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J\tAm\tColl\tCardiol\n\t46:e1,\n2005.)\nTABLE\t32.5\nClassifications\tof\tHeart\tFailure\nClass\tI\nNo\tundue\tsymptoms\tassociated\twith\tordinary\tactivity\tand\tno\tlimitation\tof\tphysical\tactivity\nClass\tII\nSlight\tlimitation\tof\tphysical\tactivity;\tpatient\n\tcomfortable\tat\trest\nClass\tIII\nMarked\tlimitation\tof\tphysical\tactivity;\tpatient\tcomfortable\tat\trest\nClass\tIV
|
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] |
Class\tIV\nInability\tto\tcarry\tout\tphysical\tactivity\twithout\tdiscomfort;\tsymptoms\tof\tcardiac\tinsufficiency\tor\nchest\tpain\tat\trest\nModified\tfrom\tHunt\tSA,\tet\tal:\tACC,\tAHA,\t2005\tguideline\tupdate\tfor\tthe\tdiagnosis\tand\tmanagement\tof\tchronic\theart\tfailure\tin\tthe\tadult:\ta\treport\tof\nthe\tAmerican\tCollege
|
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] |
the\tAmerican\tCollege\n\tof\tCardiology/American\tHeart\tAssociation\tTask\tForce\ton\tpractice\tguidelines,\t\nJ\tAm\tColl\tCardiol\n\t46:e1,\t2005.\nThe\tprogressive\tinsult\talters\tthe\tfunction\tand\tshape\tof\tthe\tleft\tventricle\tsuch\tthat\tit\thypertrophies\nin\tan\teffort\tto\tsustain\tblood\tflow,\ta\tprocess\tknown\tas\tcardiac\tremodeling.\tSymptoms\tdo\tnot\tusually
|
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] |
arise\tuntil\tmonths\tor\tyears\tafter\tcardiac\tremodeling\tbegins.\tMany\tcompensatory\tmechanisms\n\tfrom\nthe\tSNS,\tRAS,\tand\tcytokine\tsystem\tare\tactivated\tto\trestore\thomeostatic\tfunction.\tProinflammatory\ncytokines,\tsuch\tas\tTNF-α,\tIL-1,\tand\tIL-6,\tare\tincreased\tin\tblood\tand\tthe\tmyocardium\tand\thave\tbeen\nfound\tto\tregulate\tcardiac\tremodeling.\nAnother\tsubstance,
|
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] |
found\tto\tregulate\tcardiac\tremodeling.\nAnother\tsubstance,\t\nB-natriuretic\tpeptide\t(BNP)\n,\tis\tsecreted\tby\tthe\tventricles\tin\tresponse\tto\npressure\tand\tis\tpredictive\tof\tthe\tseverity\tof\tHF\tand\tmortality\tat\n\tany\tlevel\tof\tBMI.\tBNP\tis\toften\thighly\nelevated\tin\tpatients\twith\tHF\t(greater\tthan\t100\tpg/mL\tis\tabnormal,\tand\tsome\tpatients\thave\tlevels
|
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] |
more\tthan\t3000\tpg/mL).\tFor\tevery\t100\tpg/mL\trise\tin\tBNP\tconcentration,\tthere\tis\ta\tcorresponding\n35%\tincrease\tin\tthe\trelative\trisk\tof\tdeath\t(\nDesai,\t2013\n).\nEventually\toveruse\tof\tcompensatory\tsystems\tleads\tto\tfurther\tventricle\tdamage,\tremodeling,\tand\nworsening\tof\tsymptoms
|
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0.04016450420022011,
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] |
worsening\tof\tsymptoms\n\t(stage\tC).\tHF\tpatients\thave\televated\tlevels\tof\tnorepinephrine,\tangiotensin\tII,\naldosterone,\tendothelin,\tand\tvasopressin;\tall\tof\tthese\tare\tneurohormonal\tfactors\tthat\tincrease\tthe\nhemodynamic\tstress\ton\tthe\tventricle\tby\tcausing\tsodium\tretention\tand\tperipheral\tvasoconstriction.
|
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] |
These\tneurohormones\tand\tthe\tproinflammatory\tcytokines\tcontribute\tto\tdisease\tprogression;\thence,\ncurrent\tstudies\tfocus\n\ton\tinhibition\tof\tthese\tundesirable\tpathways\tand\tpromotion\tof\tdesirable\tones.\nFor\tthe\tfinal\tstages\tof\tHF,\tthere\tis\ta\tsubjective\tscale\tused\tto\tclassify\tsymptoms\tbased\ton\tthe\ndegree\tof\tlimitation\tin\tdaily\tactivities\t(\nTable\t32.5
|
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0.03390735387802124,
0.04015520215034485,
0.08421202003955841,
0.07714128494262695,
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] |
degree\tof\tlimitation\tin\tdaily\tactivities\t(\nTable\t32.5\n).\tThe\tseverity\tof\tsymptoms\tin\tthis\tclassification\nsystem\tis\tweakly\trelated\tto\tthe\tseverity\tof\tleft\tventricular\tdysfunction;\ttherefore\ttreatment\nencompasses\timproving\tfunctional\n\tcapacity\tand\tlessening\tprogression\tof\tthe\tunderlying\tdisease.
|
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] |
TABLE\t32.6\nSkeletal\tMuscle\tChanges\tin\tHeart\tFailure\nFunction\tloss\nWeakness\nFatigability\nStructural\nLoss\tof\tmuscle\tmass\nAtrophy,\tfibrosis,\tno\t≠\tapoptosis\nFiber\ttype\tswitch\ttype\tI–type\tIIb\nLoss\tof\tmitochondria\nEndothelial\tdamage\nBlood\tflow\nCapillary\tdensity\t↓\nVasodilation\nPeak\tleg\tblood\tflow\t↓\nMetabolism\nProteolysis
|
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] |
Vasodilation\nPeak\tleg\tblood\tflow\t↓\nMetabolism\nProteolysis\nOxidative\tmetabolism\t↓\tAcidosis\tglycolysis\t≠\nInflammation\nCytokine\tand\toxidative\tmarkers\nNeuroendocrine\nGH,\tIGF-1,\tepinephrine,\tnorepinephrine,\tcortisol\nInactivity\nTNF-α\t≠\t≠\nGenetic\tfactors\nMyostatin,\tIGF\nGH\n,\tGrowth\thormone;\t\nIGF\n,\tinsulin-like\tgrowth\tfactor;\t\nTNF-
|
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] |
GH\n,\tGrowth\thormone;\t\nIGF\n,\tinsulin-like\tgrowth\tfactor;\t\nTNF-\nα,\ttumor\tnecrosis\tfactor\talpha.\nFrom\tStrassburg\tS,\tet\tal:\tMuscle\twasting\tin\tcardiac\tcachexia,\t\nInt\tJ\tBiochem\n\tCell\tBiol\n\t37:1938,\t2005.\nIn\tHF\tthe\theart\tcan\tcompensate\tfor\tpoor\tcardiac\toutput\tby\t(1)\tincreasing\tthe\tforce\tof\tcontraction,
|
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] |
(2)\tincreasing\tin\tsize,\t(3)\tpumping\tmore\toften,\tand\t(4)\tstimulating\tthe\tkidneys\tto\tconserve\tsodium\nand\twater.\tFor\ta\ttime\tthis\tcompensation\tmaintains\tnear-normal\tcirculation,\tbut\teventually\tthe\theart\ncan\tno\tlonger\tmaintain\ta\tnormal\toutput\t(decompensation).\tAdvanced\tsymptoms\n\tcan\tdevelop\tin\nweeks\tor\tmonths,\tand\tsudden\tdeath\tcan\toccur\tat\tany\ttime.
|
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] |
weeks\tor\tmonths,\tand\tsudden\tdeath\tcan\toccur\tat\tany\ttime.\nThree\tsymptoms—fatigue,\tshortness\tof\tbreath,\tand\tfluid\tretention—are\tthe\thallmarks\tof\tHF.\nShortness\tof\tbreath\ton\texertion,\tor\teffort\tintolerance,\tis\tthe\tearliest\tsymptom.\tThe\tshortness\tof\nbreath\tknown\tas\torthopnea\tis\tbreathlessness\twhile\tlying\tdown.\tFluid\tretention\tcan\tmanifest\tas
|
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] |
pulmonary\tcongestion\tor\tperipheral\tedema.\n\tEvidence\tof\thypoperfusion\tincludes\tcool\tforearms\tand\nlegs,\tsleepiness,\tdeclining\tserum\tsodium\tlevel\tcaused\tby\tfluid\toverload,\tand\tworsening\trenal\nfunction.\nDecreased\tcranial\tblood\tsupply\tcan\tlead\tto\tmental\tconfusion,\tmemory\tloss,\tanxiety,\tinsomnia,\nsyncope
|
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] |
syncope\n\t(loss\tof\toxygen\tto\tthe\tbrain\tcausing\tbrief\tloss\tof\tconsciousness),\tand\theadache.\tThe\tlatter\nsymptoms\tare\tmore\tcommon\tin\tolder\tpatients\tand\n\toften\tare\tthe\tonly\tsymptoms;\tthis\tcan\tlead\tto\ta\ndelay\tin\tdiagnosis.\tOften\tthe\tfirst\tsymptom\tin\tolder\tadults\tis\ta\tdry\tcough\twith\tgeneralized\tweakness\nand\tanorexia.\nCardiac\tcachexia
|
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and\tanorexia.\nCardiac\tcachexia\n\tis\tthe\tend\tresult\tof\tHF\tin\t10%\tto\t15%\tof\tpatients.\tIt\tis\tdefined\tas\tinvoluntary\nweight\tloss\tof\tat\tleast\t6%\tof\tnonedematous\tbody\tweight\tduring\ta\t6-month\tperiod\t(\nSpringer\tet\tal,\n2006\n).\tUnlike\tnormal\tstarvation,\twhich\n\tis\tcharacterized\tby\tadipose\ttissue\tloss,\tthis\tcachexia\tis
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is\tcharacterized\tby\tadipose\ttissue\tloss,\tthis\tcachexia\tis\ncharacterized\tby\ta\tsignificant\tloss\tof\tlean\tbody\tmass.\tThis\tdecrease\tin\tlean\tbody\tmass\tfurther\nexacerbates\tHF\tbecause\tof\tthe\tloss\tof\tcardiac\tmuscle\tand\tthe\tdevelopment\tof\ta\theart\tthat\tis\tsoft\tand
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] |
flabby.\tIn\taddition,\tthere\tare\tstructural,\tcirculatory,\tmetabolic,\tinflammatory,\tand\tneuroendocrine\nchanges\tin\tthe\tskeletal\tmuscle\tof\tpatients\twith\n\tHF\t(\nDelano\tand\tMoldawer,\t2006\n)\t(\nTable\t32.6\n).\tSome\nchanges\tin\tcardiac\tfunction\tcan\tbe\tattributed\tto\taging\tand\tare\tlisted\tin\t\nBox\t32.7\n.\nBOX\t32.7
|
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] |
Box\t32.7\n.\nBOX\t32.7\nPrincipal\tEffects\tof\tAging\ton\tCardiovascular\tStructure\tand\nFunction\nIncreased\tvascular\tstiffness\nIncreased\tmyocardial\tstiffness\nDecreased\tbeta-adrenergic\tresponsiveness\nImpaired\tmitochondrial\tATP\tproduction\nDecreased\tbaroreceptor\tresponsiveness\nImpaired\tsinus\tnode\tfunction\nImpaired\tendothelial\tfunction
|
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Impaired\tsinus\tnode\tfunction\nImpaired\tendothelial\tfunction\nNet\teffect:\tMarked\treduction\tin\tcardiovascular\treserve\nATP,\n\tAdenosine\ttriphosphate.\nFrom\tRich\tMW:\tOffice\tmanagement\tof\theart\tfailure\tin\tthe\telderly,\t\nAm\tMed\n\t118:342,\t2005.\nCardiac\tcachexia\tis\ta\tserious\tcomplication\tof\tHF\twith\ta\tpoor\tprognosis\tand\tmortality\trate\tof\t50%
|
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] |
in\t18\tmonths\t(\nCarlson\tand\tDahlin,\t2014\n).\tSymptoms\tthat\treflect\n\tinadequate\tblood\tsupply\tto\tthe\nabdominal\torgans\tinclude\tanorexia,\tnausea,\ta\tfeeling\tof\tfullness,\tconstipation,\tabdominal\tpain,\nmalabsorption,\thepatomegaly,\tand\tliver\ttenderness.\tAll\tof\tthese\tcontribute\tto\tthe\thigh\tprevalence\tof
|
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] |
malnutrition\tobserved\tin\thospitalized\tpatients\twith\tHF.\tLack\tof\tblood\tflow\tto\tthe\tgut\tleads\tto\tloss\tof\nbowel\tintegrity;\tbacteria\tand\tother\tendotoxins\tmay\tenter\tthe\tbloodstream\n\tand\tcause\tcytokine\nactivation.\tProinflammatory\tcytokines\tsuch\tas\tTNF-α\tand\tadiponectin\tare\thighest\tin\tpatients\twith
|
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cardiac\tcachexia.\tAn\tincreased\tlevel\tof\tTNF-α\tis\tassociated\twith\ta\tlower\tBMI,\tsmaller\tskinfold\nmeasurements,\tand\tdecreased\tplasma\ttotal\tprotein\tlevels,\tindicative\tof\ta\tcatabolic\tstate.\nAdiponectin\tlevels\tare\thigh\tin\tHF\tand\tare\ta\tmarker\tfor\twasting\tand\ta\tpredictor\tof\tmortality.\tAs
|
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] |
with\tTNF-α,\tadiponectin\tlevels\talso\tare\tcorrelated\tinversely\twith\tBMI.\tPharmacologic\ttreatments\tfor\nmuscle\twasting\tare\tbeing\texplored.\nRisk\tfactors\nThe\tFramingham\tHeart\tStudy\t(see\t\nFocus\tOn:\n\tFramingham\tHeart\tStudy\n)\tshowed\tthe\trisk\tfactors\tfor\nHF\twere\thypertension,\tdiabetes,\tASCVD,\tand\t\nleft\tventricular\thypertrophy\t(LVH)\n\t(enlargement\tof
|
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] |
left\tventricular\thypertrophy\t(LVH)\n\t(enlargement\tof\nthe\tleft\tventricle\tof\tthe\theart).\tAntecedent\thypertension\n\tis\tpresent\tin\tabout\tthree\tfourths\tof\tHF\npatients.\tIndividuals\twho\thave\tdiabetes\tmellitus\tand\tischemic\theart\tdisease\tmore\tfrequently\tdevelop\nHF\tcompared\twith\tpatients\twithout\tdiabetes\t(\nRosano\tet\tal,\t2006\n).\tLeft\tventricular\tdysfunction
|
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] |
Rosano\tet\tal,\t2006\n).\tLeft\tventricular\tdysfunction\nwithout\tischemia\tis\toften\trelated\tto\texcessive\talcohol\tintake.\tDiabetes\tis\tan\tespecially\tstrong\trisk\nfactor\tfor\tHF\tin\twomen.\tThe\tprevalence\tof\thypertension\tand\tdiabetes\n\tincreases\twith\tage,\tmaking\tthe
|
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] |
increases\twith\tage,\tmaking\tthe\nelderly\tparticularly\tvulnerable\tto\tHF.\tAnother\tlarge\tcohort\tstudy\tof\tolder\tadults\t(70\tto\t79\tyears\told)\nshowed\tthat\twaist\tcircumference\tand\tpercentage\tof\tbody\tfat\twere\tthe\tstrongest\tpredictors\tof\twho\nwould\tdevelop\tHF\t(\nNicklas\tet\tal,\t2006\n).\tA\trecent\tstudy\tof\telderly\tindividuals\twith\tHF\tfound\ta\tstrong
|
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).\tA\trecent\tstudy\tof\telderly\tindividuals\twith\tHF\tfound\ta\tstrong\nassociation\tbetween\tvitamin\tD\tdeficiency\tand\tHF\trisk\t(\nPorto,\t2018\n).\tData\tfrom\tthe\tMulti-ethnic\nStudy\tof\tAtherosclerosis\t(also\tknown\tas\tMESA)\tconcluded\tthat\thigh\tEPA\tblood\tlevels\twere\nsignificantly\tinversely\tcorrelated\twith\trisk\tof\tHF\t(\nBlock,\t2019
|
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] |
significantly\tinversely\tcorrelated\twith\trisk\tof\tHF\t(\nBlock,\t2019\n).\tNumerous\tchanges\tin\tcardiovascular\nstructure\tand\tfunction\talso\tplace\tthe\telderly\tat\thigh\trisk\tfor\tdeveloping\tHF\t(see\t\nBox\t32.7\n).\nPrevention\nBecause\tlong-term\tsurvival\trates\tfor\tpersons\twith\tHF\tare\tlow,\tprevention\n\tis\tcritical.\tHF\tis
|
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] |
is\tcritical.\tHF\tis\ncategorized\tinto\tfour\tstages\tranging\tfrom\tpersons\twith\trisk\tfactors\t(stage\tA—primary\tprevention)\tto\npersons\twith\tadvanced\tHF\t(stage\tD—severe\tdisease).\tFor\tstages\tA\tand\tB\tthe\taggressive\ttreatment\tof\nunderlying\trisk\tfactors\tand\tdiseases\tsuch\tas\tdyslipidemia,\thypertension,\tand\tdiabetes\tis\tcritical\tto
|
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prevent\tstructural\tdamage\tto\tthe\tmyocardium\tand\tthe\tappearance\tof\tHF\tsymptoms.\n\tSuch\tprevention\nhas\tbeen\tvery\teffective.\tEven\tpatients\twho\texperience\tan\tMI\tcan\treduce\tthe\trisk\tof\tHF\twith\nantihypertensive\ttherapy.\tPatients\tare\toften\tasymptomatic\tduring\tthese\ttwo\tstages.
|
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] |
For\tstages\tC\tand\tD,\tsecondary\tprevention\tstrategies\tto\tprevent\tfurther\tcardiac\tdysfunction\tare\nwarranted.\tThese\tstrategies\tinclude\tthe\tuse\tof\tACE\tinhibitors\t(first\tline\tof\ttherapy),\tARBs,\naldosterone\tblockers,\n\tbeta-blockers,\tand\tdigoxin.\tEarly\tdetection,\tcorrection\tof\tasymptomatic\tleft
|
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] |
ventricular\tdysfunction,\tand\taggressive\tmanagement\tof\trisk\tfactors\tare\tneeded\tto\tlower\tthe\nincidence\tand\tmortality\tof\tHF.\nMedical\tmanagement\nTherapy\trecommendations\tcorrespond\tto\tthe\tstage\tof\tHF.\tFor\tpatients\tat\thigh\trisk\tof\tdeveloping\tHF\n(stage\tA),\ttreatment\tof\tthe\tunderlying\tconditions\t(hypertension,\tdyslipidemia,\n\tthyroid\tdisorders,
|
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] |
thyroid\tdisorders,\narrhythmias),\tavoidance\tof\thigh-risk\tbehaviors\t(tobacco,\texcessive\talcohol,\tillicit\tdrug\tuse),\tand\nlifestyle\tchanges\t(weight\treduction,\texercise,\treduction\tof\tsodium\tintake,\theart-healthy\tdiet)\tare\nrecommended.\tAll\tthese\trecommendations\tare\tcarried\tthrough\tthe\tother\tstages.\tIn\taddition,\tan
|
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] |
implantable\tdefibrillator,\twhich\tshocks\tthe\theart\twhen\tit\tstops,\tcan\tbe\tplaced\tin\tpatients\n\tat\trisk\tof\nsudden\tdeath.\tPharmacologic\ttreatment\tof\tHF\tis\tthe\thallmark\tof\ttherapy\twith\tprogressive\tstages.\nThe\tlast\tstage\talso\tincludes\tsurgically\timplanted\tventricular-assist\tdevices,\theart\ttransplantation,\nand\tcontinual\tintravenous\ttherapy.
|
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and\tcontinual\tintravenous\ttherapy.\nThe\tshort-term\tgoals\tfor\tthe\ttreatment\tof\tHF\tare\tto\trelieve\tsymptoms,\timprove\tthe\tquality\tof\tlife,\nand\treduce\tdepression\tif\tit\tis\tpresent.\tThe\tlong-term\n\tgoal\tof\ttreatment\tis\tto\tprolong\tlife\tby\tlessening,\nstopping,\tor\treversing\tleft\tventricular\tdysfunction.\tMedical\tmanagement\tis\ttailored\tto\tclinical\tand
|
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hemodynamic\tprofiles\twith\tevidence\tof\thypoperfusion\tand\tcongestion.\tIn\tsome\tcases,\tsurgical\nprocedures\tare\tneeded\tto\talleviate\tthe\tHF\tcaused\tby\tvalvular\tdisease;\tmedical\tmanagement\tis\nlimited\tin\tthese\tinstances.\nStandard\tfluid\trestrictions\tare\n\tto\tlimit\ttotal\tfluid\tintake\tto\t2\tL\t(2000\tmL)\tdaily.\tWhen\tpatients\tare
|
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severely\tdecompensated,\ta\tmore\trestrictive\tfluid\tintake\t(1000\tto\t1500\tmL\tdaily)\tmay\tbe\twarranted\nfor\tadequate\tdiuresis.\tA\tsodium-restricted\tdiet\tshould\tbe\tmaintained\tdespite\tlow-sodium\tblood\tlevels\nbecause\tin\tthis\tcase\tthe\tsodium\thas\tshifted\tfrom\tthe\tblood\tto\tthe\ttissues.\tSerum\tsodium\tappears\tlow\nin\ta\tpatient\twho\tis\tfluid\toverloaded
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] |
take\ta\tdiuretic,\taldosterone\tantagonists,\tdigitalis,\tand\tvasodilators\t(e.g.,\thydralazine).\n\tBasically\tthese\nmedications\treduce\texcess\tfluid,\tdilate\tblood\tvessels,\tand\tincrease\tthe\tstrength\tof\tthe\theart’s\ncontraction.\tSeveral\tof\tthese\tmedications\thave\tneurohormonal\tbenefits\talong\twith\ttheir\tprimary
|
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] |
mechanism\tof\taction.\tFor\texample,\tACE\tinhibitors\t(e.g.,\tcaptopril,\tenalapril)\tnot\tonly\tinhibit\tthe\tRAS\nbut\talso\timprove\tsymptoms,\tquality\tof\tlife,\texercise\ttolerance,\tand\tsurvival.\tSimilarly,\n\tspironolactone\nhas\tdiuretic\tand\taldosterone-blocking\tfunctions\tthat\tresult\tin\treduced\tmorbidity\tand\tmortality\tin
|
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] |
patients.\tMost\tof\tthese\tmedications\tcan\taffect\tnutrition\tstatus\t(see\t\nChapter\t8\n).
|
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] |
Medical\tnutrition\ttherapy\nThe\tRDN\tprovides\tMNT,\twhich\tincludes\tassessment,\ta\tnutrition\tdiagnosis,\tand\tinterventions\n(education,\tcounseling).\tAs\tpart\tof\ta\tmultidisciplinary\tteam\t(physician,\tpharmacist,\n\tpsychologist,\nnurse,\tand\tsocial\tworker),\tthe\tRDN\tpositively\taffects\tpatient\toutcomes.\tReduced\treadmission\tto\tthe
|
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hospital,\tfewer\tdays\tin\tthe\thospital,\timproved\tcompliance\twith\trestricted\tsodium\tand\tfluid\tintakes,\nand\timproved\tquality\tof\tlife\tscores\tare\tthe\tgoals\tin\tHF\tpatients.\nNutrition\tscreening\tfor\tHF\tin\tolder\tadults\tcan\thelp\tprevent\tdisease\tprogression\tand\timprove\ndisease\tmanagement,\toverall
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] |
disease\tmanagement,\toverall\n\thealth,\tand\tquality-of-life\toutcomes.\tThe\tfirst\tstep\tin\tscreening\tis\ndetermination\tof\tbody\tweight.\tAltered\tfluid\tbalance\tcomplicates\tassessment\tof\tbody\tweight\tin\tthe\npatient\twith\tHF.\tWeights\tshould\tbe\ttaken\tbefore\teating\tand\tafter\tvoiding\tat\tthe\tsame\ttime\teach\tday.
|
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] |
A\tdry\tweight\t(weight\twithout\tedema)\tshould\tbe\tdetermined\ton\tthe\tscale\tat\thome.\tPatients\tshould\nrecord\tdaily\tweights\tand\tadvise\ttheir\n\tcare\tproviders\tif\tweight\tgain\texceeds\tmore\tthan\t1\tlb\ta\tday\tfor\npatients\twith\tsevere\tHF,\tmore\tthan\t2\tlb\ta\tday\tfor\tpatients\twith\tmoderate\tHF,\tand\tmore\tthan\t3\tto\t5\tlb
|
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with\tmild\tHF.\tRestricting\tsodium\tand\tfluids\talong\twith\tdiuretic\ttherapy\tis\trecommended\tto\trestore\nfluid\tbalance.\nDietary\tassessments\tin\tHF\tpatients\treveal\tthat\tmore\tthan\thalf\thave\tmalnutrition,\tusually\trelated\tto\nthe\tcardiac\tcachexia\n\tmentioned\tearlier.\tNegative\tenergy\tbalance\tand\tnegative\tnitrogen\tbalances\tcan
|
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be\tnoted.\tIn\toverweight\tpatients,\tcaloric\treduction\tmust\tbe\tmonitored\tcarefully\tto\tavoid\texcessive\nand\trapid\tbody\tprotein\tcatabolism.\tNutrition\teducation\tto\tpromote\tbehavior\tchange\tis\ta\tcritical\ncomponent\tof\tMNT.\tThe\tbenefits\tof\tMNT\tshould\tbe\tcommunicated\tto\tpatients.\nThe\ttotal\tdiet\tmust\tbe\taddressed\tin\tpatients\twith
|
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The\ttotal\tdiet\tmust\tbe\taddressed\tin\tpatients\twith\n\tHF\tbecause\tunderlying\trisk\tfactors\tare\toften\npresent;\tdietary\tchanges\tto\tmodify\tthese\trisk\tfactors\tare\tan\timportant\tcomponent\tof\tMNT.\tFor\ndyslipidemia\tor\tatherosclerosis,\ta\theart-healthy\tdiet\tlow\tin\tSFAs,\ttrans\tfatty\tacids,\tand\tcholesterol
|
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] |
and\thigh\tin\tfiber,\twhole\tgrains,\tfruits,\tand\tvegetables\tis\trecommended.\tFor\tpersons\twith\nhypertension,\tthe\tDASH\tdiet\tis\trecommended.\tBoth\tof\tthese\tdietary\tpatterns\n\temphasize\tlower-\nsodium\tfoods\tand\thigher\tintake\tof\tpotassium.\tTotal\tenergy\texpenditure\tis\thigher\tin\tHF\tpatients
|
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] |
because\tof\tthe\tcatabolic\tstate;\tadequate\tprotein\tand\tenergy\tshould\tbe\tprovided\t(\nAcademy\tof\nNutrition\tand\tDietetics,\tEvidence\tAnalysis\tLibrary,\t2017\n).\nSalt\trestriction\nExcessive\tsodium\tintake\tis\tassociated\twith\tfluid\tretention\tand\t\nedema\n.\tA\t2-g\tsodium\trestriction\tis\nregularly\tprescribed
|
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edema\n.\tA\t2-g\tsodium\trestriction\tis\nregularly\tprescribed\n\tfor\tpatients\twith\tHF.\tThe\tAND\t(2012)\tEAL\trecommends\ta\t2-g\tsodium\trestriction\nbut\tnotes\tthat\tthe\tevidence\tfor\tthis\trecommendation\tis\tonly\t“fair.”\tThe\tHeart\tFailure\tSociety\tof\nAmerica\trecommends\t2\tto\t3\tg\tof\tsodium\tdaily\tunless\tsevere\tsymptoms\tare\tpresent,\tthen\tthe\nrecommendation\tis\tfor\t2\tg\t(
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] |
recommendation\tis\tfor\t2\tg\t(\nGupta\tet\tal,\t2012\n).\tThe\tupdated\tAHA\trecommendation\tis\tfor\t“moderate”\nsodium\trestriction.\t\nTable\t32.7\n\tsummarizes\n\tthe\trecommendations\tfrom\tmultiple\torganizations.\tThe\ninconsistencies\tin\tthe\tdifferent\torganizations\tare\tdue\tto\tthe\tweak\tdatabase\tof\tstudies.\tMany\thave
|
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] |
small\tsample\tsizes\tand\tmany\twere\tnot\trandomized\ttrials.\tThree\tof\tthe\tlarger\tstudies\tthat\twere\nrandomized\thad\tconsistent\tresults\tbut\tshowed\tthat\tsodium\trestriction\twas\tassociated\twith\tworse\noutcome\t(\nGupta\tet\tal,\t2012\n).\tIt\tis\thypothesized\tthat\tthis\n\teffect\tmay\tbe\trelated\tto\tneurohormones
|
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] |
effect\tmay\tbe\trelated\tto\tneurohormones\nincluding\taldosterone,\tnorepinephrine,\tand\tangiotensin\tII,\tall\tof\twhich\tincreased\twith\tdietary\nrestriction.\tThese\thormones\tact\tto\tconserve\tfluid,\tthus\ttrying\tto\trestore\tblood\tflow.\tAldosterone\npromotes\tsodium\treabsorption,\tand\tvasopressin\tpromotes\twater\tconservation\tin\tthe\tdistal\ttubules\tof
|
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] |
the\tnephron.\tThis\tcomplex\tbalance\tis\tfurther\tcomplicated\tby\tthe\tmedications\n\tused\tfor\tHF.
|
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] |
TABLE\t32.7\nDietary\tSodium\tIntake\tin\tHeart\tFailure\nGuideline\nYear\nSodium/Fluid\tRestriction\nRecommendations\nLevel\tof\nEvidence\nNational\tHeart\tFoundation\tof\nAustralia/Cardiac\tSociety\tof\nAustralia\tand\tNew\tZealand\n2006\n<3\tg/day\tfor\tNYHA\tclass\tII\twithout\tperipheral\nedema/<2\tg/day\tfor\tNYHA\tclass\tIII\tand\tIV\nC\n<2\tL/day\tfor\tall\tpatients\tand\t<1.5\tL/day\tduring
|
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] |
C\n<2\tL/day\tfor\tall\tpatients\tand\t<1.5\tL/day\tduring\nfluid\tretention\tepisodes\nHeart\tFailure\tSociety,\tIndia\n2007\n<2\tg/day\nNot\tstated\n<2\tL/day\nEuropean\tSociety\tof\tCardiology\n2008\nModerate\trestriction\t1.5-2\tL/day\tin\tpatients\twith\nsevere\tsymptoms\tand\tespecially\twith\nhyponatremia\nC\nCanadian\tCardiovascular\tSociety\n2008\n<2\tg/day\nNot\tstated\n2\tL/day
|
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] |
C\nCanadian\tCardiovascular\tSociety\n2008\n<2\tg/day\nNot\tstated\n2\tL/day\nAmerican\tCollege\tof\nCardiology/American\tHeart\nAssociation\n2009\nModerate\trestriction\t(≤2\tg/day\tif\tvolume\noverload,\tfollowed\tby\tfluid\tintake\trestriction\nto\t2\tL/day\tif\tfluid\tretention\n\tpersists)\nC\nRoyal\tCollege\tof\tPhysicians\n2010\nSalt\treduction\nFluid\trestriction\nLimited;\nfurther
|
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] |
2010\nSalt\treduction\nFluid\trestriction\nLimited;\nfurther\nresearch\nrequired\nHeart\tFailure\tSociety\tof\tAmerica\n2010\n2-3\tg/day;\t<2\tg/day\tmay\tbe\tconsidered\tin\nmoderate\tto\tsevere\theart\tfailure\nC\n<2\tL/day,\tif\tfluid\tretention\tpersists\tand\tif\tsevere\nhyponatremia\t(serum\tNa\t<130\tmEq/L)\tis\npresent\nScottish\tIntercollegiate\tGuidelines\nNetwork\n2010\n<2.4\tg/day
|
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] |
present\nScottish\tIntercollegiate\tGuidelines\nNetwork\n2010\n<2.4\tg/day\n\ttailored\tfluid\trestriction\n1+\nAmerican\tDietetic\tAssociation\n2011\n<2\tg/day\t1.4-1.9\tL/day\tdepending\ton\tclinical\nsymptoms\nFair\nLevel\tof\tEvidence:\t\nC\n,\tLimited\tpopulations\tevaluated.\tOnly\tconsensus\topinion\tof\texperts,\tcase\tstudies,\tor\tstandard\tof\tcare;\t\nFair\n,\tBenefits\texceed\tthe
|
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] |
Fair\n,\tBenefits\texceed\tthe\nharms\tbut\tquality\tof\tevidence\tis\tnot\tas\tstrong;\t\n1\n+,\twell-conducted\tmeta-analysis,\tsystemic\treviews,\tor\trandomized\tcontrolled\n\ttrials\twith\tlow\trisk\tof\nbias.\nNYHA\n,\tNew\tYork\tHeart\tAssociation.\nFrom\tAmerican\tHeart\tAssociation:\t\nContemporary\treviews\tin\tcardiovascular\tmedicine\n\t(website).
|
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Contemporary\treviews\tin\tcardiovascular\tmedicine\n\t(website).\nhttp://circ.ahajournals.org/content/126/4/479/T1.expansion.html\n,\t2015.\nPatient\tcompliance\twith\tsodium\trestriction\tof\t2\tg/day\thas\tbeen\tshown\tto\tbe\tpoor.\tThis\tcan\tlead\tto\ngenerally\tinadequate\tnutritional\tintake\tthat\tmay\tbe\ta\tcontributing\n\tfactor\tto\tpoor\toutcomes
|
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0.07079366594552994,
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] |
factor\tto\tpoor\toutcomes\nassociated\twith\tsodium\trestriction.\tA\tone-size-fits-all\tsodium\trestriction\tis\tnot\tpossible.\tThe\tHF\nstage,\tamount\tof\tedema\tpresent,\toverall\tnutritional\tstatus,\tand\tmedications\tmust\tbe\ttaken\tinto\nconsideration.\tThere\tis\tconsensus\tthat\thigh\tsodium\tintake\t(above\t3\tg/day)\tis\tcontraindicated\tfor\tHF.
|
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] |
The\tdegree\tof\trestriction\tdepends\ton\tthe\tindividual\t(see\t\nFocus\tOn:\n\tSodium\tand\tSalt\tMeasurement\nEquivalents\n).\n\t\nFOCUS\tON\nSodium\tand\tSalt\tMeasurement\tEquivalents\nSodium\tchloride\tis\tapproximately\t40%\t(39.3%)\tsodium\tand\t60%\tchloride.\tTo\tconvert\ta\tspecified
|
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0.007710388395935297
] |
weight\tof\tsodium\tchloride\tto\tits\tsodium\tequivalent,\tmultiply\tthe\tweight\tby\t0.393.\tSodium\talso\tis\nmeasured\tin\tmilliequivalents\t(mEq).\tTo\tconvert\tmilligrams\tof\tsodium\tto\tmEq,\n\tdivide\tby\tthe\tatomic\nweight\tof\t23.\tTo\tconvert\tsodium\tto\tsodium\tchloride\t(salt),\tmultiply\tby\t2.54.\tMillimoles\t(mmol)\tand
|
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0.0024079177528619766
] |
milliequivalents\t(mEq)\tof\tsodium\tare\tthe\tsame.\tFor\texample:\n1\ttsp\tof\tsalt\t=\tapproximately\t6\tg\tNaCl\t=\t6096\tmg\tNaCl\n6096\tmg\tNaCl\t×\t0.393\t=\t2396\tmg\tNa\t(approximately\t2400\tmg)\n2396\tmg\tNa/23\t=\t104\tmEq\tNa\n1\tg\tNa\t=\t1000\tmg/23\t=\t43\tmEq\tor\tmmol\n1\ttsp\tof\tsalt\t=\t2400\tmg\tor\t104\tmEq\n\tNa
|
[
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1\ttsp\tof\tsalt\t=\t2400\tmg\tor\t104\tmEq\n\tNa\nAdherence\tto\tsodium\trestrictions\tcan\tbe\tproblematic\tfor\tmany\tindividuals,\tand\tindividualized\ninstruction\tis\trecommended.\tEthnic\tdifferences\tin\tsodium\tconsumption\tmust\tbe\tconsidered.\tSome\ncultures\thave\ttraditional\tdiets\tthat\tare\tvery\thigh\tin\tsodium\tsuch\tas\tKosher\tand\tAsian\tdiets.\tIn\tsome
|
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cases\tregional\tcooking,\tlike\tin\tsome\tareas\tin\tthe\tsouthern\tUnited\tStates,\tdepends\theavily\ton\tsalt.
|
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] |
Positive\toutcomes\t(i.e.,\tdecreased\turinary\tsodium\texcretion,\tless\tfatigue,\tless\tfrequent\tedema)\nhave\tbeen\tobserved\tin\tHF\tpatients\treceiving\tMNT.\tThe\ttype\tof\tsodium\trestriction\tprescribed\tshould\nbe\tthe\tleast\trestrictive\tdiet\tthat\twill\tachieve\tthe\tdesired\tresults.\tThe\tfirst\tstep\tis\tto\tminimize\tor
|
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] |
eliminate\tthe\tuse\tof\ttable\tsalt\tand\thigh-sodium\tfoods\t(\nBox\t32.8\n)\t(see\t\nAppendix\t46\n\tfor\tsodium\tcontent\nof\tfoods).\nBOX\t32.8\nTop\tTen\tCategories\tof\tHigh-Sodium\tFoods\n1.\t\nSmoked,\tprocessed,\tor\tcured\tmeats\tand\tfish\t(e.g.,\tham,\tbacon,\tcorned\tbeef,\tcold\tcuts,\thot\ndogs,\tsausage,\tsalt\tpork,\tchipped\tbeef,\tpickled\therring,\tanchovies,\ttuna,\tand\tsardines)
|
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0.009796922095119953
] |
2.\t\nTomato\tjuices\tand\ttomato\tsauce,\tunless\tlabeled\totherwise\n3.\t\nMeat\textracts,\tbouillon\tcubes,\tmeat\tsauces,\tMSG,\tand\ttaco\tseasoning\tand\tother\tpackaged\nseasonings\n4.\t\nSalted\tsnacks\t(potato\tchips,\ttortilla\tchips,\tcorn\tchips,\tpretzels,\tsalted\tnuts,\tpopcorn,\tand\ncrackers)\n5.
|
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] |
crackers)\n5.\t\nPrepared\tsalad\tdressings,\tcondiments,\trelishes,\tketchup,\tWorcestershire\tsauce,\tbarbecue\nsauce,\tcocktail\tsauce,\tteriyaki\tsauce,\tsoy\tsauce,\tcommercial\tsalad\tdressings,\tsalsa,\tpickles,\nolives,\tand\tsauerkraut\n6.\t\nPackaged\tmixes\tfor\tsauces,\tgravies,\tcasseroles,\tand\tnoodle,\trice,\n\tor\tpotato\tdishes;\nmacaroni\tand\tcheese;\tstuffing\tmix\n7.
|
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or\tpotato\tdishes;\nmacaroni\tand\tcheese;\tstuffing\tmix\n7.\t\nCheeses\t(processed\tand\tcheese\tspreads)\n8.\t\nFrozen\tentrees\tand\tpot\tpies\n9.\t\nCanned\tsoup\n10.\t\nFoods\teaten\taway\tfrom\thome\nNote:\tReading\tlabels\tis\tmost\timportant;\tsome\tbrands\tare\tlower\tin\tsodium\tthan\tothers.\nMSG\n,\tMonosodium\tglutamate.
|
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MSG\n,\tMonosodium\tglutamate.\nPoor\tadherence\tto\tlow-sodium\tdiets\toccurs\tin\tpart\tas\ta\tresult\tof\tlack\tof\tknowledge\tabout\tsodium\nand\n\tlower-sodium\tfood\tchoices\tby\tthe\tpatient,\tand\tperception\tthat\tthe\tdiet\tinterferes\twith\tthe\tsocial\naspects\tof\teating.\tLack\tof\tcooking\tskills\tor\tadequate\tcooking\tfacilities\tis\tanother\tobstacle\tbecause\tit
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] |
leads\tpatients\tto\teat\tpremade\tfoods\tthat\ttend\tto\tbe\thigh\tin\tsalt.\tMemory\tloss,\tsevere\tfatigue,\tand\neconomic\tissues\tare\tall\tchallenges\tto\tfollowing\ta\tlow-sodium\tdiet.\tIn\taddition,\tfood\tlabels,\talthough\ninformative,\tmay\tbe\thard\tfor\tmany\tpatients\tor\ttheir\tcaregivers\tto\tcomprehend\t(\nBox\t32.9\n).\nBOX\t32.9\nFood\tLabeling\tGuide\tfor\tSodium\nSodium-free
|
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] |
Box\t32.9\n).\nBOX\t32.9\nFood\tLabeling\tGuide\tfor\tSodium\nSodium-free\nLess\tthan\t5\tmg\tper\tstandard\tserving;\tcannot\tcontain\tany\tsodium\tchloride\nVery\tlow\tsodium\n35\tmg\tor\tless\tper\tstandard\tserving\nLow\tsodium\n140\tmg\tor\tless\tper\tstandard\tserving\nReduced\tsodium\nAt\tleast\t25%\tless\tsodium\tper\tstandard\tserving\tthan\tin\n\tthe\tregular\tfood\nLight\tin\tsodium
|
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] |
the\tregular\tfood\nLight\tin\tsodium\n50%\tless\tsodium\tper\tstandard\tserving\tthan\tin\tthe\tregular\tfood\nUnsalted,\twithout\tadded\nsalt,\tor\tno\tsalt\tadded\nNo\tsalt\tadded\tduring\tprocessing;\tthe\tproduct\tit\tresembles\tis\tnormally\nprocessed\twith\tsalt\nLightly\tsalted\n50%\tless\tadded\tsodium\tthan\tis\tnormally\tadded;\tproduct\tmust\tstate\t“not\ta
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low-sodium\tfood”\tif\tthat\tcriterion\tis\tnot\tmet\nhttps://www.labelcalc.com/nutrient-content-claims/low-sodium-nutrition-label-guidelines-for-your-food-\nproduct/\n.\nAlcohol\nIn\texcess,\talcohol\tcontributes\tto\tfluid\tintake\tand\traises\tblood\tpressure.\tMany\tcardiologists\nrecommend\tavoiding\talcohol.\tChronic\talcohol\tingestion\tmay\tlead\tto\tcardiomyopathy\tand\tHF
|
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] |
(\nMirijello,\t2017\n).\tAlthough\theavy\tdrinking\tshould\tbe\tdiscouraged,\tthere\tis\tno\tevidence\tto\tsupport\ntotal\tabstinence\tfrom\talcohol\t(\nAND,\t2012\n).\tQuantity,\tdrinking\tpatterns,\tand\tgenetic\tfactors\tinfluence\nthe\trelationship\tbetween\talcohol\tconsumption\tand\tHF\t(\nDjoussé\tand\tGaziano,\t2008\n).\tIf\talcohol\tis
|
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] |
Djoussé\tand\tGaziano,\t2008\n).\tIf\talcohol\tis\nconsumed,\tintake\tshould\tnot\texceed\tone\tdrink\tper\tday\tfor\twomen\tand\ttwo\tdrinks\tper\tday\tfor\tmen.\tA\ndrink\tis\tequivalent\tto\t1\toz\tof\talcohol\t(1\toz\tof\tdistilled\tliquor),\t5\toz\tof\twine,\tor\t12\toz\tof\tbeer.\nCaffeine\nUntil\trecently\tcaffeine\thas\tbeen\tconsidered\tdetrimental\tto\tpatients\twith\tHF\tbecause\tit\tcontributes
|
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to\nirregular\theartbeats.\tHowever,\ta\tstudy\tin\tthe\tNetherlands\tsuggests\tthat\tmoderate\tintake\tof\teither\ntea\tor\tcoffee\treduces\tASCVD\trisk;\ttea\tactually\treduces\tASCVD\tdeaths\t(\nde\tKoning\tGans\tet\tal,\t2010\n).\nResearchers\tin\tthe\tUnited\tStates\tfollowed\t130,054\tmen\tand\twomen\tand\tfound\tthat\tthose\twho
|
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] |
reported\tdrinking\tfour\tor\tmore\tcups\tof\tcoffee\teach\tday\thad\tan\t18%\tlower\trisk\tof\thospitalization\tfor\nheart\trhythm\n\tdisturbances.\tThose\twho\treported\tdrinking\tone\tto\tthree\tcups\teach\tday\thad\ta\t7%\nreduction\tin\trisk\t(\nKlatsky,\t2010\n).\tThe\tantioxidant\teffects\tof\tcoffee\tand\ttea\tmay\tbe\tbeneficial.\tA
|
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] |
).\tThe\tantioxidant\teffects\tof\tcoffee\tand\ttea\tmay\tbe\tbeneficial.\tA\nrecently\tpublished\trandomized\ttrial\tconcluded\tthat\ta\thigh\tdose\tof\tcaffeine\tdid\tnot\tinduce\narrhythmias\tin\tpatients\twith\tsystolic\tHF\t(\nZuchinali,\t2016\n).\nCalcium\nPatients\twith\tHF\tare\tat\tincreased\trisk\tof\tdeveloping\tosteoporosis\n\tbecause\tof\tlow\tactivity\tlevels,
|
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] |
because\tof\tlow\tactivity\tlevels,\nimpaired\trenal\tfunction,\tand\tprescription\tdrugs\tthat\talter\tcalcium\tmetabolism\t(\nZittermann\tet\tal,\n2006\n).\tCachectic\tHF\tpatients\thave\tlower\tbone\tmineral\tdensity\tand\tlower\tcalcium\tlevels\tthan\tHF\npatients\twithout\tcachexia\t(\nAnker\tet\tal,\t2006\n).\tCaution\tmust\tbe\tused\twith\tcalcium\tsupplements
|
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] |
Anker\tet\tal,\t2006\n).\tCaution\tmust\tbe\tused\twith\tcalcium\tsupplements\nbecause\tthey\thave\tbeen\tshown\tto\tbe\tassociated\twith\tadverse\toutcomes\t(\nDrozd\tet\tal,\t2014\n).\nL-arginine\nIn\tpatients\twith\tHF,\tdecreased\texercise\tcapacity\tmay\tbe\tin\tpart\tdue\tto\treduced\tperipheral\tblood\tflow
|
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related\tto\timpairment\tof\tendothelium-dependent\tvasodilation.\tl-Arginine\tis\tconverted\tto\tNO,\tan\nendothelium-derived\trelaxing\tfactor.\tAt\tleast\tfour\tstudies\thave\tshown\tsome\tbenefit\twith\nsupplementation.\tThe\tstudies\twere\tsmall,\tand\tmore\tresearch\tis\tneeded\tto\testablish\tclear\nrecommendations.\nCoenzyme\tQ\n10\nSome\tstudies\ton\tthe\tuse\tof\tcoenzyme\tQ\n10\n\t(CoQ
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Coenzyme\tQ\n10\nSome\tstudies\ton\tthe\tuse\tof\tcoenzyme\tQ\n10\n\t(CoQ\n10\n)\tsupplementation\tin\tHF\tpatients\tshowed\tpositive\noutcome.\tOutcomes\tincluded\tsignificantly\timproved\texercise\ttolerance,\tdecreased\tsymptoms,\tand\nimproved\tquality\tof\tlife.\tCoQ\n10\n\tlevels\tare\tgenerally\tlow\tin\tHF\tpatients;\tit\tis\tpostulated\tthat\trepletion
|
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] |
can\tprevent\toxidative\tstress\tand\tfurther\tmyocardial\tdamage.\tA\tsystematic\treview\tof\t7\tstudies\n\tand\nover\t900\tpatients\ton\tthe\tuse\tof\tCoQ\n10\n\tin\tHF\tpatients\tconcluded\tthat\tthe\tstudies\twere\ttoo\tsmall\tand\ntoo\tdiverse\tin\tstudy\tdesign\tto\tdraw\tany\tuseful\tconclusions\t(\nMadmani\tet\tal,\t2014\n).\tPatients\ton\tstatins
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Madmani\tet\tal,\t2014\n).\tPatients\ton\tstatins\n(HMG-CoA\treductase\tinhibitors)\tmay\thave\ta\tdifferent\treason\tto\tconsider\tsupplementation.\tHMG-CoA\nreductase\tinhibitors\tare\ta\tclass\tof\tcholesterol-lowering\tdrugs\tthat\tare\tknown\tto\tinterfere\twith\nsynthesis\tof\tCoQ\n10\n.\nD-ribose
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] |
synthesis\tof\tCoQ\n10\n.\nD-ribose\nD-ribose\tis\ta\tcomponent\tof\tadenosine\ttriphosphate\t(ATP)\tfor\tcellular\tmetabolism\tand\tenergy\nproduction.\tMyocardial\tischemia\tlowers\tcellular\tenergy\tlevels,\tintegrity,\tand\tfunction.\tThe\tfailing\nheart\tis\tenergy\tstarved.\tD-ribose\tis\tbeing\ttested\tto\tcorrect\tthis\tdeficient\tcellular\tenergy\tas\ta
|
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] |
naturally\toccurring\tcarbohydrate\t(\nShecterle\tet\tal,\t2010\n).\tA\trecent\tprospective\n\tstudy\tthat\tgave\t6\nweeks\tof\tD-ribose\tsupplement\twas\tinconclusive\tin\tdetermining\tbenefit\t(\nBayram\tet\tal,\t2015\n).\nEnergy\nThe\tenergy\tneeds\tof\tpatients\twith\tHF\tdepend\ton\ttheir\tcurrent\tdry\tweight,\tactivity\trestrictions,\tand
|
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] |
the\tseverity\tof\tthe\tHF.\tOverweight\tpatients\twith\tlimited\tactivity\tshould\tbe\tencouraged\tto\tmaintain\tan\nappropriate\tweight\tthat\twill\tnot\tstress\tthe\tmyocardium.\tHowever,\tthe\tnutrition\n\tstatus\tof\tthe\tobese\npatient\tmust\tbe\tassessed\tto\tensure\tthat\tthe\tpatient\tis\tnot\tmalnourished.\tIn\tpatients\twith\tHF,\tenergy
|
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] |
needs\tare\tunclear.\tAt\tleast\ttwo\tstudies\tfound\tthat\tstandard\tenergy\tequations\tused\tto\tdetermine\ncalorie\tneeds\tunderestimated\tthe\tneeds\tof\tHF\tpatients.\tAnother\tstudy\tfound\tlower\tcalorie\tneeds\ncompared\twith\thealthy\tcontrols\t(\nAND,\t2012\n).\tThis\tarea\trequires\tmore\tresearch.\tStandard\n\tnutritional\nassessment\tshould\tbe\temployed\twith\tcareful\tmonitoring.
|
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nutritional\nassessment\tshould\tbe\temployed\twith\tcareful\tmonitoring.\nFats\nFish\tconsumption\tand\tfish\toils\trich\tin\tomega-3\tfatty\tacids\tcan\tlower\televated\ttriglyceride\tlevels\tand\nmay\tprevent\tatrial\tfibrillation\tin\tHF\tpatients\t(\nRoth\tand\tHarris,\t2010\n).\tIntake\tof\tat\tleast\t1\tg\tdaily\tof
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Roth\tand\tHarris,\t2010\n).\tIntake\tof\tat\tleast\t1\tg\tdaily\tof\nomega-3\tfatty\tacids\tfrom\teither\toily\tfish\tor\tfish-oil\tsupplements\twas\tused\tin\tthe\tstudy.\tHowever,\nfurther\tstudies\n\tare\tneeded.\tSome\tevidence\tsuggests\tthat\thigh\tsaturated\tfat\tfeeding\tin\tmild\tto\nmoderate\tHF\tpreserves\tcontractile\tfunction\tand\tprevents\tthe\tswitch\tfrom\tfatty\tacid\tto\tglucose
|
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metabolism,\tthus\tserving\ta\tcardioprotective\trole\t(\nChess\tet\tal,\t2009\n;\t\nChristopher\tet\tal,\t2010\n).\nMeal\tstrategies\nPatients\twith\tHF\toften\ttolerate\tsmall,\tfrequent\tmeals\tbetter\tthan\tlarger,\tinfrequent\tmeals\tbecause\nthe\tlatter\n\tare\tmore\ttiring\tto\tconsume,\tcan\tcontribute\tto\tabdominal\tdistention,\tand\tmarkedly\tincrease
|
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] |
oxygen\tconsumption.\tAll\tthese\tfactors\ttax\tthe\talready\tstressed\theart.\tCaloric\tsupplements\tcan\thelp\nto\tincrease\tenergy\tintake;\thowever,\tthis\tintervention\tmay\tnot\treverse\tthis\tform\tof\tmalnutrition\n(\nAnker\tet\tal,\t2006\n).\nFolate,\tvitamin\tB\n6\n,\tand\tvitamin\tB\n12\nHigh\tdietary\tintakes\tof\tfolate\tand\tvitamin\tB\n6\n\thave
|
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] |
12\nHigh\tdietary\tintakes\tof\tfolate\tand\tvitamin\tB\n6\n\thave\n\tbeen\tassociated\twith\treduced\trisk\tof\tmortality\nfrom\tHF\tand\tstroke\tin\tsome\tpopulations\t(\nCui\tet\tal,\t2010\n).\tHowever,\tdeficiencies\tof\tvitamin\tB\n12\n\tand\nfolate\thave\tbeen\tstudied\tand\tfound\tto\tbe\trelatively\trare\tin\tHF\tpatients\t(\nvan\tder\tWal\tet\tal,\t2015\n).\nMagnesium
|
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] |
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