Prise en charge nutritionnelle d’un patient atteint d’une insuffisance cardiaque

Weight loss in chronic heart failure (CHF) occurs frequently, progressively and its reversal is rare. Weight loss of more than 6% is used to define the presence of cachexia. Patients with CHF develop skeletal muscle and cardiac muscle atrophy. Anorexia plays a significant role in only 10–20% of all cases of cardiac cachexia. Higher resting metabolic rate in patients with heart failure at least partially accounts for unexplained weight loss. Fat malabsorption and protein loss are thought to be influenced mainly by bowel perfusion and bowel edema and may contribute to the development of cardiac cachexia. A severe catabolic/anabolic imbalance in favor of catabolic metabolism is observed in cachectic CHF patients. Food intake should be assessed in order to identify and stop dietary restrictions recommended for cardiovascular risk factors and no more indicated in patients with cachexia. Many enriched small meals are necessary to cover energy and protein requirements. If this first attempt fails, nasogastric tube feeding is indicated. Parenteral nutrition should be reserved for those patients in whom enteral nutrition has failed.