Cardiovascular Health: Lifestyle & Diet

Cardiovascular Health Promotion

• Alterations in health should be modified using lifestyle and diet adjustments
• Educating individuals is key in lowering risks
• A proper diet, exercise, avoiding smoking, stress management, and proactive interventions are important health practices
• Low-dose aspirin can be a preventive measure
• Light drinking may have benefits
• Flax seed, CoQ-10, and fish oil are beneficial nutritional supplements
• Research shows high doses of fish oil may increase the risk of metastatic prostate cancer
• C-reactive protein screening is part of a comprehensive cardiovascular system assessment

Gerontologic Considerations

• Cardiovascular disease (CVD) risk increases with age
• Coronary artery disease (CAD) due to atherosclerosis is the most common problem
• CVD is a leading cause of death in adults over 65
• Cardiovascular changes are due to aging, disease, environment, and lifetime behaviors

Hyperlipidemia

• Elevated total cholesterol increases risk of coronary artery disease
• A full lipid profile, triglycerides, HDL & LDL should be evaluated
• Hyperlipidemia can have a familial tendency
• Treatment involves dietary changes, medications, alternative and complementary therapies

Adult Lipid Levels

• Total cholesterol should ideally be 200 mg/dL
• Borderline total cholesterol is between 200 to 239 mg/dL
• High cholesterol is 240 mg/dL and above
• Low HDL is 40 mg/dL
• Desired HDL is 45 mg/dL
• Optimal LDL is 100 mg/dL
• Near optimal LDL ranges from 100 to 129 mg/dL
• Borderline high LDL: 130 to 159 mg/dL
• High LDL: 160 to 189 mg/dL
• Very high LDL: 190 mg/dL or higher
• Normal triglycerides equal 150 mg/dL
• Borderline high triglycerides: 150 to 199 mg/dL
• High triglycerides: 200 to 499 mg/dL
• Very high triglycerides greater or equal to 500 mg/dL

Lipid Goals

• LDL should be less than 70 mg/dL for those with heart or blood vessel disease and very high-risk patients
• LDL should be less than 100 mg/dL for high-risk patients, and less than 130 mg/dL for others
• Total cholesterol target: 100-199 mg/dL for adults >21
• HDL goal: greater than 45 mg/dL, the higher the better

Cholesterol Improvement

• Prevent heart disease with "therapeutic lifestyle changes (TLC)" to lower LDL
• TLC changes involve decreasing saturated fat and cholesterol intake
• TLC changes involve increasing soluble fiber and physical activity
• People who are overweight should focus on weight reduction
• Controlling high blood pressure and quitting smoking are TLC recommendations

Identifying Metabolic Syndrome

• Three risk factors may indicate metabolic syndrome; needs rigorous cholesterol lowering
• Abdominal obesity in women is a waistline over 35 inches, and over 40 inches in men
• Triglycerides 150 or higher is a risk factor
• Low HDL is a risk factor; less than 40 in men and less than 50 in women
• Blood pressure of 130/85 mm Hg or higher is a risk factor
• Fasting glucose of 110 mg/dL or higher is a risk factor

Lipid Lowering Agents

• High-intensity therapy: 80mg atorvastatin (can down titrate to 40mg if not tolerated) and 20mg rosuvastatin (40mg)
• Moderate-intensity therapy: 10mg atorvastatin (20mg), 10mg rosuvastatin (5mg), 20-40mg simvastatin/pravastatin (40mg/80mg), 40mg lovastatin (80mg), 80mg fluvastatin XL and 40mg fluvastatin BID and 2mg pitavastatin
• Low-intensity therapy: 10mg simvastatin or 10-20mg pravastatin, 20mg lovastatin, and 20-40mg fluvastatin

Problems With Statins

• Statins causes muscle pain and damage
• Statins cause life-threatening muscle damage: rhabdomyolysis
  • Symptoms: severe muscle pain, liver damage, kidney failure, and death
• Statin use may increase liver enzymes on occasion
• Symptoms include fatigue or weakness, loss of appetite, pain in the upper abdomen, dark-colored urine, or yellowing of your skin or eyes
• Statins increase blood sugar or type 2 diabetes
• Neurological side effects include memory loss or confusion

Nursing Considerations for Cardiovascular Conditions

• Prevention and keeping the patient informed is crucial
• It is important to prevent complications, promote circulation
• Always provide foot care and manage issues associated with vascular disease
• Promote normality and integrate complementary therapies

Indications of Ineffective Tissue Perfusion

• Signs include hypotension and tachycardia with decreased pulse quality.
• Claudication, edema, and hair loss on extremities can indicate ineffective tissue perfusion
• Be watchful for tissue necrosis, stasis ulcers, dyspnea, and high respiratory rate
• Pallor, coolness of skin, and cyanosis should be monitored
• Watch out for decreased urinary output, delirium, altered cognition/LOC, restlessness, and memory disturbance

Promoting Normality and Integrating Complimentary Therapies

• Consider the impact of cardiovascular function on sexuality
  • A topic often avoided, yet significant
• Implement nursing interventions, including teaching
• Stress relaxation and rest for treatment
• Understand what could cause the patients stress
• Herbs and spices may prevent and/or treat cardiovascular disorders
• Some nonconventional measures include meditation, biofeedback, guided imagery, T'ai chi, and Yoga
• complementary therapies are less intrusive, less expensive, and cause minimal risks

Heart Failure

• Heart Failure incidence increases with age, and is the leading cause of hospitalization
• Annually, two million Americans suffer and up to 29,000 die as a result of heart failure
• Heart failure can be defined as a condition where the cardiac pumping function is impaired due to the inability of the ventricles fill or eject blood properly
• The heart lacks the capability to produce enough cardiac output (CO) to meet metabolic demands
  • Ventricular dysfunction
  • Reduced exercise tolerance
  • Diminished quality of life
  • Shortened life expectancy
• Heart failure is not a disease, but rather a syndrome, that's associated with hypertension and coronary artery disease
• Heart failure affects more than 5 million people in the United States
• Heart failure is the most common cause for hospitalization in adults over 65

Heart Failure: Etiology and Pathophysiology

• Primary risk factors include coronary artery disease (CAD) and advancing age
• Contributing risk factors include:
  • Hypertension
  • MI
  • Congenital Heart Defects
  • Irregular heartbeats
  • Valvular heart disease
  • Viruses
  • Diabetes
  • Certain Medications
  • Tobacco/Alcohol use
  • Sleep Apnea
  • Obesity
  • High serum cholesterol
  • African American descent

Principal Causes of Heart Failure

• Cardiomyopathy
• Congenital heart defects
• CAD/MI
• HTN
• Hyperthyroidism
• Myocarditis
• Pulmonary HTN
• Rheumatic Heart Disease
• Valve disorders

Precipitating Causes of Heart Failure

• Anemia causes a decrease in O2 carrying capacity, stimulating an increase in CO to meet tissue demands
• Infections can increase O2 demand in tissues, stimulating increased CO.
• Thyrotoxicosis changes the tissue metabolic rate, increasing heart rate (HR) and workload
• Hypothyroidism predisposes individuals to atherosclerosis and decreases heart failure.
• Dysrhythmias may decrease CO and affect workload and O2 requirements

Atrial Fibrillation

• Bacterial Endocarditis increases metabolic demands and O2 requirements
• Pulmonary Disease increases pulmonary pressure, exerting pressure on the RV, causing RV hypertrophy and failure
• Paget's Disease increases workload by increasing the vascular bed in skeletal muscle
• Nutritional Deficiencies may impair cardiac function by increasing myocardial muscle mass and contractility
• Hypervolemia increases preload leading to volume overload on the RV
• Atherosclerosis is the gradual clogging of arteries by fatty, fibrous deposits

Injury Repair

• A tiny lump of fibrous tissue is formed to repair damage to the arterial wall
• Accumulation of cholesterol and tissue buildup
• Thickening and hardening of artery walls occurs, leading to a loss of flexibility resulting in congestion

Heart Failure: Causes and Types

• Heart failure may be divided into two subgroups, primary and precipitating
  • Primary is a condition with congestive failure, and abnormal diastolic with normal systolic behavior at rest.
  • Precipitating is marked by other illnesses triggering the event

Types of Heart Failure: Right-Sided

• Heart's pumping action circulates blood from veins through the right atrium to the right ventricle.
• The right ventricle pumps the blood to the lungs for oxygen replenishment
• Right-sided heart failure often happens due to left-sided failure

Types of Heart Failure: Continued

• When the left ventricle fails, fluid pressure is transferred through the lungs, impacting the right side
• Losing pumping power in the right side can cause blood to back up through the body's veins
• Mixed systolic and diastolic failure may occur in disease states such as dilated cardiomyopathy (DCM).
  • Check for Poor EFs (<35%)
  • Check for high pulmonary pressures

Types of Heart Failure: Biventricular Failure

• Results in Both ventricles that may be dilated with poor filling and emptying capacity

Heart Failure Pathophysiology

• Compensatory mechanisms help maintain proper cardiac output.
  • Sympathetic nervous system (SNS) activation: the primary mechanism that releases catecholamines
  • These mechanisms become detrimental over time, as they increase the failing myocardium's need for oxygen and workload
• Neurohormonal responses cause the kidneys to release renin which converts angiotensinogen to angiotensin I then angiotensin I converts to angiotensin II --Angiotensin II causes the adrenal cortex to release aldosterone

Neurohormonal Responses

• Low cardiac output reduces cerebral perfusion pressure. Resulting in secretion of antidiuretic hormone (ADH)
• ADH leads to increasing water reabsorption in the renal tubules causing water retention and increased blood volume, arterial vasoconstriction, increased cardiac contractility, and hypertrophy
• Over time, a systemic inflammatory response is mounted resulting in cardiac wasting, muscle myopathy, and fatigue

Mechanisms of Compensatory

• Ventricular dilation enlarges the chambers of the heart, increasing pressure in the left ventricle
  • Initially adaptative, the mechanism eventually becomes inadequate and CO decreases
• Hypertrophy increases in muscle mass and cardiac wall to chronic dilation
  • Results in poor contractility poor coronary, and higher oxygen needs

Counter Regulatory Processes and Clinical

• Prone to ventricular dysrhythmias
• Peptides are released in response to increases in atrial volume and ventricular pressure, they promote venous and arterial vasodilation, reducing preload and afterload
• These peptides enhance diuresis and inhibit cardiac hypertrophy, which may have anti-inflammatory effects that cause prolonged heart failure
• Nitric oxide (NO) is released from the vascular endothelium in response to compensatory mechanisms. Vasodilation which then decreases afterload happens as a result
• Clinical Manifestations of Chronic HF present as fatigue, anorexia/nausea, neurologic changes

Clinical Manifestations of Chronic HF

• Dyspnea, orthopnea, plus paroxysmal nocturnal dyspnea
• Palpitations, tachycardia, and chest
• Watch out for changes in skin and neurological
  • can indicate changes in mental status
• Look out for new sleep concerns and dry cough
• Dependent edema may indicate sudden weight gain of more than 3 lbs

Acute Decompensated HF

• Patients may complain of orthopnea dyspnea, and may use accessory muscles to breath.
• Be watchful for cyanosis, cool and clammy skin, Cough with frothy and blood-tinged sputum, Breath sounds like Crackles, wheezes, rhonchi, and a hypertensive and hypotensive state

Clinical Manifestations of Right and Left Sided Heart Failure

• Right sided HF includes RV Heaves, Murmurs, increased JVD, Edema
• Patients may also experience weight gain, increased HR, Ascites, and Hepatomegaly
• Anxiety, Dependance , Right upper, Anorexia and Nausea is a key symptom with preserved EF
• Left Sided HF may also experince LV Heaves Pulses, Increased HR/PMI/ Decreased PaOC, changes in Pleural, confusion or restless anxiety

JVD

• Measure with HOB 30-45 Degrees, note if it can be found on one or both sides
• Greater than 3cm = JVD
• High risk of fatal dysrhythmias can cause HF so its important to monitor EF
• Renal insuffencies or Failure can become severe if the heart can lead to death

Heart Failure Treatments

• Goals of HF Treatment are to minimize Atrial fib most common dysrhythmia with CO 100 so it has to be regulated. Also with cardioversion
• Primary goal is to identify the History of physical to review ECGS and lab values 100 equals HF
• Hemodynamic assessments monitor, and manage Ejection fractions or stress

Gender Differences in Heart Failure

• Men experience more systolic while women experience diastolic changes
• Men tend to have faster reactions with ACE While Women deal with side effects more than coughs.
• Men may develop High HF, and have increased risks to their treatment

Functional Classifications of Heart Failure

• New York Association and Class 1-4. Also A patient can have issues, B the patint has structure with symptoms and and a refractory stage.
• HF may results with SOB, cad, , Tachypnea Impaired ABGCyanotic skin and a high blood pressure

Nursing Actions and Goals

• Decrease patient symptom, and Improve LV, reverse vascular and Increase mortality as well as decrease
• Decrease venous, and reduce volume to keep the fuilds monitored through a dieresis
• Keep patients comfortable with vasodilator/Morhpine
• For patients who dont use medication Inotrope
• For oxygen administration use digitalis with hemodynamic

Common Medications for HD and Treatment

• The medications include Diuretics with spronalactone vasodilator for ACE inhiitors BiDil
• Oxygen thearpy should be followed by a phyiscal/emotional state that improves patients with therapy for CRT.
• For Patients who dont recover it may lead to death or transplant

Diet and Weight Control for Heart Failure

• For HF its impotant to give African diet to dash/2.5 per day. Also Fluid for weight and decrease calories
• Make sure to have activity schedules in place with meds, and pulmonary monitoring

Patient safety and Support

• The plan should to limit HF and promote the quality of life
• In the plans the symptoms have the tools and its important for support and safety
• Encourage compiance and reduce the risks to the elderly and monitor for issues
• Promote cardiac activity with pulmonary function and safety