Heart Failure Flashcards
Tips to control thirst on fluid restriction
- limit salty foods
- eat ice instead of drinking water
- cold or frozen fruit
- rinse mouth with cold water or mouthwash
- hard candy/sour lemon candy
Top 10 foods high in sodium
- Smoked, processed or cured meat/fish
- Tomato juice/sauce
- Meat extract, bouillon, meat sauce, MSG, taco seasoning
- salted snacks, bread
- prep salad dressings/condiments exc mustard
- packaged mixes - sauces, gravies, rice, etc
- cheeses - processed/spreads
- frozen entrees and pot pies
- canned soup
- eating out
What is HF
Clinical syndrome characterized by
- progressive deterioration of L ventricular function
- inadequate tissue perfusion (not enough O2 to tissues)
- fatigue
- SOB
- congestion (fluid retention)
What is it called when R side of heart fails
Cor pulmonale
Consequences of HF
L ventricle cannot pump sufficient blood thru circ system, resulting in
- decreased cardiac output
- venous blood stasis (tends to pool)
- sodium and fluid retention
- mult organ system failure (no O2/too much CO2)
- malnutrition (from inad O2/nutrients to tissue)
Prognosis of HF
It is progressive with poor prognosis - 50% morbidity within 5 years
Prognosis depends on
Cause
Response to treatment
Compliance with treatment
Reasons why people not compliant with HF treatment
- polypharmacy
- low Na diet doesn’t taste good and is hard to stick with
HF risk factors
- hypertension
- coronary heart disease
- LV hypertrophy (HTN, aortic valve stenosis, cardiomyopathy, muscular dystrophy
- valvular disease
Main categories of HF causes
1) diseases that weaken the heart muscle - eg, MI
2) diseases that cause stiffening of heart muscle - eg, HTN, hemochromatosis, amyloidosis
3) diseases that increase tissue’s O2 demand beyond heart’s capacity - eg, hyperthyroidism, anemia
HF drug/nutrient interactions
- monitor K
- avoid natural licorice
- so salt substitute with K (for K sparing diuretic)
- dysgeusia (taste distortion)
- xerostomia (dry mouth)
- GI upset
- digitalis toxicity with low blood Mg or K, high blood Ca or vit D supplement
- fiber binds to digitalis and decreases absorption
5 year heart transplant survival rate
69%
only cure for unresponsive HF
heart transplant
why typical heart patient not a good candidate for transplant
- lots of other co-morbidities
- able to take lifelong immunosuppressants with bad side effects?
- wind up developing diabetes from anti rejection drugs
compensated HF
asymptomatic
- poor cardiac output made up for by increased force of contraction, increased size of left ventricle, increased HR, stimulating kidneys RAS
decompensated HF
symptomatic, heart cannot attain normal output
Classes of HF
1 - no symptoms at rest or during PA
2 - slight PA limits, comfortable at rest
3 - marked PA limitation, comfortable at rest
4 - inability to do PA without discomfort, symptoms at rest
Stages of HF
A - High Risk - no disease or structural damage but RISK FACTORS of HTN, atherosclerosis, diabetes, obesity, metabolic syndrome
B- Asymptomatic - no symptoms but evidence of structural damage if x-ray
C - Symptomatic - structural changes and symptoms like SOB, fatigue, reduced tolerance to activity
D- Advanced Disease - symptoms at rest despite meds and following treatment
Early symptoms of HF
SOB, cough, feeling of not being able to get a deep breath
3 major symptoms of HF
- exercise intolerance
- SOB esp when active but even at rest
- fluid retention and swelling (lower body edema)
nonspecific symptoms of HF
anorexia, nausea, feeling of fullness constipation, abdominal pain malabsorption enlarged liver confusion, memory loss, anxiety pulmonary congestion, edema cool extremities syncope (decreased O2 to brain)
cardiac cachexia
wasting disease from malnutrition secondary to heart failure
> 10% LBM loss
- typical to have upper body wasting and lower body edema
cachectic heart
soft, flabby heart with loss of myocardial mass due to extreme malnutrition
mechanism of cardiac cachexia
1) impaired cellular O2 supply
2) altered nutrient digestion/metabolism
3) increased nutrient requirements (hyper metabolic)
4) decreased food intake
