Cardiovascular System KNH 406

Transcription

1 Cardiovascular System KNH 406

2 Cardiovascular Disease Leading cause of death in U.S. 70 million Americans $400 billion in direct and indirect costs Rate has dropped 40% in past 30 years

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4 Cardiovascular System Anatomy & Physiology Regulates blood flow to tissues Retrieves waste products Thermoregulation Gas exchange Closed loop of blood vessels

5 Hypertension Chronic elevation in blood pressure > 140/90 mmhg Silent killer Increases risk for CHF, kidney failure, MI, stroke, aneurysms, vision problems

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7 Hypertension Etiology Primary or essential idiopathic Secondary result of another chronic condition Lifestyle factors smoking, exercise, diet Sodium intake Inflammatory response

8 Hypertension Pathophysiology Excessive secretion of vasopressin & angiotensin II Smoking Renal disease Adrenal disorders Neurological disease

9 Hypertension Treatment Reduce risk of CD and renal disease Lower BP to < 140/90 Through: Weight reduction, physical activity, nutrition therapy, pharmacological intervention Medication

10 Hypertension Nutrition Therapy DASH Dietary Approaches to Stop Hypertension Decrease sodium, saturated fat, alcohol Increase calcium, potassium, fiber Lifestyle modifications Weight loss

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12 Hypertension Nutrition Therapy Sodium restriction controversial salt sensitive or salt resistance Limit processed & cured foods, no added salt during preparation and cooking Limit to 2400 mg/day

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15 Hypertension Nutrition Therapy Alcohol in moderation Potassium, calcium, and magnesium inversely related to BP from food intake vs. supplements

16 Hypertension Nutrition Therapy DASH Comprehensive dietary method Variety of foods high fruit & vegetable intake

17 Hypertension Nutrition Therapy Physical activity At least 30 minutes per day Smoking Cessation - single most important factor

18 Hypertension Nutrition Therapy Prescription Weight reduction Assess dietary intake Meet DASH dietary goals Tailor exercise goals

19 Atherosclerosis Thickening of the blood vessel walls caused by presence of plaque (AS) Arteriosclerosis includes loss of vascular elasticity Results in restriction of blood flow Myocardial infarction (MI) Cerebrovascular incident (stroke) Peripheral vascular disease (PVD) CAD and CHF

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21 Atherosclerosis Etiology - risk factors; additive effect Family history Age and sex Obesity Dyslipidemia Hypertension

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25 Atherosclerosis Etiology - risk factors cont. Physical inactivity Atherogenic diet Diabetes mellitus Impaired fasting glucose/ metabolic syndrome Cigarette smoke

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30 Atherosclerosis Nutrition Therapy Therapeutic Lifestyle Changes (TLC) developed as component of ATP-III Modifications in fat, cholesterol Rich in fruits, vegetables, grains, fiber Limit sodium to 2400 mg Include stanol esters See Table for summary, complete guidelines in Appendix E9

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32 Atherosclerosis Nutrition Therapy - Fat Modifications Total fat 25-35% of calories Very-low-fat diets Saturated fat < 7% of calories Avoid trans fats Increase intake of monounsaturated fats & Polyunsaturated omega-6 fatty acids Increase intake of omega-3 essential fatty acids Limit dietary cholesterol < 200 mg daily

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34 Atherosclerosis Nutrition Therapy - Other Increase sources of soluble fiber Increase intake of plant sterols Weight loss BMI Regular physical activity

35 Atherosclerosis Nutrition Therapy Prescription Assessment of dietary fat intake, saturated fat intake MEDFICTS assessment tool Dietary CAGE questions Table REAP Table Target weight calculated Prioritize nutrition problems Multiple planned visits with R.D.

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37 Ischemic Heart Disease Inadequate blood supply to the heart (a.k.a. CAD) Occlusion caused by AS - may be asymptomatic Angina chest pain Can precipitate MI causing necrosis of tissue

38 Ischemic Heart Disease Etiology Acute coronary syndrome acute MI or unstable angina Plaque erosions, rupture of plaque forming thrombus, vasoconstriction Traditional risk factors for AS apply to IHD C-reactive protein (CRP) good predictor

39 Ischemic Heart Disease Pathophysiology MI or angina initiated by: Sudden blockage Hemorrhage Arterial spasm Increase in myocardial oxygen demand All related to occlusion of the lumen by AS Soft lipid more likely to cause MI

40 Ischemic Heart Disease Nutrition Therapy Post MI Decrease oral intake Clear liquids, no caffeine Progress to soft, more frequent meals Individualized use TLC recommendations

41 Peripheral Arterial Disease Occlusion of blood flow in non-coronary arteries (lower extremities) Pathophysiology similar to AS and IHD Eventually suffer from denervation of affected muscle Can cause ulceration; commonly foot or toes

42 Peripheral Arterial Disease Clinical manifestations/diagnosis Intermittent claudication cramp-like pain with activity Ankle Brachial Index (ABI) Treadmill test Major risk for amputation

43 Heart Failure Impairment of the ventricles capacity to eject or fill with blood Underlying cause structural or functional End-stage CVD

44 Heart Failure Etiology/pathophysiology Stages of heart failure see Table Primary cause IHD, htn., dilated cardiomyopathy, valvular disease Begins with heart injury or LVH BP changes Heart becomes weak and dilated Progressive

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48 Heart Failure Clinical manifestations Decreased blood flow and oxygen Dyspnea, fatigue, weakness, exercise intolerance, poor adaptation to cold Orthopenea - if left-sided failure Fluid retention, pulmonary congestion, edema, hepatomegaly, splenomegaly, ascites - if right-sided failure

49 Heart Failure Treatment Treat underlying cause Control symptoms BP control Prevent continued damage Medications Prevention of respiratory infections Exercise Nutrition therapy

50 Heart Failure Nutrition Therapy Implications Increased workload/difficulty eating Cardiac cachexia malnutrition/ wasting, fatigue, anorexia L-carnitine, CoQ10, creatine, thiamin, taurine

51 Heart Failure Nutrition Therapy Intervention Control signs and symptoms Promote overall nutritional status rehabilitation see Table Sodium and fluid restriction 2000 mg Na Fluid 1 ml/kcal or 35 ml/kg Correction of deficiencies Increase nutrient density Enhance oral intake

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53 Heart Failure Nutrition Therapy Assess drug-nutrient interactions Losses of water-soluble vitamins Supplementation may be warranted Consider arginine, carnitine and taurine in dietary regimen