7.1 Nutritional Management of Heart Failure

Heart failure management hinges on dietary changes and fluid balance. Sodium restriction, DASH diet, and omega-3 fatty acids improve heart health. Protein needs increase to maintain muscle mass. Fluid restrictions and electrolyte management are crucial.

Nutritional challenges include cardiac cachexia and micronutrient deficiencies. Weight management aims for a healthy BMI. Fluid balance strategies, electrolyte monitoring, and edema management are key. Nutritional interventions address malnutrition risks and support overall heart health.

Dietary Modifications

Sodium and Diet Recommendations

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• Sodium restriction limits intake to 2000-3000 mg/day reduces fluid retention and blood pressure
• DASH diet emphasizes fruits, vegetables, whole grains, and lean proteins lowers blood pressure and improves heart health
• Omega-3 fatty acids from fatty fish (salmon, mackerel) or supplements reduce inflammation and improve heart function
• Energy requirements vary based on weight status and activity level, typically range from 25-35 kcal/kg/day
• Protein needs increase to 1.1-1.4 g/kg/day to maintain muscle mass and prevent cardiac cachexia
• Alcohol restriction reduces strain on the heart, limit intake to no more than 1-2 drinks per day

Fluid and Electrolyte Balance

• Fluid balance maintenance crucial for heart failure management, often requires restriction to 1.5-2 L/day
• Potassium management involves monitoring levels and adjusting intake, especially when taking certain medications (ACE inhibitors)
• Diuretics help remove excess fluid from the body, reducing strain on the heart and improving symptoms
• Edema reduction strategies include elevating legs, wearing compression stockings, and following fluid restrictions

Nutritional Challenges and Interventions

• Cardiac cachexia characterized by severe muscle wasting and weight loss, requires increased calorie and protein intake
• Micronutrient deficiencies common in heart failure patients, particularly vitamin D, thiamine, and magnesium
• Malnutrition risk increases due to reduced appetite, medication side effects, and altered metabolism
• Weight management focuses on achieving and maintaining a healthy BMI (18.5-24.9 kg/m²) to reduce cardiac workload

Fluid and Electrolyte Management

Fluid Balance Strategies

• Fluid balance monitoring involves tracking daily weight, urine output, and visible edema
• Fluid restriction typically ranges from 1.5-2 L/day, adjusted based on individual patient needs
• Thirst management techniques include sucking on ice chips, using sugar-free hard candies, and rinsing mouth with cold water
• Educating patients on hidden fluid sources (soups, gelatin, ice cream) helps maintain fluid restrictions

Electrolyte Management and Medications

• Potassium management crucial due to its role in heart function and potential interactions with medications
• Diuretics classified into different types (loop, thiazide, potassium-sparing) with varying effects on electrolyte balance
• ACE inhibitors and ARBs may increase potassium levels, requiring close monitoring and dietary adjustments
• Magnesium supplementation often necessary due to losses from diuretic use and its role in heart rhythm regulation

Edema Assessment and Management

• Edema assessment involves daily weight checks, measuring ankle circumference, and monitoring for pitting edema
• Non-pharmacological edema management includes elevating legs, wearing compression stockings, and following a low-sodium diet
• Pharmacological interventions for edema primarily involve diuretic therapy, carefully titrated to avoid electrolyte imbalances
• Patient education on recognizing worsening edema signs (rapid weight gain, increased shortness of breath) crucial for early intervention

Nutritional Considerations

Cardiac Cachexia and Malnutrition

• Cardiac cachexia defined as unintentional weight loss of >5% over 6 months or BMI <20 kg/m² with muscle wasting
• Malnutrition risk factors include reduced appetite, early satiety, altered taste perception, and medication side effects
• Nutritional screening tools (Mini Nutritional Assessment, Subjective Global Assessment) help identify at-risk patients
• Intervention strategies for cachexia and malnutrition include small, frequent meals, nutrient-dense foods, and oral nutritional supplements

Micronutrient Deficiencies and Supplementation

• Vitamin D deficiency common in heart failure, supplementation may improve cardiac function and reduce inflammation
• Thiamine deficiency can exacerbate heart failure symptoms, often requires supplementation especially in diuretic users
• Magnesium plays a crucial role in heart rhythm regulation, deficiency may increase risk of arrhythmias
• Coenzyme Q10 supplementation shows promise in improving heart function and reducing hospitalization rates

Weight Management Strategies

• Weight management goals differ based on patient's current BMI and overall health status
• Overweight/obese patients benefit from gradual weight loss (0.5-1 kg/week) to reduce cardiac workload
• Underweight patients require calorie-dense, nutrient-rich diets to achieve healthy weight and improve nutritional status
• Physical activity recommendations tailored to individual capacity, typically starting with low-intensity exercises and gradually increasing