Possibility to Manage Heart Failure with Non-pharmacological Measures: Analytical Essay

“Can Heart failure be managed effectively with non-pharmacological measures?”

The heart's main functions are to pump blood, nutrients, oxygen and hormones around the body. There are two types of heart failure; Heart failure with reduced ejection fraction (HFrEF) or systolic failure and Heart failure with preserved ejection fraction (HFpEF) or diastolic failure[9]. 70-75% of cardiac patients suffer from systolic heart failure and this is where the left ventricle loses its ability to contract normally. Diastolic heart failure is where the left ventricle loses its ability to relax normally. Both cases have the same level of danger, however there is no medication to reverse the effects of heart disease - only to slow it down. Symptoms of systolic heart failure are:

• Paroxysmal nocturnal dyspnea (severe shortness of breath and coughing usually at night)
• Orthopnea (shortness of breath when lying flat)
• Tachycardia (when the heart beats more than 100 times per minute)
• Cyanosis (a bluish discolouration to the hands or feet)
• Blood-tinged sputum (coughing up blood)
• Symptoms of diastolic heart failure are:
• Ascites (protein-containing fluid within the abdomen)
• Distended jugular vein (the pressure of the superior vena cava causes the jugular vein to bulge) [8]
• Dependent edema (swelling in the lower body)
• Fatigue
• Weight gain
• Enlarged liver and spleen

In this essay, I will look at managing heart failure effectively with non-pharmacological measures including; diet, salt, fluid, alcohol, smoking, exercise, stress and vaccination.

Diet

For a cardiac patient, they have to increase and decrease a lot of nutrients. For someone suffering from heart failure, doctors recommend 10-35% of their daily calories are proteins (around 46g for women and 56g for men) [14]. Research carried out by doctors have proved that heart failure patients have a higher need for protein intake than those without heart failure. However, generally red meats - such as beef, pork or lamb - have saturated fats in them which can raise the level of the patients blood cholesterol, worsening the effects of heart failure. Nonetheless, lean meats - such as chicken, turkey or fish - have unsaturated fats which actually have health benefits. Lean meats are also a good source of omega-3, vitamin B12, fatty acids, zinc, iron and niacin. Niacin helps increase the levels of HDL (high-density lipids) which is the “good” cholesterol. Vitamin B12 has been shown to decrease levels of homocysteine, a type of amino acid affiliated with heart disease. Patients with heart failure have been seen to have lower levels of zinc, which is essential to the maintenance of normal cellular structures and functions. Iron deficiency raises the risks of heart disease and also worsens the effects of heart failure as it worsens symptoms and increases mortality risk. Iron helps the formation of red blood cells that carry oxygen around the body and also regulates many important sub-cellular functions. Omega-3 fatty acids decreases blood pressure, reduces irregular heart beats and decreases triglycerides (a type of lipid found in the blood)

Salt

One way to effectively manage heart failure without any medication is to reduce the salt in their diet. For a person going through heart failure, it is important to cut out as much salt as possible as having too much can worsen the effect of fluid buildup that happens with heart failure because salt retains water. A low-salt diet can help keep blood pressure and swelling under control [1]. It is good to choose fruits and vegetables, grains and beans, and fresh, frozen, dried fruits, fresh meats, rice and pasta and bread as they are all low in salt[11]. For a cardiac patient, it is recommended to have no more than 2.300 mg (about 1 teaspoon), but it is ideal to have less than 1,500 mg (about ¾ of a teaspoon) of salt per day. It is also important for a cardiac patient to eat fibre-rich foods as it controls blood sugar levels and can reduce the level of cholesterol in the blood [2]. One way to calculate the amount of sodium in foods is by looking at the Nutrition Facts label (some claim to be “sodium free” or “low in salt”). If there is less than 5mg of salt per serving - it is sodium free; if there is very low salt - it would be less than 35mg of salt per serving and if there is reduced salt - it should be less than 140mg per serving. However, salt does occur naturally in foods so it is good to stay away from certain types such as; smoked, cured, salted or canned fish, meat or poultry (ham, sausage, sardines or anchovies); frozen breaded meats or dinners (burritos or pizza); salted nuts and canned entreés such as ravioli, spam or chili; cottage cheese; pizza croutons or salted crackers, olives, pickles or sauerkraut; large portions of ketchup or mustard; salted butter or margarine and instant puddings and cakes [13]. To further reduce salt levels, the patient can avoid instant foods or takeaways and try new cookbooks such as “Dietitians of Canada” [12].

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Alcohol

It is also important to cut back on alcohol as it can affect the heart rate and worsen the effects of heart failure. Drinking more than the recommended amount (1 drink a day for women and two for men) can cause abnormal heart rhythms, high blood pressure and cause further damage to the heart [3].

Smoking

Smoking can not only lead to but also worsen cardiovascular diseases. The chemicals in cigarette smoke can cause the cells that line the blood cells to swell up, narrowing the blood cells and leading to many heart diseases. Continuing to smoke once they have heart failure can worsen the effects, so there is no safe amount of cigarettes to smoke. Even smoking versions of cigarettes with reduced tar and nicotine isn’t any better. It still doesn’t reduce the effects of heart failure.

Exercise

Exercising can help a patient suffering from heart failure. In the past, doctors used to think that the best thing to do was to give up physical activities- but it has been proved wrong. Activity including work and exercise is safe for most people with CVD. Exercise can help make the patient feel better, decrease the symptoms and can even improve the heart's function. There are specialized programs for cardiac patients at health care centres[10]. They have specialized staff to help them exercise safely, frequently monitor the patients health and they can teach them how to maintain a healthy heart lifestyle [4].

Stress

Stress is a normal human emotion, but if left to fester it can lead to many emotional, psychological and physical factors such as; irregular heart beats, chest pains, high blood pressure and even heart disease [5]. Stress increases the risk of heart disease as it leads to an increase in the patients blood pressure. However, scientists are unsure whether stress itself is a risk factor or if it leads to other risk factors like smoking. If stress itself is a risk factor, then chronic stress can expose the body to unhealthy elevated levels of adrenaline and cortisol [6]. To cope with stress, patients can exercise regularly, stop smoking and get enough sleep each night [7]

Vaccination

In America 2010 it was recommended that heart failure patients take the pneumococcal vaccination and influenza vaccination. Complications with the flu (influenza) are more likely to occur in people with heart failure. However, getting the vaccination can reduce the risk of catching or developing complications from influenza.

1. “Heart failure and a low-salt diet” https://www.webmd.com/heart-disease/heart-failure/low-sodium-eating#1 [6th December 2019]
2. “Diet and Heart failure” https://www.webmd.com/heart-disease/heart-failure/dietary-guidelines-heart-failure [6th December 2019]
3. “Alcohol” https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating/alcohol [6th December 2019]
4. “Exercise and activity with heart failure” https://www.hfsa.org/patient/patient-tools/educational-modules/module-5/ [6th December 2019]
5. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
6. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
7. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
8. https://www.researchgate.net/figure/Marked-bilateral-distention-of-external-jugular-veins-clearly-evident-in-patient_fig1_328832580 [11th December 2019]
9. http://www.globalsciencejournals.com/article/10.7603/s40602-015-0004-x [11th December 2019]
10. https://www.mfa.net/center/guilford-health-care-center [11th December 2019]
11. https://www.ottawaheart.ca/heart-failure-patient-guide/nutrition-guide-heart-failure [18th December 2019]
12. https://www.ottawaheart.ca/heart-failure-patient-guide/nutrition-guide-heart-failure
13. https://www.ucsfhealth.org/education/guidelines-for-a-low-sodium-diet [1st January 2020]
14. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/protein-and-heart-health [1st January 2020]
15. https://www.nia.nih.gov/health/heart-health-and-aging [1st January 2020]