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 unable pump 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 NeedsEnergy 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

Protein Research: 1.12 g protein/kg

Preserve actual body composition

Limit effects of hypercatabolism

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

ReferencesCongestive 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.

Pasini E, 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 Clin Nutr 2006; 83:731-732.