Cardiovascular System

What is cardiovascular disease (CVD)?

Leading cause of death in the US

A disorder involving the heart and/or blood vessels

Major forms include coronary artery disease, stroke/TIA, peripheral artery disease, heart failure, and arrhythmias.

What are major causes and risk factors for cardiovascular disease?

Hypertension, atherosclerosis, diabetes, poor diet, physical inactivity, nicotine/alcohol/illicit substance use, and chronic inflammation (stress) can all contribute to CVD over time.

What are modifiable cardiovascular risk factors?

Risk factors that can potentially be changed, including diet, physical activity, body weight, nicotine/alcohol/drug use, blood glucose control, blood lipid levels, and stress.

What are nonmodifiable cardiovascular risk factors?

Risk factors that cannot be changed, including age, sex, ethnicity, family history, and a family history of premature heart disease.

What is considered premature heart disease?

Heart disease occurring before age 55 in men or before age 65 in women.

What are the major functions of the cardiovascular system?

It delivers oxygenated blood and nutrients, removes waste, regulates blood flow, transports hormones, helps control body temperature and fluid volume, regulates pH, and participates in gas exchange.

What are the three layers of the heart wall?

Epicardium = outer layer; myocardium = middle muscular layer responsible for contraction; endocardium = inner layer.

What are the four chambers of the heart?

The right and left atria are the upper chambers, while the right and left ventricles are the lower chambers.

Where does normal electrical activity of the heart begin?

The sinoatrial (SA) node. It acts as the heart's natural pacemaker and initiates the electrical signal that produces a heartbeat.

What does an ECG/EKG measure?

The electrical activity of the heart (SA node activity). It can help identify abnormal rhythms and other changes in cardiac function.

What is angina pectoris?

Chest pain caused by reduced blood flow and oxygen delivery to the heart muscle.

What is dyspnea?

Shortness of breath. In cardiovascular disease it can occur when the heart cannot effectively circulate blood or fluid backs up into the lungs.

What is edema?

Swelling caused by excess fluid accumulation, commonly seen in the legs and ankles or in the lungs with cardiovascular disease.

What is syncope?

A temporary loss of consciousness or fainting, often caused by a temporary decrease in blood flow to the brain.

What are noncardiac causes of lightheadedness or syncope listed in the slides?

Orthostatic hypotension (standing up with a decrease in BP), dehydration, and hypoglycemia can all decrease adequate blood flow or energy delivery to the brain.

What are palpitations?

The sensation that the heart is beating rapidly, forcefully, or irregularly.

What is cyanosis?

A bluish discoloration of the skin caused by inadequate oxygenation of the blood.

What does a standard lipid panel assess?

Total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, non-HDL cholesterol, ApoB, and Lpa

Why is ApoB useful when evaluating cardiovascular risk?

Apolipoprotein B reflects the number of atherogenic lipoprotein particles. Higher ApoB levels are associated with greater cardiovascular risk.

What is lipoprotein(a), or Lp(a)?

A genetically influenced lipoprotein. High Lp(a) concentrations are associated with increased cardiovascular risk.

What does high-sensitivity C-reactive protein (hs-CRP) indicate?

An elevated hs-CRP can indicate vascular inflammation (inflammation of the blood vessel walls) and may be used as part of cardiovascular risk assessment.

What is myeloperoxidase (MPO) associated with?

MPO is an inflammatory marker associated with instability of atherosclerotic plaques (how likely a fatty buildup (plaque) inside an artery is to remain intact or securely walled off, rather than rupturing or eroding into the bloodstream)

Why is fibrinogen relevant to cardiovascular disease?

Fibrinogen is required for clot formation. High levels may increase clotting risk.

Fibrinogen is converted into fibrin, which forms a mesh-like structure that helps stabilize a blood clot.

What does hemoglobin A1c measure?

It reflects average blood glucose over approximately the previous 2–3 months and helps assess long-term glucose control.

Why is troponin important in cardiovascular diagnosis?

Troponin T and I are highly sensitive and specific markers of myocardial injury and are the primary biomarkers used to detect heart muscle damage.

Cardiac Troponin T (cTnT) and Troponin I (cTnI) are structural proteins found exclusively in heart muscle cells

Because their specific genetic shapes do not exist anywhere else in the body, finding them in a blood test provides 100% specific proof of myocardial injury

What is BNP or NT-proBNP used for?

These biomarkers increase when the ventricles experience stress and are especially useful in evaluating heart failure.

BNP and NT-proBNP act as "pressure gauges" that tell doctors if the heart muscle is being stretched, overworked, or placed under severe fluid strain.

Why may creatinine be assessed in cardiovascular patients?

Creatinine reflects kidney function. Kidney disease can increase cardiovascular risk and may influence treatment decisions.

Why are ALT and AST sometimes monitored in cardiovascular patients?

They assess liver function and may be monitored particularly in patients taking statin medications.

Cardiovascular patients on cholesterol-lowering statins are monitored to ensure the medication isn't irritating the liver.

What does prothrombin time (PT) measure? What is it also called? What medication is tested on this?

PT measures the time it takes for blood to clot via the extrinsic coagulation pathway.

The extrinsic pathway is the primary, rapid-response chemical chain reaction your body uses to initiate blood clotting immediately after a blood vessel injury.

Often reported as INR: International Normalized Ratio

Commonly used for people taking warfarin

What does Activated Partial Thromboplastin Time (aPTT/PTT) measure and monitor?

It measures clotting through the intrinsic pathway and is commonly used to monitor heparin therapy or investigate clotting disorders.

It is called "intrinsic" because all the proteins and components needed to start the reaction already live inside the circulating blood

What does s/p CABG mean?

Status post coronary artery bypass graft, meaning the patient previously underwent CABG surgery.

What does PPM stand for?

Permanent pacemaker.

What does CV stand for in cardiac terminology?

Cardioversion, a procedure used to restore an abnormal heart rhythm to a normal rhythm.

What is an EP (electrophysiology) study?

An electrophysiology study evaluates the electrical conduction system of the heart and can help diagnose abnormal heart rhythms.

What is a DES?

A drug-eluting stent, which is a stent placed in an artery that releases medication to help reduce re-narrowing.

What does ECHO mean?

Echocardiogram, an ultrasound examination used to visualize the heart's structure and function.

What does LVEF stand for?

Left ventricular ejection fraction, the percentage of blood ejected from the left ventricle during contraction.

What does an echocardiogram evaluate?

It uses ultrasound to examine the heart's chambers, valves, blood flow, and pumping function.

What is a cardiac stress test?

A test that evaluates heart function while cardiac demand is increased through exercise.

What is cardiac catheterization?

An invasive procedure in which a catheter is inserted into the cardiovascular system to evaluate the heart and coronary arteries.

Catheter: A flexible, hollow tube designed to insert medical fluids, drain waste, or navigate medical instruments through a specific channel in the body

What is coronary angiography?

Imaging of coronary blood vessels after contrast dye is injected, allowing areas of narrowing or blockage to be identified.

What is angioplasty or PCI?

A procedure that uses a balloon catheter to open a narrowed or blocked coronary artery and improve blood flow.

Why is a stent placed during PTCA/PCI?

A stent is a small metal mesh tube that helps hold the artery open after the narrowed area has been widened.

What is coronary artery bypass grafting (CABG)?

Surgery that creates a new route around blocked coronary arteries so blood can reach the heart muscle.

What does a pacemaker do?

It helps regulate abnormal heart rhythms by sending electrical impulses to the heart when needed.

What is an implantable cardioverter-defibrillator (ICD)?

A device that monitors heart rhythm and can deliver therapy to correct dangerous or life-threatening arrhythmias. Pacemaker + defibrillator

What is thrombolysis?

The use of medications called thrombolytics or "clot busters" to dissolve blood clots.

What are examples of thrombolytic medications from the slides?

Alteplase (tPA), reteplase, tenecteplase, streptokinase, and urokinase.

How do mechanical and bioprosthetic heart valves differ?

Mechanical valves last longer but usually require lifelong anticoagulation and INR/PT monitoring. Porcine bioprosthetic valves have a shorter lifespan (bioprosthetic valves are made of biological tissue that breaks down over time due to mechanical stress and chemical changes) but generally do not require lifelong anticoagulation.

What is the cardiac cycle?

The continuous repeating sequence of contraction and relaxation that occurs with each heartbeat.

What is systole?

The contraction phase of the cardiac cycle, when the heart pumps blood and systolic pressure reflects force against the artery walls.

What is diastole?

The relaxation phase of the cardiac cycle, when the heart fills with blood and diastolic pressure reflects arterial pressure between contractions.

What is stroke volume?

The volume of blood ejected from the left ventricle during each contraction.

What is ejection fraction?

The proportion of blood in the left ventricle that is ejected during contraction. The slides identify a normal LVEF as approximately 50–70%.

What factors regulate left ventricular ejection?

End-diastolic volume, mean aortic blood pressure, and the strength of ventricular contraction influence how much blood the ventricle ejects.

What is an arrhythmia?

Any abnormality in the normal rhythm or rate of the heartbeat.

What is bradycardia and sinus bradycardia?

A heart rate below the normal range; the slide illustrates bradycardia as less than 60 beats/minute and abnormal.

Sinus bradycardia: A specific heart rhythm below 60 bpm that is structurally normal, perfectly timed, and originates from the SA node

What is tachycardia?

A heart rate above the normal range; the slide illustrates tachycardia as greater than 100 beats/minute.

What is asystole?

Absence of effective cardiac electrical activity, often appearing as a nearly flat ECG tracing.

No blood is being pumped

Atrial flutter vs Fibrillation

Atrial flutter: Organized, 250-350 bpm, sawtooth pattern, regular rhythm
Atrial fibrillation: Uncoordinated, 350-600 bpm, irregular baseline, irregular rhythm

What information should be assessed in a cardiovascular nutrition history?

Diet patterns, sodium and fat intake, carbohydrates and sugars, alcohol, restaurant/fast-food intake, portion sizes, food access, food preparation, physical activity, tobacco use, and medical/social history.

What physical findings are important during cardiovascular nutrition assessment?

Weight history, BMI, waist circumference, muscle and fat stores, grip strength, skin condition, oral health, and signs of fluid accumulation such as edema.

What biochemical data may be assessed in cardiovascular nutrition care?

Glucose/HbA1c, electrolytes, blood pressure, lipid profile, CRP/ESR, and selected micronutrient or iron-status tests.

What is hypertension?

Persistently elevated blood pressure. It increases stress on arteries and organs and is a major risk factor for cardiovascular and renal disease.

Why is hypertension called the "silent killer"?

Many people have no noticeable symptoms even while high blood pressure is damaging blood vessels, the heart, kidneys, and other organs.

How can hypertension damage the arteries?

Continued high pressure damages the arterial lining and reduces elasticity, which encourages atherosclerosis and further impairs blood flow.

How can hypertension contribute to kidney failure?

High pressure can damage renal blood vessels and impair the kidneys' ability to remove waste and water and maintain electrolyte balance.

How can hypertension cause heart failure?

The heart must pump against greater resistance, increasing its workload. Over time the ventricles can thicken and eventually become unable to function effectively.

What complications can hypertension increase the risk of?

Atherosclerosis, coronary artery disease, myocardial infarction, stroke/CVA, peripheral vascular disease, kidney disease, and heart failure.

What symptoms may occur with hypertension?

Hypertension is usually asymptomatic, but headache and changes in vision may sometimes occur.

What blood pressure is considered normal on the slide's AHA chart?

Systolic pressure below 120 mmHg AND diastolic pressure below 80 mmHg.

What is elevated blood pressure, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis?

Elevated: 120–129 mmHg AND diastolic pressure below 80 mmHg

Stage 1: 130-139 mmHg or diastolic pressure 80-89

Stage 2: 140 mmHg or higher or diastolic pressure 90 mmHg or higher

Hypertensive crisis: 180 mmHg or higher and/or diastolic pressure higher than 120 mmHg

What determines mean arterial pressure (MAP)?

MAP is the average blood pressure in a patient’s

arteries during a single cardiac cycle

Cardiac output and total peripheral resistance together determine mean arterial pressure.

What major systems regulate arterial blood pressure?

The sympathetic nervous system

Renin-angiotensin-aldosterone system (RAAS)

Renal function:

What hormones are involved in blood pressure regulation according to the slides?

Epinephrine, vasopressin, and angiotensin II

How should a person be positioned for an accurate blood pressure measurement?

They should be seated with back support, feet flat on the floor, rested for 5-10 minutes, no caffeine, arm at heart level, and should avoid talking during the measurement.

Why is correct blood pressure cuff size important?

An inappropriate cuff can produce an inaccurate blood pressure reading, so the cuff should match the patient's arm size.

Why may blood pressure be measured in both arms?

The readings can be compared; the slides state the difference should generally be less than 10 mmHg.

What is primary or essential hypertension?

Hypertension without one single identifiable cause. It is influenced by genetics, aging, lifestyle, environmental factors, obesity, diet, activity, stress, and substance use (90-95% of cases)

Family history, aging, obesity, high salt intake, physical inactivity, stress, and alcohol use are major contributors listed in the slides.

What is secondary hypertension?

High blood pressure caused by another identifiable chronic condition or factor rather than developing primarily on its own (5-10% of cases)

Sleep apnea, kidney disease, renovascular disease, primary aldosteronism, Cushing syndrome/steroid therapy, pheochromocytoma, aortic coarctation, thyroid/parathyroid disorders, and drug/alcohol-related causes.

What is the main overall goal of hypertension treatment?

To lower blood pressure enough to reduce cardiovascular and renal disease risk while maintaining a clinically appropriate blood pressure.

Goal: BP = 140/90 mmHg

What lifestyle changes are recommended first for hypertension?

Achieve a healthy weight, follow a heart-healthy/DASH pattern, reduce sodium (< 2300 mg or <1500 mg), increase dietary potassium when appropriate, exercise, manage stress, and reduce or eliminate alcohol.

When may medication be started immediately along with lifestyle changes?

The slides recommend medication when average BP is at least 140/90, or at least 130/80 with CVD, prior stroke, diabetes, CKD, or elevated predicted cardiovascular risk.

What is the PREVENT risk calculator?

An AHA tool used in adults (ages 30-79) to estimate 10-year and 30-year risks for total CVD, ASCVD, and heart failure.

How does weight reduction affect blood pressure?

Weight loss in people with overweight or obesity can significantly lower blood pressure; greater weight loss generally produces greater reductions.

BMI reduction of >3kg/m² may produce BP drops of about 8-9 mmHg systolic and about 3.5 mmHg diastolic

What happens if BP remains elevated after an initial lifestyle trial?

The slides recommend considering medication after approximately 3–6 months if average blood pressure remains at least 130/80 mmHg, along with continued lifestyle treatment.

How do diuretics lower blood pressure?

They decrease sodium and water reabsorption by the kidneys, increasing urine output and reducing blood volume, which lowers cardiac output and blood pressure.

Why should potassium be monitored with loop and thiazide diuretics?

These diuretics can increase potassium losses in urine and may cause low potassium, so potassium values and possible supplementation should be monitored.

How do loop diuretics work?

They reduce sodium and chloride reabsorption in the loop of Henle, increasing urinary loss of sodium, chloride, potassium, and water.

What are examples of loop diuretics?

Furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex).

How do thiazide diuretics work?

They inhibit the sodium/chloride cotransporter in the distal convoluted tubule, increasing sodium and fluid loss and decreasing plasma volume.

What are examples of thiazide-type diuretics?

Chlorthalidone, hydrochlorothiazide, indapamide, metolazone, and chlorothiazide.

Difference between loop diuretics and thiazide diuretics

The difference between loop diuretics and thiazide diuretics comes down to where they work inside the kidney's filtering units (nephrons) and how aggressively they force the body to eliminate water and salt

Loop diuretics are high-potency medications used to aggressively clear severe fluid buildup in conditions like heart failure, whereas thiazide diuretics are milder medications used as a first-line therapy to lower blood pressure in primary hypertension

How do ACE inhibitors lower blood pressure?

Lower blood pressure by stopping the body from making a chemical that narrows blood vessels (angiotensin II), while simultaneously keeping a natural chemical that relaxes and widens those vessels active for longer (bradykinin)

What are examples of ACE inhibitors?

Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, and trandolapril.

How do beta-blockers lower blood pressure and cardiac workload?

They act like a shield against the body's adrenaline (stress hormones such as norepinephrine and epinephrine), which slows down your heart rate and makes it pump with less force, so your heart doesn't have to work or breathe as hard

What are examples of beta-blockers?

Atenolol, bisoprolol, carvedilol, labetalol, metoprolol, nebivolol, propranolol, and others.

What are possible nutrition diagnoses for a patient with hypertension?

Excessive energy or sodium intake, inadequate calcium/potassium/magnesium/fiber intake, overweight/obesity, nutrition knowledge deficit, and physical inactivity.

What is the DASH diet?

Dietary Approaches to Stop Hypertension; an eating pattern rich in fruits, vegetables, whole grains, low-fat dairy, and lean protein that limits sodium, saturated fat, added sugar, and red/processed meats.

Why does DASH help lower blood pressure?

It provides potassium, magnesium, calcium, and fiber while limiting sodium and saturated fat, supporting healthier vascular function and blood pressure regulation.