Quiz 4 Weeks 9-12 15% Flashcards
1
Q
What is cardiovascular disease?
A
- an umbrella term for a group of disorders that involve the heart and blood vessels
- coronary artery disease (most common)
- hypertension
- ischemic heart disease (limited blood flow to the heart, over time some of the blood vessels are diseased or narrow)
- peripheral vascular disease
- heart failure
2
Q
What is the cardiovascular system?
A
- consists of blood, blood vessels, and the heart
- when the heart pumps, it moves blood through the blood vessels
- blood transports oxygen and nutrients to tissue cells and carries away metabolic wastes (CO2)
3
Q
What are the 2 major types of blood vessels?
A
- Arteries: carry oxygenated blood away from the heart to the tissues
- Veins: carry deoxygenated blood from tissues back to the heart
4
Q
What are the 2 main circuits of the cardiovascular system?
A
- Arteries and veins from closed pathways/circuits within the body
1. Pulmonary circulation: heart pumps deoxygenated blood to the lungs where it picks up oxygen and gives off CO2. Oxygenated blood returns to the heart which then pumps it into the systemic circulation
2. Systemic circulation: the heart pumps oxygenated blood into the aorta which branches into arteries that enter tissues and organs. Blood delivers O2 and picks up CO2. The deoxygenated blood enters veins and drains into the inferior vena cava and superior vena cava: two large veins that drain deoxygenated blood back into the heart
5
Q
How many Canadian adults live with heart disease?
A
- 1 in 12
- 2.4 million Canadians
- every hour 12 Canadian adults are diagnosed
- more common in ages 20+
- heart disease affects men and women equally but differently: men at a younger age, women older age
- there has been a decline in heart disease: reduced sodium intake, trans fat in products, medical advancements
6
Q
What is the role of the cardiovascular system?
A
- regulates blood flow to tissues
- delivers oxygenated blood and nutrients to all organs, tissues and vessels.
When there is reduced blood flow, there is reduced oxygen to the periphery (parts of the nervous system outside the brain and spinal cord) and organs.
When the heart is damaged, it tries to work in overdrive to make sure a sufficient amount of blood is injected into the body to help sustain its needs (esp energy needs). Over time as the muscle weakens, blood flow reduces to the body into tissues and organs = detrimental side effects - Retrieves waste products.
As blood is brought into your tissues and organs helps retrieve and eliminate CO2 through kidneys, urination, and breath
- Blood helps: regulate body temp transport hormones very important in the maintenance of fluid volume regulates pH & gas exchange
7
Q
What happens when there’s a dysfunction in your vessels or heart?
A
The fibres in the septum stretch and elongate = cardiomyopathies and enlarged heart. An enlarged heart doesn’t function as efficiently
8
Q
How does blood flow through the heart?
A
- inferior vena cava: returns blood back to the right side of the heart, from trunk and legs
- superior vena cava: returns blood from the head and upper limbs. Deoxygenated blood comes in (pulmonary system) and is pushed out through the pulmonary arteries to the left and right lung. Here it picks up O2 and flows back in through the right pulmonary veins
- blood comes into the left pulmonary veins into the left atrium where blood moves through into the right atrium (this is where the heart muscle works very hard to eject blood through to the systemic circulation (lower body) through the aorta (three branches) = where blood gets to your tissues and gives all the O2 away and picks up CO2 to be brought back and circulated again
- valves are like little doors and prevent backflow of blood through the system = a closed system, blood should be moving in one direction
- when there is a dysfunction in the valves, blood can move backward = regurgitation, which causes dysfunction in the heart over time
- coronary arteries come out of the aorta that goes into your neck = where we can diagnose coronary artery disease (build-up of plaque in the coronary arteries)
- electrical conductance of the heart: specific nodes and sinus nodes = messenger system of the heart muscle and tell the heart to relax and beat = sequential movement of the heart/rhythm
Dysfunction with these nodes can cause irregularities in heartbeat and rhythm = further heart disease
9
Q
What are two big players in heart disease?
A
- coronary artery disease (CAD)
2. hypertension
10
Q
What is coronary artery disease (CAD)?
A
- caused by atherosclerosis (progressive thickening of plaque on the blood vessels)
- healthy lumen of an artery is very pinkish and smooth, as plaque builds up
First step: fatty streak, can be removed but if you have a genetic predisposition, poor dietary habits, or comorbidities then you will see plaque progress to,
Second step: fibrous plaque: can start to see plaque build up on several different organs and even on the heart
Third step: advanced plaque = complete occlusion Thrombus = heart attack, stroke - comorbidities can affect blood vessels: there are a lot of channels that help with constriction and relaxation, therefore when the vessel is diseased, the vessels don’t relax and explain as they should = rigid/constricted state and is where plaque loves to build-up
11
Q
What are some risk factors of Atherosclerosis?
A
- accumulation of plaque
- production of less nitric oxide
- oxidized LDL cholesterol is taken up my macrophages
- formation of foam cells and fatty streaks
Comorbidities:
- smoking
- obesity
- hypertension
- elevated LDL cholesterol: not being moved and utilized by the body = builds up within your arteries
Atherosclerosis can happen in any vessel within the body
Coronary artery disease = accumulation of plaque buildup within the coronary artery (main artery), which distributes the main source of oxygenated blood to your entire body
- genes
- high saturated fat/cholesterol diet
- elevated serum triglycerides
- inactivty
- diabetes
- stress
- decreased HDL: important to have a normal range of HDL because it helps remove LDL so it doesn’t stick/transports LDL, reduces the risk of CVD, helps with the integrity of the blood vessel - maintains health and flexibility
- ageing
- hyperhomocysteinemia
- endothelial dysfunction
Lots of dietary factors can be intervened
12
Q
What are some clinical findings of atherosclerosis?
A
- elevated serum total cholesterol
- elevated LDL cholesterol
- elevated serum triglycerides
- elevated c-reactive protein
- low HDL
Remember that atherosclerosis is hard to diagnose if these blood values are not elevated and even if they are elevated we can’t say for sure that the person has it unless done with ultrasounds or tools looking for plaque
13
Q
What are non-modifiable risk factors of atherosclerosis?
A
- genetics/ family history
- increasing age
- sex (males more)
- race
14
Q
What are modifiable risk factors of atherosclerosis?
A
- type 1 diabetes (can reduce your risk if you have controlled T1D)
- high blood pressure
- high LDL
- low HDL
- high blood pressure
- uncontrolled hypertension = significant risk because of the vessels surrounding the heart, mico vessels = very serious that needs to be controlled
- dyslipidemia (unhealthy levels of fats in the blood) found from a lipid profile
- obesity
- physical inactivity
- smoking
- unhealthy diet
15
Q
Why are lipoproteins important?
A
- lipids are transported via lipoproteins, which are composed of a lipid interior and protein shell
- important to see how much LDL and HDL is in each type of lipoprotein - cholesterol, triglyceride, phospholipid, apolipoproteins = want VDLD and LDL to be lower and HDL higher
- different types of lipids can have densities of different lipoproteins within each one
16
Q
What are some lipid profile targets for dyslipidemia?
A
- dyslipidemia = elevated total or LDL levels
- we want an LDL-C consistently < 2.0 mmol/L
- or >50% reduction of LDL-C when treatment is begun
- alternative target variables are non-HDL-C <2.6 mmol/L
- > 50% reduction in LDL-C for patients with LDL-C >5.0 mmol/L and have begun treatment = decreases the risk of CVD events and mortality
17
Q
What are some diagnostic tests for atherosclerosis?
A
- blood and urine tests are most commonly done to see if the patient is at risk for atherosclerosis
- Doppler ultrasound is used often, one of the best tools
- ECG/EKG
- angiography: going through one of the leg or arm arteries, put a catheters through the heart to access if there’s plaque buildup
- heart MRI
18
Q
What is the nutrition therapy for atherosclerosis and CAD?
A
- focus on dietary patterns, ex. prescribing the Mediterranean diet and individualizing the diet for the patient: low in saturated and trans, high in unsaturated fat, high starch and fibre, evidence that it lowers the risk of CVDs
- portfolio diet
- DASH diet
- dietary patterns high in nuts, legumes, olive oil, F&Vs, total fibre, - low glycemic load/index
- vegetarian
19
Q
What are the differences in dietary fats?
A
- there’s 9 cals for every gram of fat no matter the type but the quality of the fat is what is important
Monounsaturated fat (MUFAs)
- positive health effect with CVD
- reduced mortality
- reduced CAD risk
- reduced stroke risk
- increased vascular function
- does the opposite of trans and saturated fats
- sources: olive oil, canola, peanut, sunflower, and soybean oil, avocado, peanut butter, almond butter, nuts and seeds, low G.I, whole grains
Polyunsaturated fat (PUFAs): omega 3 & 6 FAs
- mixed PUFA sources = sources with a combination of omega 3 & 6, ex. fatty fish (salmon, mackerel), eggs, flaxseeds, walnuts, soybeans, tofu,
- omega 6 (linoleic acid) sources: sunflower oil, safflower oil, corn oil, soybean oil, nuts and seeds, grains
- omega 3 (linolenic acid, EPA/DHA) sources: flaxseed oil, walnut oil, canola, nuts and seeds, fatty fish, fortified foods
- omega 6 gets a bad wrap since there’s a higher consumption (soybean and corn oil heavily used) when compared to omega 3
- talk to your patients about where they are getting their sources from, how much, and council accordingly
Saturated Fats
- decreasing intake can help reduce the risk of CVD
- research is a bit mixed right now, some people say saturated fats should not be completely eliminated from the diet
- sources: cheese, coconut oil, red meat, chicken with skin, butter, high-fat milk, palm oil, palm kernel oil
- recommend: leaner meats, cooking chicken without the skin, lower-fat dairy products, mindful of your consumption with oils
Trans Fats
- detrimental to the entire vascular system when eating a high trans-fat diet = plaque build-up & fatty streaks, leads to CVD
- increases LDL-C and blood lipids
- decreases HDL
- sources: chips, fries, hydrogenated oils, baked goods, icing, coffee whiteners, vegetable shortening, hard margarine
- trans fats come from hydrogenation of polyunsaturated FAs by taking vegetable oils or fats that are liquid at room temp and go through a chemical process to become solid at room temp
- WHO recommends <1% total energy should come from trans fat in the diet
- educate your patients about which food sources has trans fats and the effects it has on their body
20
Q
What are the recommendations for saturated fat?
A
<9% total energy to help maintain a healthy LDL cholesterol and reduce the risk of developing CAD or hypertension
21
Q
What happens when you replace saturated fat with unsaturated fats?
A
- you can see a 1% decrease in dietary saturated FAs
- 2% decrease in blood LDL and heart disease risk
22
Q
How to suggest dietary patterns to lower LDL
A
- dietary patterns high in pulses >1 serving/day or >130g/day
- low glycemic index
- DASH diet
- Portfolio
- each patient is different and collaborative
23
Q
What are the differences between soluble and viscous soluble fibre?
A
- soluble fibre: creates a gel inside the body which slows transit time, recommended in diabetes because it slows the spike in insulin
- viscous soluble fibre: creates more of a gel-like consistency ex. oats, barley, flax seeds
the gelling can help bind to fats and cholesterol and helps to excrete cholesterol - we don’t get energy from fibre since it goes right through the body
- insoluble fibre creates roughage, helps move things a lot faster
24
Q
What are plant sterols?
A
- naturally occurring in some food sources
- have a similar structure to cholesterol
- body does not absorb it well
- can lower serum LDL and total cholesterol levels
25
Q
What are recommendations for omega 3 FAs?
A
- include fatty fish in a meal two or three times a week
- better health benefits if fish is grilled, baked, boiled
- plant sources include flaxseed, flaxseed oil, canola, soybean oil, and nuts
26
Q
Are fish oil (EPA/DHA) supplements recommended?
A
- for CVD prevention: not recommended because it shows no benefit to preventing CVD
- for CVD management: 800-1000 mg EPA/DHA is recommended for:
patients with CAD
at risk for sudden cardiac death
high triglycerides
27
Q
What is hypertension (HTN)?
A
- when your blood pressure, the force of your blood pushing against the walls of your blood vessels is consistently too high
- doesn’t mean you have dysfunction with your heart
- focuses on the vessels and the force it takes for blood to be pushed through your vessels
- if the blood going through your vessels has some resistance, your heart works harder to get that blood to where it needs to go = increases force and causes pressure on the vessels, over time can lead to plaque build-up and might not dilate and constrict as they should
- over time the heart muscles can become enlarged from working harder to push the blood in the right direction
28
Q
What is systolic and diastolic blood pressure?
A
- systolic: the force at which blood is pumped out of the heart (out of the left ventricle)
- diastolic: pressure in blood vessels when the heart is at rest (in the vessels, not the heart itself)
- stage 1 hypertension: anything above systolic mm/Hg 130-139 or diastolic 80-89
high blood pressure has to be diagnosed over 3 doctor visits
verbal recommendations to improve blood pressure
high blood pressure on third visit = maybe put on meds - stage 2 hypertension: 140 or high systolic, 90+ diastolic
put on meds
recommend lifestyle changes - hypertensive crisis: higher than 180 systolic, 120+ diastolic = high risk for a heart attack
- elevated blood pressure: anything above systolic 120-129 or diastolic 80-89
- normal blood pressure: less than 120/80
29
Q
What are the two pathophysiologies of hypertension?
A
- primary/essential: idiopathic (relating to any disease which arises spontaneously where the cause is unknown) but influenced by lifestyle factors and inflammatory response
most individuals fall under this category - secondary hypertension: the result of another chronic condition
ex. if the patient has a renal disease they could develop hypertension
30
Q
What are the factors that influence arterial blood pressure?
A
- Mean arterial blood pressure: pressure in our arteries
- heart rate and stroke volume (amount of blood/volume that’s ejected from your left ventricle on each pump of your heart) affect cardiac output
- parasympathetic activity, sympathetic activity and epinephrine, and venous return have an effect on stroke volume and heart rate
- blood volume and respiratory activity affects venous return
- if you have secondary hypertension there are many factors that can influence the parasympathetic/sympathetic systems as well as your blood volume and respiratory activity
- Total peripheral resistance: blood flow offered by all of the systemic vasculatures, excluding the pulmonary vasculature, can be affected by blood viscosity (consistency of blood) and arteriolar radius
- Vasopressin and angiotensin II: blood vessel constrictors, when there’s an increase in sympathetic activity, we might see more circulating levels of Vasopressin and angiotensin II = causes more constriction in the arteries, which increase resistance the blood is seeing when going through the arteries
- therefore factors that influence arterial blood pressure can come from components that affect the heart and how the blood vessel functions
31
Q
What are factors that influence blood pressure?
A
- 90 - 95% of hypertension cases are caused by unknown circumstances
Non-Modifiable risk factors:
- increasing age: your vessels become more used, more prone to comorbidities
- genetics/ family history: a huge determinant of hypertension
Modifiable risk factors:
- high LDL
- low HDL
- alcohol
- diabetes
- obesity
- physical inactivity
- smoking
- unhealthy diet
32
Q
What is a comprehensive treatment of HTN?
A
- want to focus on physical activity and dietary intake, reducing sodium intake
- most individuals are on two or more meds
- dietary approach: DASH, sodium restriction, potassium intake
33
Q
What are drug therapies for HTN?
A
- Diuretics: Hydrochlorothiazide (HCTZ) & Indapamide (soft diuretic): problem with hypertension is there is an increased blood volume because of the amount of blood that needs to be forced through for adequate delivery to organs and tissues. Therefore diuretic drugs decrease the blood volume within the arteries by urinary excretion through the kidneys, water, and sodium reabsorption
Food interaction: want to avoid natural black licorice and grapefruit because it affects the mechanisms of the meds - Vasodilators: Angiotensin-converting enzyme (ACE) inhibitors - Enalapril, Perindopril.
Food interaction: can cause dry cough, hyperkalemia (potassium level in your blood is higher than normal) - Angiotensin receptor blocker - Candesartan, eprosartan, irbesartan, valsartan, losartan. A sympathetic nervous system feedback loop that helps with blood volume. Interferes with one of the points of the feedback system
Food interaction: Avoid natural licorice and grapefruit, salt substitutes (use potassium salt, which can increase your blood potassium and cause hyperkalemia) - Calcium channel blockers: Amlodipine (Norvasc), Diltiazem, Verapamil.
Food interaction: can cause nausea, heartburn. Avoid licorice, limit caffeine, avoid/limit alcohol
34
Q
What is the DASH study?
A
- randomized control trial
- looked at three groups of diet
- the DASH diet + sodium reduction is the best way to reduce blood pressure
- DASH = low in saturated fat, cholesterol, total sat, and sodium
35
Q
What 3 foods contribute most to high sodium intakes?
A
- bakery products 20%: Canadians eat a lot of bread
- mixed dishes: frozen and non-frozen 19%
- processed meats 11%
36
Q
Which 2 groups are the biggest sodium consumers?
A
- kids: based on what their caregivers are feeding them
2. males: consume more than women
37
Q
What are tips to reduce sodium intake?
A
- use herbs and spices instead
- homemade baked goods
- make own sauces
- low sodium sauces
- watch out for takeout soups: look at menus online before ordering food to see sodium amounts
- ask for sauce on the side when eating out
- choose fresh, frozen or canned
- use fresh poultry, fish, and lean meat, rather than canned, smoked or processed
- rinse canned foods such as tuna and canned beans to remove sodium
38
Q
What has changed in the new nutrition labels in Canada?
A
- made calories & serving size bigger to read
- added new percent daily value for sugars because there are a high intake of sugars and to be mindful of added sugar
- nutrients at the bottom changed: vit A and C are not shown because we get enough in our diet. Calcium and iron stayed and potassium was added for heart health/blood pressure
- percent daily value for sodium, a footnote at the bottom helps them avoid 15% or more of sodium in a product
