{"id":1912,"date":"2023-06-14T12:14:38","date_gmt":"2023-06-14T15:14:38","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1912"},"modified":"2023-10-24T12:48:17","modified_gmt":"2023-10-24T15:48:17","slug":"nutricao-parenteral-doenca-cardiaca","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-doenca-cardiaca\/","title":{"rendered":"Quais s\u00e3o as recomenda\u00e7\u00f5es da nutri\u00e7\u00e3o parenteral para doen\u00e7as card\u00edacas?"},"content":{"rendered":"<p>Em pacientes com diversas condi\u00e7\u00f5es cr\u00f4nicas, a interven\u00e7\u00e3o nutricional adequada \u00e9 parte essencial do manejo cl\u00ednico apropriado. E isso inclui problemas no cora\u00e7\u00e3o, que n\u00e3o raro progridem para quadros de insufici\u00eancia card\u00edaca, associados a diferentes graus de desnutri\u00e7\u00e3o. <strong>Desse modo, a nutri\u00e7\u00e3o parenteral para pessoas com doen\u00e7as card\u00edacas \u00e9 indicada em diferentes contextos. <\/strong><\/p>\n<p>Sem d\u00favida, avaliar e reconhecer aqueles pacientes que se beneficiam da introdu\u00e7\u00e3o da <a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/dosagens-adequadas-na-nutricao-parenteral-entenda-a-importancia\/\">nutri\u00e7\u00e3o parenteral<\/a> pode contribuir para desfechos positivos, sempre de forma a minimizar os riscos de complica\u00e7\u00f5es ou mesmo das consequ\u00eancias do estado nutricional inadequado.<\/p>\n<p>&nbsp;<\/p>\n<h2>O aspecto nutricional no paciente card\u00edaco<\/h2>\n<p>Pacientes com problemas card\u00edacos, principalmente insufici\u00eancia card\u00edaca cr\u00f4nica, podem ser acometidos com a chamada caquexia card\u00edaca<sup>1<\/sup>. \u00a0Cabe refor\u00e7ar que alguns dos dist\u00farbios cardiovasculares mais comuns relacionados \u00e0 insufici\u00eancia card\u00edaca s\u00e3o<sup>2<\/sup>:<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>isquemia do mioc\u00e1rdio;<\/li>\n<li>hipertens\u00e3o arterial sist\u00eamica;<\/li>\n<li>cardiomiopatia dilatada;<\/li>\n<li>doen\u00e7a de Chagas;<\/li>\n<li>doen\u00e7a valvular card\u00edaca.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>A partir disso, a caquexia card\u00edaca \u00e9 caracterizada por perda n\u00e3o intencional de peso acima de 5% nos \u00faltimos 12 meses ou IMC abaixo dos 20 kg\/m<sup>2 1<\/sup>. Al\u00e9m disso, o paciente deve apresentar uma condi\u00e7\u00e3o cr\u00f4nica e ao menos tr\u00eas dos marcadores cl\u00ednicos a seguir<sup>1<\/sup>:<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Decr\u00e9scimo da for\u00e7a muscular;<\/li>\n<li>Fadiga;<\/li>\n<li>Anorexia;<\/li>\n<li>Baixo n\u00edvel de gordura corporal;<\/li>\n<li>Altera\u00e7\u00f5es bioqu\u00edmicas, caracterizadas sobretudo pela eleva\u00e7\u00e3o de marcadores inflamat\u00f3rios (prote\u00edna reativa C ou interleucina IL-6), anemia (Hb abaixo de 12g\/dL) ou baixa albumina s\u00e9rica (abaixo de 3.2 g\/DL);<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Desse modo, essa condi\u00e7\u00e3o est\u00e1 associada a uma sobrevida menor, independente de outras vari\u00e1veis relevantes, como idade e grau de comprometimento card\u00edaco<sup>1<\/sup>. <\/strong><\/p>\n<p>No mais, o desequil\u00edbrio nutricional est\u00e1 relacionado a acelera\u00e7\u00e3o de altera\u00e7\u00f5es morfol\u00f3gicas e fisiol\u00f3gicas, mesmo em um cora\u00e7\u00e3o saud\u00e1vel (a partir de estudos experimentais com ratos)<sup>3-8<\/sup>, bem como o agravamento de anemias associadas \u00e0 insufici\u00eancia card\u00edaca<sup>9<\/sup>.\u00a0 <strong>Algumas evid\u00eancias apontam que a insufici\u00eancia card\u00edaca tamb\u00e9m pode comprometer a perfus\u00e3o intestinal, levando \u00e0 forma\u00e7\u00e3o de edemas na parede do intestino<sup>9<\/sup>, com consequente piora da absor\u00e7\u00e3o de nutrientes, prejudicando ainda mais o estado nutricional<sup>10,11,12.<\/sup><\/strong><\/p>\n<p><em><sup>\u00a0<\/sup><\/em><\/p>\n<h2>As indica\u00e7\u00f5es de nutri\u00e7\u00e3o parenteral para doen\u00e7as card\u00edacas<\/h2>\n<p>Posto que pacientes com insufici\u00eancia card\u00edaca experimentam maior dificuldade de manter um consumo cal\u00f3rico adequado<sup>13<\/sup>, o que pode desencadear a caquexia card\u00edaca, \u00e9 fundamental que eles recebam suporte nutricional adequado.<\/p>\n<p>Assim sendo, <strong>de acordo com as <\/strong><a href=\"https:\/\/espen.info\/documents\/0909\/Cardiology%20and%20Pneumology.pdf\"><strong>diretrizes espec\u00edficas para o manejo de pacientes com problemas cardiol\u00f3gicos e pulmonares <\/strong><\/a><strong>da ESPEN (<em>The European Society for Clinical Nutrition and Metabolism<\/em>), as vias oral e enteral devem ser a escolha de prefer\u00eancia para oferta nutricional nesses quadros<\/strong>. Essa orienta\u00e7\u00e3o se d\u00e1 pelo menor risco de complica\u00e7\u00f5es e pelo impacto econ\u00f4mico<sup>14<\/sup>, quando comparada a nutri\u00e7\u00e3o parenteral.<\/p>\n<p>De todo modo<strong>, a via parenteral \u00e9 indicada sempre que as vias oral e enteral n\u00e3o estiverem dispon\u00edveis ou a ingest\u00e3o alimentar for insuficiente para atingir 100% das necessidades nutricionais<sup>14<\/sup><\/strong>. Tal recomenda\u00e7\u00e3o segue a mesma orienta\u00e7\u00e3o conhecida para pacientes graves admitidos em ambiente hospitalar devido a outros problemas.<\/p>\n<p>Seguindo a mesma diretriz da ESPEN, embora n\u00e3o haja na literatura estudos espec\u00edficos bem desenhados para avaliar a introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes card\u00edacos, ela deve ser introduzida para interromper, minimizar ou reverter a perda de peso, principalmente por conta da m\u00e1 absor\u00e7\u00e3o<sup>14<\/sup>.\u00a0 <strong>Por outro lado, a mesma diretriz<sup>14<\/sup> n\u00e3o indica a <\/strong><a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/como-e-aplicada-a-nutricao-parenteral\/\"><strong>prescri\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral<\/strong><\/a><strong> de modo profil\u00e1tico (ou seja, para prevenir o quadro de caquexia card\u00edaca).<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong><em>Leia tamb\u00e9m:<\/em><\/strong><a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/post-o-que-e-nutricao-parenteral\/\"><strong><em> afinal, o que \u00e9 nutri\u00e7\u00e3o parenteral? <\/em><\/strong><\/a><\/p>\n<p><strong><em>\u00a0<\/em><\/strong><\/p>\n<h2>Eventuais contraindica\u00e7\u00f5es da nutri\u00e7\u00e3o parenteral para doen\u00e7as card\u00edacas<\/h2>\n<p>Por fim, n\u00e3o h\u00e1 contraindica\u00e7\u00e3o espec\u00edfica para introdu\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral. Logo, devem ser considerados os mesmos aspectos gerais para pacientes com outras condi\u00e7\u00f5es. Todavia, vale considerar situa\u00e7\u00f5es espec\u00edficas tais como fun\u00e7\u00e3o card\u00edaca diminu\u00edda e reten\u00e7\u00e3o de fluidos.<\/p>\n<p><strong>Nesse sentido, a nutri\u00e7\u00e3o parenteral deve ser evitada ou acompanhada de cuidados para que a sobrecarga de volume de fluidos nesses pacientes n\u00e3o prejudique sua condi\u00e7\u00e3o e torne-se uma interven\u00e7\u00e3o inefetiva<sup>14<\/sup><\/strong>.<\/p>\n<p>Ainda que estudos adicionais devam ser conduzidos para refor\u00e7ar este t\u00f3pico, a nutri\u00e7\u00e3o parenteral nas doen\u00e7as card\u00edacas comp\u00f5e um recurso importante para reverter o impacto da desnutri\u00e7\u00e3o hospitalar, principalmente se acometidos pela caquexia.<\/p>\n<p>&nbsp;<\/p>\n<p>Aproveite para saber mais sobre outras indica\u00e7\u00f5es de nutri\u00e7\u00e3o parenteral no artigo dispon\u00edvel <a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/indicacao-nutricao-parenteral\/\">aqui.<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Refer\u00eancias<\/strong><\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li>Okoshi MP, Capalbo RV Romeiro FG, Okoshi K. Cardiac cachexia: perspectives for prevention and treatment. <em>Arq BrasCardio<\/em>.2016;<em>108<\/em>: 74-80. Dispon\u00edvel em: <a href=\"https:\/\/www.scielo.br\/j\/abc\/a\/JdxHDwtW8KLsGFcN9NvgMhM\/?lang=en&amp;format=html\">https:\/\/www.scielo.br\/j\/abc\/a\/JdxHDwtW8KLsGFcN9NvgMhM\/?lang=en&amp;format=html<\/a> Acesso em fev. 2023.<\/li>\n<li>Bocchi EA, Marcondes-Braga FG, Bacal F, Ferraz AS, Albuquerque D, Rodrigues D, et al. [Updating of the Brazilian guideline for chronic heart failure &#8211; 2012]. Arq Bras Cardiol. 2012;98(1 Suppl 1):1-33. Dispon\u00edvel em <a href=\"https:\/\/www.scielo.br\/j\/abc\/a\/j966TNy8Qr8ph7TQfLJXmky\/?lang=pt\">https:\/\/www.scielo.br\/j\/abc\/a\/j966TNy8Qr8ph7TQfLJXmky\/?lang=pt<\/a> Acesso em fev. 2023.<\/li>\n<li>Okoshi MP, Okoshi K, Pai VD, Pai-Silva MD, Matsubara LS, Cicogna AC. Mechanical, biochemical, and morphological changes in the heart from chronic food restricted rats. Can J Physiol Pharmacol. 2001;79(9):754-60.<\/li>\n<li>Cicogna AC, Padovani CR, Okoshi K, Matsubara LS, Aragon FF, Okoshi MP. The influence of temporal food restriction on the performance of isolated cardiac muscle. Nutr Res. 2001;21(4):639-48.<\/li>\n<li>Cicogna AC, Padovani CR, Okoshi K, Aragon FF, Okoshi MP. Myocardial function during chronic food restriction in isolated hypertrophied cardiac muscle. Am J Med Sci. 2000;320(4):244-8.<\/li>\n<li>Okoshi K, Fioretto JR, Okoshi MP, Cicogna AC, Aragon FF, Matsubara LS, et al. Food restriction induces in vivo ventricular dysfunction in spontaneously hypertensive rats without impairment of in vitro myocardial contractility. Braz J Med Biol Res. 2004;37(4):607-13.Dispon\u00edvel em: <a href=\"https:\/\/www.scielo.br\/j\/bjmbr\/a\/ZMWS7mvVhZfPnLGdDS8f5kJ\/?lang=en\">https:\/\/www.scielo.br\/j\/bjmbr\/a\/ZMWS7mvVhZfPnLGdDS8f5kJ\/?lang=en<\/a>\u00a0 Acesso em fev. 2023.<\/li>\n<li>Okoshi MP, Okoshi K, Matsubara LS, Pai-Silva MD, Gut AL, Padovani CR, et al. Myocardial remodeling and dysfunction are induced by chronic food restriction in spontaneously hypertensive rats. Nutr Res. 2006;26(11):567-72.<\/li>\n<li>Gut AL, Sugizaki MM, Okoshi MP, Carvalho RF, Pai-Silva MD, Aragon FF, et al. Food restriction impairs myocardial inotropic response to calcium and beta-adrenergic stimulation in spontaneously hypertensive rats. Nutr Res. 2008;28(10):722-7. Dispon\u00edvel em: <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0271531708001437?via%3Dihub\">https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0271531708001437?via%3Dihub<\/a> Acesso dez. 2022.<\/li>\n<li>Romeiro FG, Okoshi K, Zornoff LA, Okoshi MP. Gastrointestinal changes associated to heart failure. Arq Bras Cardiol. 2012;98(3):273-7. Dispon\u00edvel em <a href=\"https:\/\/www.scielo.br\/j\/abc\/a\/QGjZYVrJPfCnSPfCKzpZkQy\/?lang=en\">https:\/\/www.scielo.br\/j\/abc\/a\/QGjZYVrJPfCnSPfCKzpZkQy\/?lang=en<\/a> Acesso fev. 2023.<\/li>\n<li>Krack A, Sharma R, Figulla HR, Anker SD. The importance of the gastrointestinal system in the pathogenesis of heart failure. Eur Heart J 2005;26:2368\u201374. Dispon\u00edvel em: <a href=\"https:\/\/academic.oup.com\/eurheartj\/article\/26\/22\/2368\/507647?login=false\">https:\/\/academic.oup.com\/eurheartj\/article\/26\/22\/2368\/507647?login=false<\/a> Acesso fev. 2023.<\/li>\n<li>von Haeling S, et al. Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure. Cardiovasc Res 2007;73:298\u2013309.\u00a0 Dispon\u00edvel em: <a href=\"https:\/\/academic.oup.com\/cardiovascres\/article\/73\/2\/298\/486489?login=false\">https:\/\/academic.oup.com\/cardiovascres\/article\/73\/2\/298\/486489?login=false<\/a> Acesso fev. 2023.<\/li>\n<li>Sandek A, Bauditz J, Swidsinski A, et al. Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol 2007;50:1561\u20139. Dispon\u00edvel em: <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0735109707023273?via%3Dihub\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0735109707023273?via%3Dihub<\/a> Acesso fev. 2023.<\/li>\n<li>Aquilani R, Opasich C, Verri M, Boschi F, Febo O, Pasini E, et al. Is nutritional intake adequate in chronic heart failure patients? J Am Coll Cardiol. 2003;42(7):1218-23.Dispon\u00edvel em: <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S073510970300946X?via%3Dihub\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/S073510970300946X?via%3Dihub<\/a> Acesso fev. 2023.<\/li>\n<li>Anker SD, Laviano A, Filippatos G, John M, Paccagnella A, Ponikowski P, Schols AM; ESPEN. ESPEN Guidelines on Parenteral Nutrition: on cardiology and pneumology. Clin Nutr. 2009 Aug;28(4):455-60.Dispon\u00edvel em: <a href=\"https:\/\/espen.info\/documents\/0909\/Cardiology%20and%20Pneumology.pdf\">https:\/\/espen.info\/documents\/0909\/Cardiology%20and%20Pneumology.pdf<\/a> Acesso fev. 2023.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Em pacientes com diversas condi\u00e7\u00f5es cr\u00f4nicas, a interven\u00e7\u00e3o nutricional adequada \u00e9 parte essencial do manejo cl\u00ednico apropriado. E isso inclui problemas no cora\u00e7\u00e3o, que n\u00e3o raro progridem para quadros de insufici\u00eancia card\u00edaca, associados a diferentes graus de desnutri\u00e7\u00e3o. Desse modo, a nutri\u00e7\u00e3o parenteral para pessoas com doen\u00e7as card\u00edacas \u00e9 indicada em diferentes contextos. Sem d\u00favida, [&hellip;]<\/p>\n","protected":false},"author":5902,"featured_media":1913,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[41],"tags":[231,200,229,230,67],"class_list":["post-1912","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo","tag-caquexia-cardiaca","tag-desnutricao-clinica","tag-doencas-cardiacas","tag-insuficiencia-cardiaca","tag-nutricao-parenteral"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nutri\u00e7\u00e3o parenteral em doen\u00e7as card\u00edacas e prescri\u00e7\u00e3o espec\u00edfica<\/title>\n<meta name=\"description\" content=\"A nutri\u00e7\u00e3o parenteral para doen\u00e7as card\u00edacas atua na revers\u00e3o de defici\u00eancia nutricional quando h\u00e1 intoler\u00e2ncia \u00e0 via oral ou 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