Cardiac Cachexia

What is cardiac cachexia?

Cardiac cachexia (kuh KEK see uh) is a type of malnutrition and muscle loss that affects people with heart failure, usually in the end stage. Cachexia translates to “bad condition.” It can affect people with multiple illnesses that result in a state of unintentional muscle wasting and weight loss.

Multiple causes combine to make people with heart failure lose weight when they aren’t trying. Healthcare providers define the amount of unintentional weight loss for cardiac cachexia as 5% during the past year. Others say 6% or more weight loss (along with other symptoms) means you have cardiac cachexia.

How common is cardiac cachexia?

Cardiac cachexia affects about 10% to 39% of people who have chronic heart failure with symptoms. More than 20 million people in the world have chronic heart failure.

What are the symptoms?

Symptoms of cardiac cachexia include:

• Losing more than 5% of your weight (fat, not fluid) in less than a year without trying.
• Losing muscle strength.
• Feeling very tired.
• Being unable to complete daily activities because of low energy.
• Losing your desire to eat.

What causes cardiac cachexia?

Multiple factors add up to cause cardiac cachexia in people with severe heart failure, such as:

• Having an imbalance in your metabolism.
• Eating or drinking too little protein.
• Not absorbing nutrients well.
• Not being physically active.

What are the complications of cardiac cachexia?

Cardiac cachexia can lead to sarcopenia (losing muscle mass) and sometimes scarring on your heart muscle. It can lead to frailty and weakness, which in turn can lead to falls and injuries. Loss of appetite can lead to electrolyte and fluid derangements. Cachexia can lead to osteoporosis, which causes decreased bone density and can make you more likely to have falls and fractures. Also, cardiac cachexia can get worse and be fatal.

How is cardiac cachexia diagnosed?

A healthcare provider can diagnose cardiac cachexia when you’ve slowly lost 5% or more of your weight during the last year and also have at least three of these issues:

• Fatigue.
• Loss of muscle strength or mass.
• Anorexia.
• Inflammation.
• Anemia.
• Too little of the albumin protein.

What tests will be done to diagnose cardiac cachexia?

A provider will order lab tests and imaging tests, such as:

• Blood tests.
• Electrocardiogram (EKG).
• Echocardiogram.
• Chest X-ray.
• DEXA (DXA) scan.
• Computed tomography (CT).
• Magnetic resonance imaging (MRI).
• Cardiopulmonary exercise testing.

These tests are important because people with heart failure have swelling that can make it difficult to measure body mass index (BMI).

A right heart catheterization can help a provider see how much excess fluid you have. This can also help with figuring out how much weight you’ve lost and how much fluid your body is retaining (holding).

How is cardiac cachexia treated?

Cardiac cachexia treatment isn’t as simple as eating more food. This complex condition requires more than one kind of approach.

You can expect a provider to tell you to do some aerobic exercise to help you prevent more muscle loss. Researchers have found that exercise is one of the best forms of cardiac cachexia treatment. Cardiac rehab can help people with heart failure:

• Improve their quality of life.
• Have fewer hospital stays.
• Live longer.

A healthcare provider may admit you to the hospital if you’re fainting and have very low blood pressure. They’ll keep checking your weight and how much you’re able to eat and drink. You can go home after you take in enough nutrition. Over the next two to four weeks, you’ll need to see a:

• Cardiologist.
• Nutritionist.
• Primary care provider.

If your heart failure is at an advanced stage, it may not be possible to reverse cachexia without treating the underlying heart failure. This may require an appointment with an advanced heart failure specialist. They may be able to prescribe medications or (if appropriate) refer you for surgery including a mechanical heart pump or heart transplant.

Specific medicines or supplements used

A provider may order:

• Protein supplement.
• Vitamins C and E.
• Omega-3 fatty acids.
• Anabolic steroids.
• Human growth hormone (HGH).
• Ghrelin receptor agonists.
• Beta-blockers.
• Selective androgen receptor modulators.

Side effects of the treatment

Side effects of more common medications for cardiac cachexia may include:

• Oily skin.
• Ankle swelling.
• Fatigue.
• Nausea.
• Dizziness.
• Trouble sleeping (insomnia).

How can I lower my risk of cardiac cachexia?

To help lower your risk of cardiac cachexia, a provider may prescribe medicines such as:

• Angiotensin-converting enzyme (ACE) inhibitors.
• Beta-blockers.
• Loop diuretics.
• Aldosterone antagonists.

What can I expect if I have cardiac cachexia?

Cardiac cachexia often has a poor prognosis. However, getting a prompt diagnosis and treatment for cardiac cachexia can help improve your outcome. The sooner you start treatment, the better your chances of improving your situation.

Does cardiac cachexia cause death?

Yes, it can. The prognosis for cardiac cachexia isn’t good. About 50% of people who have the condition die in 18 months. Some people only survive three, six or 12 months, according to one study.

How do I take care of myself?

Eating soft foods may help you avoid having shortness of breath while eating. Consuming smaller meals more often may help, too.

Healthcare providers have different opinions on how much salt you should have, so check with your provider for their recommendation. Many providers agree that the Mediterranean Diet and DASH diet are good for people with cardiac cachexia.

Take any nutritional supplements your provider believes will help you. These can improve your quality of life and survival. Improving your body’s intake of nutrients can help prepare you for surgery if you’re receiving a heart transplant.

When should I see my healthcare provider?

Talk to your healthcare provider about how often they want to see you. You may need frequent check-ins, even if it’s just to report your weight and calorie intake.

What questions should I ask my doctor?

Questions to ask your healthcare provider include:

• How advanced is my cardiac cachexia?
• Can you recommend a specific diet for me?
• What are the best nutritional supplements for me?

A note from Cleveland Clinic

If you have advanced heart failure and notice some weight loss, talk to your healthcare provider right away. The swelling that happens in people with heart failure can keep you from seeing the severity of the weight loss. Be an advocate for yourself so you can get the help you need to keep cardiac cachexia from getting worse.