CVD Secondary Prevention, CVA and HF Flashcards
Definition of secondary prevention
Considerations of age, menopause, and diabetes on secondary prevention
prevention of the reccurrance of a cardiovascular event in diagnosed patients with CVD: MI, CVA, or HF
Age: FRS relevant up to age 79, dietary changes more relevant <80
Menopause (51-58 or following hysterectomy): ↑ risk of CVD following, estrogen keeps blood vessel walls flexible
- BP change, LDL ↑, HDL ↓, TG ↑
- no found benefit of hormone replacement on CVD Risk
Diabetes: vascular changes, increased CVD risk (2-4x more likely to die from heart disease)
Heart attack symptoms in men vs women
Men: chest pain, SOB, discomfort in jaw/neck/back/arm/shoulder
Women: chest pain, SOB, discomfort in jaw/neck/back/arm/shoulder AND nausea, light-headedness or unusual fatigue
Electrocardiogram (ECG/EKG)
Echocardiogram
Exercise stress test
EKG: Measures heart’s activity
Echocardiogram: echo is ultrasound to measure how well heart pumps
Exercise stress test (EKG + treadmill test): how well heart works when working hard
Stable angina, unstable angina, NSTEMI and STEMI definitions based on EKG
Stable angina: pain during increased demand due to stable plaque preventing the vessel dilating to allow adequate flow
Normal EKG and troponins
Unstable angina: plaque ruptures and forms thrombus causing partial occlusion and supply ischemia, pain at rest
Normal, inverted T wave or ST depression + normal troponins
NSTEMI: plaque rupture + thrombosis –> partial occlusion resulting in injury and infarct to subendocardial myocardium
Normal, inverted T wave or ST depression + elevated troponins
STEMI (ST elevation myocardial infarction): complete occlusion of blood vessel –> injury and infarct to myocardium
Hyperacute T waves or ST elevation + elevated troponins
MI biomarkers and timeframe
Troponin: sensitive and specific for myocardial damage peaking at 12 hours
Creatine kinase (CK-MB) test: relatively specific when skeletal muscle damage not present (10-24 hour peak)
Lactate dehydrogenase: not as specific as troponin (peaks 72 hours)
4 Cardiac surgeries/procedures
Food rx following MI?
Thrombolysis: procedure to dissolve clots in coronary arteries within 3 hours of heart attack - delivered through catheter
Cardiac catheterization: catheter vs arm/groin or neck to visualize or produce angiogram
Angioplasty/PTCA: catheter used to insert stent or balloon
CABG: coronary artery bypass graft (single - quadruple)
Food rx: NPO, then clear liquids to support blood flow to heart
Medications following a MI
Antiplatelet agents to prevent clots and keep stent open (ex. aspirin)
Statins - ↓ cholesterol
Beta blockers/ACE inhibitors - treat high BP
Nitrates: vasodilation and relieve chest pain (ex. nitroglycerin)
Anticoagulants to reduce clotting ability
Stomach protection from stress and aspirin:
cimetidine, famotidine, ranitidine or PPIs like pantoprazole
Healthy quantities of nuts, legumes, olive oil (EVOO vs canola), f&v, fiber/whole grains in 2° prevention
Nuts ≥ 30g/d
Legumes ≥ 4 servings/week
Olive oil ≥ 60 mL/d
EVOO is cold pressed, more EFA, MUFA and anti-inflam but $$ (lasts 12-18 months)
Canola and regular olive oil more refined and stable - lasts longer, lower $$ (better for high-heat frying)
- contains some trans fat from refinement process
F&V ≥ 5 servings/d
Fiber ≥ 30g/d and whole grains ≥ 3 servings/d
Cerebrovascular accident types
Signs of stroke
Ischemic: blood clot blocks blood flow in an artery of the brain causing tissue death
Hemorrhagic: blood vessel burst within the brain causing a brain hemorrhage
Transient ischemic attack (TIA, mini-stroke) - lasting < 5 minutes with short lasting symptoms
Chronic ischemic changes = CVA over time left changes
Signs: Face, Arms, Speech, Time (FAST)
Controllable risks for stroke
Diet therapy for stroke
Obesity, low PA, sleep apnea, heavy alcohol use, smoking/drugs, diabetes, CVD, high cholesterol high BP
Diet:
low Na, DASH diet, heart healthy diet like Mediterranean, fiber
Risk of malnutrition - not the time for weight loss
Atrial fibrillation
Type of common heart arrhythmia
Normal beating in upper chambers of heart is irregular - atria lack coordination causes reduced blood flow into ventricles and increases risk of clot developing
Important risk factor for stroke - can develop in older age
Complications following stroke and examples
75% of stroke survivors experience disabilities (varying severity) including mental, physical or emotional changes
Ex. Weakness/paralysis can improve or remain long term, limited mobility, feeding difficulties, dysphagia, malnutrition, speech challenges
Definition of heart failure and causes and pathophysiological changes
AKA congestive heart failure
Heart is not pumping as strongly/effectively as it should
Causes: injury to heart or congenital abnormality
–> kidney compensatory actions to maintain CO (NE/RAAS activation vasoconstriction to ↑ BP)
–> ventricular muscle undergo hypertrophy due to working harder and heart enlarges (cardiomegaly)
Signs/symptoms of HF
lung crackles, SOB
elevated jugular venous pressures
peripheral and pulmonary edema and ascites
heart murmur
low BP
HR > 100 BPM
Left ventricular ejection fraction
Blood pumped out of left ventricle with each contraction
Amount pumped out/amount in chamber
Normal = 50-70%
Borderline = 41-49% (symptoms noticeable during activity)
Reduced = ≤ 40% (symptoms noticeable at rest)
Right vs left-sided HF
Right ventricle weakening affects lungs first
–> high pressure in pulmonary capillaries due to low ejection fraction leads to pulmonary congestion/edema
Left ventricle weakening affects blood to body
–> increased venous pressure results in edema in legs and ascites around organs
–> sudden weight gain as a sign of worsening HF
–> use of diuretics (Water pills) to increase urine output and decrease edema
Difficult in practice to know which started, often both
BNP
B-type natriuretic peptide - can be used in diagnosis of HF because it is secreted by muscle fibers in left ventricle when stretched
Nutritional concerns with HF
sodium intake (restricted)
fluid intake (monitor intake vs output, may need restriction)
nutritional adequacy due to early satiety, SOB - prevent malnutrition, cardiac cachexia
25-30 kcal/kg
1.1-1.4g/kg protein
Energy dense foods and oral nutritional supplements as needed based on risk of malnutrition
Prognosis for HF
Cardiac cachexia
Prognosis: 20% die within a year of diagnosis (high)
For some can be controlled, for others it worsens and infection/cardiac events worsen status
Cardiac cachexia: 10-15% of patients, end result of HF
Weight loss w/ significant LBM loss including cardiac muscle
Poor prognosis, high mortality
Due to inadequate blood supply to GI, anorexia, nausea, fullness feeling, constipation, abdominal pain, malabsorption, loss of normal bowel function
