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, MexicanAmerican men, White men,
White women, and MexicanAmerican women
Medical Diagnosis
and Management

Medical history and symptoms
Treatment of Underlying Conditions

Physical Exam:

Hypertension


Blood pressure

Dyslipidemia

Weight

Thyroid disorders

Listen to heart and lungs

Arrhythmias
Blood test:

Sodium, Potassium, albumin, and
creatinine

Chest X-Rays

EKG: Electrocardiogram

Echocardiography

Exercise Stress Test
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
Conditions:

Smoking

Coronary heart disease

Overweight

Past MI


Diet high in fat and Abnormal heart valves
cholesterol
 Heart muscle disease or
Physical inactivity
inflammation
Excessive alcohol  Heart defects present at
consumption
birth
Male sex
 Severe lung disease

Lower education



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
Lifestyle changes

Low in saturated fat, trans fat,
cholesterol

Increase physical activity

Increase: whole grains, F&V

Manage stress

Restricted sodium diet- <2 gm/day (DASH
diet)

Get adequate rest

Lose or maintain appropriate weight

Limit fluid to 2 L per day

Develop support

Severely decompensated, 1000-1500
mL daily

Supplementation: Magnesium, Thiamin

Ensure adequate: B6, B12 and folate in
diet.

Avoid: tobacco, alcohol
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

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


Aldosterone blockers


Warfarin, heparin
Antiplatelet Agents


Eplerenone, Spironolactone
Anticoagulants


Candesartan, Eprosartan



Reduce cardiac output

Acebutolol, Atenolol, Betaxolol
Norvasc, Cardizem

Digoxin (Lanoxin)

Diuretics

Plavix, Reopro
Beta-blockers
Calcium Channel Blockers

Vasodilators


Bumetanide, Chlorothiazide
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/heartdisease/guide-heart-failure. Accessed February 9, 2014.
Heart Failure. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/heartfailure/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): 41A43A.
Vieth R, Kimball S: Vitamin D in congestive heart failure, Am J Clin Nutr 2006; 83:731-732.