cardiovascular Flashcards
1
Q
Name the three layers of a typical blood vessel
A
- Tunica intima
- Tunica media
- Tunica adventitia
2
Q
Which layer of a blood vessel will you find the endothelial cells?
A
Tunica intima
3
Q
What is the tunica media made of? (type of muscle and including what else)
A
Made up of smooth muscle, with elastic and collagen
4
Q
What kind of fibres are found on the tunica adventitia?
A
Sympathetic fibres
5
Q
Why do we have tight junctions in the endothelium?
A
To allow the crossing of small molecules and water, but holding plasma and blood cells within the vessel
6
Q
Which blood vessel layer creates nitric oxide?
A
Endothelium
7
Q
What are the jobs of the glycocalyx?
A
- to sense sheer blood stress against the walls of the vessel
- lubricates the red blood calls as they prepare to go into a single file and cross the capillary
8
Q
Name 2 condition that can damage the glycocalyx, and which disease does this start?
A
- insulin resistance
- inflammation
- start of atherosclerosis
9
Q
Name 3 key functions of the endothelium
A
- Semi-permeable barrier (fluid balance, selective movement of substrates)
- Homeostasis
- Immune defense
10
Q
What are 3 roles of nitric oxide in the cardiovascular system
A
- Inhibits leukocyte adhesion
- Apposes oxidation of LDLs
- Regulates vascular tone
11
Q
Where is nitric oxide secreted
A
The endothelium
12
Q
What do PPAR’s do to HDL and triglycerides?
A
HDL - increase
triglycerides - decrease
13
Q
What 2 places can we find PPAR’s?
A
In the cardiac tissue and in BAT (brown adipose tissue)
14
Q
Which condition can PPAR gamma improve?
A
Insulin resistance
15
Q
name 3 CVD risk factors
A
- genetics
- family history
- ethnicity
- gender
16
Q
Why is elevated homocysteine a CVD risk factor?
A
- associated with LDL oxidation
- monocyte disfunction
- causes endothelium disfunction
17
Q
What can cause high homocysteine levels?
A
- low B12 and folate (needed for remethylation of homocysteine to methionine)
- ## genetic polymorphism (MTHFR)
18
Q
How is nitric oxide generated?
A
from L-arginine via the enzyme eNOS (endothelial nitric oxide synthase)
19
Q
What does PPAR stand for
A
Peroxisome proliferator-activated receptor
20
Q
What do PPARs do?
A
- decrease inflammation
- promote ED health
- balances lipid profile
21
Q
How do PPARs balance lipid profiles?
A
- enhances HDL
- lowers triglycerides
22
Q
How can you naturally enhance PPARs
A
- green tea
- oregano
- thyme
- roesmary
23
Q
Name 3 genes that can cause cardio vascular disease if they have a SNP
A
- MTHFR
- NOS3
- MnSOD
- ACE
24
Q
What does elevated Endothelin-1 (ET-1) lead to?
A
vasoconstriction leading to high BP
25
What are some CV symptoms of high Leptin?
- high heart rate
- high BP
- Sodium retention
- vasoconstriction of vessels
26
The thickness of which layers of the heart are directly impacted by insulin resistance?
Tunica media and tunica intima
27
Name some risk factors for cardiovascular disease
- Dyslipidaemia
- Family history
- Genetics
- Gender
- Hypertension
- Mitochondrial dysfunction
- Elevated homeocystine
28
Which SNP is associated to CVD and how?
- MTHFR: impacts supply of methyl groups
needed to methylate B12 in the methionine cycle
29
How is obesity linked to CVD?
* Inflammation is linked with ↑ endothelin-1 (ET-1),
a potent vasoconstrictor peptide. Elevated ET-1
leads to fibrosis of VSMCs and ↑ ROS.
* Adiponectin is decreased in obesity.
* Adiponectin also ↑ insulin sensitivity, thus low
levels contribute to insulin resistance.
* Obesity is associated with high levels of leptin, which activates the
SNS causing sodium retention, vasoconstriction & ↑ blood pressure.
30
How does insulin resistance cause CVD?
Generates chronic hyperglycaemia
leading to oxidative stress, inflammation and cellular damage.
31
Explain Advanced glycation end products (AGEs)
Harmful compounds
formed when protein or lipids becomes glycated after exposure to glucose.
32
In which 2 ways to AGEs exert their effects?
Receptor mediated: Bind to the RAGE receptor on cells (like endothelial cells, smooth muscle cells, and immune cells), leading to increased inflammatory cytokines and ROS
Non- receptor mediated: Increased EC matrix synthesis, trapping
ED LDL and cross binding with collagen (vascular stiffening).
33
What do AGEs lead to?
oxidative stress, vascular ED and immune cell dysfunction.
34
Name some causes of AGEs:
- Highly refined carbs, processed foods, meat and dairy
- High heat, grilling, roasting,
searing / frying
- Smoking and sedentary lifestyles
35
Alterations in the gut microbiota cause what leading to CVD?
- increase in harmful metabolites such as trimethylamine-N-oxide (TMAO).
36
What is TMAO associated with in the ED?
TMAO is
associated with endothelial dysfunction and increased risk of CVD
37
Why is PRAL a dietary consideration in CV disease
Foods rich in protein (meat and cheese) may induce low grade metabolic acidosis
38
Why are trans fats a dietary consideration in CV disease
- promote dyslipidaemia (high LDL and TGS, low HDL)
- increase inflammation, contribute to ED disfunction
-encourage visceral adiposity and increase risk of IR
39
Why is fructose a dietary consideration in CV disease
- increase risk of de novo lypogenesis
- increase fatty acids (palmitic acid)
40
Which nutritional defiencies are a dietary consideration in CV disease
- vitamin C
- D
- E
- CoQ10
- Mg
41
Why is increased palmitic acid a risk for CV disease
it's a major driver of atherosclerosis and coronary artery disease
42
Explain the cardiac risk tools (CV test)
calculate score based
on CV risks e.g., age, BMI, smoking.
43
Explain cardiac troponin (CV test)
Cardiac troponin proteins hs-cTnT and hs-cTnI are released into the blood when heart muscle is damaged
44
Explain Lp-PLA 2 (CV test)
Enzyme produced by monocytes, macrophages, T-cells. Upregulated in atherosclerotic plaques and vascular inflammation.
45
Explain hsCRP (CV test)
Inhibits NO and e-NOS and is involved in plaque deposition.
46
Explain MPO (CV test)
Released by macrophages and measures the body’s response to damaged arterial walls. High MPO is associated with inflammation / oxidative stress and a poor prognosis.
47
Which diet is associated with CVD
Plant based and Mediterranean diet
48
Why is the mediterranean diet helpful with CVD
- lowers inflammatory mediators
- reduces adiposity
- reduces risk of thrombosis
- increased SCFAs
- improved insulin sensitivity
- increased adiponectin
- improved ED function
49
how does vitamin C promote CV health
- down regulates NADPH oxidase
- up regulated endothelial nitric oxide synthesis
- lowers tendency for platelet aggregation
50
how does vitamin E promote CV health
- Mixed tocotrienols and tocopherols plus vitamin C will protect the endothelium from NOS and support NO synthesis
- reduces oxidation of LDL
- anti-thrombotic
51
how does vitamin D promote CV health
- modulates the production of NO
- Modulates RAAS system (BP control)
- anti-inflammatory
52
how do omega-3 fatty acids promote CV health
- improve lipid and lipoprotein profiles
- EPA and DHA are anti-inflammatory
- DHA supports membrane fluidity
53
how does magnesium promote CV health
- vasodilator
- regulates iron transporters
- reduces platelet aggregation
- helps regulate vascular tone and stabilise heart rhythm
54
how does CoQ10 promote CV health
- needed for ATP production
- supports mitochondrial health
- major antioxidant
- reduces oxidation of LDL
- increases levels of superoxide dismutase which preserves activity of NO
55
how does Hawthorne promote CV health
- natural ace inhibitor
- natural diuretic
- natural beta-blocker
- Antioxidant
- improves BP
- Inhibits vasoconstrictive endothelin-1
- increases NO
56
how does garlic promote CV health
- antioxidant
- anti-hypertensive by promoting NO in endothelium
- lowers homocystine
- regulated lipid profile
- anti-platelet effect
- enhances SOD and glutathione
57
What is lipoprotein A?
A form of LDL with a high risk of clotting
58
why is linoleic acid (LA) a problem in CV disease?
- easily oxidised, causing it to be easier for LDL to cross into the endothelium, causing atherosclerosis.
59
How do you reduce LA?
- reduce intake of high LA vegetable oils (replacing some vegetable oil with saturated fat)
60
How does exercise protect us from CVD
- improves lipid profile (lowers triglycerides)
- improves insulin sensitivity and insulin signalling in the ED
- lowers resting BP
61
Nutrient depletions: Statins
CoQ10 synthesis
62
Nutrient depletions: Cholestrymine
- lowers cholesterol: fat soluble vitamins and beta-carotene
63
Nutrient depletions: diuretics
- increase excretion of potassium, calcium, thiamine (B1 = heart failure) and zinc
- drive T2DB
64
Nutrient depletions: ACE inhibitors
- binds with zinc preventing utilisation (major anti-inflammatory and gut integrity)
65
Nutrient depletions: Beta blockers
- causes fatigue, nightmares from melatonin deficiency
- decreases CoQ10 production
66
Nutrient depletions: PPI
- depletes B12, Mg
67
Hypertension symptoms:
fatigue, dizziness, headaches, visual disturbances
68
define systolic BP
pressure of blood on arterial walls during heart compression
69
define diastolic BP
force of blood when the heart relaces
70
What is the UK definition of hypertension:
140/90 mmHg minimum (naturopathically, 110-115 and above is indicative)
71
Hypertension risk factors
- genetic
- obesity
- alcohol
- stress
- nutritional deficiencies (Mg, K)
- high table salt
- inactivity
- drugs
- smoking (NSAIDS, corticosteriods)
72
How will increasing potassium lower hypertension:
- increase NO leading to vasodilation
- increases sodium excretion
- reduces sensitivity to the vasoconstrictor angiotensin 2
- antioxidant and anti-inflammatory
73
What does the DASH diet include?
fruit and veg, grains, low fat or no fat dairy foods, lean meat and fish, nuts seeds and beans and fats and oils.
74
what are the limitations of the DASH diet
potential high levels of fructose from hydrogianted fats, vegetable oils
75
Name some supplements for hypertension
- vitamin D
- L-argenine
- Magnesium
- B6
76
How can the glucocalyx be damaged?
- inflammation
- oxidised LDL
- oxidative stress
- hyperglycaemia
- endotoxaemia
77
What are inflammasomes?
macrophages in the subendothelial space that release inflammatory cytokines and activate IL-6
78
what are some ways to prevent atherosclerosis?
- low intake of saturated fats
- increase omega-3 (avocado and EVOO)
- red yeast rice
- increase dietary fibre
- Hawthorne berries
- Beetroot
- blueberries
- L-theanine
79
How do you reduce homocytine?
increase B6 B12 and folate, and trimethylglycine.
80
How do you reduce fibrinogen levels?
Mediterranian diet, and garlic. Also exercise.
81
How does L-citrulline prevent/manage atherosclerosis?
L-citrulline is converted to arginine, which NO is synthesised from via eNOS. Arginine is involved in lowering BP in the kidneys.
82
How does B3 prevent/manage atherosclerosis?
- reduces LDL, LDL-P, TGs, VLDL.
- can also decrease fibrinogen
83
How does B5 prevent/manage atherosclerosis?
- Increasing HDL
84
How does omega-3 prevent/manage atherosclerosis?
- anti-inflammatory
- anti-thrombotic
- lowers BP
- lowers heart rate
- lowers IR
85
How does pomegranet prevent/manage atherosclerosis?
- powerful antioxidant
- reduces levels of oxidised LDL
- improves HDL function
- reduces macrophages ability to uptake oxidised LDL (as this carries on to create foam cells)
- reverses cholesterol transport
86
How does pine bark extract prevent/manage atherosclerosis?
- anti-inflammatory
- antioxidant
- falvonoid
- anti-thrombotic
- Enhances NO and ED function
87
What is myeloperoxidase (cardiovascular inflammatory marker)?
An enzyme secreted from macrophage cells that increases oxidation of lipoproteins
88
How does lycopene prevent/manage atherosclerosis?
- It suppresses intestinal cholesterol absorption
- powerful antioxidant
- decreases LDL
- increases HDL
89
Name some practical strategies for CVD and HTN
- sauna
- dry skin brushing
- stress management
- exercise
- yoga
- acupuncture
90
what is the main cause of ischaemic heart disease
atherosclerosis
91
define ischaemic heart disease
an imbalance between myocardial oxygen supply and demand, associated with inadequate arterial supply via the coronary arteries
92
define angina
chest pain caused by insufficient blood supply to the myocardium via coronary arteries
93
What's the difference between stable and unstable Angina?
Stable: predictable chest pain, symptoms resolved once oxygen levels are stable
Unstable: Unpredictable, pain occurs at rest. More sever and serious.
94
Angina symptoms
- SOB
- constricting chest pains (neck, L shoulder arm and jaw)
- worsened by exertion, relieved at rest
- sweating
- nausea
95
Angina risk factors
- smoking
- vitamin D deficiency
- family history
96
Allopathic diagnosis tests for angina
- ECG
- cardiac stress test
- angiogram
97
what are some medications prescribed for angina?
- nitrates
- calcium channel blockers
- beta blockers
98
define a myocardial infarction
Acute blockage of the coronary artery usually due to a thrombus, resulting in death of myocardial tissue
99
What enzymes do ischaemic myocardial cells release?
adenosine and lactate, into nerve endings causing pain
100
What is the main risk of a MI?
prolonged ischaemia causing myocardial necrosis, leading to scar tissue, causing the heart to grow in size leading to lowered efficiency. This can lead to heart failure.
101
MI risk factors:
- sex
- physical factors such as stress, sudden life events
- drug induced (cocaine)
- severe hypotension
- severe anaemia
102
What is the potential link with males being more likely to have a MI
low testosterone
103
Complications of a MI
- arrhythmia
- death
- heart failure
- cardiogenic shock; rapid reduction in blood flow to rest of the body, leading to multiple organ failure (rare)
104
name some naturopathic approaches to IHD
- vitamin D status
- warming herbs and spices to aid blood flow (cayenne, ginger)
- increasing movement
- address stress
105
How is L-carnitine a natural approach to IHD
- improves utilisation of fatty acids (hearts main source of energy)
- shuttles out toxins from mitochondria
- major antioxidant
106
How is Magnesium a natural approach to IHD
Mg deficiency has been shown to cause coronary artery spasms. It also controls movement of calcium into smooth muscle cells leading to smooth muscle contraction
107
How is CoQ10 a natural approach to IHD
- increases ENOS and NO
- stabliser of calcium ion channels
- increases inflammatory effects by lowering TNF and IL-6
- Improved ED function and vascular elasticity
108
How is L-arganine a natural approach to IHD
precursor to NO
109
How is Ginko biloba a natural approach to IHD
inhibits platelet activating factor by blocking the receptors
110
Signs and symptoms of heart failure
- nocturnal apnoea
- breathlessness
- fluid retention (ankle and abdomen oedema)
- fatigue
- lightheadedness
- tachycardia
111
Name some causes/risk factors of heart failure
- coronary heart disease
- IHD
- hypertension
- cardiomyopathy
- pulmonary hypertension (thickening of the heart making right side work harder)
- thyroid dysfunction
112
how can IR cause heart failure?
- decreased production of myocardial glucose (25% of myocardial ATP is glucose)
- enhances fatty acid oxidation (75% of myocardial ATP is fatty acids)
113
How can obesity cause heart failure?
Obesity causes changed to heart structure
114
How can vitamin D deficiency cause heart failure
vitamin D is needed for calcium absorption, and calcium is needed for muscle contraction.
115
Name some supplements that can help HF
- CoQ10 (mitochondrial help)
- D-ribose (regulates low myocardial ATP)
- Mg (needed for ATP, vasodilator)
116
Name some causes/risk factors for haemorrhoids and varicose veins
- high abdominal pressure (pregnancy, constipation, childbirth, obesity)
- being sedentary
- low fibre diet
- dehydration (blood viscosity)
- inherited valve defects
- smoking
- vitamin C deficiency
- abdominal bloating
117
Name some naturopathic approaches for varicose veins/haemorrhoids
- vitamin C (collagen synthesis)
- bioflavonoids (buckwheat, grapes, apples, cranberries)
- optimise liver function
- reduce weight
- Raising feet above heart
118
which foods are phlebotonic foods?
flavonoids
119
How are vitamin C and bioflavonoids a natural approach to varicose veins and haemorrhoids?
supports connective tissue integrity by increasing collagen synthesis and
120
according to TCM, what will the tongue look like if there is blood pooling?
purple tongue with a think yellow brown covering
