Cardiac Cachexia

  • Author Footnotes
    1 Julie Cavey, DNP, APNP, works with advanced heart failure/cardiac transplant service at St Luke's Medical Center in Milwaukee, WI
    Julie Cavey
    1 Julie Cavey, DNP, APNP, works with advanced heart failure/cardiac transplant service at St Luke's Medical Center in Milwaukee, WI
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  • Author Footnotes
    1 Julie Cavey, DNP, APNP, works with advanced heart failure/cardiac transplant service at St Luke's Medical Center in Milwaukee, WI


      Cardiac cachexia is a form of malnutrition and complication of advanced heart failure. The weight loss is unintentional and occurs from catabolic processes that are neurohormonal, immunological, and metabolic in origin. Body wasting of bone, muscle, and fat tissue; dyspnea; malabsorption or loss of nutrients through the gastrointestinal tract; deconditioning; and anorexia are present in cardiac cachexia. The body initially compensates, but the heart further decompensates, and terminal hemodynamic compromise occurs. Defining and diagnosing this syndrome has improved through recent research. The purpose of this article is to present current evidence regarding cardiac cachexia and management strategies that advance practice nurses can use.


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        • Anker S
        • Sharma R
        The syndrome of cardiac cachexia.
        Int J Cardiol. 2002; 85: 51-66
        • Thomas DR
        Loss of skeletal muscle in aging: examining the relationship of starvation, sarcopenia and cachexia.
        Clin Nutrit. 2007; 26: 389-399
        • Moughrabi S
        • Evangelista L
        Cardiac cachexia at a glance.
        Progress Cardiovasc Nurs. 2007; 4: 101-102
        • Anker S
        • Coats A
        Cardiac cachexia: A syndrome with impaired survival and immune and neuroendocrine activation.
        Chest. 1999; 3: 836-847
        • Lloyd J
        • Adams R
        • Camethon M
        • et al.
        Heart disease and stroke statistics: 2009 update.
        Circulation. 2009; 119: e21-e181
        • vonHealing S
        • Doehner W
        • Anker S
        Nutrition, metabolism, and the complex physiology of cachexia in chronic heart failure.
        Cardiovasc Res. 2007; 73: 298-309
        • Araujo J
        • Lourenco P
        • Rocha-Goncalves F
        • et al.
        Nutritional markers and prognosis in cardiac cachexia.
        Int J Cardiol. 2009; 7: 1-5
        • Shirley S
        • Davis L
        • Waag Carlson B
        The relationship between body mass index/body composition and survival in patients with heart failure.
        Am Acad Nurs Pract. 2008; 20: 326-332
        • Freeman L
        The pathophysiology of cardiac cachexia.
        Curr Opin Support Palliat Care. 2009; 3: 276-281
      1. cardiovascular effects, ACE inhibitors have been Tsai B, Pitcher J, Meldrum D, et al. Hypoxic pulmonary vasoconstriction and pulmonary artery cytokine expression are mediated by protein kinase C. Am J Physiol Lung Cell Mol Physiol. 200;287:1215-1219.

        • Doehner W
        • Pilaum C
        • Rauchhaus M
        • et al.
        Leptin, insulin sensitivity and growth hormone binding protein in chronic heart failure with and without cardiac cachexia.
        Eur J Endocrinol. 2001; 145: 727-739
        • Sacca L
        Heart failure as a multiple hormonal deficiency syndrome.
        Circulation. 2009; 2: 151-156
        • Jankowski E
        • Biel B
        • Majda J
        • et al.
        Anabolic deficiency in men with chronic heart failure: Prevention and Detrimental Impact on survival.
        Circulation. 2006; 114: 1829-1837
        • Jacobsson A
        • Pihl E
        • Martensson J
        • Fridlund B
        Emotions, the meaning of food and heart failure: A grounded theory study.
        Issues Innovations Nurs Pract. 2004; 46: 514-522
        • Piano M
        • Prasun M
        Neurohormone activation.
        Crit Care Nurs Clin North Am. 2003; 15: 413-421
        • Springer J
        • Filippatos G
        • Akashi Y
        • Anker S
        Prognosis and therapy approaches of cardiac cachexia.
        Curr Opin Cardiol. 2006; 21: 229-233
        • Berry C
        • Clark A
        Catabolism in chronic heart failure.
        Eur Heart J. 2000; 21: 521-532
        • Katz A
        • Katz P
        Diseases of the heart in the works of Hippocrates.
        Br Heart J. 1962; 24: 257-264
        • Oreopoulos A
        • Ezekowitz J
        • McAlister F
        • Kalantar-Zadhr K
        • et al.
        Association between direct measures of body composition and prognostic factors in chronic heart failure.
        Mayo Clinic Proc. 2010; 85: 609-617
        • Wilson D
        in: Laboratory and Diagnostic Tests. McGraw Hill, New York2008: 455
        • Scirica B
        • Cannon C
        • Sabatine M
        • Jarolim P
        • et al.
        Concentrations of C-reactive protein and B-type naturetic peptide 30 days after acute coronary syndromes independently predicts hospitalizations for heart failure and cardiovascular death.
        Clin Chem. 2009; 55: 265-273
        • Black S
        • Kushner I
        • Samols D
        C-Reactive protein.
        J Biol Chem. 2004; 279: 48487-48490
      2. Cachexia and omega-3 polyunsaturated fatty acids.
        Palliat Med. 2005; 19: 500-502
        • vonHealing S
        • Sandek A
        • Anker S
        Pleiotropic effects of angiotensin-converting enzyme inhibitors and the future of cachexia therapy.
        J Am Geriatr Soc. 2005; 53: 2030-2031
        • DelFabbro E
        • Dalal S
        • Bruera E
        Symptom control in palliative care-Part II: Cachexia/anorexia and fatigue.
        J Palliat Med. 2006; 9: 409-421
        • Khawam E
        • Luarencic G
        • Malone D
        Side effects of antidepressants: an overview.
        Cleveland Clin J Med. 2006; 743: 351-361

      Uncited reference

        • Akner G
        • Cederholm T
        Treatment of protein energy malnutrition in chronic nonmalignant disorders.
        Am J Clin Nutr. 2001; 74: 6-24