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Congestive Heart Failure > Alcohol and Smoking

Why should I avoid alcohol?

CHF is fairly common among older people who have had long time drinking problems, probably because the high alcohol use often leads to high blood pressure.

The new Canadian Heart and Stroke Foundation publication " Managing Your Congestive Heart Failure" (Heart and Stroke Foundation of Canada) recommends people with CHF:

  • Reduce alcohol use to no more than one drink per day. This is equal to:
    • a glass of wine (5 oz./150 mL/12% alcohol),
    • beer (12 oz./350 mL/  5% alcohol), or
    • one mixed drink (1 1/2 oz./50 mL/ 40% alcohol).
  • In some types of heart failure, alcohol must be totally avoided.
  • Talk with your doctor about alcohol, your medical condition and the medications you are on. You need to discuss drinking alcohol with your doctor because:
    • Alcohol may change how your medication works
    • Alcohol can affect other medical conditions you may have
    • Alcohol reduces the strength of the heart’s contraction
    • Alcohol may cause or worsen irregular heart rhythm

Some Medications for CHF Can Adversely Interaction with Alcohol

There are five common groups of medications for congestive heart failure, each working in different ways to help the heart:

  • Aldosterone antagonists,
  • Angiotensin converting enzyme (ACE) inhibitors,
  • Beta blockers,
  • Diuretics, and
  • Digoxin (Lanoxin®). 

It is recommended that people avoid drinking alcohol if taking the beta blocker propranolol ("INDERAL") because the combination lowers blood pressure too much.

Alcohol's Interaction with Other Heart Drugs 


Nitrates relax blood vessels and lower the demand for oxygen by the heart. Some examples are: isosorbide dinitrate (e.g. ISORDIL, SORBITRATE) and nitroglycerin (e.g. NITRO, NITRO-DUR, TRANSDERM-NITRO)

Alcohol's Interaction with this medication:

Avoid alcohol because it may add to the blood vessel-relaxing effect of nitrates and result in dangerously low blood pressure.

HMG-COA Reductase inhibitors

Otherwise known as "statins," these medications are used to lower cholesterol.

Alcohol's Interaction with this medication:

Avoid drinking large amounts of alcohol because it may increase the risk of liver damage.

Quit Smoking

How does smoking do to my heart?

Smoking is bad for your heart as well as your lungs. Cigarette smoke contains carbon monoxide which interferes with your body's oxygen carrying ability. Smoking is a risk factor for high blood pressure, heart failure, and coronary artery disease which lead to heart attack.

Cigarette smoke contains Nicotine which acts on the adrenal gland (the main stress gland) to stimulate the release of a hormone that causes your blood pressure to raise abruptly.

Smoking increases your heart’s workload. Cigarette smoking decreases the amount of oxygen that can ultimately reach the blood stream. This leads to a decrease in the amount of oxygenated blood reaching the heart muscle. Smoking also narrows the vessels that carry the blood, making your heart pump against increased pressure.

Also, s moking is hard on the heart, and the toxins in cigarette smoke increases the clumping of blood platelets which leads to atherosclerosis (hardening of the arteries) as well as increased chance of blood clots forming in an already narrowed artery in the heart or the brain and cause heart attacks or strokes.

Smoking harms the heart extensively. The best action you can take to manage CHF is to stop smoking.

Why should I quit smoking?

  • Coronary heart disease is the leading cause of death in the U.S., and the leading cause of death caused by smoking. Almost one-fifth of deaths from heart disease are caused by smoking.
  • Smoking-related coronary heart disease may contribute to congestive heart failure. An estimated 4.6 million Americans have congestive heart failure and 43,000 die from it every year.
  • Cigarette smoking has been associated with sudden cardiac death of all types in both men and women.
  • Strokes are the third leading cause of death in the United States. And cigarette smoking is a major cause of strokes.
  • The U.S. incidence of stroke is estimated at 600,000 cases per year, and the one-year fatality rate is about 30%.
  • Smoking also harms thousands of nonsmokers who are exposed to cigarette smoke, including infants and children.
  • The increased risk of heart disease due to smoking disappears in less than 10 years after stopping. In fact, after one year off cigarettes, the excess risk of heart disease caused by smoking is reduced by half. After 15 years of abstinence, the risk is similar to that for people who've never smoked.
  • The risk of stroke decreases steadily after smoking cessation. Former smokers have the same stroke risk as nonsmokers after 5 to 15 years.
  • The increased risk of lung cancer disappears within 15 years.
  • Men and women who quit at ages 65 to 69 increase their life expectancy by 1 year.
  • Stop smoking can have just as powerful an impact on your health as drugs. Ex-smokers and never-smokers both had a 30 % lower risk of dying than current smokers, a reduction in mortality similar to that achieved by angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and other drugs commonly used to treat heart failure.

Is it too late for me to quit smoking?

It's never too late! Even when patients have had significant heart damage from previous heart attacks and are currently in heart failure, quitting smoking is still very important and prolongs lives.

How do I quit?

Step One

  • List your reasons to quit and read them several times a day.
  • Wrap your cigarette pack with paper and rubber bands. Each time you smoke, write down the time of day, how you feel, and how important that cigarette is to you on a scale of 1 to 5.
  • Rewrap the pack.

Step Two

  • Keep reading your list of reasons and add to it if you can.
  • Don’t carry matches, and keep your cigarettes out of easy reach.
  • Each day, try to smoke fewer cigarettes, and try not to smoke the ones that aren’t most important.

Step Three

  • Continue with Step Two. Set a target date to quit. Don’t buy a new pack until you finish the one you’re smoking.
  • Change brands twice during the week, each time for a brand lower in tar and Nicotine.
  • Try to stop for 48 hours at one time.

Step Four

  • Quit smoking completely. Throw out all cigarettes and matches. Hide lighters and ashtrays.
  • Stay busy! Go to the movies, exercise, take long walks, go bike riding.
  • Avoid situations and “triggers” you relate with smoking.
  • Find healthy substitutes for smoking.
  • Carry sugarless gum or artificially sweetened mints. Munch carrots or celery sticks. Try doing crafts or other things with your hands.
  • Do deep breathing exercises when you get the urge

What if I smoke after quitting?

It’s hard to stay a nonsmoker once you’ve had a cigarette, so do everything you can to avoid that “one.” The urge to smoke will pass. The first 2 to 5 minutes will be the toughest. If you do smoke after quitting:

  • This doesn’t mean you’re a smoker again — do something now to get back on track.
  • Don’t punish or blame yourself — tell yourself you’re still a nonsmoker.
  • Think about why you smoked and decide what to do the next time it comes up.
  • Sign a contract to stay a nonsmoker.

What happens after I quit?

  • You breathe much easier.
  • It’s easier to climb stairs.
  • Smoker’s cough goes away.
  • Your senses of smell and taste come back.
  • You will digest normally.
  • You feel alive and full of energy.
  • You’re free from the mess, smell and burns in clothing.
  • You feel free of “needing” cigarettes.
  • You’ll live longer and have less chance of heart disease, stroke, lung disease and cancer.


  • American Heart Association. How can I quit smoking? Retrieved November 16, 2004, from http://www.americanheart.org/downloadable/heart/110288043796734%20HowCanIQuitSmoking.pdf
  • Heart and Stroke Foundation (2002). Managing congestive heart failure. Retrieved November 16, 2004, from http://ww1.heartandstroke.ca/images/English/Managing_CHF.pdf
  • Jackson Health System. Congestive heart failure handbook. Retrieved November 16, 2004, from http://um-jmh.org/body.cfm?id=1438
  • U. S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the Surgeon General. Available from: http://www.cdc.gov/tobacco/sgr/sgr_2004/

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