Weight loss greater than 6% independently correlates with reduced survival in patients with congestive heart failure (CHF).¹ Cardiac cachexia is a gradual and graded process, with wasting affecting muscle, bone, adipose tissue and the heart.¹ Reduced appetite has been proposed as a important factor for weight loss caused by cardiac cachexia.²

The mechanism of cardiac cachexia remains largely unclear. Gastric myoneural inhibition and gastrointestinal hypomotility with delayed gastric emptying is commonly observed, and gut hormones may also play a role, because the anorexia is often characterised by a premature feeling of fullness and loss of hunger.² The gut hormone ghrelin stimulates hunger, increases food consumption. and was previously shown to be raised in patients with cardiac cachexia and CHF.³ Ghrelin is produced from the stomach and usually rises in anticipation of a meal and then falls after the ingestion of nutrients.

The gut hormone PYY3–36, acting as a terminator of hunger, is produced by the L cells in the distal gastrointestinal tract; it reduces appetite and 24 hour food intake by binding to the neuropeptide Y Y2 receptor in the hypothalamic arcuate nucleus.⁴

Severe pulmonary hypertension results in a low cardiac output and neurohumoral activation. Patients frequently report loss of appetite and weight, and since it occurs in a young population …