Introduction:
The loss of muscle mass that occurs in cardiac cachexia may be due to the imbalance of protein synthesis and its degradation. Another reason may be intestinal malabsorption. Cachexia and cardiac cachexia are considered exceptional conditions because the fat accumulation provides protection instead of acting as a risk factor.
What Is Cachexia?
Cachexia is a wasting syndrome and a complex problem that can be considered more than a loss of appetite. In this condition, there is a change in how the body uses proteins, carbohydrates, and fat. The calories burn faster, and muscle and fat may be lost, both of which can be observed in this condition.
Researchers are still not aware of what happens in the body due to cachexia. This condition involves many organs and systems in the body. In this condition, there may be a development of insulin resistance. This occurs as the muscles, fat, and liver cells may not respond to insulin. Hence, the body cannot use glucose in the blood for energy.
Researchers have found that certain chemicals are released into the blood in cancer cases. These chemicals include cytokines and are considered to be responsible for the loss of fat and muscles. The chemicals can speed up the metabolism and use calories faster. There may be severe weight loss due to the faster use of calories. Even with normal eating, weight loss may be observed.
80 percent of individuals with advanced cancer may be affected by cachexia. This condition is associated with other conditions like heart disease, HIV (human immunodeficiency virus), and kidney disease. The side effects of cancer treatment can make this condition even worse.
What Is Cardiac Cachexia?
Cardiac cachexia is a condition in which there is a wasting of muscles among those affected by chronic heart failure. This condition may lead to weight loss, decreased physical activity, and reduced quality of life.
Cardiac cachexia may be seen in 10 to 39 percent of individuals affected by chronic heart failure. More than 20 million individuals may suffer from chronic heart failure in the world. Heart failure is a public health issue caused by structural and functional abnormalities in the heart. The main causes of heart failure include myocardial ischemia, systemic hypertension, dilated cardiomyopathy, Chagas’ disease, and valve-related diseases.
After the cardiac injury, there may be changes in the structure and functions of the ventricles. This is called cardiac remodeling. This process may be accompanied by neurohormonal and inflammatory changes that affect different organs and systems. In recent years, it has been found that pathological changes are not only seen in the cardiovascular system but can also be observed in the renal, neuroendocrinological, immunological, hematologic, gastrointestinal, and musculoskeletal systems. Changes are observed in nutritional status as well.
What Are the Causes of Cardiac Cachexia?
Many factors combine to cause cardiac cachexia among individuals with heart failure.
These include,
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Imbalance in the metabolism.
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Reduced intake of protein.
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Decreased absorption of nutrients.
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Less physical activity.
The exact causes are not known. It is thought that there is an imbalance in how the nervous system sends signals to the digestive system or the digestive tract.
What Are the Symptoms of Cardiac Cachexia?
The main symptom of cachexia is weight loss. Other symptoms of cardiac cachexia include,
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Feeling weak and tired.
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Shortness of breath.
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Being less physically active.
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Feeling nauseated.
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Loss of appetite.
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Constipation.
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Changes observed in the taste of foods.
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Loss of muscle strength.
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The immune system may be impaired.
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Experience anemia.
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Increased inflammation may be observed.
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Wound healing may be delayed.
Symptoms of cardiac cachexia may affect the quality of life of an individual.
How Heart Failure Is Related to Cardiac Cachexia?
It has been observed that chronic heart failure may occur due to changes in the structure and functions of the heart. These changes may lead to increased intracardiac pressure or changes in cardiac output. This may cause less perfusion to vital organs like the kidneys, intestines, or skeletal muscles. This process causes neurohormonal abnormalities and immunological activation, further resulting in an inflammatory process leading to muscle wasting.
Two types of hormones are responsible for the pathophysiology of cardiac cachexia:
Neurohormones- RAAS (renin-aldosterone-angiotensin-system), glucocorticoids, and testosterone.
Metabolic Hormones: These include growth hormones such as ghrelin, leptin, adiponectin, myostatin, and follistatin. The changes in these hormones and their interactions may reduce muscle mass, as occurs in the case of cardiac cachexia.
What Are the Complications of Cardiac Cachexia?
The complications of cardiac cachexia include,
Loss of Muscle Mass: Cardiac cachexia may lead to sarcopenia (loss of muscle mass). Sometimes, there may be a scar on the heart muscle. This may cause weakness and result in falls and injury.
Loss of Appetite: This may cause electrolyte and fluid imbalances.
Osteoporosis: This condition causes decreased bone density and can make an individual fall more likely.
Fatal: Cardiac cachexia may decrease the survival rate of an individual. It may become worse and be fatal.
How to Diagnose Cardiac Cachexia?
There is no particular test available to diagnose cardiac cachexia. Healthcare providers generally try to rule out the causes of weight loss.
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If an individual has lost 5 percent of body weight in six months without trying to lose weight, the doctor may advise blood tests for substances like albumin.
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Sometimes it is difficult to notice weight loss in an individual with heart failure. This may be because a failing heart causes retention of the water in the body and makes it swell. This may cause an increase in body weight. In such cases, other tests are advised to determine the loss of muscles.
Tests that can be advised in the case of cardiac cachexia include,
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Blood tests.
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Electrocardiogram.
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Echocardiogram.
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Chest X-ray.
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DEXA scan (Dual-energy X-ray absorptiometry).
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Computed tomography.
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Magnetic resonance imaging.
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Cardiopulmonary exercise testing.
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Excess fluid can be measured by right heart catheterization.
How to Treat Cardiac Cachexia?
There are no particular medicines available to treat cardiac cachexia. The doctor must continue to treat heart failure so that symptoms can be improved. Treatment can be given to eliminate the extra fluid responsible for the body's swelling.
Other treatments that can be given include,
Exercise: Exercises can be done to improve the strength of existing muscles and build new ones.
Eating Right: Education about eating right can improve cardiac cachexia.
Supplements: Vitamin C, D, and folate will be provided to improve the situation.
Medications: Medicines that can make an individual hungrier should be given.
Conclusion:
Cardiac cachexia is a complex condition that develops along with chronic heart failure. It leads to the wasting of muscles and weight loss. The reasons for this condition may be different . Hence, it is important to know about this complex condition called cardiac cachexia, its causes, symptoms, complications, and management. Further research is required to know more about this condition.
