Exam 3 - cardiovascular disease Flashcards
What falls under cardiovascular disease?
- coronary heart disease
- atherosclerosis
- hypertension
- peripheral vascular disease
- heart failure
What is atherosclerotic cardiovascular disease (ASCVD)?
- narrowing of vessels by the buildup of planque starting from an injury to the endothelial cells that line the vessels
- Poor endothelial cells causes heart disease, foam cells damage, stemming from oxidized cholesterol
- plaque known as atherosclerosis can rupture causing a blood clot that blocks blood flow
What is the technical term for a heart attack?
Myocardial Infarction
What is a temporary ischemic stroke (TIA)?
true stroke
What is angina?
chest pain
What is intermitent claudication?
peripheral vascular disease
- could cause dead limbs, necrosis, gangrene
What lipoproteins are associated with being atherogenic?
Apo B100, LDL-C
- half of the people with atherosclerosis have normal lipid levels
- small density lipoproteins are much more atherogenic
What lipoprotein is positively associated with HDL?
Apo A1
What are the risk factors for CVD?
- inflammatory markers
- blood lipids (thought half have normal levels and still presiposed for CVD)
- lifestyle factors: smoking, poor diet, physical inactivity, alcohol, insufficient sleep, stress
- Age: men > 45, women > 55
- gender: men higher likelihood, although women are more likely to die due to not knowing they are having a heart attack
- genetics: gamily members with heart evens put you at elevated risk
- presence of other diseases: diabetes, HTN, low HCL, glucose intolerance, obesity
What are the inflammatory markers for CVD?
- fibrinogen
- C-reactive protein (CRP not a good screening tool)
- homocysteine - high levels associated with heart disease
- Lp-PLA2 - produced by macrophages and foam cells, true marker for atherosclerosis
What are some preventative measures for ASCVD?
- children older than 2 emphasize activity to maintain IBW
- Adults: total cholesterol < 170 mg/dl, HDL > 50, examine lifestyle and overall health before advising patients and dosing
- healthy lifestyle is the backbone of CVD prevention and treatment
ACC/AHA diet recommendations for ASCVD
- Maintain or reach target weight
- Reduce calories from saturated fat (5-6%)
- Eliminate consumption of trans fat
- Limit sweets, SSB and red meat
- Follow diet therapy for other diseases
- Emphasize fruit, vegetables, legumes, whole grains, fish (fatty fish 2 x week) or omega 3 (inhibits Apo B100 synthesis), nuts, nut oils, low-fat dairy
- Antioxidant rich diet
- 25-30 grams soluble fiber/day
- Plenty of stanols and sterols
- Dietary cholesterol is no longer restricted
- DASH diet great, vegan benefits and MedDiet fit recs.
- Include exercise too!
What is the pharmacologic management for ASCVD?
- diet to minimize need for drug therapy
- normally a mixture of medications
- bile acid sequestrants
- nicotinic acid - therapeutic dose causes flushing
- HMG CoA reductase inhibitors (statins)
- fibric acid derivatives
- probucol (decrease Tryglyceride synthesis)
What are statins, when are they used, how do they work?
- Inhibit HMG CoA Reductase (rate limiting step of making cholesterol in the body)
- ACC/AHA Recommend for: LDL cholesterol ≥ 190mg/dL or those with Diabetes, age 40–75 with LDL-C 70–190mg/dl; or in those with a 10-year risk of developing heart attack or stroke of
- 7.5% or more
- Side effects: Need for supplement of CoQ 10
- Subset of humans 5-10% will have serious side effects from statins, must taper on or off the drug
What are the medical interventions for ASCVD?
- Percutaneous coronary intervention (PCI) – stent
- Coronary artery bypass graft (CABG) - open heart surgery
T/F right after medical intervention (surgery) is the best time for nutrition education
FALSE
* Must put outpatient resources in their hands
* Wrong time for in person education right after surgery, though doctors will refer a dietitian right away
* Patient will most likely not be receptive to the education
What is hypertension?
- Persistently high arterial blood pressure
- Systolic BP = contraction phase
- Diastolic BP = relaxation phase
- BP is reported as systolic over diastolic
- endothelial lining thins as you age, so high blood pressure becomes much more common with age
- higher risk associated with black americans
What are the blood pressure ranges?
Normal: <120/<80 mm Hg
Prehypertension: systolic 120-129 and diastolic less than 80
Stage 1: systolic 130-139 or diastolic between 80-89
Stage 2: systolic at least 140 or diastolic at least 90
Hypertensive crisis: systolic over 180 or diastolic over 120
What are risk factors and adeverse prognosis in hypertension?
- Black race
- Youth
- Male
- Persistent DP >115 mm Hg
- Smoking
- Diabetes
- Hypercholesterolemia
- Obesity
- Excessive ETOH intake – very adjustable lifestyle factor
- End-organ damage
- Cardiac enlargement
- MI – myocardial infarction
- HF – heart failure
Pathophysiology of Hypertension
- When diameter of a blood vessel is decreased by atherosclerosis, resistance and BP increase.
- Sympathetic nervous system is short-term control of BP.
- Kidney is long-term control of BP.
- Fluid volume - Problem: Water deficit, Solution: vasopressin released leads to increased water reabsorption in kidneys, Result: increase blood volume and blood pressure
- Renin-angiotensin-aldosterone system - Problem: Decrease in Na, plasma volume, BP, Solution: renin released –> renin activates angiotensin I –> ACE converts angiotensin I to angiotensin II –> aldosterone secreted –> Na and Cl reabsorption in kidneys, Result: water retention and BP increased
Untreated or uncontrolled hypertension can lead to what?
Leads to increased
* Workload on heart
* Damage to arteries
* Atherosclerosis
* Coronary heart disease esp. HF
* Strokes
* Transient ischemic attacks (TIAs)
* Kidney damage
* Microvascular hemorrhages in brain and eye
What are the most common mediations for HTN?
Diuretics
ACE inhibitors
Angiotensin II receptor blockers
What is the MNT for HTN?
- DASH diet (Ca, Vit D, Vit K, Na, Mg)
- Weight management
- Alcohol in moderation
- Physical activity
- MUFA
- Omega 3 mixed results
- HTN sodium: less than 1500 mg/d
What are the DASH pattern recommendations?
2000 kcal, 1500 mg sodium
7 - 8 whole grains/day
4 - 5 vegetables/day
4 - 5 fruits/day
2 - 3 low-fat or fat-free dairy products/day
2 or less servings of meat/poultry/fish/day
4 - 5 servings nuts, beans, or legumes per week
2-3 fats/oils/day
5 sweets per week
What are the risk factors for metabolic syndrome?
Risk factors – any three
* Elevated waist circumference (40 males, 35 females)
* Elevated TG (150 or more)
HTN (130/85 or more)
* Low HDL (less than 40 for males; less than 50 for females
* Impaired fasting glucose (FBS 100 or more)
General things to know for cardiac transplants
- Generally for cardiomyopathy
- For refractory, end-stage HF
- Nutrition support before and after surgery
- Immediate posttransplant MNT is similar to other surgery patients
- Long-term MNT is aimed at comorbid conditions
