Heart Failure Jerri Lamar
Learning Objectives • Understand classification of heart failure, along with the signs and symptoms. • Identify heart failure stages for the development of diagnosis, intervention and patient-centered goals.
Definitions • Heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen • Healthy Heart: Pumps 50% of the blood in the ventricle in one beat • Failing Heart: 40% or less of the blood in the ventricle in one beat • Further categorization • Systolic failure vs Diastolic failure • Heart is unablepump all the blood it receives= excess fluids can back up into the lungs and other parts of the body • Pulmonary congestion or peripheral edema
Compensation Mechanisms • Heart: • Enlarges • Increases muscle mass • Pumps faster • Stimulate kidneys to conserve sodium and water • Body: • Blood vessels narrow • Sending blood to most vital organs
Public Health Problem • Affects more than 5 million Americans • 500,000 new cases diagnosed each year • 10 per 1,000 population after the age of 65 • Highest rates: Black women, followed by Black men, Mexican-American men, White men, White women, and Mexican-American women
Medical Diagnosis and Management • Medical history and symptoms • Physical Exam: • Blood pressure • Weight • Listen to heart and lungs • Blood test: • Sodium, Potassium, albumin, and creatinine • Chest X-Rays • EKG: Electrocardiogram • Echocardiography • Exercise Stress Test Treatment of Underlying Conditions • Hypertension • Dyslipidemia • Thyroid disorders • Arrhythmias
Nutrition Assessment • Anorexia • Nausea, abdominal pain and feeling of fullness • Constipation • Malabsorption • Malnutrition • Cardiac cachexia • Hypomagnesemia • Hyponatremia
Signs and Symptoms • Shortness of breath • Fatigue • Fluid Retention • Persistent coughing or wheezing • Lack of appetite, nausea • Confusion/memory loss • Increased heart rate • Anxiety • Insomnia • Syncope and Headache
Stages of Heart Failure
Classifications
Risk Factors • Smoking • Overweight • Diet high in fat and cholesterol • Physical inactivity • Excessive alcohol consumption • Male sex • Lower education Conditions: • Coronary heart disease • Past MI • Abnormal heart valves • Heart muscle disease or inflammation • Heart defects present at birth • Severe lung disease • Hypertension • Dyslipidemia • Diabetes • Sleep Apnea
Diagnosis:PES Statement • Food and nutrition knowledge deficit related to no previous nutrition education as evidenced by the consumption of and inability to identify high sodium foods. • Excessive sodium intake related to frequent use of convenience and fast foods as evidenced by diet history.
Intervention: Therapeutic Diet • Small, frequent meals • Low in saturated fat, trans fat, cholesterol • Increase: whole grains, F&V • Restricted sodium diet- <2 gm/day (DASH diet) • Limit fluid to 2 L per day • Severely decompensated, 1000-1500 mL daily • Supplementation: Magnesium, Thiamin • Ensure adequate: B6, B12 and folate in diet. • Avoid: tobacco, alcohol Lifestyle changes • Increase physical activity • Manage stress • Get adequate rest • Lose or maintain appropriate weight • Develop support Education • Salt alternatives • Label Reading
Herbs, Botanicals, and Supplements • L-arginine- reduces endothelin (protein that causes blood vessel constriction) • Chromium- dyslipidemia • Coenzyme Q10- repletion may prevent oxidative stress and further myocardial damage • Omega-3 fatty acids in fish oil capsules- lower elevated triglyceride levels, prevent atrial fibrillation, and possibly reduce mortality rates • Vitamin D- may improve inflammation • Avoid: • Grapefruit juice • Niacin • Vitamin E
Energy and Protein Needs Energy Protein Research: 1.12 g protein/kg Preserve actual body composition Limit effects of hypercatabolism • Severe HF= energy needs increased by 30-50% more than basal level due to increased energy expenditure of the heart and lungs • 31-35 kcal/kg of body weight • Cardiac cachexia- 1.6-1.8 times the REE
Medications • ACE inhibitors • Decrease sodium and water retention • Benazepril, Captopril, Enalapril • Angiotensin receptor blockers • Candesartan, Eprosartan • Aldosterone blockers • Eplerenone, Spironolactone • Anticoagulants • Warfarin, heparin • Antiplatelet Agents • Plavix, Reopro • Beta-blockers • Reduce cardiac output • Acebutolol, Atenolol, Betaxolol • Calcium Channel Blockers • Norvasc, Cardizem • Digoxin (Lanoxin) • Diuretics • Bumetanide, Chlorothiazide • Vasodilators • Hydralazine, Isordil • Statins • Lipitor, crestor
Medical Treatment • Percutaneous coronary intervention (PCI) • Coronary artery bypass • Valve replacement • Defibrillator implantation • Left ventricular assist device (LVAD) • Heart transplant
References Congestive Heart Failure. American Heart Association Web site. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongeni talHeartDefects/Congestive-Heart-Failure_UCM_307111_Article.jsp. Accessed February 9, 2014. Escott-Stump S. Heart Failure. Nutrition and Diagnosis-Related Care. 6th ed. Lippincott Williams & Wilkins; 2007: 333-338. Heart Disease and Congestive Heart Failure. WebMD Web site. http://www.webmd.com/heart- disease/guide-heart-failure. Accessed February 9, 2014. Heart Failure. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/heart- failure/basics/definition/CON-20029801. Last updated Aug. 16, 2013. Assessed February 13, 2014. Heart Failure. National Institute of Health Web Site. http://www.nlm.nih.gov/medlineplus/heartfailure.html. Accessed February 10, 2014. Mahan KL, Escott-Stump S, Raymond JL, Krause MV. Heart Failure. In: Alexopoulos Y, ed. Krause's Food & the Nutrition Care Process. 13th ed. St. Louis, MO: Elsevier/Saunders; 2012:769-777. PasiniE, Opasich C, Pastoris O, Aquilani R. Inadequate Nutritional Intake for Daily Life Activity of Clinically Stable Patients with Chronic Heart Failure, Am J Cardiol. 2004, 93 (Suppl): 41A- 43A. Vieth R, Kimball S: Vitamin D in congestive heart failure, Am J ClinNutr 2006; 83:731-732.
