Heart failure;
Definition;
- Heart failure and (HF )is an impairment of the ventricle, capacity to eject blood from the heart or to fill with blood .
- The underlying cause of this disorder can be either structural or functional in nature.
- Heart 💜 faiuler represent the end stage of all form of cardiovascular diseases.
Epidemiology:
Data framing Ham heart study indicate that:
- After age 65, the incidence of heart failure is slightly below 10 per 1,000 in the population
- 75% of person diagnosed with heart failure have hypertension, lifetime risk of heart failure doubles for those with the resting blood pressure of 160 /90 mm HG compared to those with the blood pressure below 140 / 90 mm HG.
- Among MI survivor 22% of males and 46% of females with be disabled with heart failure with in 6 years.
- At age 40, lifetime risk of developing heart failure is one in five for who have not suffered and MI, this drops to one in nine for males and one in six for women.
- Heart failure is closely associated with aging.
- Women have a higher relative risk of heart failure primarily because women comprise over 60% of the population over 65 years of age and 75% of the population over the age of 85 years.
- The prevalence incidence and mortality for heart failure in diabetic are very high.
- For every hundred individuals with diabetes who are free of heart failure at the start of a year 12 will develop heart failure and 6 will die within that year.
Etiology;
- Heart failure may result from disorder of the pericardium myocardium, endocardium, or vessels, but the reality is due to impaired lift water cooler myocardial function.
- Heart failure is a broad term, and may be used to describe conditions in which left ventricular size and ejection fraction are maintained as well as those in which the left ventricle is dilated and ejection fraction is severely reduced.
- The primary causes of heart failure or IHD, hypertension and dilated cardiomyopathy.
- In women, hypertension is the most common causes, of while in men IHD is the most common cause.
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Pathophysiology:
- Referred to as a "final common pathway of many risk factors and cardiovascular illnesses.
- Heart failure is a process beginning with an injury to the heart
- or
- with left ventricle hyper trophy that impairs a overall function of the heart.
- To compensate the impairment in function, the renin - angiotensin - aldosterone system initiate change in BP that werson the dysfunction.
As a result;
- The heart becomes weakned and dilated,
- Myocardial fibrosis limits the ability of the walls to respond to stresses.
- Oxidative damage for the a contractlity.
- Overall structure of the heart is changed in such a way that it cannot function properly.
Clinical manifestation;
In general comedy carries blood flow and oxygen supply lead to to
- Dyspnea,
- Fatigue,
- Weakness,
- Exercise intolerance,
- Adaptation to cold temperatures,
- When left - side failure is predominant dyspnea is more predominant.
- Right -sided failure is a characterized by the sign and symptoms caused by systemic backup of the circulatory system.
- This fluid retention can cause pulmonary congestion and edema in the periphery.
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- Nutrition therapy for heart failure;
- 50% of patients with heart failure are malnourished.
- Nutrition therapy that restricts both sodium and fuid is crucial to control acute symptoms.
- Individuals with heart failure have difficulty eating and many experience a syndrome of malnutrition call cardiac cachexia.
- Further factor for malnutrition are
- Decrease blood flow to the gastro-intestinal tract causing slowed Peristalsis and early satiety
- Impairment of nutrient absorption due to this decrease blood flow,
- Side effect from drugs such as nausea, vomiting and anorexia, which are common with the use of ACE inhibitors, beta-blockers, cardiac glycosides and digoxin.
Nutrition assessment diagnosis;
- The intake of sodium and fluid can directly impact the progression and management of HF,
- Accurate assessment of both of these nutrients is essential.
- Furthermore, problems with satiety and possible drug /nutrient interactions as noted above need to be carefully examined before determining the presence of common nutrition diagnosis such as excessive sodium.
- Fluid intake
- Inadequate oral food/beverages intake,
- Food- medication interactions,
- Impaired ability to prepare foods/ meals
Nutrition intervention:
- Nutrition counseling for individual with HF is priority .
- Specific nutrition education for a patient can lead to fewer red missions and an overall improved response to medical treatment.
Sodium:
- Are 2000 MG sodium diet is standard initial recommendation for individuals with HF.
- Adjustments to levels of 2000 mg 1000mg aur 500 mg maybe the prescribed depending on the patien's individual medical condition -specially fluid and volume states as well as overall oral intake.
- Anorexia ,fatigue and shortness of breath lead to such poor oral intake that many patients consume much less than 2000 mg.
Fluid:
- Fluid requirement are typically calculated at 1ml/ kcal or 35 ml /kg.
- To treat fluid overload in HF, a fluid limitation of 1500 ml/ day is the standard recommendation, with an upper level of 2000 ml.
- Again, adjustment will need to be made based on renal and cardiac status in order to prevent volume overload.
- Fluid restriction is one of of the most difficult diet modification for patients to tolerate.
- When providing nutrition education on fluid restriction make sure the patients understand
- The specific volume that is allowed,
- What items are considered to be fluid,
- Desperation to add with controlling thirst.
- All beverages and foods such as soups, sherbet, ice cream, custard and gelatin should be counted with the fluid allowance.
- Good morning care coma rising the mouth frequently coma and using cold or frozen foods can help control thirst.
Nutrient drug interaction:
- Use of multiple diuretics may lead to losses of multiple water- soluble nutrient, including potassium magnesium, thiamin, riboflavin and pyridoxine.
- Nutrition education for increasing this nutrient within the diet is the first level of intervention.
- At 2nd, levels coma multivitamin should be recommended daily tell normal level in blood.
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