This document discusses congestive heart failure (CHF) and its nutrition management. Myocardial infarction can weaken the heart, limiting its ability to pump blood and removing fluid from the body. This causes a build up of fluid in the extremities and lungs. Nutrition is also impaired as the heart and lungs work harder to pump more fluid. Treatment includes diuretics to reduce fluid load and strengthen the heart. Nutrition therapy aims to reduce cardiac workload by limiting sodium and fluid intake to reduce fluid retention, and providing nutrient-dense foods and supplements if needed to support nutrition and weight status. Close monitoring is needed when providing nutrition support to avoid worsening heart failure.

1. Lecture 6b
10 Feb. 2014
Congestive heart failure
Class activity-what is the best approach to avoiding
CHF

2. Pathology
Myocardial infarction can lead to chronic or
congestive heart failure
-a weakened heart does not pump sufficient
blood to the kidneys
-hence kidneys’ ability to filter blood and
produce urine is reduced
-decreased urine production results in more
water being retained in the blood

3. Pathology
Myocardial infarction can lead to chronic or
congestive heart failure
-weakened heart can not keep up with water
load returning to heart and fluid backs up in
the extremities and in lungs
-heart becomes even more weakened because
it tries to pump more fluid
-ultimately the heart is overwhelmed by the
fluid load and quits

4. CHF and Nutrition status
-build up of fluid causes heart and lungs to work
harder
-when the heart and lungs work harder they
require more energy
-yet that extra energy is not available because fluid
build up impairs cardiac and pulmonary function

5. CHF and Nutrition status
- since blood flow and oxygen delivery are
critical to the processes of digestion,
absorption and transport and energy release
the extra energy required for the heart and
lungs is not there
- therefore heart and lungs cannot keep up
and there is heart failure and ultimately
flooding of the lungs
-all above limits energy and protein intake

6. CHF and Nutrition status
-oral intake may be limited by anorexia, taste
sensitivity, intolerance to food odours,
physical exhaustion, low sodium diet
-weight loss may go unnoticed due to oedema
since oedema masks weight loss
-consequently PEM can occur – in this case
PEM is called cardiac cachexia

7. Treatment of CHF
-treatment consists of diuretics (reduce fluid
load) and glycosides (strengthen cardiac
intropy)
-with this combination strong chance of
potassium deficiency (why?) and constipation
constipation can stress heart

8. Nutrition therapy for CHF
-increase potassium by eating potassium rich
foods if potassium deficient
-if overweight –lose weight- why?
-aims are to reduce or restore nutrition status
and to reduce cardiac work

9. Nutrition therapy for CHF
-reduce fluid and sodium intake- remember
body in CHF is having trouble keeping up
with the water load
-sodium increases the water load and
ultimately the blood pressure

10. Nutrition therapy for CHF
reduce fluid and sodium intake- remember body in
CHF is having trouble keeping up with the water
load
-as blood pressure increases the risk of kidney
failure increases
-if kidney failure occurs then fluid retention
will shut down the body
-dialysis is an option but not nearly as
good as properly functioning kidneys

11. Nutrition therapy for CHF
reduce fluid and sodium intake- remember body in
CHF is having trouble keeping up with the water
load
-patient gets high nutrient density foods-get
energy and protein with less fluid
-heart healthy diet described in previous
lectures is appropriate to ensure that there is
a reduced risk of heart attack or subsequent
heart attack

12. Nutrition therapy for CHF
-a healthier heart is critical to being able to meet
the demands of increased water load
-max 2000 mg sodium per day
-if recurrent or persistent fluid retention then no
more than 2 litres of fluid/day
-adequate fibre
-no alcohol

13. Nutrition therapy for CHF
-carbohydrate requirement is dictated by the
presence of hyperglycemia-
- possible reasons for hyperglycemia
-if supplements are required then nutrient dense
liquids are the first choice

14. Nutrition therapy for CHF
-if patient does not want to eat then duodenal
feeding can be initiated
-feedings begin slowly (30 ml/hour) and then
are increased gradually
-fluid and electrolyte status must be carefully
monitored
why?

15. Nutrition therapy for CHF
-if patient does not want to eat then duodenal
feeding can be initiated
-overly aggressive nutritional support can
worsen CHF resulting in pulmonary edema
-2 kcal/ml and moderate to low sodium
-continuous nasogastric feeding can result in
loss of body weight (fluid) loss and lean body
mass increase without compromising cardiac
status

16. Nutrition therapy for CHF
if oral and tube feeding fail then parenteral feeding
is instituted
-as with nasogastric- therapy begins slowly
-1500 ml per day to start
-cachetic patient as low as 600 ml/day –why?
-central venous pressure, pulse rate, arterial
blood pressure and urine output are tracked
as fluid input increases

17. Nutrition therapy for CHF
-at the first sign of nutritional inadequacy, enteral
or parenteral therapy should begin as progression
of nutritional inadequacy is slow and nutritional
goals take longer to obtain

18. Nutrition therapy for CHF
-sodium-4 grams sodium chloride -no sodium
added diet-high sodium foods restricted (processed
foods- eg hot dogs)
-2 grams sodium chloride - mild sodium restriction
-1 gram sodium chloride –moderate sodium
restriction
-500 mg sodium chloride - strict sodium restriction
-250 mg sodium chloride -severe sodium restriction
-normal intake of other nutrients