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
the _______________ of the heart pumps blood through the pulmonary circulation to pick up oxygen.
the ______________ of the heart pumps blood with its oxygen load throughout the body.
-Known as the "silent killer"
-Increases risk for CHF, kidney failure, MI, stroke, aneurysms, and vision problems
Hypertension, chornic elevation in blood pressure
Value that classifies hypertension
140/90 mm Hg
<120/80 mm Hg
systolic 120-139 mm Hg or
diastolic 80-89 mm Hg
Hypertension stage 1 values:
systolic: 140-159 mm Hg or
diastolic: 90-99 mm Hg
Hypertension stage 2 values:
systolic: 160 or higher or
diastolic: 100 or higher
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
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
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
Thiazides- ex. hydrochlorothizadide
-also inhibits Na+ reabsorption
dilates blood vessels because it blocks angiotensin I from being converted to angiotensin II, which constricts blood vessels.
Beta blockers- ex. propanonol
Decreases stroke volume
calcium blocking agent
allows blood vessels to relax
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
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
exogenous fat, cholesterol and fat soluble vitamins
-mainly made of TAGs
exogenous and indogenous fat
-mainly made of TAGs
mainly cholesterol left once some fat stored in body cells, can become oxidized and deposit in arteries, causing atherosclerosis.
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.
-Mainly protein and phospholipid
nitrogen containing compound in the body
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
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.
high fat diet and CHD
a high fat diet can contribute to increased amounts of LDL available to be oxidized.
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
thickening of the blood vessel walls caused by presence of plaque
-includes loss of vascular elasticity
-results in restriction of blood flow and possibly
~peripheral vascular disease
~CAD and CHF
risk factors associated with atheroslcerosis
-age and sex
-atherogenic diet- low in vegetables, fruits and whole grains
-impaired fasting glucose/metabolic syndrome
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
-decrease cholesterol production by the liver
-worry about liver damage
Niacin given in large amounts, often given with statin drugs (decrease LDL and increase HDL)
prevents some fat absorption
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
-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
Ischemic Heart Disease
inadequate blood supply to the heart
-may be asymptomatic
-angina = chest pain
-can precipitate MI causing necrosis of tissue
stable vs. unstable
chest pain when exercising = stable angina
chest pain when resting = unstable angina
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
impairment of the ventricles' capacity to eject or fill with blood
Heart failure treatment
-decrease fluid, due to edema
- treat underlying cause
-prevent continued damage
-prevention of respiratory infections
malnutrition/wasting, fatigue, anorexia
coronary artery disease
Coronary heart disease
high blood pressure
average macronutrient distribution range
upper tolerable limit
saturated fatty acid
monounsaturated fatty acid
polyunsaturated fatty acid
low density lipoprotein
high density lipoprotein
_____________ of vegetable oils results in the formation of trans fatty acids
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
abnormal condition of the heart and its vascular system including those associated with atherosclerosis
Heart disease definition
abnormal condition of the heart and its vascular system, such as heart failure and coronary heart disease
choronic accumulation of cholesterol and lipid deposits on the arterial walls, resulting in the formation of fatty streaks and hardened plaque called atheroma
heart failure definition
an insufficiency of the heart as a pump.
coronary heart disease
the accumulation of cholesterol and lipid, causing narrowing of the arteries of the heart.
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
What diet is recommened after a coronary artery bipass graft?
TLC diet, salt restricted, less than 2 g per day, may be fluid restricted
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
the largest lipoproteins, the most enriched in triglycerides, and the least dense. They transport dietary triglycerides and cholesterol.
the smallest lipoproteins and the richest in proteins, and they therefore have the highest density.
principally constituted of triglycerides. They transport endogenous triglycerides originating in the liver.
Intermediate density lipoproteins are intermediate lipoprotein particles that contain as much triglyceride as cholesterol.
lipoproteins rich in cholesterol and represent about 70% of the total cholesterol in humans.
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.
What are apolipoproteins and what are their principal functions?
proteins on the surface of lipoproteins.
1. structural components
3. bind to specific cell receptors
4. competitive inhibitors
the presence of abnormally high concentrations of cholesterol in the blood
the presence of abnormally high concentrations of triglycerides in the blood
the presence of abnormally high concentrations of lipoproteins in the blood.
abnormally elevated arterial blood pressure or (high blood pressure)
a cerebral 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.
a reduction of blood supply to a localized tissue or organ, usually caused by arterial narrowing or obstruction of blood inflow to the tissue.
a redution of blood supply in the brain, which results in impaired cerebral oxygen supply.
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.
reduction of blood supply to the heart muscle.
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.
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.
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
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.
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.
a lipid-containing yellowish plaque or nodule, especially of the skin of individuals with very high blood cholesterol concentrations.
15 risk factors for coronary heart disease
-Age > 55
-body mass index > 25
-diet high in SFA, trans fats, cholesterol, sugars, alcohol, and salt and low in fibers
-high blood pressure, especially high in systolic blood pressure
-family history of hyperlipidemia or coronary heart disease
-peripheral vascular disease or carotid atherosclerosis