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.