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Define CHF (Congestive Heart Failure)
A clinical "syndrome" characterized by:
- Progressive deterioration of the left ventricle
- Inadequate tissue perfusion
- Shortness of breath (SOB)
- Congestion (fluid retention)
What are the consequences of a failing heart?
The left ventricle cannot pump sufficient blood through the circulatory system.
This results in:
- Decreased cardiac output
- Venous blood stasis
- Sodium and fluid retention
- Multiple organ system failure
- Inadequate oxygen and nutrients delivered to tissue and increased kcal needs
What is the prognosis for CHF?
The prognosis for CHF is poor with 50% morbidity within 5 years.
The prognosis depends on:
2. Response to treatment
3. compliance with treatment
What are the causes for CHF?
There three main categories of causes of CHF:
1. Diseases that weaken the heart muscle (MI)
2. Diseases that cause stiffing of the heart muscles (HTN, hemochromatosis, amyloidosis)
3. Disease the increase oxygen demand by the body tissue beyond the capability of the heart to deliver adequate oxygen-rich blood (Hyperthyroidism, anemia)
- Other causes include:
- Diseased heart, hypertension, diabetes, kidney disease, extreme obesity, left ventricular dysfunction, toxins, malnutrition (protein, thiamin, selenium, magnesium, phosphorus), lupus (and other collagen disorders), thyroid disease, acromegaly (excessive growth hormone), hypoparathyroidism, tachycardia, and sleep apnea
What are compensated and decompensated CHF?
Compensated CHF is the beginning stages of CHF. It is asymptomatic and the poor cardiac output is compensated for by:
- Increasing the force of contraction of the heart
- Increasing the size of the left ventricle
- Pumping the heart more often (increased heart rate)
- Stimulating the kidneys to conserve sodium and water
Decompensated CHF occurs after a few months when the heart can no longer attain a normal output.
What are the symptoms of CHF?
Early symptoms are SOB, cough, or a feeling of not being able to get a deep breath.
The 3 Major Symptoms are:
1. Exercise intolerance (Unable to walk the dog around the block, difficulty walking around the house etc)
2. SOB (difficulty breathing, especially when active, or even at rest.)
3. Fluid retention and swelling
What is Cardiac Cachexia?
Involuntary weight loss of at least 6% nonedematous (lean body mass including heart muscle) body weight during a 6-month period
It occurs in 10%-15% of CHF patients
What are the characteristics of Cardiac Cachexia?
Malnutrition secondary to heart failure, loss of lean tissue and fat, upper-body and temporal wasting, and lower extremity edema
What are the mechanisms of Cardiac cachexia?
Impaired cellular oxygen supply
Altered nutrient digesting/metabolism (fat and protein malabsorption, constipation, anorexia, increased levels of tumor necrosis factor (TNF-alpha) leading to inflammation)
Increased nutritional requirements (hypermetabolic due to increased work of breathing and mechanical work of the heart)
Decreased nutritional intake low PO intake (reduced funtional gastric volume, dyspnea (SOB) and weakness, low-sodium diet is unpalatable, and side effects of meds)
Treatment of CHF
Goal: Minimize stress on the heart
In the beginning (first stages):
- - treat the underlying conditions
- - Avoid aggravators (tobacco, etoh, high NA, excessive weight)
- - Lifestyle changes (activity if tolerated, caffeine restriction, fluid restriction, sodium restriction)
As the disease progresses ad drug therapy (ACE-inhibitors, beta-blockers etc)
In the late stages consider heart transplant or hospice care.
What is the major concern with assessment tools and CHF?
The fluid retention causes the values to change.
What is the connection between antioxidants and CHF?
Evidence exists that oxidative stress plays a pivotal role in critical illness.
There is decreased antioxidant defenses so increased antioxidant consumption may be helpful.
What are the two types of COPD?
Related to Emphysema and Chronic Bronchitis
What are the causes of COPD?
- Smoking (All kinds of smoking increase risk for COPD)
- Occupational Hazard
- Air Pollution
- Secondhand Smoke
- Genetics (There is some genetic predisposition)
What is Cor Pulmonale?
Right sided heart failure related to COPD
It develops late in Emphysema and early in Chronic Bronchitis
What is the relation between nutrient status and COPD?
- Well nourished people maintain and have better lung function.
- The better the nourishment the healthier the immune system and the better gut integrity is maintained.
However, when it is hard to breath it is hard to eat. This makes it hard to maintain proper nourishment.
What are the nutrient risks related to COPD?
- Decreased energy
- Decreased appetite
- Increased calorie needs
- Drug side effects impair eating
- Food does not taste the same
- It's hard to prepare food
- Flattening of the diaphragm causes increased satiety
- Patient may dsat while eating
MNT goals with COPD?
- Maintain body composition
- Maintain lean body mass
- Energy - REE x 1.5
- Protein - 1.2 - 1.7 g/kg
- Increase Vitamin C with smoking
- Increase Vitamin D,K, and Ca with certain drugs (broncodialators)
- Increase fat and protein
- Decrease carbohydrate consumption
Why do lower carbohydrate diets help?
Carbohydrate metabolism has a higher respiratory quotient (RQ) which causes increased CO2 production.