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Heart Failure

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.

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Heart Failure

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  1. Heart Failure Jerri Lamar

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. Nutrition Assessment • Anorexia • Nausea, abdominal pain and feeling of fullness • Constipation • Malabsorption • Malnutrition • Cardiac cachexia • Hypomagnesemia • Hyponatremia

  8. 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

  9. Stages of Heart Failure

  10. Classifications

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. Medical Treatment • Percutaneous coronary intervention (PCI) • Coronary artery bypass • Valve replacement • Defibrillator implantation • Left ventricular assist device (LVAD) • Heart transplant

  18. 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.

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