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Clinical Nutrition 1 > CVD & secondary prevention > Flashcards

CVD & secondary prevention Flashcards

1
Q

Arteries carry _ blood
Veins carry _ blood

What is the exception?

A

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.

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2
Q

What regulates arterial blood pressure?

A
  • sympathetic nervous system
  • renin-angiotensin-aldosterone system
  • renal function
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3
Q

Vasodilation =

A

pipe is wider, less resistance –> less pressure

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4
Q

Vasoconstriction =

A

narrowed pipe, increased resistance –> more pressure

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5
Q

The Framinghman risk score are not available for which ages?

A

80+

benefits versus risk of restrictive diet

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6
Q

How are CVD different in women?

A
  • decreased risk for CVD pre-menopause
  • symptoms of heart attacks not “typical”
  • less in women than in men
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7
Q

Why are CVD more prevalent in men?

A

Estrogen has a positive effect on the inner layer of artery wall –> helps keep blood vessels flexible

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8
Q

T/F

Due to the protection effect of oestrogen, hormone replacement therapy for prevention fo CVD is a good solution

A

False

Studies have not found a benefit of hormone replacement therapy for prevention of CVD

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9
Q

When does menopause happen?

A

age 51-54

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10
Q

What happens to the lipid profile during menopause?

A
  • BP increase
  • LDL-C increase
  • HDL decreases or remains same
  • TG increase
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11
Q

Adults with diabetes are __ likely to die form heart disease than adults without diabetes

A

2-4 times more likely

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12
Q

Myocardial Infarction / heart attack =

A

When one of the coronary arteries becomes blocked and heart tissue dies because not getting enough oxygen

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13
Q

Common heart attack warning signs

A
  • pain or discomfort in chest
  • lightheadedness, nausea, vomiting
  • jaw, neck or back pain
  • discomfort or pain in a rm or shoulder
  • shortness of breath
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14
Q

To tests to check the heart rhythm

A
  • echo = echocardiogram

- EKG= electrocardiogram

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15
Q

What are 4 types of heart attacks

A
  • stable angina
  • unstable angina
  • NSTEMI
  • STEMI
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16
Q

How can you characterise a STEMI?

A

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

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17
Q

How can you characterise a NSTEMI?

A

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

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18
Q

What are the 3 biomarkers for an MI

A
  • troponin
  • creatine kinase test
  • lactase dehydrogenase
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19
Q

What is the most sensitive and specific test for myocardial damage? Why?

A

Troponin

Because it has increased specificity compared with creatine Kinase.

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20
Q

When is the peak of troponin

A

12 hours

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21
Q

When is the peak of CK-MB (Creatine Kinase)

A

10-24 hours

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22
Q

When is the peak of LDH (lactate dehydrogenase)

A

72 hours

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23
Q

When is CK-MB specific?

A

Is relatively specific when skeletal muscle damage is not present

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24
Q

Potential cardiac surgeries or procedures post MI

A
  • depends on how fast medical treatment is obtained

- thrombolysis (to dissolve clots in coronary arteries)

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25
Q

When is thrombolysis performed?

A

within 3 hours of the heart attack

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26
Q

3 types of surgeries :

A
  • cardiac catherization
  • angioplasty or PTCA (percutaneous transluminal coronary angioplasty)
  • CABG (Coronary Artery Bypass Graft)
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27
Q

Cardiac catherization

A
  • passing catheter via arm, groin, neck
  • visualization
  • angiogram
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28
Q

Angioplasty or PTCA

A

Use a catheter to insert a stent or a balloon to open up the artery

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29
Q

Coronary Artery Bypass Graft

A

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

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30
Q

Post-MI diet

A
  • nothing per mouth or clear liquids without caffein

- progress to small soft tolerated meals

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31
Q

Why should nothing be fed to a patient after surgery?

A

Want blood flow supported or maximised to heart as opposed to GI tract

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32
Q

5 ways to lower risk of a second heart attack

A
  • Take medication
  • Follow-up with Doctor
  • Participate in Cardiac rehab
  • Manage risk factors
  • Get support
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33
Q

Medications after a heart attack

A
  • 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)
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34
Q

What is a cerebrovascular accident or stroke ?

A

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

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35
Q

Types of strokes

A
  • 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)
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36
Q

4 signs of stroke

A
  • Face (is it drooping)
  • Arms (can you raise both)
  • Speech (is it slurred or jumbled)
  • Time (to call 911 right away)
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37
Q

A patient has right-sided weakness, which side of the brain is affected?

A

Left side

38
Q

Pre-diabetes range for HgA1C

A

6.0-6.4%

39
Q

What are 2 common risk factors for stroke?

A
  • hypertension

- obesity

40
Q

What are sodium recommendations?

A

2g sodium

41
Q

Why would you estimate energy requirement for weight loss of an obese patient (in the CVD context)

A

Can be useful if providing a DASH diet for a specific kcal range

42
Q

What is the stroke nutrition therapy?

A
  • 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
43
Q

Problem of canned fish

A

High in sodium

44
Q

A patient with high TG should avoid and achieve:

A

avoid:

  • sugars, sweets, sweetened beverages
  • alcohol

achieve:
- healthy weight

45
Q

Coconut oil effect on lipid profile

A
  • increases Tchol and LDL (more than unsat/monunsat veg oils

- can increase HDL

46
Q

Coconut is _% saturated fat. Mostly with FA?

A

87% SFA

Lauric acid

47
Q

How to make a client-entered plan?

A

ask :

  • what she knows about her condition
  • what has contributed to stroke
  • what she should change
  • what information does she want
48
Q

What is A-fib (Atrial fibrillation)

A

Is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications.

49
Q

A-fib treatments

A
  • anti-coagulants to thin out the blood (Warfarin)

- vitamin K intake should be consistent

50
Q

Sources of vitamin K

A
  • cooked greens (spinach, kale, collards, beet greens)

- raw leafy greens, asparagus, broccoli, bran, chickpeas, lentils, soybeans, swiss card, liver, oils, egg yolk

51
Q

A patient on warfarin should be cautious about which vitamin supplements

A

Vitamin A or E can affect clotting time

52
Q

Which natural products affect clotting time and can interact?

A
  • high amounts of onions, garlic, avocado, cranberry juice, soy milk, green tea
  • ginkgo, ginseng, coenzyme Q1°, St Johns wort, fish oils
53
Q

_% of stroke survivors face disability

A

75%

54
Q

What is the disability that can occur post-stroke

A

Physical, mental and/or emotional changes:

  • anxiety, mood swings
  • cognition, attention, memory changes
  • depression
  • muscle weakness
  • paralysis
  • vision loss
  • speech loss
  • difficulty swallowing
55
Q

Other complications that occur in more severe cases:

A
  • limited mobility

- dysphagia, reduced intake, modified texture diet, malnutrition, reduced speech

56
Q

What is heart failure (or Congestive Heart Failure)

A

The heart is pumping but not as strongly as it should

57
Q

How does the heart pump become less effective

A

1- injury to heart cor congenital abnormality
2- compensatory actions to maintain cardiac output
3- ventricular muscles undergo hypertrophy because they are working harder

58
Q

What are compensatory actions to maintain cardiac output ?

A

norepinephrine and activation of RAAS

59
Q

heart failure symptoms

A
  • 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
60
Q

Risk factors for HF

A
  • HTN
  • ischemic heart disease
  • diabetes M
  • smoking
  • hyperlipidemia
  • heavy alcohol
  • valvular heart disease
  • family history
61
Q

Which test can determine valve dysfunction, elevated pulmonary arterial pressure, wall abnormalities

A

Echocardiogram (echo)

62
Q

_% of blood is pumped during normal ejection fraction

A

50-70%

63
Q

_% of blood is pumped during borderline ejection fraction

A

41-49%

64
Q

_% of blood is pumped during reduced ejection fraction

A

<40%

65
Q

Ejection fraction = __/__

A

amount of blood pumped out / amount of blood in chamber

66
Q

High pressure in pulmonary capillaries leads to _

A

pulmonary congestion or edema

67
Q

Evolution of Congestive heart failure (of Left side)

A
  1. left ventricle weakens and can’t empty
  2. decreased cardiac output to system
  3. decreased renal blood flow simulates renin-angiotensin and aldosterone secretion
  4. backup of blood into pulmonary vein
  5. high pressure in pulmonary capillaries leads to pulmonary congestion or edema
68
Q

Which side of the heart fails first usually?

A

Left

69
Q

When right ventricle weakens and can’t empty as much as normal it affects :

A

the lungs

70
Q

When left ventricle weakens and can’t empty as much as normal it affects :

A

less blood to body

71
Q

Increased venous pressure results in :

A

edema in legs and around abdominal organs (ascites)

72
Q

Sign that HF is worsening?

A

Sudden weight gain (because is fluid gain)

73
Q

In a patient with HF why does :

  • pulse increase
  • respiration increase
  • blood pressure lowers
A

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

74
Q

What is pedal edema

A

touch the feet and the dent stays

75
Q

Why does heart enlarge in HF

A
  • 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
76
Q

Biomarker of heart failure :

why?

A

B-type natriuretic peptide (BNP)

Secreted when the muscle fibres in the L ventricle are stretched

77
Q

What medication could help a patient with HF?

A

Diuretics to increase urination

78
Q

How to assess fluid balance?

A
  • visually (by doctors/nurse)
  • diluted lab values (low sodium, albumin,…)
  • clammy skin
  • intake and output records
79
Q

What are the intakes and output in an I and O record

A 
Intake= all fluids liquid at body temperature 
Output= urine (24h), feces/stool (diarrhea, watery stool) if applicable, vomiting if applicable
80
Q

3 main nutritional concerns for patients with HF

A
  • sodium intake
  • fluid intake
  • overall nutritional adequacy due to early satiety, shortness of breath
81
Q

Fluid management for patients with HF

A
  • 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
82
Q

Sodium management for patients with HF

A

2000mg/Day of sodium

83
Q

Adequate diet for a patient with heart failure

A
  • 2g sodium
  • 1.5L of fluid (depends on severity)
  • small meals and snacks
  • nutrient dense snacks, oral nutritional supplements
84
Q

What can be difficult to assess if there is fluid retention?

A

BMI because it could mask weight loss

85
Q

How many g of proteins should be targeted ?

A
  1. 1-1.4g /kg actual body weight

1. 1g/kg if edema is increasing weight

86
Q

If edema present and low activity what is a quick Estimated Energy Requirement calculation?

A

25kg/kg actual weight

87
Q

When advanced heart failure, what do you want to prevent, and optimise?

A

prevent weight loss

optimize protein and calorie intake

88
Q

What is the mortality rate of people dying within the first year of diagnosis for HF

A

20%

89
Q

What is cardiac cachexia the end result of ?

A

End result of heart failure for 10-15% HF patients

90
Q

Cardiac cachexia =

A

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

The heart is soft and flabby

91
Q

Consequence of cardiac cachexia

A

inadequate blood supply to GI tracts : anorexia, nausea, feeling of fullness, constipation, abdominal pain, malabsorption, loss of normal bowel function

Clinical Nutrition 1 (13 decks)

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