Rapid Access Heart Failure Clinic

Often the initial visit to our Rapid Access CHF Clinic is arranged by the emergency department physician who would have attended to your symptoms at the hospital. Sometimes, however, you may have seen your family doctor, walk-in clinic or urgent care physician who can make the same call. In any case, the physician would have suspected the possibility of heart failure based upon your symptoms and cardiac risk factors. They would have referred you to our Rapid Access clinic to quickly determine your risk for congestive heart failure and to help prevent the development of future cardiac events and complications.

Upon arriving at Cambridge Cardiac Care, please register with our friendly staff at the reception window. You will first be called in by a technologist who will commence your cardiac testing which may include an ECG, Echocardiogram, Holter Monitor, ABPM, Stress Test and Stress Echocardiogram. Upon completing the full workup, you will meet with the specialized cardiac nurse or the cardiologist who will review your test results and consult with you regarding your risk of congestive heart failure. They may suggest further testing and possibly commence an appropriate treatment plan. Follow up appointments may be required.

Since you may be undergoing cardiac testing at your first appointment, it is important to follow these instructions carefully. You may also visit the test-specific pages on our website to get more detailed information in advance of your appointment. If you are coming for tests to investigate possible CHF, please read carefully:

General Cardiac Testing Instructions:

• Shower in the morning, before your appointment.
• Do not wear lotions or body oil.
• Do not wear jewelry or perfume.
• Wear comfortable exercise clothing to your appointment.
• Eat a light meal 2-3 hours before your appointment.
• Stay away from caffeine. No coffee, tea, chocolate, soda pop, or decaf products.
• Bring running shoes to change into during your appointment.
• Bring a bottle of water and a light snack just in case.
• Bring a list of all your medications.
• Bring your health card. Be prepared to be in the clinic for up to four hours.

Heart failure patients must keep track of a few things everyday. First, you must record your weight everyday. You must also keep track of your symptoms. You must monitor your liquid intake. And you MUST control the amount of salt you ingest.

1. Weight tracking: Keep a reliable record of your weight. Log your weight every day first thing in the morning (after urination and before eating). Make sure to do it at the same time everyday, wearing similar clothing. Bring your weight record with you to your cardiology and cardiac rehab appointments. Remember: weight gain of 3 pounds in 2 days, or 5 pounds or more in a week, may be a significant marker in disease progression and is cause for possible further followup or investigation.
2. Symptom monitoring: Watch out for any of these symptoms since they may indicate disease progression. Call your healthcare provider if you experience:
   1. Worsening shortness of breath or a persistent cough
   2. Difficulty breathing, lying down or needing to sleep in a chair due to difficulty breathing
   3. Increased swelling or abdominal girth
   4. Worsening fatigue/weakness
   5. Pain or feeling of ‘fullness’ in stomach area
3. Limit fluids: Consume no more than 1.5L (6 cups) to 2.0L (8 cups) per day. This includes all liquids from water and coffee/tea to soft drinks and alcohol.
4. Watch your diet: Reduce your salt/sodium in your diet. Strictly follow a low-salt diet (DASH diet in English; DASH diet in Portuguese) to reduce high blood pressure, keep swelling under control, and make breathing easier. This means limiting salt intake to 1.5 g - 2 g per day. Always read the label: salt is found in most foods so don’t just calculate what you sprinkle from the salt shaker. Learn how to manage your potassium intake as well by following our useful Potassium guide If you have diabetes, you should also be following the STEP 2 diet.

Heart failure means the heart is not able to pump enough blood to keep up with the basic demands of the rest of the body. “Failure” refers to the failure to keep pace with the body’s needs, not that the heart has stopped. There may be many root causes for the heart to become inefficient at pumping blood. Often heart failure develops as a result of damage sustained by a heart attack or by inflammation from a heart infection (myocarditis). Still others will develop CHF due to a stiffening of the heart chambers that can be the result of chronic high blood pressure, for example.

Heart failure is a very serious condition. Historically, only 50% of heart failure patients would make it past 5-years after diagnosis. Now, with newer therapies and diligent adherence to lifestyle changes, some heart failure patients could achieve a near-normal life expectancy. Although there is no cure for heart failure, it is possible to control and possibly even reverse some of the underlying causes of heart failure in some patients. Thanks to modern medicine and science-based cardiac rehabilitation programs, there is reason for optimism and hope for many heart failure patients .

Although the three conditions may sound similar in their terminology, heart failure, heart attack and cardiac arrest each refers to a very different disease process. These differences are important for patients to understand.

Although there many possible causes of heart failure, one of the most common causes is a heart attack. A heart attack can damage and weaken the heart, reducing its ability to pump blood to the body. Keep in mind, heart attacks can eventually lead to heart failure, but heart attacks and heart failure are two different things.

Another common cause of CHF is a disease of the heart muscle called cardiomyopathy which can result from excessive alcohol or drug use, metabolic disorders (such as high blood pressure, diabetes, or obesity ), viral infections or auto-immune conditions.

Ejection fraction (EF) is a measurement of how well the heart pumps blood. This measurement can be used to determine the severity of heart failure and to develop an appropriate treatment plan. A healthy EF is between 50-70%. Meanwhile, borderline ejection fraction falls between 41-49% which means a little less than half of the oxygenated blood in the heart’s chamber is actually getting pumped out to the rest of the body. This is sometimes called Heart Failure with Mid-range Ejection Fraction and can cause symptoms like shortness of breath during regular daily activities. When 40% or less of the oxygen-rich blood is pumped to the body, it results in Heart Failure with Reduced Ejection Fraction.

While ejection fraction is an important marker for heart failure, it is not a definitive diagnostic tool: heart failure can occur even with a normal EF if the heart muscle is stiffened by conditions like high blood pressure. In fact, nearly half of all heart failure patients have normal range EF, a condition called Heart Failure with Preserved Ejection Fraction. Therefore, a normal range EF on its own does not rule out heart failure. Other tests may be needed to get a clearer picture of what is going on.

If you have been prescribed medication and lifestyle changes for heart failure, your symptoms and ejection fraction may improve as a result. You must, however, maintain these changes and continue on medication. Studies show that stopping medication weakens heart strength further, making it even more difficult to get back previous gains. With CHF, you must stay the course.

The initial assessment appointment at the Rapid Access Congestive Heart Failure Clinic may take up to 4-hours. As such, it is best to be prepared with a bottle of water and a light snack in case the appointment runs long. The duration will depend on what specific tests are being done in your case. As well, medical emergencies with other patients can also sometimes cause delays; we appreciate your patience.

Some patients may be required to discontinue taking certain medications the day of their initial assessment. This does not, however, apply to all patients. So, please, do not stop any medications on your own without the express instructions of your healthcare provider. If you are instructed to suspend certain medications on the day of your appointment, you may resume taking them immediately upon completing the necessary cardiac tests.

Explore these important resources specifically for heart failure patients.

The clinic nurse, rehab team and cardiologist are full of information and helpful guidance, but you can’t take these experts home with you to help make the right choices day to day. That’s why we have compiled these valuable resources: from the CHF diet and recipes to exercise and lifestyle management, these tools can help guide you along the way.