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MNT 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Tips to control thirst on fluid restriction

A
  • 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
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2
Q

Top 10 foods high in sodium

A
  • 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
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3
Q

What is HF

A

Clinical syndrome characterized by

  • progressive deterioration of L ventricular function
  • inadequate tissue perfusion (not enough O2 to tissues)
  • fatigue
  • SOB
  • congestion (fluid retention)
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4
Q

What is it called when R side of heart fails

A

Cor pulmonale

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5
Q

Consequences of HF

A

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)
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6
Q

Prognosis of HF

A

It is progressive with poor prognosis - 50% morbidity within 5 years

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7
Q

Prognosis depends on

A

Cause
Response to treatment
Compliance with treatment

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8
Q

Reasons why people not compliant with HF treatment

A
  • polypharmacy

- low Na diet doesn’t taste good and is hard to stick with

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9
Q

HF risk factors

A
  • hypertension
  • coronary heart disease
  • LV hypertrophy (HTN, aortic valve stenosis, cardiomyopathy, muscular dystrophy
  • valvular disease
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10
Q

Main categories of HF causes

A

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

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11
Q

HF drug/nutrient interactions

A
  • 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
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12
Q

5 year heart transplant survival rate

A

69%

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13
Q

only cure for unresponsive HF

A

heart transplant

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14
Q

why typical heart patient not a good candidate for transplant

A
  • lots of other co-morbidities
  • able to take lifelong immunosuppressants with bad side effects?
  • wind up developing diabetes from anti rejection drugs
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15
Q

compensated HF

A

asymptomatic
- poor cardiac output made up for by increased force of contraction, increased size of left ventricle, increased HR, stimulating kidneys RAS

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16
Q

decompensated HF

A

symptomatic, heart cannot attain normal output

17
Q

Classes of HF

A

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

18
Q

Stages of HF

A

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

19
Q

Early symptoms of HF

A

SOB, cough, feeling of not being able to get a deep breath

20
Q

3 major symptoms of HF

A
  • exercise intolerance
  • SOB esp when active but even at rest
  • fluid retention and swelling (lower body edema)
21
Q

nonspecific symptoms of HF

A 
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)
22
Q

cardiac cachexia

A

wasting disease from malnutrition secondary to heart failure
> 10% LBM loss
- typical to have upper body wasting and lower body edema

23
Q

cachectic heart

A

soft, flabby heart with loss of myocardial mass due to extreme malnutrition

24
Q

mechanism of cardiac cachexia

A

1) impaired cellular O2 supply
2) altered nutrient digestion/metabolism
3) increased nutrient requirements (hyper metabolic)
4) decreased food intake

25
Q

goal of treatment of HF

A

minimize stress on the heart

26
Q

HF Stage A treatment

A

treat underlying causes - treat hypertension, quit smoking and alcohol/drugs, treat lipid disorder, encourage exercise, control metabolic syndrome, drug therapy (ACE, ARB)

27
Q

HF Stage B treatment

A

add ACE or beta blockers (help heart beat regular) as appropriate, talk about low Na diet

28
Q

HF Stage C treatment

A

add aldosterone antagonist, digitalis, hydrazine/nitrates as appropriate, add Na restriction, pace maker or implantable defibrillator

29
Q

HF Stage D treatment

A

hospice, transplant

30
Q

HF MNT

A
  • kcal (weight loss or increase if malnourished 1.3-1.5)
  • protein - close to RDA unless hyper metabolic, then 1.5
  • carbs - watch CO2, makes it harder to breath
  • Na - moderate restriction,
31
Q

connection between antioxidants and HF

A
  • increasing evidence that oxidative stress causes critical illness by decreasing antioxidant defenses
  • HF patients may benefit from diet high in antioxidants and phytochemical - whole grains, variety of fruit and veg, nuts, seeds
  • co-Q is lower in HF patients and those who take statins
32
Q

HF meds

A
  • diuretics - lasiks
  • spironolactone - aldosterone antagonist and K-sparing diuretic
  • ACE inhibitors, angiotensin receptor blockers (ARB)
  • digitalis - toxin, strengthens heart contractions, slows HR, helps eliminate fluids
  • vasodilators

MNT 2 (9 decks)

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