ch13 CVD

CVD INTRO

what is the leading cause of death in the U.S

CVD

what are the major forms of CVD (5)

• HTN

• atherosclerosis

• ischemic heart disease

• peripheral vascular disease

• heart failure

ischemic heart disease aka (2)

coronary heart disease (CHD) or coronary artery disease (CAD)

what are the types of ischemic heart disease (2 categories)

acute coronary syndrome and chronic ischemic syndrome

acute coronary syndrome includes which diseases

• unstable angina

• acute MI (STEMI, STEMI)

chronic ischemic syndrome includes which?

stable angina

atherosclerosis can result in what CVDs?

MI, cardiovascular accident, peripheral vascular disease, coronary heart disease, heart failure

what are the 2 main types of heart failure

compensated and decompensated HF

what are the HF categories regarding heart structure

right and left HF

heart failure can result in a need for

heart transplant

HEART STRUCTURE AND FUNCTION

what are the 3 layers of the heart

• Epicardium- outer

• Myocardium- middle

• Endocardium - inner

what are the 4 chambers of the heart

left atrium, left ventricle, right atrium, right ventricle

what does the right side of the heart do (right ventricle and atrium)

receive deoxygenated from the body and pump it to the lungs for oxygenation

what does the left side of the heart do (left ventricle and atrium)

receive oxygenated blood from the lungs and pump it to the body

what is the blood flow of the heart (starting with right side)

Deoxygenated blood enters right atrium via superior vena cava-->

right ventricle -->

pumped through pulmonary trunk (right & left pulmonary arteries) -->

pulmonary circulation (CO2 removed and O2 added) -->

blood returns to heart via pulmonary vein -->

left atrium -->

left ventricle -->

enters systemic circulation through aorta (artery)

the heart pumps via what type of activity

electrical

electrical activity of the heart originates at

the sinoatrial (SA) node

what is the process of the electrical conduction of the heart?

SA —> internodal pathway —> atrioventricular (AV) node —> bundle of his —> Purkinje fibers

OR

SA —> interatrial pathway

electrical activity of the heart is measured via

electrocardiogram (ECG)

what is the cardiac cycle (what does it refer to>)

the repeating contraction and relaxation cycle

what are the 2 phases of the cardiac cycle that

systole and diastole

what is systole

contraction

what is diastole

relaxation

what is systolic blood pressure

force exerted on the walls of the blood vessels during contraction

what is diastolic blood pressure

force exerted during relaxation

when we measure blood pressure, we are usually measuring what type?

arterial blood pressure (ABP)

seen as 130/76 for example

what is arterial blood pressure regulated by? (3)

• sympathetic nervous system

• renin-angiotensin-aldosterone system (RAAS)

• renal function

what hormones are involved in blood pressure regulation? (3)**

epinephrine, vasopressin (ADH), and angiotensin 2

epinephrine is from what system?

sympathetic nervous system

what is mean arterial blood pressure (MAP)

represents the resistance against which the ventricles must contract in order to eject blood into systemic circulation (an average)

mean arterial pressure (MAP) is determined what 2 factors

cardiac output and total peripheral resistance

what is cardiac output? (what is it determined by)

stroke volume x heart rate

what is stroke volume?

volume of blood ejected with each contraction of LV (left ventricle)

The amount of blood pumped per beat

stroke volume is regulated by what 3 things?

end diastolic volume (EDV), mean aortic blood pressure (MAP), and strength of ventricular contraction

what is end diastolic volume (EDV)?

amount of blood in the ventricles at the end of a diastole

aka end-load

stroke volume is enhanced by (2)

sympathetic stimulation (which increases heart contractility) and by increasing Venous Return

what 5 factors impact venous return?

• sympathetic activity (epinephrine)

• blood volume

• respiratory activity

• skeletal muscle activity

• cardiac suction effect

what is blood volume regulated by?

salt and water balance (vasopressin, RAAS)

what is heart rate determined by? (what regulates it)

balance between parasympathetic and sympathetic NS

parasympathetic nervous system effect on HR

decrease

sympathetic NS effect of HR

increase it (via epinephrine)

what is total peripheral resistance determined by? (2)

arteriolar radius and blood viscosity

HYPERTENSION

blood pressure measurement is what BP over what BP

systolic/diastolic

hypertension is characterized by how many elevated reading

2 or more

what is considered hypertension?

≥140/90 mmHg

what is normal blood pressure? (#’s)

<120/80 mmHg

what is elevated BP (#’s)

120-129/<80 mmHg

what is stage 1 HTN

130-139 mmHg OR 80-89 mmHg

what is stage 2 HTN

 ≥ 140mmHg OR ≥ 90mmHg

HTN is classifies as either one of what 2 categories?

primary or secondary

what is primary HTN

idiopathic (no known cause) but influenced by lifestyle factors and inflammatory factors

what is secondary HTN

result of another chronic condition (e.g. kidney disease, other cardiovascular diseases, endocrine disorders, or neurogenic disorders)

what specific factors contribute to HTN? (4)

• excessive vasopressin and angiotensin II

• smoking

• renal disease

• adrenal disorder

adrenal disorder can result in excessive secretion of

epinephrine and norepinephrine

what hormones can contribute to HTN***

vasopressin, angiotensin, epinephrine/norepinephrine

how can vasopressin (ADH) and angiotensin II contribute to HTN

excessive secretion of these 2 can lead to vasoconstriction and fluid retention which increase BP

how can epinephrine and norepinephrine contribute to HTN?

cause vasoconstriction —> increase cardiac output and peripheral resistance —> increased BP

for HTN treatment, what are the 2 main goals

1. reduce risk of CVD and renal disease

2. lower BP to clinically appropriate levels

how do we treat HTN (4 main components)

1. weight reduction

2. physical activity

3. nutrition therapy

4. pharmacological intervention

what are the recommendation for weight reduction in HTN treatment?

reduce weight to maintain or get to a normal BMI (18.5-24.9 kg/m²)

per 10kg weight loss, what is the reduction we see in systolic BP?

5-20 mmHg

what are the physical activity reccomendations for HTN treatment?

engage in regular exercise 150-300 mins/week (especially moderate to vigorous range)

any amount of physical activity will have a positive impact on BP

physical activity can decrease systolic BP by how much?

4-9 mmHg

what types of medications are commonly used for HTN treatment (2 main)

ACE inhibitors and diuretics

what do ACE inhibitors do?

are vasodilators that reduce BP by decreasing peripheral vascular resistance by interfering with the production of angiotensin II from angiotensin I

ACE inhibitor end in what suffix?

-pril

common ACE inhibitors

• enalapril

• lisinopril

• captopril

nutrition assessment for CV system (overall)

what are the common nutrition diagnosis for HTN?

• Excessive energy intake

• Excessive sodium intake

• Inadequate calcium, fiber, potassium, or magnesium intake

• Overweight/obesity

• Food- and nutrition-related knowledge deficit

• Physical inactivity

what is the nutrition intervention for HTN (main diet)

DASH + low sodium diet

DASH diet provides (per 2000 kcals)

• potassium

• mg

• calcium

• pro

• fiber

• sodium

• 4,700 mg potassium

• 500mg magnesium

• 1,240 mg calcium

• 90g pro

• 30g fiber

• 2,400 mg sodium

what are the 7 main food groups of DASH diet?

• Grains and gran products

• Vegetables

• Fruits

• Low fat/fat free dairy

• Meats, poultry, fish

• Nuts, seeds, beans

• Fats and oils

what are the 2 food groups of DASH diet that are to restrict?

• sweets

• sodium

what is the main emphasis of the DASH diet? (food groups)

fruits and vegetables

what types of grain and grain products are recommended in DASH diet

whole wheat bread (English muffin, pita, naan, bagels), cereals, grits, oatmeal, crackers, unsalted pretzels and popcorn

why are grains and grain products recommended in DASH diet? (nutrients)

major source of energy and fiber

what are the recommended daily servings for fruits and vegetables

4-5 servings a day for each (largest increase)***

why are vegetables recommended in DASH diet? (nutrients)

rich sources of potassium, magnesium, and fiber

why are fruits recommended in DASH diet? (nutrients)

important sources of potassium, magnesium, and fiber

why are low-fat or fat free dairy foods recommended in DASH diet? (nutrients)

major sources of calcium and protein

how many servings of meats, poultry, and fish and recommended per day in DASH diet?

2 or less

what types of meats, poultry, and fish are reccomended in DASH diet

only lean types; do not fry; remove skin and fat

why are meats, poultry, and fish recommended in DASH diet? (nutrients)

rich sources of protein and magnesium

how many servings of nuts, seeds, and beans per week in dash diet

4-5

why are nuts, seeds, beans recommended in DASH diet? (nutrients)

rich sources of energy, mg, potassium, protein, and fiber

for fats and oils, what % of fat should come from diet

27% of calories

for sweets, they should be low in

fat

sodium should be restricted to at least

2,300 mg

one tsp of salt provides how much sodium?

2300mg

what are methods to reduce sodium intake? (6)

• Avoid fast food restaurants (most items are high sodium)

• Ask about how food is prepared. Request that they prepare without salt, MSG, or salt-containing ingredients. Most restaurants are willing to accommodate

• Know the terms that indicate high sodium content (pickled, cured, soy sauce, broth)

• Do not add salt to food preparation or at table

• Limit condiments such as mustard, ketchup, pickles, and sauces with salt-containing ingredients

• Choose fruits or veggies instead of salty snack foods

for optimal blood pressure control, sodium should be restricted to

1500 mg/day

adopting DASH in HTN treatment can reduce systolic BP by how much?

8-14 mmHg

adopting lower sodium intake in HTN treatment can decrease systolic BP by how much?

2-8 mmHg when consuming no more than 2,400mg/d

decreasing alcohol consumption to 2 drinks/day (men) or 1 drink/day (woman) impacts systolic BP how?

decrease by 2-4 mmHg

ATHEROSCLEROSIS

what is atherosclerosis

thickening of blood vessel walls caused by presence of plaque and loss of vascular elasticity

atherosclerosis results in

restriction of blood flow