Fixing cardiac cachexia is not as easy as you might think.

• Physiological systems are interdependent, and just like a cat's cradle, when you pull on one string, there may be far reaching consequences.
• First, the problem is linked to a failing heart, which may not be fixable.
• The basic approach is:
  • Improve heart function and reduce tissue hypoxia.
  • Prevent infections and other conditions that further debilitate the patient.
  • Meet hyperbolic state with adequate calories.
• Many CHF patients also have diabetes and renal impairment which complicates things, especially with regard to daily carbohydrate and protein intake.

• Small, frequent meals to prevent high serum glucose levels and rapid fat infusion.
• Preferred foods, at least those that are reasonable, to improve appetite and intake.
• The so called 'heart healthy' diet may have to wait, rather focus on intake for now.
• Calories are generally figured at 1.5 times calculated daily need.
• High protein diet may not be indicated particularly if there is renal impairment
• Restrict sodium and adjust potassium based on lab values.
• Supplement vitamins and minerals
• Thiamine, folate, B₁₂, B₆, and E
• Magnesium, zinc and possibly iron (careful with iron, check serum levels first).
• Enteral or parenteral (intravenous) nutrition may be needed.

Our next patient is a 32 year-old Native American woman who complains of lethargy.