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Clinical nutrition 1 > Heart Diseases and Stroke > Flashcards

Heart Diseases and Stroke Flashcards

1
Q

the left atrium of the heart collects ____ blood that goes into left ventricle and pumped _____

A

oxygenated blood

pumped into body

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2
Q

______ blood comes back to heart in right atrium and pumped to _____

A

deoxygenated blood

pumped to lungs to collect oxygen

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3
Q

the pulmonary artery carries ____

A

deoxygenated blood

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4
Q

the left ventricle pumps oxygenated blood to the body via the ____

A

aorta

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5
Q

how is the arterial blood pressure regulated

A

regulated by the sympathetic nervous system, the renin-angiotensin-aldosterone system (RASS) and renal fucntion

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6
Q

____ of an artery would mean that the there is relaxing and widening of the blood vessel. There would be ____ resistance and ___ blood pressure. ____ is the opposite

A

vasodilation
there would be less resistance and less blood pressure
Vasoconstriction is the opposite

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7
Q

the Framingham Risk Scores are not available for ____ why?

A

80 years old or older
we have to consider that if a patient enters in 80 -> less benefit in making dietary changes at that point [life expectancy is reduced], there are more risks when restricting their diet

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8
Q

why does CVD risk increases with menopause

A

decline in estrogen, 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

what are the physiological changes in women post-menopause

A
  • average age 51-55yo (induced at younger age in women who have had a hysterectomy)
  • BP tends to increase
  • LDL-c tends to increase
  • HDL declines or remains the same
  • TG tend to increase
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10
Q

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

A

diabetes

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11
Q

what is ischemia?

A

when blood supply is inadequate and tissues are not getting enough oxygen

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12
Q

what causes a myocardial infarction (MI) aka Heart attack?

A

a blockage in one of the arteries feeding the muscle of the hearts -> ischemic section

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13
Q

what are the symptoms felt by a men experiencing a heart attack

A
  • Acute chest pain
  • shortness of break
  • pain or discomfort in the jaw, neck, back, arm, or shoulder
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14
Q

what are the symptoms felt by a women experiencing a heart attack

A
  • feeling NAUSEOUS, light-headed, unusually tired
  • chest pain
  • shortness of break
  • pain or discomfort in the jaw, neck, back, arm, or shoulder
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15
Q

which are the tests to diagnose a myocardial infarction

A
  • Electrocardiogram (EKG)
  • Echocardiogram (Echo)
  • Exercise stress test (treadmill test)
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16
Q

what does the electrocardiogram EKG measure?

A

measures heart’s electrical activity

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17
Q

what does the echocardiogram measure?

A

measures how well the heart pumps

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18
Q

what does the exercise stress test measure?

A

see how well the heart functions when it’s working hard

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19
Q

stable angina

A

angina pain develops when there is increased demand in the settling of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand

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20
Q

unstable angina

A

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

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21
Q

NSTEMI

A

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

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22
Q

STEMI

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 EKG changes and a rise in TROPONINS

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23
Q

what is the most sensitive and specific test for myocardial damage? why?

A

Troponin levels because it has increase specificity compared with Creatine Kinase-MB + peak at 12hrs

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24
Q

what are the three biomarkers that can be measured to evaluate degree of damage during MI

A
  • troponin
  • creatine kinase (CK-MB) test
  • lactate dehydrogenase (LDH)
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25
Q

what is thrombolysis

A

a procedure post MI consisting in delivering medication through a catheter in aim to dissolve clots in coronary arteries. Usually within 3hrs of the heart attack

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26
Q

about cardiac catheterization

A
  • passing catheter via arm, groin, neck
  • helps in visualization with the help of dyes
  • angiogram
27
Q

about angioplasty of PTCA

A

PTCA: percutaneous transluminal coronary angioplasty

use catheter to insert stent or balloon to try to open up part that is clogged

28
Q

what is a CABG

A

coronary artery bypass graft

-> by-pass a blocked section of a coronary artery and to deliver oxygen to the heart

29
Q

what diet should one be on immediately post-MI

A
  • nothing by mouth 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)
30
Q

is extra-virgin olive oil better than regular olive oil

A

EVOO is extracted using only pressing where as regular olive oil is a combination of virgin oil and refined olive oil
-> EVOO is considered to be better than regular olive oil due to increased polyphenols/antioxidants since it is less refined/processed => stronger anti-inflammatory properties

31
Q

is olive oil a better choice than canola oil?

A
  • olive oil has proportionately more essential FA, MUFA and more anti-inflammatory properties
  • canola processing most often includes heating, pressing, chemical extraction, bleaching, deodorizing
    => more stable and less expansive
32
Q

is canola better than olive oil for cooking?

A
  • canola is better for high-heat drying since it has a higher smoke point
  • olive oil is fine for low to moderate heat frying
33
Q

what are industrial produced trans-fats?

A

resulting from partially hydrogenated vegetable oils

but we still have naturally occurring trans fat and small amounts in foods such as canola oil

34
Q

what are the 5 ways to lower the risk of a SECODN heart attack

A
  1. take your medication
  2. follow-up with your doctor
  3. participate in cardiac rehab [physical and emotional recovery]
  4. manage risk factors
  5. get support
35
Q

what are some medications that could be taken post-heart attack

A
  • antiplatelets agents (aspirin): to prevent blood clots and keep a stent open
  • statins: to lower cholesterol levels
  • beta-blockers, ACE inhibitors: to treat high BP
  • nitrates: to expand the arteries and relieve chest pain
  • anticoagulants: to reduce the blood’s ability to clot (warfarin - Coumadin)
  • medications to protect the stomach (stress + aspirin)
36
Q

what is a cerebrovascular accident (CVA) or stroke

A

when part of the brain is not getting blood or oxygen - part of brain tissue is dying

37
Q

what are the 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 
=> FAST
38
Q

signs and symptoms of a stroke

A

Weakness - sudden loss of strength or sudden numbness in the face, arm, leg, even if temporary
Trouble speaking - sudden difficulty speaking or understanding or sudden confusion even if temporary
Vision problems - sudden trouble with vision, even if temporary
Headache - sudden severe and unusual headache
Dizziness - sudden loss of balance, especially with any of the above signs

39
Q

risks for strokes/CVA

A
  • obesity - lack of exercise - sleep apnea - heavy alcohol use - smoking/drug use - diabetes - cardiovascular disease - high cholesterol - high BP
40
Q

if right side weakness is felt, which side of the brain is the lesion on

A

left side

41
Q

what is the target LDL-c level for higher risk patients

A

< 2.0 mmol/L

42
Q

what is the target triglycerides level for higher risk patients

A

< 0.7 mmol/L

43
Q

how to conduct nutrition assessment calculations for someone who experienced a stroke

A
  • Mifflin St-Jeor [current weight]
  • activity factor -> 1.3 [sedentary]
  • subtract for weight loss
  • 2g sodium
44
Q

what kind of diet should one who experienced a stroke follow

A

low in sodium
have plenty of vegetables, fruits, whole grains, fat-free or low-fat dairy products
eat heart healthy kinds of fat [omega-3 FA] to reduce buildup of plaque
20-30 grams of fiber per day (soluble fiber)
water

45
Q

eating habits for someone with high TG

A
  • limit or avoid sugar, sweets, sweetened beverages
  • avoid alcohol
  • achieve healthy weight
46
Q

is coconut oil a good choice for someone who has undergone a stroke?

A

coconut oil is high in saturated fats but includes medium chain FA which appear to be not as negative as animal fats
-> frequent or regular use of coconut oil should not be recommended

47
Q

how to choose a healthy margarine

A
  • soft
  • source of omega-3
  • low in saturated fats
  • plant based oils, some include olive oil
48
Q

what is atrial fibrillation

A

irregular heart beat -which can disrupt flow of blood through the heart -> important risk factor for stroke

49
Q

what are the treatments and interventions for atrial fibrillation

A
  • treatment: directed toward heart rate control and/or anticoagulation based on the client’s symptoms and risk factors (blood thinners - warfarin[coumadin])
  • nutritional implication and nutrition intervention: vitamin K intake should be consistent, other nutrients that affect clothing or vitamin K absorption should be consistent
50
Q

what are some disabilities that can be experienced after a stroke

A

(affects 75% of stroke survivors)

  • anxiety, mood swings
  • changes in cognition, attention, memory
  • depression
  • muscle weakness
  • paralysis
  • vision loss
  • speech loss
  • difficulty swallowing
51
Q

what is heart failure (or congestive heart failure)

A

the heart is pumped but not pumping as strongly as it should

52
Q

why does the pump become less effective in HF

A
  • injury to heart or congenital abnormality
  • compensatory actions to maintain cardiac output (norepinephrine and activation of RAAS)
  • ventricular muscles undergo hypertrophy because they are working harder
53
Q

why do we call heart failure congestive heart failure?

A

due to extra fluid in lungs causing congestion

54
Q

why does the heart enlarge in HF (cardiomegaly)

A
  • less effective pump, has to pump more
  • less blood flow because less effective pump
  • kidney tried to compensate: renin + aldosterone cause vasoconstriction and try to increase blood volume
  • > heart has to work harder, vicious cycle
  • with time it gets worse
55
Q

which test is done to diagnose HF?

A

echocardiogram (echo) to determine decreased left ventricular ejection fraction

56
Q

what is the left ventricular ejection fraction (LVEF or EF)

A

measurement of how much blood is being pumped out of the left ventricle of the heart
normal ejection fraction - 50 to 70% (30-50% left in the left ventricle)

57
Q

what is left-sided HF

A

left ventricle doesn’t contract with enough force - low LVEF
High pressure in pulmonary capillaries resulting from backing-up of oxygenated blood into lungs, leads to pulmonary congestion or edema

58
Q

what is right-sided HF

A

increased venous pressure from backing-up deoxygenated blood results in edema in legal and around abdominal organs (ascites)

59
Q

signs and symptoms of HF

A
  • ascites (liquid in abdomen)
  • pedal edema 2+
  • shortness of breath
  • increased pulse (heart is working harder even though there’s less blood being pumped)
  • increased respirations (to get more oxygen)
  • lower BP (90/70) (decreased blood circulation)
60
Q

why is B-type natriuretic peptide (BNP) used to diagnose HF

A

because it is secreted when the muscle fibres in the ventricle are stretched (evaluate amount of damage)

61
Q

which are the three main nutritional concerns for patients with HF?

A
  1. sodium intake (2000mg/day)
  2. fluid intake (1.5-2L for mild; 1-1.5L/day for severe CHF)
  3. overall nutritional adequacy (optimization) due to early satiety, shortness of breath [small, soft meals and snacks, nutrient dense foods, nutritional supplements]
62
Q

what is the estimated energy requirement for HF

A

note: weight and bMI can be difficult to assess if there is fluid retention
EER: 25-30kcal/kg actual body weight [use judgement]
protein: 1.1-1.4g/kg actually body weight

63
Q

what is cardiac cachexia

A
  • end result of HF
  • weight loss with significant loss of lean body mass including cardiac muscle
  • inadequate blood supply to GI tract: decreased food intake overall => malnutrition even worse, cardiac cachexia is also worse

Clinical nutrition 1 (7 decks)

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