It has become very apparent that overall, Americans are overweight and practice very poor eating habits. While diet should be considered important for everyone, Heart Failure patients need to pay strict attention to what they are eating, specifically their sodium intake.

The Reference Daily Intake (RDI), once commonly referred to as the Recommended Daily Allowance (RDA), is the amount of nutrients that The United States Department of Agriculture (USDA) deems necessary to maintain a balanced diet. Most all food is labeled with nutritional information to help consumers understand what they are eating.

The RDI is based on a diet consisting of 2,000 calories per day with an allowance of 2,400 milligrams (2.4 grams) of sodium for an average healthy adult and children over 4 years old. Heart Failure patients are strongly advised to have a daily intake consisting of less than 2000 milligrams (2 grams). While the RDI is different for every Heart Failure patient, this gives you a basic guideline.

When reading about Heart Failure, the term "low sodium intake" always pops up. While many people believe that just means not picking up the salt shaker, they are unaware of just how much sodium is already in the foods they buy at the grocery; not to mention the sodium in fast food. By simply taking the time to read the Nutrition Facts on food labels, and choosing foods with lower sodium, people can drastically cut their sodium intake. (It should also be noted that the majority of fast food restaurants publish nutritional facts for their menu items). The following table explains food labels pertaining to sodium, based on a 3½ ounce serving. (See Table 1)

Table 1

Let us take note that nutrition labels break food down into serving sizes. That can be very deceiving. For example, when reading the label on a 10 ¾ oz. can of soup, it indicates the amount of sodium (along with calories, fat grams, protein, carbohydrates, fiber and cholesterol) for ONE serving. In actuality, there are 2.5 servings in most every can. So if you plan on eating the entire can of soup (which is not out of the ordinary), you have to multiply the nutritional information by 2.5.

An entire can of a popular brand of tomato soup contains 1775 milligrams of sodium (which is more than 75 percent of the RDI for Heart Failure patients). In comparison, a can of the lower sodium variety with tomato pieces contains only 120 milligrams of sodium. Big difference! A 6 ounce can of Solid White Albacore Tuna in water contains 625 milligrams of sodium. The Low Sodium variety contains just 250 total milligrams. (You can serve with a fresh whole tomato and/or cucumber which contain less that 25 milligrams of sodium combined).

If you want to eat crackers with your soup or tuna fish, check out the sodium in your saltines. One serving (about 5 crackers) of saltine crackers contain 190 milligrams of sodium (Over 10 percent of the RDI). The lower sodium variety contains only 25mgs.

Surprisingly, even the cookies or pudding that you may want for dessert contain sodium. One serving (4 ounces-½ cup) of pudding contains between 180 and 200 milligrams of sodium. While that is not much, if you are counting milligrams, they add up.

About three regular sized chocolate chip cookies contain 105 milligrams of sodium. Approximately two of a popular brand of fat free cookie cakes, contain only 25 milligrams of sodium (You may have four and still be getting less than 50% of the chocolate chip cookies sodium amount).

Remember that these examples are for just one meal. You still have two other full meals, plus snacks, to consider. Foods that contain less than 140 milligrams of sodium are considered "low in sodium," but be careful. You might eventually want to try the Very Low Sodium or Salt Free foods that are available.

You might initially dislike the taste of lower sodium products, but you can spice them up with a sodium alternative like a salt free seasoning. There are several brands and flavors on the market to choose from. According to Denise Overbey, RD, LD/N, a dietitian in Tampa, Florida, "There are sodium free alternatives for example: salt free seasonings, herbs, spices, garlic, onion or lemon juice that can add flavor to foods." Be sure to consult your physician for dietary recommendations.

Ms. Overbey adds that, "Usually foods with low sodium, low fat/cholesterol, and are high in fiber are recommended for Heart Failure patients since maintaining a healthy weight is also important. Fluids may be limited, so a patient should check with their physician for any fluid restrictions."

Consult your physician for the recommended sodium intake for yourself; but lowering your sodium intake on your own will definitely help.

And consider that once you begin to eat foods with less sodium, regular foods will begin to taste "too salty." It is just a matter of changing taste buds and habits.

Summer is fast approaching and most people are preparing their travel plans. While that can be fun and exciting, Heart Failure patients have many factors to consider. A person might feel much better after undergoing treatment for Heart Failure, but they may still need to take it easy.

The American Heart Association and the American College of Cardiology suggests that as long as there are no complications, patients who have had heart surgery, such as coronary angioplasty or coronary artery bypass grafting, should wait at least two weeks before flying.

The first step in traveling when you are a Heart Failure patient is consulting your team-meaning your physician and your surgeon. Even though you might feel fine, you will still need the thumbs up from your care givers. Flying or sitting in a car for long periods of time can take a toll on anybody, but Heart Failure patients have higher risk factors.

The actual traveling portion of a trip can be very hard on a person's circulatory system. Keeping your blood flowing freely is a constant goal for maintaining cardiac health. If you are sitting on a plane, car, or bus, your blood may not be circulating as freely as it should.

If your physician and heart surgeon have given you the go ahead for flying, you must try to make sure that your blood is circulating normally while on the plane. When flying, request an aisle seat. It will give you more freedom to stand up and walk around a bit when needed. If you can't stand up as much as you would like to at least massage your legs. Rotate your ankles and wiggle your toes. Taking these small actions will help your blood flow.

It should be noted that you will need to alert airport security of a pacemaker, metal stent, or defibrillator in place in case they require an in depth search.

If you are on a road trip, make frequent stops. Get out of your vehicle and stretch and walk around for ten minutes or so. You might be in a hurry to get to your destination, but stopping every couple of hours will not only make you feel better, it will reduce your risk of complications.

When traveling dress in layers in case you become too hot or too cold. Wear loose fitting clothing. You don't want to wear anything tight or restricting. Comfortable shoes are best, preferably something that you can slip in and out of easily. You might want to keep a pair of slippers in your car or carry on luggage.

Make sure to always drink plenty of non-alcoholic beverages while traveling. If you are driving pack a cooler with water and snacks like apples and low fat/low sodium crackers and cheese. You can also take healthy snacks on the flight in case the airline only offers salty snacks or meals high in fat. If you know that the flight includes a meal, you may request a low sodium/low fat or diabetic meal. Talk to your travel agent or ask the airline when you book the flight.

After arriving at your destination, you will still need to monitor yourself. If you are a person who exercises make sure that you find a place to workout-a hotel or local gym, a pool or somewhere safe to walk. You want to maintain your exercise regime.

Heart Failure patients generally have medications that they are required to take on a regular basis. Always keep your medications in your purse or carry-on luggage. If your luggage goes to a different destination than you do, which happens frequently, you do not want to have to scurry around finding a doctor or pharmacy. If you do happen to misplace your meds, don't panic. Call your physician's office and explain. More than likely, replacing your meds won't be very difficult.

Make sure that you have any and all paper work concerning your condition with you while traveling. Become familiar with your medications and any implanted devices such as stents or a pacemaker. Include medical or medication instructions into your carry on bag. Make a list of all of your medications-the brand name and generic names as well.

Most importantly, if at any time during your travel you feel abnormal pain or symptoms, make sure that you have located the nearest cardiac physician or hospital. If you should need to see a physician, take all of your paper work to their office or hospital.

Just remember that vacationing is supposed to be relaxing. If you will consult your physicians, take the proper precautions, and plan ahead you will be more able to relax and enjoy your trip.

Some advanced Heart Failure patients are finding help with a biventricular pacemaker. The procedure, also known as Cardiac Resynchronization Therapy (CRT), involves surgically implanting a battery operated device under the skin. The purpose of the biventricular pacemaker is to synchronize heart beats to a normal, healthy pace through electricity.

In order to fully understand Biventricular Pacemaker (BiV) surgery, one must first gain an understanding of traditional, standard pacemakers and how they work.

Part of Heart Failure diagnosis may include an Echocardiogram (ECG) to determine a patient's QRS Interval. An Echocardiogram (ECG) is a test that shows a picture of the heart's movements. It shows the heart's four chambers and the heart valves. This test is administered to evaluate the overall performance of the heart. The patient will feel no discomfort, as this test is non-invasive.

An ECG graph is set up like a grid with small squares (They are the machines that are frequently shown on Medical Drama TV shows-SEE Figure 1). Each square on the grid is labeled with a letter of the alphabet (ABC...JKL..QRS...XYZ). The QRS Interval is between the letters between P and T on the graph and represents the time that it takes the lower chambers of the heart (ventricles) to come together during a breathing cycle. If there is blockage in either ventricle, the longer the QRS Interval; thus signifying a slow heart beat.

Figure 1

There are four chambers of the heart; the left and right atriums (upper chambers) and the left and right ventricles (lower chambers). Conventional pacemakers are used to correct slow heartbeats through wires (leads) that send electrical impulses to 1 or 2 chambers of the heart (generally the right atrium and the right ventricle).

If a patient is diagnosed with advanced Heart Failure (Class III or IV-see Classifications of Heart Failure) their surgeon may suggest implanting a Biventricular pacemaker rather than a standard pacemaker. If an ECG determines that there is not a sufficient amount of blood pumping from the left ventricle, a BiV pacemaker may be an alternative.

The difference with a BiV pacemaker is that, in addition to the electrical leads being attached to the right atrium and the right ventricle, a third lead will be placed in the vein that controls the blood flow action of the left ventricle (the coronary sinus vein). The BiV device transmits electrical signals through the leads to the heart muscle. The electrical signals will force the lower chambers (ventricles) to contract simultaneously. This synchronized contraction is meant to improve cardiac function.

As stated earlier, advanced Heart Failure patients are candidates for a BiV pacemaker. If a physician has determined that a patient is experiencing severe Heart Failure symptoms (see-Symptoms of Heart Failure), has a history of Heart Failure or heart attack, or is taking Heart Failure medications, they may be eligible for placement of a Biventricular Pacemaker.

Building a strong rapport with your physician is as essential as proper diagnosis. Consult with your physician about your options.

Left Ventricular Reconstructive Surgery, referred to as LVR, is a procedure being studied in advanced Heart Failure patients. When a person experiences a Heart Attack in the Left Ventricle (the lower left pumping chamber of the heart that receives blood from the left atrium and pumps oxygen into the circulation), partial loss of the heart’s muscle movement occurs.

Nearly 70% of the 300,000 deaths from Heart Failure that occur annually in the
US, have a lack of blood flow through an artery or throughout the circulatory system (Ischemic Cardiomyopathy) as an underlying cause (etiology).

A Heart Attack may cause a scar on the Left Ventricle (LV) of the Heart. If the scarred area becomes thin and begins to inflate with each Heartbeat, an expansion of a blood vessel (aneurysm) may occur. Previous Heart damage coupled with the aneurysm causes the Heart to have to pump more rigorously.

The Dor Procedure, which was modernized by Vincent Dor, MD in 1985 is a practical method for restoring a dilated left ventricle to its normal dimensions. The LVR surgery not only restores the LV to its normal proportions, it involves removal of the dead tissue area and/or aneurysm. Ideally, the Dor procedure may create complete recovery in the Left Ventricle allowing it to pump sufficient amounts of blood without being over worked.Research shows that the "five year survival matches or exceeds that of cardiac transplant, and freedom from Heart Failure post-operatively reaffirms the effectiveness (efficacy) and durability of LVR."Advanced Heart Failure patients often experience various heart problems before Left Ventricular issues occur. It is not unusual for a Heart Surgeon to perform concomitant or affiliated procedures while performing LVR. Because of the use of a lung-machine LVR is considered a major open-heart surgery so therefore, other procedures may be performed concurrently. A coronary bypass, which establishes a route past an obstruction and improves oxygen supply to the heart; or mitral valve repair, to close leaks, are common concomitants of LVR. Prior to surgery patients may need to undergo a series of tests including, but not limited to: routine blood tests, chest X-rays, and a Magnetic Resonance Imaging (MRI), which uses powerful magnetic fields to create images of tissues and organs. A cardiac catheterization, which extracts blood from the chambers of the heart for testing, and an echocardiogram, a noninvasive method that utilizes sound to visualize the heart's valves, walls and chambers; both need to be administered within one year of surgery.

Patients that may qualify for LVR have experienced an abnormally rapid heart rate greater than 100 beats per minute(ventricular tachycardia), Mitral valve leaks, severe coronary artery disease, and/or a Heart Attack creating an aneurysm (see above) in the Left Ventricle. But as with all symptoms patients need to be properly diagnosed by a Cardiac specialist. Once the severity and position of the Heart condition is properly diagnosed, the surgery may be performed.

LVR consists of the surgeon placing a small incision in the LV and locating the dead tissue and or aneurysm. Depending on the size, part of the scar tissue may be removed before completing the procedure. Rows of stitches are placed around the circumference of the tissue to separate the frame from the healthy tissue. The stitches are then pulled together tightly, commonly referred to as a "purse string" procedure. One last row of stitches is placed outside of the LV to further strengthen the area.

In the RESTORE Registry, published in JACC in October, 2004, 1198 patients underwent the procedure at 11 international centers. Thirty-day mortality was 5.3%, and only 8.2% required IABP (Intra-aortic Balloon Pump) support, 1% required VAD (Ventricular Assist Device) or membrane oxygenator support. The five year survival was 68.6% for all patients, but increased to 77% for patients with a pre-operative EF (Ejection Fraction-a healthy heart empties 60-70% from the ventricle)? 30%. (See Table 1)

Table 1