of the reason, ask your doctor or nurse.

If you develop a new cough, it could be due to worsening heart failure, a respiratory infection, pulmonary disease, or a side effect from a heart failure medicine such as your ACE (angiotensin- converting enzyme) inhibitor pills. Again, ask your doctor or nurse, especially if your cough is keeping you awake at night.

Beta-blockers, another important type of medicine used to treat heart failure, can cause or aggravate bronchospastic symptoms in people with asthma. Bronchospastic symptoms are those that occur when your airways tighten and can include shortness of breath, wheezing, coughing, or difficulty breathing in or out. If you take a beta-blocker pill and have breathing problems, tell your doctor or nurse. Do not stop these medications suddenly without consulting your health care team.

High Blood Pressure

High blood pressure makes the heart work harder, so high blood pressure can make people with heart failure feel worse and have more problems.

If you have high blood pressure and are taking medicines to keep it normal, be sure to take your medicines only as prescribed by your doctor. Your doctor or nurse may also recommend that you learn to take your own blood pressure and keep a record of your blood pressure measurements. This is done to see if your high blood pressure pills are working properly.

Many of the medicines used to treat heart failure are also used to treat high blood pressure. These include ACE inhibitors, beta-blockers, diuretics (water pills), and angiotensin receptor blockers (ARBs). Some high blood pressure medicines may slow your heart rate (e.g., beta-blockers), and some may cause fluid retention. If you have questions about the side effects of any of your blood pressure medicines, you should contact your doctor or nurse.

Questions to Ask Your Doctor Nurse

Q: Do I have high blood pressure? What should my blood pressure be?

Reason for asking this question: It is important for you to understand all of your chronic medical conditions, so the doctors and nurses involved in your care can develop a treatment plan that will work well for you. It is also easier to participate more actively in your own care if you understand the medical conditions affecting your health.

Q: Should I check my blood pressure at home?

A: Ask your doctor or nurse if they recommend that you check your blood pressure at home.

High Cholesterol

High cholesterol can increase a person's risk of developing coronary artery disease, and having a heart attack. Having a heart attack damages heart muscle and can worsen heart failure. If you already have coronary artery disease and heart failure, it is important to work with your doctor or nurse to reduce your cholesterol levels to normal to decrease your risk of having a heart attack.

To manage your cholesterol, you should:

  • Decrease your weight to expected levels for your height, especially if you are overweight or obese.
  • Limit your fat and cholesterol intake and follow a low-sodium diet. Read food labels to be sure you are not choosing foods that are high in fat or sodium. (See Module 2: How to Follow a Low-Sodium Diet for information on how to read food labels and on how to choose low-sodium foods.)
  • Take statins or other medications to lower your LDL cholesterol, if prescribed by your doctor or nurse.
  • Exercise regularly after consulting with your doctor.
Decreased Kidney Function

People with heart failure frequently have decreased kidney function (called renal insufficiency). This can be due to the normal aging processes, heart failure, and to medicines used to treat heart failure. If you have mild or moderate kidney impairment, taking medicines prescribed for heart failure most likely will not affect your kidney impairment.

If you experience symptoms of retaining too much fluid, your doctor or nurse may increase your diuretic (water pill) to overcome changes in your kidney function. Symptoms of fluid retention (also called water and salt retention or edema) include:

  • Swelling in your legs, arms, or abdomen (edema).
  • Worsening shortness of breath (congestion).
  • Increase in weight.
  • Inability to sleep lying down.

If your kidney function worsens, your doctor or nurse will need to change some of your heart failure medicines.

Always take your diuretic and other heart failure medicines only as prescribed. Taking too much of some medicines can worsen your kidney function. (See Module 3: Heart Failure Medicines for information on taking diuretics and other medicines to treat heart failure.)

You should also follow a low-sodium diet and monitor your fluid intake. (See Module 2: How to Follow a Low-Sodium Diet for more information on how to reduce your sodium intake.)

Arthritis and Muscle and Joint Pain

Osteoarthritis is the most common form of joint disease. People with heart failure can also suffer from painful arthritis. Symptoms associated with the disease increase with age. Non-steroidal anti-inflammatory Drugs (NSAIDs) are typically used to manage arthritis pain and other medical conditions. You can buy some NSAIDs over-the-counter, while others require a prescription. NSAIDs include medicines such as aspirin, ibuprofen, indomethacin, naproxen, celecoxib, and valdecoxib.

Celecoxib and valdecoxib are members of a class of anti-inflammatory medicines called COX-2 inhibitors. This class of drugs has come under increased attention recently, because of some reports that they can increase the risk of clotting, heart attacks, and strokes. These medicines are available by prescription only. NSAIDs including the newer COX-2 inhibitors may interact with your heart failure and blood pressure medicines. They may also affect your kidney function and can make your symptoms of heart failure worse. In general, it is preferable to use acetaminophen to treat arthritis, and muscle and joint pain. Ask your doctor and nurse about the best treatment for your arthritis.

Remaining active is one way to decrease the symptoms of arthritis and help you feel better when you have heart failure. (See Module 5: Exercise and Activity for ways to safely increase your activity level.)

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