CVD & secondary prevention Flashcards
Arteries carry _ blood
Veins carry _ blood
What is the exception?
Arteries –> oxygenated blood
Veines –> deoxygenated blood
Pulmonary artery contains deoxygenated blood grinds to the lungs. Pulmonary vein contains oxygenated blood to be pumped to the body.
What regulates arterial blood pressure?
- sympathetic nervous system
- renin-angiotensin-aldosterone system
- renal function
Vasodilation =
pipe is wider, less resistance –> less pressure
Vasoconstriction =
narrowed pipe, increased resistance –> more pressure
The Framinghman risk score are not available for which ages?
80+
benefits versus risk of restrictive diet
How are CVD different in women?
- decreased risk for CVD pre-menopause
- symptoms of heart attacks not “typical”
- less in women than in men
Why are CVD more prevalent in men?
Estrogen has a positive effect on the inner layer of artery wall –> helps keep blood vessels flexible
T/F
Due to the protection effect of oestrogen, hormone replacement therapy for prevention fo CVD is a good solution
False
Studies have not found a benefit of hormone replacement therapy for prevention of CVD
When does menopause happen?
age 51-54
What happens to the lipid profile during menopause?
- BP increase
- LDL-C increase
- HDL decreases or remains same
- TG increase
Adults with diabetes are __ likely to die form heart disease than adults without diabetes
2-4 times more likely
Myocardial Infarction / heart attack =
When one of the coronary arteries becomes blocked and heart tissue dies because not getting enough oxygen
Common heart attack warning signs
- pain or discomfort in chest
- lightheadedness, nausea, vomiting
- jaw, neck or back pain
- discomfort or pain in a rm or shoulder
- shortness of breath
To tests to check the heart rhythm
- echo = echocardiogram
- EKG= electrocardiogram
What are 4 types of heart attacks
- stable angina
- unstable angina
- NSTEMI
- STEMI
How can you characterise a STEMI?
By a complete occlusion of the blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes an a rise in troponins
How can you characterise a NSTEMI?
During a NSTEMI, the plaque rupture and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium
What are the 3 biomarkers for an MI
- troponin
- creatine kinase test
- lactase dehydrogenase
What is the most sensitive and specific test for myocardial damage? Why?
Troponin
Because it has increased specificity compared with creatine Kinase.
When is the peak of troponin
12 hours
When is the peak of CK-MB (Creatine Kinase)
10-24 hours
When is the peak of LDH (lactate dehydrogenase)
72 hours
When is CK-MB specific?
Is relatively specific when skeletal muscle damage is not present
Potential cardiac surgeries or procedures post MI
- depends on how fast medical treatment is obtained
- thrombolysis (to dissolve clots in coronary arteries)
When is thrombolysis performed?
within 3 hours of the heart attack
3 types of surgeries :
- cardiac catherization
- angioplasty or PTCA (percutaneous transluminal coronary angioplasty)
- CABG (Coronary Artery Bypass Graft)
Cardiac catherization
- passing catheter via arm, groin, neck
- visualization
- angiogram
Angioplasty or PTCA
Use a catheter to insert a stent or a balloon to open up the artery
Coronary Artery Bypass Graft
A procedure to bypass a blocked section of a coronary artery and to deliver oxygen to the heart by using vessels from other parts of the body
Post-MI diet
- nothing per mouth or clear liquids without caffein
- progress to small soft tolerated meals
Why should nothing be fed to a patient after surgery?
Want blood flow supported or maximised to heart as opposed to GI tract
5 ways to lower risk of a second heart attack
- Take medication
- Follow-up with Doctor
- Participate in Cardiac rehab
- Manage risk factors
- Get support
Medications after a heart attack
- anti platelet agents = to prevent blood clots and keep a stent open (aspirin)
- statins = to lower cholesterol levels
- beta blocker, ACE inhibitors = to treat high blood pressure
- nitrates= to expand the arteries and relieve chest pain (nitroglycerin)
- anticoagulants = to reduce the blood’s ability to clot (Warfarin)
- medications to protect the stomach from stress and aspirin (cimetidine, famotidine, ranitidine, protein pump inhibitors like pantoprazole)
What is a cerebrovascular accident or stroke ?
A stroke happens when blood stops flowing to any part of your brain, damaging brain cells. The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done
Types of strokes
- Ischemic stroke = Caused by a blockage or clot in a blood vessel in your brain.
- Hemorrhagic stroke = Caused when an artery in the brain breaks open
- Transient ischemic attack (TIA) = Caused by a small clot that briefly blocks an artery. (called a mini-stroke)
4 signs of stroke
- Face (is it drooping)
- Arms (can you raise both)
- Speech (is it slurred or jumbled)
- Time (to call 911 right away)
A patient has right-sided weakness, which side of the brain is affected?
Left side
Pre-diabetes range for HgA1C
6.0-6.4%
What are 2 common risk factors for stroke?
- hypertension
- obesity
What are sodium recommendations?
2g sodium
Why would you estimate energy requirement for weight loss of an obese patient (in the CVD context)
Can be useful if providing a DASH diet for a specific kcal range
What is the stroke nutrition therapy?
- low sodium
- plenty of vegetables, fruits, whole grains, fat-free, low-fat dairy products
- heart-healthy fats to reduce plaque buildup
- if need to lose weight: follow a plan
- 20-30g fiber
- fatty fish twice a week
Problem of canned fish
High in sodium
A patient with high TG should avoid and achieve:
avoid:
- sugars, sweets, sweetened beverages
- alcohol
achieve:
- healthy weight
Coconut oil effect on lipid profile
- increases Tchol and LDL (more than unsat/monunsat veg oils
- can increase HDL
Coconut is _% saturated fat. Mostly with FA?
87% SFA
Lauric acid
How to make a client-entered plan?
ask :
- what she knows about her condition
- what has contributed to stroke
- what she should change
- what information does she want
What is A-fib (Atrial fibrillation)
Is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications.
A-fib treatments
- anti-coagulants to thin out the blood (Warfarin)
- vitamin K intake should be consistent
Sources of vitamin K
- cooked greens (spinach, kale, collards, beet greens)
- raw leafy greens, asparagus, broccoli, bran, chickpeas, lentils, soybeans, swiss card, liver, oils, egg yolk
A patient on warfarin should be cautious about which vitamin supplements
Vitamin A or E can affect clotting time
Which natural products affect clotting time and can interact?
- high amounts of onions, garlic, avocado, cranberry juice, soy milk, green tea
- ginkgo, ginseng, coenzyme Q1°, St Johns wort, fish oils
_% of stroke survivors face disability
75%
What is the disability that can occur post-stroke
Physical, mental and/or emotional changes:
- anxiety, mood swings
- cognition, attention, memory changes
- depression
- muscle weakness
- paralysis
- vision loss
- speech loss
- difficulty swallowing
Other complications that occur in more severe cases:
- limited mobility
- dysphagia, reduced intake, modified texture diet, malnutrition, reduced speech
What is heart failure (or Congestive Heart Failure)
The heart is pumping but not as strongly as it should
How does the heart pump become less effective
1- injury to heart cor congenital abnormality
2- compensatory actions to maintain cardiac output
3- ventricular muscles undergo hypertrophy because they are working harder
What are compensatory actions to maintain cardiac output ?
norepinephrine and activation of RAAS
heart failure symptoms
- confusion
- coughing
- edema in angles and legs
- pulmonary edema
- tiredness
- shortness of breath
- ascites
- pumping action of the heart weaker
- pleural diffusion (excess fluid around lungs
Risk factors for HF
- HTN
- ischemic heart disease
- diabetes M
- smoking
- hyperlipidemia
- heavy alcohol
- valvular heart disease
- family history
Which test can determine valve dysfunction, elevated pulmonary arterial pressure, wall abnormalities
Echocardiogram (echo)
_% of blood is pumped during normal ejection fraction
50-70%
_% of blood is pumped during borderline ejection fraction
41-49%
_% of blood is pumped during reduced ejection fraction
<40%
Ejection fraction = __/__
amount of blood pumped out / amount of blood in chamber
High pressure in pulmonary capillaries leads to _
pulmonary congestion or edema
Evolution of Congestive heart failure (of Left side)
- left ventricle weakens and can’t empty
- decreased cardiac output to system
- decreased renal blood flow simulates renin-angiotensin and aldosterone secretion
- backup of blood into pulmonary vein
- high pressure in pulmonary capillaries leads to pulmonary congestion or edema
Which side of the heart fails first usually?
Left
When right ventricle weakens and can’t empty as much as normal it affects :
the lungs
When left ventricle weakens and can’t empty as much as normal it affects :
less blood to body
Increased venous pressure results in :
edema in legs and around abdominal organs (ascites)
Sign that HF is worsening?
Sudden weight gain (because is fluid gain)
In a patient with HF why does :
- pulse increase
- respiration increase
- blood pressure lowers
Heart pumps less blood, HR increases so it pumps more often
Tissues get less oxygenated blood, breathes more often trying to get more oxygenated blood circulating
Lower BP because heart not effectively pumping as much volume
What is pedal edema
touch the feet and the dent stays
Why does heart enlarge in HF
- less effective pump, has to pump more
- less blood flow
- kidney compensates : renin and aldosterone cause vasoconstriction and try to increase blood volume
- heart has to work harder, vicious circle
Biomarker of heart failure :
why?
B-type natriuretic peptide (BNP)
Secreted when the muscle fibres in the L ventricle are stretched
What medication could help a patient with HF?
Diuretics to increase urination
How to assess fluid balance?
- visually (by doctors/nurse)
- diluted lab values (low sodium, albumin,…)
- clammy skin
- intake and output records
What are the intakes and output in an I and O record
Intake= all fluids liquid at body temperature Output= urine (24h), feces/stool (diarrhea, watery stool) if applicable, vomiting if applicable
3 main nutritional concerns for patients with HF
- sodium intake
- fluid intake
- overall nutritional adequacy due to early satiety, shortness of breath
Fluid management for patients with HF
- fluid restrictions
= 1-2L/d for milf CHF
= 1-1.5L/d for more severe CHF or more severe hyponatremia - limit alcohol to 1 drink per day
Sodium management for patients with HF
2000mg/Day of sodium
Adequate diet for a patient with heart failure
- 2g sodium
- 1.5L of fluid (depends on severity)
- small meals and snacks
- nutrient dense snacks, oral nutritional supplements
What can be difficult to assess if there is fluid retention?
BMI because it could mask weight loss
How many g of proteins should be targeted ?
- 1-1.4g /kg actual body weight
1. 1g/kg if edema is increasing weight
If edema present and low activity what is a quick Estimated Energy Requirement calculation?
25kg/kg actual weight
When advanced heart failure, what do you want to prevent, and optimise?
prevent weight loss
optimize protein and calorie intake
What is the mortality rate of people dying within the first year of diagnosis for HF
20%
What is cardiac cachexia the end result of ?
End result of heart failure for 10-15% HF patients
Cardiac cachexia =
Weight loss with significant loss of lean body mass including cardiac muscle
The heart is soft and flabby
Consequence of cardiac cachexia
inadequate blood supply to GI tracts : anorexia, nausea, feeling of fullness, constipation, abdominal pain, malabsorption, loss of normal bowel function
