Information for South Asians

HEART FAILURE

Beating Heart Disease Together

About this booklet

This booklet is for South Asian people who have heart failure.

The booklet explains:

what heart failure is what causes it the symptoms how it is diagnosed how it is treated, and what you can do to help yourself.

The information in this booklet is not a substitute for the advice your doctor may give you based on his or her knowledge of your condition. This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages.

Acknowledgements
The British Heart Foundation would like to thank: Haslemere Allotments Gordon House Surgery, and Professor Jaspal S Kooner, Dr Nabeel Ahmed and Ealing Hospital for their continued support.

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Contents
What is heart failure? What are the symptoms of heart failure, and how is it diagnosed? What can be done for heart failure? Medicines to treat heart failure What you can do to help yourself Other treatments that can help some people with heart failure Heart failure and your quality of life If you look after someone with heart failure For more information Technical terms Index 5 8 15 16 24 38 39 42 44 46 47

what is heart failure?

The heart is a pump which delivers blood and oxygen around the body. Heart failure is the term used when the heart becomes less efficient at pumping blood around the body, either while you are resting or active.
Heart failure is a name for a collection of symptoms. These symptoms are all caused by your heart not being able to pump as much blood and oxygen around your body as it should do. The term heart failure is unfortunate because it implies that the heart has actually failed. In fact, it means that the heart muscle is not working as well as it should be. But many people can have some control over their condition with a combination of medicines and making changes to their lifestyle, or sometimes with other medical treatments.

How a normal heart works

Your heart is a muscle about the size of your fist. Your body needs a constant supply of oxygen to keep it going. Your heart pumps blood containing oxygen through your arteries to all the parts of your body, so that each part gets the oxygen it needs. The movement of the blood through the heart is regulated by a system of four valves. These make sure that the blood flows in the correct direction.

arteries

the heart

arteries

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What causes heart failure?

The most common causes of heart failure are: heart attacks or high blood pressure.

A heart attack causes damage to the heart muscle. This happens when the heart muscle is deprived of oxygen and blood because the arteries have become blocked, as in coronary heart disease. (For more information on coronary heart disease, see our booklet Living with angina and heart disease. See page 44.) High blood pressure is when the pressure of the blood in the arteries is too high. People with high blood pressure rarely have symptoms, but if the high blood pressure is not treated, it can lead to heart failure. Knowing what causes high blood pressure can help to reduce your risk of this happening to you. We explain more about high blood pressure on page 26.

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Other possible causes of heart failure are: a viral infection a disease of the heart muscle called cardiomyopathy heart valves that either leak or are too narrow an abnormal heart rhythm (an arrhythmia) drinking too much alcohol thyroid gland disease, or anaemia (a lack of iron in the blood).

In some cases the cause is not known.

Can heart failure be cured?

With the right treatment and by making changes to your lifestyle, your heart failure can be managed so that you can have a longer and better life. However, these changes are unlikely to reverse your condition. The most important thing is to manage your symptoms well. Many people in the early stages of heart failure can lead full and active lives. And those with more advanced heart failure can learn to work within their limits and get as much out of life as possible.

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What are the symptoms of heart failure, and how is it diagnosed?

The main signs and symptoms of heart failure are:

breathlessness swelling of the ankles and feet, and tiredness, which can be mild or severe.

Symptoms may come on suddenly, or they may develop slowly over weeks or even months. They may also happen after a heart attack. However, these symptoms can also be caused by other medical conditions, so it is important to talk to your doctor to get an accurate diagnosis.

Breathlessness
If you have heart failure, breathlessness is most likely to happen when you are active or when you are lying flat in bed. It may even wake you up at night, and you may need to sit up, with pillows to support you, or go to the window for some fresh air. The breathlessness is caused by a build-up of fluid in the lungs, which can make you wheeze or cough. Being breathless can be very frightening, which can make the breathlessness worse.

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Swelling of the ankles and feet

People with heart failure often have swelling of the ankles and feet. Sometimes the swelling may spread to the legs, thighs and groin and even to the abdomen. One of the jobs of our kidneys is to keep the right balance of water, salt and potassium in our bodies. If your heart is not pumping enough blood to the kidneys, your kidneys cannot do their job properly and fluid builds up in different parts of your body. This is what causes the swelling. One way to check if you are retaining fluid is to weigh yourself at the same time every day. If you find you have put on 2 to 3 pounds (1 to 2 kilos) over two to five days, the weight gain may be due to fluid retention. If you put on this amount of weight over a couple of weeks, it is more likely to be due to an increase in body mass (fat).

Tiredness
The tiredness can be mild or severe. For some people, it can be quite overwhelming, making it difficult to carry on as normal. The tiredness is caused by your muscles not getting enough oxygen, or because you are not sleeping properly. We explain how to help control these symptoms of heart failure on page 15. If you have these symptoms and they are getting worse, you should speak to your doctor or nurse immediately. If the symptoms are very bad, you should call 999 for an ambulance.

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How is heart failure diagnosed?

Your doctor may be able to tell you if you have heart failure by doing a careful physical examination. You may have to have some other tests done too. Your doctor will:

examine your heart rate and rhythm take your blood pressure check whether you have fluid in your lungs, legs and in other parts of your body listen to sounds made by your heart valves, and check if the blood pressure in your neck is high.

Your doctor will also do blood tests to find out if you have early signs of anaemia, kidney damage or thyroid disease. The other tests you will have are an electrocardiogram (ECG), an echocardiogram (see photo opposite) and a chest X-ray.

An electrocardiogram (ECG)
An ECG is a test that records the rhythm and electrical activity of your heart. Several small sticky patches are put onto your arms, legs and chest. The patches are connected to wires which lead to the ECG recording machine. This recording machine picks up the electrical signals produced by each heartbeat and records several beats onto paper. The ECG machine only records signals from your heart. It does not affect your heart in any way. The whole test takes about five minutes and is not uncomfortable at all.

An echocardiogram
An echocardiogram is a test to check the pumping action of your heart. A recorder (probe) is placed on your chest and a pulse of high-frequency

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sound is passed through the skin of your chest. Lubricating jelly is rubbed on your chest first, to help make a good contact with the probe. The probe then picks up the echoes reflected from various parts of the heart and shows them as a picture on a screen. The test can take up to an hour. It doesnt hurt at all.

How do I know if I have mild or severe heart failure?

Doctors divide heart failure into four classes.

Class 1 Very few or no obvious symptoms In people with Class 1 heart failure, the heart is not working as well as it should be, but they should be able to do everything that they normally do. Class 2 Mild heart failure People with Class 2 heart failure may get breathless when they do everyday activities. Class 3 Moderate heart failure People with Class 3 heart failure are quite limited in what they do, and find that they are breathless and become exhausted easily. They are usually comfortable when they are resting. Class 4 Severe heart failure People with Class 4 heart failure are breathless even when they are not very active for example, when walking around the house or even while resting. They may be unable to sleep lying down because they get breathless or because it makes them cough.

Your doctor will classify your heart failure into one of these groups by examining you, doing some of the tests described on page 10 and talking to you about your symptoms.

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Will my heart failure get worse over time?

You can help to slow down the progression of your heart failure if you look after yourself and set realistic goals to manage your symptoms. Your doctor or heart failure nurse will help you to do this. Sometimes, managing your symptoms can improve the pumping action of your heart and help to overcome some of the problems you are experiencing. In some cases, with good management, it is possible to prevent your heart failure getting worse for many years. It is normal for you and your family to be concerned about your condition. You should talk to your health professionals who will be able to help you and your family to live as normal a life as possible.

How do I know that my symptoms are due to heart failure?

The symptoms of heart failure breathlessness, swelling and tiredness are not always caused by heart failure.

Breathlessness
It is normal to become breathless when you are physically active. Breathlessness is only a problem if you find that you are becoming increasingly breathless doing activities that you could previously do easily such as walking, climbing stairs, shopping or hoovering. Breathlessness is also common in smokers. And people who are very overweight may get very out of breath when they are physically active.

Swelling
Ankle-swelling can be caused by varicose veins, especially in women. It can also be a side effect of some medicines. People who are overweight may get swollen ankles even if they do not have heart failure.

Tiredness
Tiredness can be a result of a number of conditions, such as anaemia or an underactive thyroid gland. It can also be a side effect of some medicines.

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What can be done for heart failure?

It is possible to help control the symptoms of heart failure. This can be done in these four ways.
Your doctor can give you medicines to help. See page 16. There are things you can do to help yourself. See page 24. A pacemaker can help a small number of people with heart failure. See page 38. In a very small number of cases, people with heart failure may be offered a heart transplant if their heart failure is severe, but this is rare. See page 38.

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Medicines to treat heart failure

You may need to take several different medicines for your heart failure.
Taking the right pills properly: will help to control the symptoms of your heart failure may treat the cause of your heart failure, and may make you feel better and live longer.

Your doctor may prescribe one or more of these medicines for you: diuretics ACE inhibitors beta-blockers anti-platelet drugs digoxin anticoagulants.

You may also be given nitrates. And you may be given statins, to lower your cholesterol level. (For more information on nitrates and statins, see our booklet Taking medicines for your heart. See page 44.)

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On the following pages we explain what the medicines do to help your heart failure. For information on the side effects of these medicines, see our booklet Taking medicines for your heart. (See page 44.) Serious side effects are rare. If you do get any side effects, tell your doctor so that he or she can change your dose, or perhaps give you a different medicine instead. Most people with heart failure will have regular blood tests to make sure that the levels of important substances in the blood such as potassium and sodium remain within the normal limits. People who have heart failure may need to have these blood tests more frequently than people who are taking the same drugs but who do not have heart failure.

Dont stop taking your medication without speaking to your doctor first, as it can make your symptoms worse.

Complementary medicines
Some homeopathic or herbal remedies, and food supplements such as vitamins and minerals, may interact with your medicines. Before taking any of these you should discuss them with your doctor, nurse or pharmacist.

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Diuretics
Diuretics are also called water tablets.

How does this medicine help people with heart failure?

Diuretics help your kidneys to work. They increase the amount of water and salt passed from the kidneys into the urine. So they can be a great help in relieving any ankle-swelling and breathlessness caused by heart failure. They also help to control your blood pressure, and help other medicines such as ACE inhibitors and beta-blockers to work better.

Other information
You should tell your doctor or nurse if you: have difficulty passing urine pass less urine than normal are constipated begin to feel dizzy or faint (if this is a new symptom for you, or if it becomes worse). You will need to have a blood test about every six months to make sure that your kidneys are working properly. Some people may have a test more frequently, depending on their condition. If you have heart failure, you should avoid eating salt and salty food (see page 34). Salt can also counteract the effect of the diuretics. So, if you are taking these medicines, avoid salty foods, and dont add any salt or salt substitute to food, either during cooking or at the table.

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ACE inhibitors
How does this medicine help people with heart failure?
ACE inhibitors relax the blood vessels, and help improve the flow of blood to the heart muscle, making it easier for the heart to pump blood around your body. They also reduce the risk of having a heart attack or of dying from heart failure. ACE inhibitors can lower your blood pressure dramatically so, when you start taking these medicines, you will have your blood pressure checked regularly. ACE inhibitors are not suitable for everyone with heart failure.

Other information
If you have heart failure and are taking ACE inhibitors, you should avoid drinking alcohol as it can lead to dizziness. You should avoid salt substitutes as they contain potassium. And dont take potassium supplements or other supplements that contain potassium. ACE inhibitors can sometimes cause a dry, irritating cough. If this happens to you, you should tell your doctor about it. He or she may be able to prescribe another medicine instead.

Beta-blockers
How does this medicine help people with heart failure?
Beta-blockers prevent the heart from beating as quickly and forcefully as usual. They also increase the amount of blood that your heart can pump with each beat, and reduce the risk of dying from heart failure. Beta-blockers are usually given to people with mild to moderate heart failure. When you first start taking them, your symptoms may seem worse for a while. It can take a couple of months before you feel the benefits.

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If you have asthma or suffer from wheezing, your doctor will need to choose your beta-blocker carefully, as some types tend to narrow the air passages.

Other information
Dont stop taking beta-blockers suddenly without medical advice as this can make your symptoms much worse.

Anti-platelet drugs
How does this medicine help people with heart failure?
Anti-platelet drugs such as aspirin help to reduce blood clotting, by stopping blood platelets (cells in the blood) from sticking together. They also reduce the risk of having a heart attack.

Other information
If you cannot take aspirin, your doctor may prescribe another drug, called clopidogrel, for you. This has the same effect as aspirin. You normally have to take aspirin for the rest of your life. Some people may need to take other anti-platelets for different lengths of time, depending on their condition. You should not take any remedies that contain aspirin such as medicines for muscle and joint pains, and some remedies that people take for colds and flu as they can reduce the effect of the aspirin you are taking to protect your heart. And you should avoid all other medicines that contain aspirin. If you need to take something for a temperature or to relieve pain, ask your pharmacist or doctor which type of medicines is suitable for you. Always try and take your aspirin with or after food.

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Digoxin
How does this medicine help people with heart failure?
Digoxin slows the heart rate and strengthens the force of the heartbeat. It can help your heart to pump blood around the body more efficiently and help to control irregular heart rhythms.

Other information
Digoxin may not be suitable for people who already have a slow heartbeat or for people with certain heart conditions such as some abnormal slow heart rhythms.

Anticoagulants
How does this medicine help people with heart failure?
Anticoagulants make your blood thinner, so they help to stop clots in the blood from forming. This means that they can help to prevent a heart attack or stroke.

Other information
If you are taking anticoagulants, you should always carry with you an Anticoagulant record card that has details of the anticoagulant medicines you are taking. Your doctor will give you this card. Also, if you are having any tests or treatment, tell any doctors or nurses that you are taking anticoagulants. You will need to have regular blood tests to check that you have the right dose of anticoagulant. These tests are usually done at your doctors or at an anticoagulant clinic at the hospital. Some anticoagulants interact with other medicines. So, check with your doctor or pharmacist before you take any other medicines. You should not drink cranberry juice if you are taking anticoagulants.

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Taking your medicines

Below is a guide to taking your medicines safely and making sure that they have the best possible effect in relieving your symptoms. Write out a list of your medicines, the doses, and when you take them. At least once a month, or whenever you get a new prescription, check that your list of medicines matches the medicines you are taking. Have a fixed routine for taking your tablets so that you know which you can take together and what time is the best time for you to take them. If you miss a dose or cant remember taking it, dont take a double dose. Wait until you are next due to take the medicine. It is safer to take too little medicine rather than too much. Always check with the pharmacist or your doctor before taking over-the-counter medicines. Tell your doctor about any unwanted side effects you think you are experiencing. Never share your medicines with other people or take other peoples medication. They may be taking different doses or preparations of the medicine. Dont stop taking any medication without talking to your doctor first.

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What you can do to help yourself

It makes good sense to do everything you can to stop or slow down any progression of your heart failure. These are the things that you can do to help yourself.
Control your blood pressure. If you smoke, stop smoking. Be physically active, within the limits advised by your doctor. Work towards a sensible body weight. Eat a healthy diet. Watch the amount of fluid that you drink. If you drink alcohol, keep within sensible limits. Take your medicines regularly, as advised by your doctor.

We explain more about these things on the next pages.

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Control your blood pressure

We know that high blood pressure is one of the most common causes of heart failure. People with high blood pressure rarely have any symptoms, and the only way you can tell if you have high blood pressure is by having your blood pressure measured. If you have high blood pressure, it is important that you take your blood pressure medication properly. Other things you can do to help control your blood pressure are:

Eat a healthy diet avoiding salt or salt substitutes and making sure your diet is high in fruit and vegetables. Manage how much fluid you have. Limit how much alcohol you have. Keep as active as your symptoms allow.

We explain more about all these things on the next pages. For more information on blood pressure, see our booklet Blood pressure and how to control it. (See page 44.)

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If you smoke, stop smoking

Stopping smoking is the single most important thing a smoker can do to live longer. If you stop smoking, you are likely to:

feel more alert increase your energy levels and fitness sleep better improve your circulation and oxygen levels improve your symptoms, and reduce your risk of having a heart attack or stroke.

If you have tried to stop smoking and have gone back to smoking again, there are things that can help you. Ask your doctor about products to help you stop smoking. If you need extra help with stopping smoking, you can call Quitline or the NHS Smoking Helpline. Quitline English: 0800 00 22 00 Bengali: 0800 00 22 44 Mondays 1pm to 9pm Gujarati: 0800 00 22 55 Tuesdays 1pm to 9pm Hindi: 0800 00 22 66 Wednesdays 1pm to 9pm Punjabi: 0800 00 22 77 Thursdays 1pm to 9pm Urdu: 0800 00 22 88 Sundays 1pm to 9pm NHS Smoking Helpline English: 0800 169 0 169 Bengali: 0800 169 0885 Tuesdays 1pm to 9pm Gujarati: 0800 169 0884 Tuesdays 1pm to 9pm Hindi: 0800 169 0883 Tuesdays 1pm to 9pm Punjabi: 0800 169 0882 Tuesdays 1pm to 9pm Urdu: 0800 169 0881 Tuesdays 1pm to 9pm

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Be physically active, within the limits advised by your doctor

The type of activity that is recommended for good heart health is moderate, rhythmic (aerobic) exercise such as brisk walking or cycling. Walking and cycling are particularly good as you can often build them into your daily routine. Or, if your mobility is limited, you can do exercises while you are sitting in a chair. Get advice from your doctor or heart failure nurse about how much activity you should do to start with. The benefits of physical activity are that it is likely to:

raise your energy levels and make you feel less tired improve your breathing improve your blood pressure lower your cholesterol improve your weight, and make you feel better mentally and physically.

If you have heart failure, you will have good and bad days. On the good days, you will feel that you can do lots of things. But you need to find a balance between doing too much and doing too little. Plan what you know you can do in a day. Then, each day, do what you planned to do, not what you feel you can do. This is because, if you do too much, youll feel tired the next day and you wont be able to do what you had planned for that day.

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Work towards a sensible body weight

If you are overweight, you need to lose some weight. Dont try to lose the extra weight too quickly. Losing weight slowly and steadily about a pound, or half a kilo, a week is more healthy, and youre more likely to keep the weight off for good.

Eat a healthy diet

Eating healthily can help you to control your weight, your blood pressure, your blood sugar and your cholesterol.

What you can do

Eat at least five portions of fruit and vegetables a day. Eat less fat, particularly saturated fat. Eat one or two portions of fish a week. One of these should be oily fish. Eat less salt.

We explain all these things on the next pages. You can still eat your favourite dishes. You just need to make small and gradual changes in what you eat. For more information, see our booklet Looking after your heart, and the healthy recipes in our Asian cookbook Healthy meals, healthy heart. (See page 44.)

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Is a vegetarian diet better than a non-vegetarian diet?

Both a vegetarian and a non-vegetarian diet can be healthy, provided they are balanced. Vegetarians need to make sure that they are getting enough protein in their diet for example, from beans, pulses, tofu or Quorn. These foods are low in fat and also provide fibre. Eating these foods, combined with eating more fruit and vegetables as part of a balanced diet, will ensure you get all the nutrients you need, as well as helping to keep your heart healthy. Vegetarians should also follow the advice to have a diet that is low in fat (especially saturated fat), sugar and salt (see pages 33 and 34). Some vegetarians use a lot of butter and ghee in their cooking, which adds a lot of saturated fat. Try using a small amount of olive oil or rapeseed oil instead. Use a spoon to measure the oil rather than pouring it. Also, some vegetarians add salt to give foods extra flavour. Instead of salt, use other flavourings for foods such as lemon juice, chilli and other herbs and spices.

Eat at least five portions of fruit and vegetables a day

Eating a diet that is rich in a range of vegetables and fruits lowers the risk of heart disease. Eat at least five portions of fruit and vegetables a day. Try to eat a wide variety of fruit and vegetables. They can be fresh, frozen or tinned. Dried and juiced also count, but only once a day.

Eat less fat, particularly saturated fat

There are two main types of fats in foods: saturated fats and unsaturated fats. A diet that is low in saturated fats can lower your blood cholesterol level, help prevent you putting on weight, and can reduce the risk of coronary heart disease or stroke. Saturated fats are found mostly in foods from animal sources such as fatty meat, and in dairy products such as butter, ghee, cheese, cream and full-fat milk. Palm oil, coconut oil, coconut cream and coconut milk are also high in saturated fat. Unsaturated fats are mainly found in vegetable oils and plant oils such as corn oil, sunflower oil, olive oil and rapeseed oil.

Eat one or two portions of fish a week

Eating oily fish regularly can help to protect your heart. The particular oil in fish that has these good effects is called omega-3. It is found mainly in oily fish such as trout, sardines, herrings, mackerel or fresh tuna. Aim to have two portions of fish a week. One of these portions should be oily fish. If you dont eat oily fish, there are some vegetarian sources of omega-3 that you can include in your diet. These include flaxseed oil, rapeseed oil, flax seeds, rape seeds, and walnuts. However, we dont know for certain if these sources of omega-3 give the same benefits as oily fish.

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Avoid salt
Most of the salt we eat is hidden in processed foods and in pre-cooked or pre-prepared meals, which are sometimes very salty. When choosing these foods, choose ones that are labelled low salt or reduced salt. But you should still check the labels to see whether they are actually low in salt. See the box below.

What is a lot and a little salt?

This is a lot (per 100 grams of food): 1.5 grams of salt or more 0.6 grams of sodium or more This is a little (per 100 grams of food): 0.3 grams of salt or less 0.1 gram of sodium or less

Avoid adding salt when cooking or at the table. Use spices, herbs or lemon juice for flavour instead. Dont use any salt substitutes as these may contain large amounts of potassium, which is not recommended if you have heart failure. It is better to try to get used to food without salt.

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Watch the amount of fluid that you drink

Your doctor may have told you to restrict the amount of fluid you drink. To check how much fluid you have in a day, each time you drink something, pour the equivalent amount into an empty 2-litre bottle or two 1-litre bottles. If you do this for a whole day, you will be able to see how much you drink in a day. Remember that some foods such as soup contain a lot of water, so you have to include that too. If you have been told to restrict your fluid intake, try writing a plan of when you would most like your drinks, and spread them out throughout the day. If you do feel thirsty but your fluids are restricted, you could try the following. Chew chewing gum or have a boiled sweet occasionally. Rinse your mouth out with water or mouthwash without swallowing it. Add a little lemon juice to one of the glasses of water from your daily allowance. The sour taste will quench your thirst more effectively. Suck an ice cube, but remember to include that in your allowance.

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If you drink alcohol, keep within sensible limits

Alcohol can alter your fluid balance quite dramatically, and it can lead to high blood pressure. It can also make some of the symptoms of your heart failure worse such as dizziness and tiredness. Men should drink no more than 3 units of alcohol a day, and a total of no more than 21 units a week. Women should drink no more than 2 units of alcohol a day, and a total of no more than 14 units a week.

1 unit of alcohol =
a small glass (100ml) of wine (10% ABV [alcohol by volume]) or half a pint (300ml) of normal strength lager, cider or beer (3% to 5% ABV) or a pub measure (25ml) of spirits

Avoid binge drinking. If you have a problem with retaining too much fluid, check with your doctor how much you can drink, especially beer. If your heart has already been damaged by alcohol, your doctor has probably already told you that it would be better for you to give up alcohol altogether.

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Other treatments that can help some people with heart failure
Pacemaker
A small number of people with heart failure may benefit from having a special type of pacemaker, called a bi-ventricular pacemaker, fitted. This device may help to synchronise the heart rhythm and control the heart rate. It is not suitable for everyone. It is generally used in people with moderate to severe heart failure who are not responding to their medication.

Heart transplant
In a very small number of people with severe heart failure, a heart transplant may be an option. This form of treatment is for patients who have been carefully chosen, but it is not suitable for everyone. If your cardiologist (a doctor who specialises in the heart) thinks that you may be suitable for a heart transplant, he or she will ask you to go to a transplant centre for an assessment.

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Heart failure and your quality of life

Tiredness and breathlessness are common symptoms of heart failure and can make it difficult for some people to live their lives normally. Some people also find that their mood is affected and may feel more depressed than is usual for them, or lose their confidence. Some have chest pain.
Do tell your doctors and nurses about how you feel, and about the ways in which heart failure is affecting your everyday life. They may be able to adjust your treatment to help improve the quality of your life. Your doctor may be able to refer you to other health professionals who can help. For example: Many areas of the country now have heart failure nurses. These nurses can see you in hospital and also give you and your family support, information and guidance when you get home. Ask your GP for information. If you have heart failure and also have angina or have had a heart attack, you may be able to go on a cardiac rehabilitation programme. This usually involves going once or twice a week for between 6 and 12 weeks, or longer. The programme might be run either at your local hospital or at a centre near you. It usually includes exercise sessions to encourage you to do as much physical activity as you can. You will also get advice about healthy eating and other ways to help your heart. To find out where your local cardiac rehabilitation programme is, call 0300 330 3311. You will need to check that the programme is suitable for people with heart failure. A specialist in palliative care may be able to help improve your symptoms and help you and your family cope with your illness. Your GP can give you information about this.

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A counsellor may be able to help you cope with your heart failure. Your GP may be able to refer you to one, or it might be possible to get a referral through the hospital. Counselling can be particularly useful for people who feel depressed. Your doctor may also be able to prescribe medication to help with depression. Talking to others can also be very helpful. You may find it helpful to join a heart support group. A heart support group gives you, your partner and family the chance to meet and talk to people who are going through a similar experience. Groups vary. They may meet every week, every fortnight or every month. The British Heart Foundation keeps an up-to-date list of all heart support groups in England and Wales which are linked to the British Heart Foundation. To find out about the nearest one to you, call 0300 330 3311. People with heart failure can become tired and depressed about their limitations, and worried about their future. Understanding what heart failure is and the medicines used to treat it, and being involved in making decisions about your treatment, will all help you to have more control over your condition.

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If you look after someone with heart failure

Looking after someone who has heart failure can be very demanding both physically and emotionally.
If you are caring for someone with heart failure, it is important that you look after your own health and make sure you get regular breaks both for your own wellbeing and for the person you are looking after. Remember that doctors, nurses, social workers, voluntary groups and friends can all help. Ask for help and support whenever you need it. If you cannot leave the person you are caring for on their own for long, it may be possible to arrange respite care. This means that the person is looked after in a care home for a few days, for example while you have a break. The heart failure nurse or social worker may be able to help you arrange this.

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For more information

British Heart Foundation website
bhf.org.uk For up-to-date information on coronary heart disease, the British Heart Foundation (BHF) and its services.

Heart HeLPLine
0300 330 3311 A local rate number. For information and support on anything relating to heart health. This service is available in English only.

Booklets
The following booklets are available in Bengali, Gujarati, Hindi, Punjabi and Urdu: Blood pressure and how to control it Cholesterol and what you can do about it Diabetes and how it affects your heart Heart failure Living with angina and heart disease Looking after your heart Taking medicines for your heart

The following booklets are available in English only: The heart failure plan Eating for your heart Healthy meals, healthy heart Physical activity and your heart Smoking and your heart So you want to lose weight for good

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DVDS
The following DVDs are available in Urdu, Hindi, Gujarati, Punjabi and Bengali. They are free, but a donation of 5 per DVD would be welcome. Living to prevent heart disease Get fit, keep fit prevent heart disease Cardiac surgery Cardiac rehabilitation Affairs of the heart

Magazines and services

Heart & soul is a glossy lifestyle magazine aimed at the South Asian community. This free magazine is packed full of information on leading a healthy lifestyle and features celebrities talking about their own health, delicious recipes and real-life stories. To receive your free copy call 0870 600 6566. Available in English only. Heart Matters is a free service designed for anyone who has, or is at risk of developing, a heart condition, and for anyone who cares for someone with a heart problem. Members receive personalised information, and can get specialist support from cardiac nurses or heart health advisers, either by phone or email. They also get regular issues of Heart health magazine, which includes updates on treatment and research and looks at issues related to heart health. To join Heart Matters, either register at our website bhf.org.uk/heartmatters or call 0300 330 3300 (a local rate number). This service is available in English only.

How to Order
The British Heart Foundation also produces other educational materials that may be of interest. To find out about these, to order a Heart health catalogue, or to order publications, please call the BHF Orderline on 0870 600 6566, go to bhf.org.uk/publications or email orderline@bhf.org.uk. You can download many of our publications from bhf.org.uk/publications Our publications are free of charge, but we would welcome a donation.

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technical terms
ACE inhibitor A medicine used to treat heart failure. It relaxes the blood vessels and helps to improve the flow of blood to the heart muscle. anticoagulant A medicine used to help stop clots in the blood from forming. anti-platelet drug A medicine used to help stop clots in the blood from forming. arteries Vessels which carry blood from the heart to other parts of the body. beta-blocker A medicine used to treat heart failure. It prevents the heart from beating as quickly as usual. blood pressure The pressure of the blood in the arteries. cardiomyopathy A disease of the heart muscle. digoxin A medicine used to treat heart failure. It slows the heart rate. diuretic Also known as water tablets. Diuretics increase the output of water and salt in the urine. ECG See electrocardiogram. echocardiogram An ultrasound picture of the heart which shows the structure of the heart and how it is working. electrocardiogram A test to record the rhythm and electrical activity of the heart. Also called an ECG.

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INDEX
ACE inhibitors activity alcohol ankle-swelling anticoagulants anti-platelet drugs aspirin beta-blockers blood pressure breathlessness cardiomyopathy carer causes of heart failure depression diagnosis diet digoxin diuretics drugs eating ECG echocardiogram electrocardiogram exercise 19 29 37 9, 13 21 20 20 19 6, 26 8, 13 7 42 6 39, 40 10 31 21 18 16 31 10 10 10 29 fat in the diet fluid healthy eating heart attack high blood pressure medicines nitrates nurses pacemaker quality of life rehabilitation salt smoking sodium statins support groups swelling symptoms of heart failure tests tiredness transplant treatment water tablets weight 33 9, 36 31 6 6, 26 16 16 39 38 39 39 34 27 34 16 40 9, 13 8 10 9, 13 38 15 18 9, 31

Have your say

We would welcome your comments to help us produce the best information for you. Why not let us know what you think? Contact us through our website at bhf.org.uk/contact. Or, write to us at the address on the back cover.

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The British Heart Foundation is the nations heart charity, saving lives through pioneering research, patient care and information. We rely on donations to continue our vital work. If you would like to make a donation to the British Heart Foundation, please ring our donation hotline on 0300 330 3322 or contact us through our website at bhf.org.uk/donate or send it to us at the address below. This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages. To order further copies, please call the BHF Orderline on 0870 600 6566.

This service is available in English only.

British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW Phone: 020 7554 0000 Fax: 020 7554 0100 Website: bhf.org.uk
British Heart Foundation 2009, a registered charity in England and Wales (225971) and Scotland (SC039426)

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