Chronic Heart Failure

CHRONIC HEART FAILURE / RIGHT HEART FAILURE / COR-PULMONALE

Chronic heart failure is a syndrome which results in a low cardiac output and congestive symptoms due to abnormality of cardiac function.

CAUSES:

  • Right ventricular infarction (death of a part of the chamber of the heart due to lack of blood supply to it).
  • Valvular heart disease (pulmonary or tricuspid valve disease)
  • Isolated right ventricular cardiomyopathy (a chronic disorder of the muscles of the heart)
  • Primary pulmonary hypertension
  • Secondary pulmonary hypertension – Left heart failure
  • – Chronic lung disease (cor pulmonale)

SIGN AND SYMPTOMS:

  • Weakness, fatigue.
  • Scanty urination.
  • Headache.
  • Sleeplessness.
  • Restlessness.
  • Sluggish mental state.
  • Cough.
  • Labored breathing at rest or on mild to severe exertion.
  • Breathlessness that prevents the patient from lying down and makes them sit propped up (orthopnoea).
  • Lack of appetite.
  • Nausea.
  • Vomiting.
  • Fullness after meals.
  • Pain in the right upper part of the abdomen situated below the ribs.
  • Need to pass urine at night.
  • Accumulation of fluid in the feet.
  • Generalized massive swelling of the legs, trunk and genitalia due to retention of fluid.
  • Stools are pale, offensive, greasy and difficult to wash off.

DIETARY MANAGEMENT:

  • Cut down salt (common table salt) intake in your diet; do not exceed more then 2 to 2.5 gm a day.
  • Reduce intake of fluids, it should be under medical guidance.
  • Take frequent small, bland, low caloric feeds at the onset of disease.
  • Eat boiled food, without spices.
  • Instead of frying – boil, steam, grill or roast food.
  • Add very little salt to food; do not add salt to cooked food.
  • Avoid other sources of salts like- baking powder and baking soda (sodium bicarbonate), monosodium glutamate and sodium benzoate. These are commonly known as Worcestershire sauce, soy sauce, onion salt, garlic salt and bullion salt.
  • Avoid salt-preserved foods like ketchups, sauces, pickles, canned and processed foods.
  • Consume food rich in magnesium
  • – Nuts and sea food, green leafy vegetables, sea plants like Japanese sea plants, whole grains Peas, lotus stem, pulses, legumes and oil seeds
  • Increase calcium intake:-
  • – milk and sea food, nuts, green leafy vegetables, whole grains, peas, lotus stem, pulses, legumes and oil seeds
  • Avoid diet rich in saturated fats e.g. meat, eggs, milk products, cheese, butter etc.
  • Avoid foods rich in cholesterol: ground nut oil, ghee, butter, whole milk, eggs, lard (fats derived from pig meat), tallow (fats derived from goat or sheep mutton) – all non-vegetarian food contain cholesterol in varied amount.
  • Increase intake of foods that contain PUFA`s (poly unsaturated fatty acids): flax / linseed oil is the richest source of PUFA`s. Other oils that contain PUFA`s are safflower oil, soybean oil, sesame oil, olive oil etc. As all oils are high in fats, its consumption should be limited. The intake of oils should not exceed 10-15 gm a day.
  • Consume whole grain cereals and whole pulses.
  • Take high fiber diet – whole grains, bran, oat, green leafy vegetables, peas, beans, potatoes, raw vegetables, salads, dried fruits and fresh fruits.
  • Cut down the intake of sugar and other sweeteners.
  • Replace whole milk with semi-skimmed or skimmed milk.
  • Avoid fat-rich desserts and fried snacks like cakes, pastries, puddings etc.