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NUTR 344 > Cardiovascular Disease (CVD) with a focus on Secondary Prevention > Flashcards

Cardiovascular Disease (CVD) with a focus on Secondary Prevention Flashcards

1
Q

• What is secondary prevention?

A

• Health care designed to prevent recurrence of cardiovascular events (e.g.
heart attack or stroke) in patients with diagnosed CVD.

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2
Q

How is arterial blood pressure regulated?

A

It is regulated by the sympathetic nervous system, the renin-angiotensin-aldosterone system (RAAS) and renal function

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3
Q

WHat is the exclusion from the rule artery=oxygenated blood, vein= deoxygenated blood?

A

pulmonary artery carries deoxygenated blood the only exclusion from the rule that arteries carry oxygenated blood; pulmonary vein is an exclusion as well

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4
Q

• Framingham Risk Scores, not available for __ years old or older

A

• Framingham Risk Scores, not available for 80 years old or older

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5
Q

WHy do we refrain from putting elderly on restrictive diets?

A

restrictive diets at older ages may lead to malnutrition -> do more harm than good

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6
Q

Why do we say that women are a bit neglected in terms of CVD?

A

Decreased risk for CVD prior to menopause-> less studied than men
Don’t know the exact symptoms

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7
Q

is hormonal replacement therapy beneficial for prevention of CVD?

A

no

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8
Q

How does estrogen help with CVD?

A

Estrogen is believed to have a positive effect on the inner layer of artery wall, helping to keep blood vessels flexible.

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9
Q

When does menopause occur?

A
  • Average age is 51 - 54 years old

* Induced at a younger age in women who have had a hysterectomy

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10
Q

What happens to lipid profiles after the menopause?

A
  • Blood pressure tends to increase
  • LDL cholesterol tends to increase
  • HDL, or “good” cholesterol, declines or remains the same.
  • Triglycerides tend to increase.
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11
Q

Adults with diabetes are __ times more likely to die from heart disease than adults without diabetes.

A

Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

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12
Q

Myocardial Infarction (MI) or Heart Attack- definition

A

when one of the coronary arteries (one of the arteries that feed the heart muscle) becomes blocked and the heart tissue dies as it is not getting enough oxygen

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13
Q

5 common heart attack warning signs

A

common heart attack warning signs:
Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
Nausea, indigestion, heartburn or abdominal pain.
Shortness of breath.
Cold sweat.
Fatigue.
Lightheadedness or sudden dizziness.

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14
Q

Both __ and __ can cause chest pain and frequently co-exist

A

Both GERD and coronary artery disease (CAD) can cause chest pain and frequently co-exist

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15
Q

Echo vs EKG

what can be used for either?

A

echocardiogram (echo) electrocardiogram (EKG)

ECG

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16
Q

define stable angina; EKG and troponins

A

STABLE ANGINA - Angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand.
EKG: normal; normal troponins

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17
Q

define unstable angina; EKg and troponins

A

UNSTABLE ANGINA : The plaque ruptures and a thrombus forms around the ruptured plaque, causing partial occlusion of the vessel. Angina pain occurs at rest or progresses rapidly over a short period of time.
EKG: Normal, Inverted T waves, or ST depression. Troponins: Normal

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18
Q

define NSTEMI; EKG and troponins

A

NSTEMI : During an NSTEMI, the plaque rupture and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium.
EKG: Normal, Inverted T waves, or ST depression
Troponins: Elevated

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19
Q

define STEMI; EKG and troponins

A

A STEMI is characterized by complete occlusion of the blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins.
EKG: hyperacuate T waves or ST elevation
Troponins: elevated

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20
Q

What is the superior marker for myocardial damage. Why?

A

troponins
The most sensitive and specific test for myocardial damage. Because it has increased specificity compared with CK-MB, troponin is a superior marker for myocardial injury.

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21
Q

When do troponins peak?

A

12h

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22
Q

Is CK-MB test specific? When does it peak?

A

Creatine Kinase
It is relatively specific when skeletal muscle damage is not present.
10-24h

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23
Q

Is LDH test specific? When does it peak?

A

Lactate dehydrogenase
LDH is not as specific as troponin.
72h

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24
Q

What is the treatment applied post MI if Mi was detected early on? How soon should it be detected?

A

Thrombolysis (to dissolve clots in coronary arteries). Usually within 3 hours of the heart attack.

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25
Q

What does type of treatment post MI depend on?

A

depend how fast medical treatment is obtained for attack and severity

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26
Q

Describe Cardiac catheterization

A

can be done after or before a heart attack
• Passing catheter via arm, groin or neck
• visualization
• Angiogram- injecting special
fluid (called dye or contrast) through the catheter into a blood vessel or a chamber of the heart.
Since the dye is visible by X-ray, an X-ray movie of the circulation can be recorded.

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27
Q

Describe Angioplasty or PTCA (percutaneous transluminal coronary angioplasty)

A

Use catheter to insert
• stent
• balloon
-> opens up the artery

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28
Q

CABG

A

multiple bipasses can be done
vessel is taken eg from a leg; attaching it to an aorta and below the site where occlusion has occurred
allow to bypass the blocked section of coronary artery

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29
Q

What diet should he be on, immediate post-MI?

A
  • Npo or clear liquids without caffeine
  • Progress to small soft tolerated meals (Initially want blood flow supported or maximized to heart (as opposed to GI tract))
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30
Q

What are the symptoms experienced after MI

A

MI: Pain, anxiety, fatigue, SOB

• Fear, depression

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31
Q

5 Ways to Lower Your Risk

of a SECOND Heart Attack

A

1) TAKE YOUR MEDICATIONS
2) FOLLOW-UP WITH YOUR DOCTOR. See your doctor within 6 weeks of your heart attack to help keep your recovery on track.
3) MANAGE RISK FACTORS
Common risk factors include smoking, high cholesterol, high blood pressure and diabetes.
4) PARTICIPATE IN CARDIAC REHAB
5) Get support

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32
Q 
Medications after a heart attack
could include (6)
A 
Antiplatelet agents
Statins
Beta blockers, ACE inhibitors
Nitrates
Anticoagulants
Medications to protect the stomach
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33
Q

Why would we use Medications to protect the stomach after MI?
Examples

A

stress + aspirin given post MI can resutl in ulcers
• Examples: cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac), or proton pump inhibitors such as pantoprazole (Pantoloc).

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34
Q

Why would we use Antiplatelet agents after MI? Examples

A

to prevent blood clots and keep a stent open.

• Example: aspirin.

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35
Q

Why would we use statins after MI? Examples

A

Statins – to lower cholesterol levels.

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36
Q

Why would we Beta blockers, ACE inhibitors use after MI? Examples

A

to treat high blood pressure

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37
Q

Why would we use nitrates after MI? Examples

A

to expand the arteries and relieve chest pain. • nitroglycerin

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38
Q

Why would we use anticoagulants after MI? Examples

A

to reduce the blood’s ability to clot.

• Warfarin (Coumadin)

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39
Q

What is a stroke?

A

insufficient blood supply to brain and death

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40
Q

what are the 2 types of stroke?

A

hemorrhagic and ischemic
Hemorrhagic- blood vessel bursts due to high pressure, atherosclerosis or congenital malformation. Bleeding and decreased blood flow; blood build up -> increased pressure and damage to smaller vessels

ischemic stroke- occurs when an artery to the brain is blocked

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41
Q

What are the signs of stroke

A

F: Face drooping. Ask the person to smile, and see if one side is drooping. …
A: Arm weakness. Ask the person to raise both arms. …
S: Speech difficulty. People having a stroke may slur their speech or have trouble speaking at all. …
T: Time to call 911!

42
Q

What is the rule of side of weakness association with side of lesion

A

it opposite

so if the weakness is on the right side, the lesion is on the left

43
Q

Ischemic stroke vs hemorrhagic in terms of signs

A

Ischemic- Patients may experience a combination of symptoms that include numbness or weakness on one side of the body or face, trouble speaking and difficulty with vision or balance.
Hemorrhagic- People who experience this type of stroke, in addition to other stroke symptoms, will likely experience a sudden onset headache or head pain — a warning sign that might not occur during ischemic stroke.

44
Q

Which formula is recommended for caloric calculations?

A

Mifflin St-Jeor

45
Q

What is the recommended sodium intake after a stroke/heart attack?

A

2g/day

46
Q

Stroke nutrition theraphy

A

1) eat low sodium
2) eat lots of veggies, fruits, whole grains, low fat dairy
3) eat healthy kinds of fat
4) aim for healthy weight
5) get 20-30g of fiber

47
Q

Diet guidelines for high TGs

A
  • Limit or avoid sugar, sweets, sweetened beverages
  • Avoid alcohol
  • Achieve healthy weight
  • Follow other heart healthy guidelines
48
Q

Coconut oil vs butter vs unsaturated/monounsaturated vegetable oils,

A
  • Compared to butter, coconut oil does not ↑ TChol, LDL to same extent
  • Compared to unsaturated/ monounsaturated vegetable oils, coconut oil does ↑ TChol and LDL to a greater extent
49
Q

Coconut oil is high in _- chain fatty acids

A

Coconut oil is high in medium chain fatty acids

50
Q

Final coconut oil verdict

A

Even though coconut oil can ↑ HDL, it still is not recommended as an alternative to non-hydrogenated vegetable oils

51
Q

What is AFib?

A

Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications.

52
Q

AFib treatment and intervention

A

treatment is directed toward heart rate control and/or anticoagulation based on the client’s symptom and risk factors

53
Q

What is the action of anticoagulants

A

Interferes with clotting

Thins out the blood

54
Q

Nutritional implication of taking anti-coagulants

A

Warfarin (Coumadin): need consistent vitamin K intake

55
Q

Which food intake should especially be controlled when taking warfarin

A

Especially cooked greens (spinach, kale, collards, beet greens,..)
• Leafy greens (raw), asparagus, broccoli, bran, chickpeas, lentils, soybeans,
swiss chard, liver, oils, egg yolk…

56
Q

Apart from foods, what else can affect clotting time and thus has to be controlled?

A

High vitamin A or E can also affect clotting time.

57
Q

__ patients may need lower dose of warfarin (__ or __?)

A

Asian patients may need lower dose of warfarin (genetics or diet?)

58
Q

Natural products and warfarin

A

Some natural products also affect clotting time and some case reports of interaction:
• High amounts onions, garlic, avocado, cranberry juice, soy milk, green tea.
• ginkgo, ginseng, coenzyme Q10, St Johns wort, fish oil supplements,

59
Q

• Disability affects _% of stroke survivors

A

• Disability affects 75% of stroke survivors

60
Q

• Physical, mental, and/or emotional changes that can occur after a stroke

A
  • Anxiety, mood swings
  • Changes in cognition, attention, memory
  • 30 to 50 % suffer depression
  • muscle weakness
  • Paralysis
  • Vision loss
  • Speech loss
  • Difficulty swallowing
61
Q

What do the other members of the team do for patients with stroke?

A
  • Physician for overall care and prescriptions: cigarette smoking, alcohol, exercise, medical condition…
  • Physical Therapy (PT): help improve muscle strength & coordination, mobility (such as standing and walking)
  • Occupational Therapy (OT): help the individual to conduct activities of daily living (ADL) like brushing teeth, combing hair, bathing, feeding, cooking, toileting, or dressing. Swallowing assessment.
  • Social workers plans for discharge.
  • Psychologists: post-stroke depression
  • Nurses: Front line care: giving medications, skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure.
62
Q

What is heart failure?

A

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. In some cases, the heart can’t fill with enough blood. In other cases, the heart can’t pump blood to the rest of the body with enough force. Some people have both problems

63
Q

Why does the pump become less effective?

A

Injury to the heart or congenital abnormality-> Compensatory actions to maintain cardiac output (norepinephrine and activation of RAAS)-> Ventricular muscles undergo hypertrophy because they are working harder

64
Q

Risk factors for heart failure

A 
• Hypertension
• Ischemic heart disease (IHD)
• Valvular heart disease
• Diabetes mellitus
• Heavy alcohol or substance use
• Chemotherapy or radiation
 therapy
• Family history of cardiomyopathy
• Smoking
• Hyperlipidemia
65
Q

Symptoms for heart failure

A 
• Breathlessness
• Fatigue
• Leg swelling
• Confusion- especially in the elderly
• Orthopnea
• Paroxysmal nocturnal
 dyspnea
66
Q

What can echo determine when there’s heart failure?

A
  • Decreased left ventricular (LV) ejection fraction
  • Increased LV end-systolic and end-diastolic diameter
  • LVH
  • Wall motion abnormalities and diastolic dysfunction
  • Increased RV size and/or RV dysfunction
  • Valve dysfunction
  • Elevated pulmonary arterial pressures (PAP)
67
Q

WHat is Left ventricular ejection fraction

A

Left ventricular ejection fraction (LVEF or EF)= measurement of how much blood is being pumped out of the left ventricle of the heart

68
Q

What does ejection fraction comapre?

A

the amount of blood in the heart to the amount of blood pumped out

69
Q

Cut-off for ejection fraction?

A

normal: 50-70% - usually normal activity
Borderline: 41-49%- symptoms mat become noticeable
Reduced: <40%- symptoms may become noticeable even during rest

70
Q

What is Left-sided Heart Failure?

A

Left ventricle doesn’t contract with enough force, low LVEF

71
Q

What leads to pulmonary congestion or edema?

A

Pulmonary congestion is defined as accumulation of fluid in the lungs, resulting in impaired gas exchange and arterial hypoxemia.
High pressure in pulmonary capillaries leads to pulmonary congestion or edema

72
Q

what is pulmonary congestion?

A

Pulmonary congestion is defined as accumulation of fluid in the lungs, resulting in impaired gas exchange and arterial hypoxemia.

73
Q

__ or __ sides can fail: most often __ fails first

A

One or both sides can fail: most often left fails first

74
Q

What happens if left ventricle weakens?

A

Left ventricle weakens and cannot empty properly = less blood to body

75
Q

What happens if right ventricle weakens?

A

Right ventricle weakens and cannot empty as much as normal

76
Q

Left-sided congestive heart failure effects (5)

A
  1. Left ventricle weakens and cannot empty
  2. Decreased cardiac output to system
  3. Decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion
  4. Backup of blood into pulmonary vein
  5. High pressure in pulmonary capillaries leads to pulmonary congestion or edema
77
Q

What is the final outcome of right side heart failure

A

Very high venous pressure causes distended neck vein and cerebral edema
Increased venous pressure results in edema in legs, liver, and abdominal organs (ascites)

78
Q

What is the sudden weight gain a sign of and why?

A

Sudden weight gain can be a sign that heart failure is

worsening as it’s a sign of fluid retention and heart failure

79
Q

Why is there edema in HF?

A

Increased venous pressure results in edema of periphery in right-sided HF
High pressure in pulmonary capillaries leads to pulmonary congestion or edema in left-sided HF

80
Q

What is cardiomegaly and why is it observed in HF?

A

Cardiomegaly (enlarged heart)
• Less effective pump, has to pump more
• Less blood flow
• Kidney tries to compensate: renin + aldosterone cause vasoconstriction and
try to increase blood volume
• Heart has to work harder, vicious circle
• With time, gets worse

81
Q

What is the use of BNP in HF?

A

B-type natriuretic peptide
BNP can be used in the diagnosis of heart failure because it is secreted when the muscle fibers in the left ventricle are stretched.

82
Q

Suspect acute heart failure- steps of proceeding

A

1) Initial workup (history, physical, ECG, Chest X-ray)

2) In uncertain-> test BNP

83
Q

What might happen to lab values when assessing fluid balance?

A

• Lab values may appear diluted (Lower) ex. sodium, albumin, etc..

84
Q

What might happen to skin when retaining fluid?

A

• Skin tends to be clammy when retaining fluid

85
Q

I & O values from nurses

A

Intake and Output records of “sensible” losses (that we can easily measure)
• Intake: All fluids that are liquid at body temperature (milk, juice, water, tea, coffee, broth/soup, popsicle, jell-o, nutritional liquid supplements..) . IV fluids.
• Output: urine (can be collected for 24 hours), feces/stool if applicable (ex. diarrhea or watery stool), vomiting if applicable.

86
Q

Three main nutritional concerns for pts with HF are:

A
  1. Sodium intake
  2. Fluid intake
  3. Overall nutritional adequacy (optimization) due to early satiety, shortness of breath (SOB): Important to prevent malnutrition, cardiac cachexia…
87
Q

Fluid intake recommendations in patients after heart attacks/storkes

A

• Sodium:2,000mg/day • Fluid:1–2L/day

88
Q

Fluid restrictions
• __ per day for mild CHF
• __ per day for more severe CHF or more severe hyponatremia (< __
mmol/l Na+ in blood test)

A

Fluid restrictions
• 1 to 2L per day for mild CHF
• 1 to 1.5 L per day for more severe CHF or more severe hyponatremia (< 130
mmol/l Na+ in blood test)

89
Q

WHat changes should be made to the Texture and timing of foods of a patient after a heart attack/stroke?

A

Texture and timing of foods should be adjusted to allow adequate energy intake without discomfort

90
Q

Alcohol intake in post-HF patients

A

imit alcohol intake to one drink per day
• In patients in whom alcohol is believed to be a causative factor in the heart
failure, abstinence from alcohol is mandatory

91
Q

Note about weight and BMI assessment in post-HF patients

A

eight and BMI can be difficult to assess if there is fluid retention (can mask weight loss)

92
Q

Note about Estimated Energy requirement in HF patients

A

Calculations typically for comparison purposes (to compare to intake). If edema present and low activity, then 25 kcal/kg actual weight could give a rough initial estimate. Use judgement.

93
Q

Note about protein in HF patients

A

1.1 – 1.4 g/kg actual body weight as a target for comparison purposes. If edema is increasing weight, then use lower end of range. Use judgement

94
Q

What is our goal in severe cases of HF in terms of nutrition

A

In more advanced heart failure, typically we want to prevent further weight loss and optimize protein and kcalorie intake since there is high risk of malnutrition and poorer prognosis with malnutrition.

95
Q

What determines if HF progresses or stabilizes?

A
  • For some patients, HF can be controlled with lifestyle changes, diet, and medication.
  • For others, the condition progressively worsens.
  • Infection and/or cardiac events can further weaken the heart.
96
Q

What is the mortality rate associated with HF?

A

The mortality rate is high, with 20% of people dying within the first year of diagnosis.

97
Q

What is cardiac cachexia and what is the associated prevalence?

A

End result of heart failure (10 – 15 % of HF patients)

Weight loss with significant loss of lean body mass including cardiac muscle

98
Q

What is the heart like during cardiac cachexia?

GI?

A

Heart is soft and flabby
Inadequate blood supply to GI tract: anorexia, nausea, feeling of fullness, constipation, abdominal pain, malabsorption, loss of normal bowel function

99
Q

Why is cardiac cachexia so dangerous?

A

Poor prognosis, high mortality

100
Q

Stages of heart failure

A

https://img.grepmed.com/uploads/1716/classification-heartfailure-cardiology-congestive-diagnosis-original.jpeg

NUTR 344 (22 decks)

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