Cardiovascular Disease

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Cardiovascular Disease
2012-02-12 23:07:26
Medical Nutrition Therapy

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  1. Which layer of the three layers of the heart is responsible for the muscle contraction that moves blood through the heart?
    The myocardium- the middle layer
  2. the _______________ of the heart pumps blood through the pulmonary circulation to pick up oxygen.
    right side
  3. the ______________ of the heart pumps blood with its oxygen load throughout the body.
    left side
  4. -Known as the "silent killer"
    -Increases risk for CHF, kidney failure, MI, stroke, aneurysms, and vision problems
    Hypertension, chornic elevation in blood pressure
  5. Value that classifies hypertension
    140/90 mm Hg
  6. Normal BP:
    <120/80 mm Hg
  7. Prehypertension values:
    • systolic 120-139 mm Hg or
    • diastolic 80-89 mm Hg
  8. Hypertension stage 1 values:
    • systolic: 140-159 mm Hg or
    • diastolic: 90-99 mm Hg
  9. Hypertension stage 2 values:
    • systolic: 160 or higher or
    • diastolic: 100 or higher
  10. c-reactive protein
    • released during inflammation, (+ relationship w/ hypertension)
    • less than 1 mg/mL = low risk
    • 1-3 mg/mL = average
    • more than 3 mg/mL = high risk
  11. smoking and the relation to hypertension
    smoking decreases NO, Nitrous Oxide, which dilates blood vessels, so it results in constriction of blood vessels because there is less NO to dilate blood vessels
  12. Loop diuretics- ex. furosemide
    • -inhibits sodium reabsorption which decreases water and decreases BP.
    • -decreased water means decreased potassium, so consumption of potassium rich foods such as baked potatoes, bananas and oranges should be increased
  13. Thiazides- ex. hydrochlorothizadide
    -also inhibits Na+ reabsorption
  14. ACE inhibitor
    dilates blood vessels because it blocks angiotensin I from being converted to angiotensin II, which constricts blood vessels.
  15. Beta blockers- ex. propanonol
    Decreases stroke volume
  16. calcium blocking agent
    allows blood vessels to relax
  17. DASH diet
    • Dietary Approach to Stop Hypertension
    • -decrease sodium, saturated fat, alcohol
    • -increase calcium, potassium, fiber
    • -variety of foods- high fruit and vegetable intake
    • -promotes weight loss
  18. Nuts and hypertension
    nuts contain NO, Nitrous Oxide, which decreases BP because NO dilates blood vessels putting less pressure on the walls of the vessels
  19. chylomicron
    • exogenous fat, cholesterol and fat soluble vitamins
    • -mainly made of TAGs
  20. VLDL
    • exogenous and indogenous fat
    • -mainly made of TAGs
  21. LDL
    mainly cholesterol left once some fat stored in body cells, can become oxidized and deposit in arteries, causing atherosclerosis.
  22. Process of break down of fat and how it is used
    • Mouth: lingual lipase
    • Stomach: gastric lipase
    • small intestine: triggers gallbladder to release bile, bile emulsifys fat, which increases the surface area that can be acted on by enzymes
    • -pancreatic lipase breaks down to glycerol, cholesterol and fatty acids.
    • -it is made into a chylomicron, which travels in the lymph to the liver.
    • -The liver repackages it into VLDL, which travels through the blood. When it comes across a cell with LDL triglycerides are pulled out and stored in the cell and now the VLDL becomes an LDL or cholesterol.
  23. HDL
    -Mainly protein and phospholipid
  24. Homocysteine
    nitrogen containing compound in the body
  25. Process of CHD
    • -Injury to the lining of an artery, due to inflammation, increased homocyteine, or unknown cause
    • -The body tries to repair the damage and sends monocytes to the area, which burrow into the blood vessel walls where they mature into macrophages
    • -macrophages consume oxidized LDL and die causing a buildup of tough fibrous scar tissue that can inhibit blood flow and promote clot formation called, plaque and fatty streaks.
    • -This build up can lead to atherosclerosis, or a thickening of blood vessel walls, and loss of vascular elasticity
  26. homocysteine and CHD
    High homocysteine levels can contribute to the initial damage to the artery. Homocysteine levels can be decreased by increasing folate, B12, and B6 in the diet. These can be found in fortified breakfast cereals, green vegetables, orange juice and animal products.
  27. high fat diet and CHD
    a high fat diet can contribute to increased amounts of LDL available to be oxidized.
  28. antioxidants and CHD
    • Anitoxidants prevent LDL from becoming oxidized and depositing, so it can't be consumed by mature macrophages, decreasing cell death and scar tissue build up.
    • -found in sources of Vitamin E, Vitamin C, and Beta- carotene
  29. Blood lipid levels and CHD
    -total cholesterol
    -LDL cholesterol
    -HDL cholesterol
    • < 200 mg/dL
    • < 100 mg/dL
    • > 60 mg/dL
    • < 150 mg/dL
  30. Atherosclerosis
    • thickening of the blood vessel walls caused by presence of plaque
    • -includes loss of vascular elasticity
    • -results in restriction of blood flow and possibly
    • ~myocardial infarction
    • ~cerebrovascular incident
    • ~peripheral vascular disease
    • ~CAD and CHF
  31. risk factors associated with atheroslcerosis
    • -family history
    • -age and sex
    • -obesity
    • -dyslipidemia
    • -hypertension
    • -physical inactivity
    • -atherogenic diet- low in vegetables, fruits and whole grains
    • -diabetes mellitus
    • -impaired fasting glucose/metabolic syndrome
    • -smoking
  32. NO- Nitrous Oxide
    • - a substance naturally produced by endothelial cells
    • -controls the normal relaxation of smooth muscles in the arteries and arterioles
    • -regulates leukocyte adhesion, platelet adhesion and thrombosis
  33. statin drugs
    • -decrease cholesterol production by the liver
    • -worry about liver damage
  34. Niacin
    Niacin given in large amounts, often given with statin drugs (decrease LDL and increase HDL)
  35. cholestyramine
    prevents some fat absorption
  36. TLC diet
    • Therapeutic Lifestyle Changes
    • -modifications in fat and cholesterol
    • -rich in fruits, vegetables, grains, fiber (focus on water soluble fiber)
    • -limit sodium to 2400 mg
    • - include plant stanol esters
  37. Fat modifications
    • -total fat: 25-35% of calories
    • -very low fat diets
    • -saturated fat < 7% of calories
    • -avoid trans fats
    • - increase intake of monounsaturated fats and polunsaturated omega 6 fatty acids
    • -increase intake of omega-3 essential fatty acids
    • -limit dietary cholesterol < 200 mg daily
  38. Ischemic Heart Disease
    • inadequate blood supply to the heart
    • -may be asymptomatic
    • -angina = chest pain
    • -can precipitate MI causing necrosis of tissue
  39. angina
    stable vs. unstable
    • chest pain when exercising = stable angina
    • chest pain when resting = unstable angina
  40. Nutrition Therapy post MI
    • -Decrease oral intake
    • -clear liquids, no caffeine- avoid temperature extremes in liquids and foods
    • -progress to soft, more frequent meals
    • -smaller meals limited in calories to avoid increased work of the heart for digestion not necessarily weight control
    • -individualized- use TLC recommendations
  41. Heart Faliure
    impairment of the ventricles' capacity to eject or fill with blood
  42. Heart failure treatment
    • -decrease sodium
    • -decrease fluid, due to edema
    • - treat underlying cause
    • -control BP
    • -prevent continued damage
    • -medications
    • -exercise
    • -nutrition therapy
    • -prevention of respiratory infections
  43. cardiac cachexia
    malnutrition/wasting, fatigue, anorexia
  44. CAD
    coronary artery disease
  45. CVD
    cardiovascular disease
  46. CHD
    Coronary heart disease
  47. CVA
    cerebrovascular accident
  48. HF
    heart failure
  49. MI
    myocardial infarction
  50. HT
  51. BP
    blood pressure
  52. HBP
    high blood pressure
  53. AMDR
    average macronutrient distribution range
  54. AI
    adequate intake
  55. UL
    upper tolerable limit
  56. SFA
    saturated fatty acid
  57. MUFA
    monounsaturated fatty acid
  58. PUFA
    polyunsaturated fatty acid
  59. EPA
    eicosapentanoic acid
  60. DHA
    docohexaenoic acid
  61. Chol
  62. TG
  63. ApoB
    apolipoprotein B
  64. LDL
    low density lipoprotein
  65. HDL
    high density lipoprotein
  66. _____________ of vegetable oils results in the formation of trans fatty acids
  67. What are the AMDR recommendations for protein, fat, and carbohydrate?
    • Carbohydrate: 45-65% energy intake
    • Protein: 10-35% energy intake
    • Fat: 20-35% energy intake
  68. cardiovascular disease
    abnormal condition of the heart and its vascular system including those associated with atherosclerosis
  69. Heart disease definition
    abnormal condition of the heart and its vascular system, such as heart failure and coronary heart disease
  70. Atherosclerosis
    choronic accumulation of cholesterol and lipid deposits on the arterial walls, resulting in the formation of fatty streaks and hardened plaque called atheroma
  71. heart failure definition
    an insufficiency of the heart as a pump.
  72. coronary heart disease
    the accumulation of cholesterol and lipid, causing narrowing of the arteries of the heart.
  73. What type of diet is recommended for cardiac cachexia?
    • -muscle wasting due to lack of blood flow
    • -limited salt and water
    • -ensure or supplement
    • -high protein, low sodium bar
  74. What diet is recommened after a coronary artery bipass graft?
    TLC diet, salt restricted, less than 2 g per day, may be fluid restricted
  75. What dietary recommendations are given to clients on Coumadin to limit adverse effects from nutrient-drug interaction?
    a stable intake of vitamin K, make them aware of vitamin K sources, such as spinach
  76. chylomicrons
    the largest lipoproteins, the most enriched in triglycerides, and the least dense. They transport dietary triglycerides and cholesterol.
  77. HDLs
    the smallest lipoproteins and the richest in proteins, and they therefore have the highest density.
  78. VLDLs
    principally constituted of triglycerides. They transport endogenous triglycerides originating in the liver.
  79. IDLs
    Intermediate density lipoproteins are intermediate lipoprotein particles that contain as much triglyceride as cholesterol.
  80. LDLs
    lipoproteins rich in cholesterol and represent about 70% of the total cholesterol in humans.
  81. How are lipoproteins classified?
    • they are classified according to their chemical composition and by physical characteristics such as their size, density, flotation index, and electrophoresis mobility
    • -By weight: more fat = decreased weight.
  82. What are apolipoproteins and what are their principal functions?
    • proteins on the surface of lipoproteins.
    • 1. structural components
    • 2. cofactors
    • 3. bind to specific cell receptors
    • 4. competitive inhibitors
  83. Hypercholesterolemia
    the presence of abnormally high concentrations of cholesterol in the blood
  84. hypertriglyceridemia
    the presence of abnormally high concentrations of triglycerides in the blood
  85. hyperlipoproteinemia
    the presence of abnormally high concentrations of lipoproteins in the blood.
  86. hypertension
    abnormally elevated arterial blood pressure or (high blood pressure)
  87. cerebrovascular accident
    a cerebral stroke
  88. stroke
    an acute brain attack due to an impairment of cerebral blood flow and resulting in a reduction or loss of consciousness, sensations, and voluntary movement.
  89. ischemia
    a reduction of blood supply to a localized tissue or organ, usually caused by arterial narrowing or obstruction of blood inflow to the tissue.
  90. ischemic stroke
    a redution of blood supply in the brain, which results in impaired cerebral oxygen supply.
  91. transient ischemic attacks
    unexpected, abrupt, frequently recurring episodes of temporary reduction of blood supply to a localized tissue or organ, which can lead to a stroke.
  92. myocardial ischemia
    reduction of blood supply to the heart muscle.
  93. angina pectoris
    a disease characterized by intense, often constricting, spasmodic pain attacks in the chest due to myocardial ischemia caused by a lack of oxygen supply to the heart muscle.
  94. congestive heart failure
    characterized by the inability of the heart muscle to maintain sufficient blood flow to tissues or to pump out the blood coming back to the heart by the venous circulation. As a result, edema and congestion develop tissues.
  95. myocardial infarction
    a heart attack or the necrosis of an area of the heart muscle due to an obstruction of the coronary arterial blood flow by a thrombus or embolus
  96. percutaneous transluminal coronary angioplasty
    a surgery to repair stenosed arteries of the heart. This type of intervention involves the introduction of a catheter through the skin and into the lumen of a cardiac artery that is stenosed and needs to be enlarged to re-establish blood flow.
  97. coronary artery bipass graft
    a major surgery to treat obstructed or almost obstructed arteries of the heart. During surgery, another blood vessel is taken from another part of the body and used to replace one or more occluded heart arteries and re-establish blood circulation past the obstruction.
  98. xanthomata
    a lipid-containing yellowish plaque or nodule, especially of the skin of individuals with very high blood cholesterol concentrations.
  99. 15 risk factors for coronary heart disease
    • -Age > 55
    • -male gender
    • -sedentary lifestyle
    • -body mass index > 25
    • -abdominal obesity
    • -diet high in SFA, trans fats, cholesterol, sugars, alcohol, and salt and low in fibers
    • -cigarette smoking
    • -diabetes mellitus
    • -hyperlipidemia
    • -high blood pressure, especially high in systolic blood pressure
    • -family history of hyperlipidemia or coronary heart disease
    • -peripheral vascular disease or carotid atherosclerosis
    • -high blood homocysteine concentrations
    • -presence of xanthomata
  100. Type 1 hyperlipidemia
    • lipoproteins in excess in the blood: chylomicrons
    • Consequence: elevated blood cholesterol concentrations
  101. Type IIa
    • lipoproteins in excess in the blood: LDLs
    • Consequence: elevated blood cholesterol concentrations
  102. Type IIb
    • Lipoproteins in excess in the blood: LDLs and VLDLs
    • Consequence: elevated blood cholesterol and triglyceride concentrations
  103. Type III
    • lipoproteins in excess in the blood: IDLs
    • Consequence: elevated blood cholesterol and triglyceride concentrations
  104. Type IV
    • Lipoproteins in excess in the blood: VLDLs
    • Consequence: elevated blood triglyceride concetrations
  105. Type V
    • Lipoproteins in excess in the blood: chylomicrons and VLDLs
    • Consequence: elevated blood triglyceride concentrations