1. HF Basics
Pathophys
MNT
Pathophys/
Risk factors/
MNT
HF Bonus
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2. In heart failure, the heart cannot provide adequate blood flow to the rest of the body, causing hallmark symptoms such as fatigue, shortness of breath, and often times most notably this

3. What is fluid retention?

4. The incidence of new cases of HF has risen during the last 20 years because of an aging population, an increased number of people being saved from MI, and because of an increase in this

5. What is obesity?

6. Heart failure was formerly (and still often) referred to as this

7. What is congestive heart failure?

8. HF can be further categorized as this, when the heart cannot pump, or eject blood efficiently out of the heart

9. What is systolic failure?

10. The prevalence of HF in this racial group is reported to be 25 percent higher than in whites

11. African Americans

12. The natriuretic peptide system impacts the handling and pressure regulation of these 2 things and may influence myocardial structure and function

13. What is salt and water?

14. Patients classified with this level of HF may experience symptoms even while at rest

15. What is class IV?
●Class I – Patients with heart disease without resulting limitation of physical activity. Ordinary physical activity does not cause HF symptoms such as fatigue or dyspnea.
●Class II – Patients with heart disease resulting in slight limitation of physical activity. Symptoms of HF develop with ordinary activity but there are no symptoms at rest.
●Class III – Patients with heart disease resulting in marked limitation of physical activity. Symptoms of HF develop with less than ordinary physical activity but there are no symptoms at rest.
●Class IV – Patients with heart disease resulting in inability to carry on any physical activity without discomfort. Symptoms of HF may occur even at rest

16. This process is when the shape and function of the left ventricle is altered due to a progressive insult on the heart

17. What is cardiac remodeling?

18. Neurohormones are often increased in patients with HF
Neurohormones are often increased in patients with HF. They increase stress on the ventricle 2 ways, by causing peripheral vasoconstriction and this

19. What is sodium retention?
Norepinephrine, angiotensin II, adolsterone, endothelian, and vasopressin

20. Neurohormones and these (secreted by certain cells of the immune system) contribute to progression of HF P

21. What are cytokines?
Proinflammatory cytokines such as IL-1, IL-6 are increased in the blood of heart failure patients that they think are responsible for regulated the cardiac remodeling that we see in these patients

22. This has been shown to be predictive of worsened survival and increased length of stay in patients with chronic HF. The risk and prevalence of ____ in advanced heart failure has been shown to be as high as 90% in some studies

23. What is malnutrition?

24. Salt restriction is commonly recommended, although there are insufficient data to support any specific level of sodium intake in patients with symptomatic HF. This is the sodium restriction most often recommended.

25. What is 2g or less. Some recommend 2-3g
Sodium restriction should be the least restrictive that will still achieve the desired results.
Given the available evidence, we suggest sodium restriction (eg, <2 g/d) in patients with symptomatic HF. The 2013 ACC/AHA guidelines suggest some degree (eg, <3 g/d) of sodium restriction in patients with symptomatic HF [16], while the 2012 ESC guidelines note that the safety and efficacy of salt restriction require further study

26. Medical Nutrition Therapy for HF patients often includes recommendations aimed at maintaining adequate vitamins and minerals intake, especially these, that may be depleted with diuretics (name 3)

27. What are water-soluble vitamins and minerals that are important for a healthy heart - thiamin, magnesium, and potassium?

28. Dietitians often recommend patients with HF who are on a sodium restricted diet choose foods with this many mg of sodium or less per serving
Edema in HF patients results from impaired cardiac function. Poor blood flow to the kidneys leads to secretion of antidiuretic hormone (aldosterone and vasopressin) which act to conserve fluid, which can lead to accumulation of fluid in the tissues.

29. What is 140 mg?

30. This is the most commonly ordered fluid restriction for HF patients

31. What is 2 liters?
Edema in HF patients results from impaired cardiac function. Poor blood flow to the kidneys leads to secretion of antidiuretic hormone (aldosterone and vasopressin) which act to conserve fluid, which can lead to accumulation of fluid in the tissues.
Fluid restriction (1.5 to 2 L/day) may be helpful in patients with refractory HF, particularly those with hyponatremia

32. The Framingham study showed that risk factors for HF include HTN, diabetes, CHD, and this which involves the enlargement of the left ventricle of the heart

33. What is left ventricular hypertrophy?
Left ventricular hypertrophy (LVH) is a condition in which the muscle wall of heart'sleft pumping chamber (ventricle) becomes thickened (hypertrophy). Other conditions, such as heart attack, valve disease and dilated cardiomyopathy, can cause the heart (or the heart cavity) to get bigger.

34. Patients with heart failure are at a greater risk for malnutrition because of malabsorption due to this

35. What is gut edema? (or lack of blood flow to the gut)

36. Coronary heart disease and diabetes mellitus have become increasingly responsible for HF while this has become less common because of improvements in detection and therapy

37. What is Hypertension?
Over four decades of observation in the Framingham Study, the prevalence of coronary disease as a cause of HF increased 41 percent per calendar decade in men and 25 percent in women; the prevalence of diabetes as a contributing cause increased by more than 20 percent per decade

38. Foods that are liquid at room temperature such as this are considered a fluid and need to be counted in total fluid restriction

39. What are popsicles, soup, ice cream, and Jell-O

40. Heart failure patients who are obese may benefit from a hypocaloric diet to reduce stress on the heart and encourage weight loss. However, this is not appropriate in patients who are determined to be what

41. What is Malnourished?
Getting a good estimate of a dry weight and weight changes over time, in addition to a complete diet history is very important. Older patients decompensating quickly may be indicative of those malnourished or at risk for malnutrition.

42. In HF, there are 4 ways the heart can compensate for poor cardiac output. Name one of these ways:____

43. Increasing the force of contraction Increasing in size
Pumping more often.
Stimulating the kidneys to conserve sodium and water.
1. Increasing the force of contraction 2. Increasing in size 3. Pumping more often. 4. Stimulating the kidneys to conserve sodium and water.

44. This phrase is used to describe the end result of HF that occurs in 10-15% of patients. It involves involuntary weight loss of at least 6% over 6 months (not due to fluid) and contributes to the high prevalence of malnutrition in hospitalized patients with HF

45. What is cardiac cachexia?
…recall cachexia is the loss of lean body mass, not adipose tissue

46. Levels of this hormone are high in heart failure patients and can be a marker of wasting

47. What is adiponectin?
Often inversely correlated with BMI, some studies show adiponectin is increased in cardiac cachexia irrespective of BMI. This suggests a role of adiponectin in the wasting process of cachectic patients.
hormone adiponectin secreted by fat tissue acts in the brain to reduce body weight. When adiponectin, which is involved in glucose and lipid metabolism, 
BNP (B-natriuretic peptide) is secreted by ventricles in response to pressure and is predictive of severity and mortality from HF

48. Daily monitoring of this is recommended to detect fluid accumulation before it becomes symptomatic.

49. What is weight?

50. This describes a wasting syndrome that includes loss of lean tissue, muscle mass, and bone mass

51. What is cachexia?

52. Final Jeopardy
Make your wager

53. Final Answer

54. Final Question