Diseases of cardiovascular System-ch13 (2).pdf

Chapter 13 Diseases of the Cardiovascular System Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. Marcia Nelms, Nutr...

Chapter 13 Diseases of the Cardiovascular System Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Learning Objectives Explain cardiac function and regulation of blood pressure Discuss the causes and pathophysiology of hypertension and medical treatment Explain the D A S H diet and how nutrition therapy can be used to treat hypertension Define atherosclerosis and explain its consequences, pathophysiology, and risk factors Describe medical nutrition therapy for cardiovascular disease Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Learning Objectives Continued 1 Discuss the process of nutrition assessment, intervention, diagnosis, and treatment of atherosclerosis Differentiate between ischemic heart disease and other types of heart disease Describe ischemic heart disease pathophysiology and treatment Define peripheral artery disease (P A D) Compare peripheral artery disease (P A D) risk factors and causes Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Learning Objectives Continued 2 Discuss peripheral artery disease’s (P A D) clinical manifestations Discuss nutrition assessment, diagnosis, medical treatment, and nutrition therapy for heart failure Discuss nutrition assessment, diagnosis, and treatment of heart failure Explain appropriate nutrition intervention for heart transplant surgery patients Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Introduction Cardiovascular diseases are the leading cause of death in the United States An estimated 92.1 million American adults live with one or more cardiovascular diseases (C V D’s) Direct and indirect costs of C V D are estimated to be 316 billion dollars Age-adjusted C V D death rate has dropped over the past 40 years A result of developments in treatment and prevention of these diseases Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Major Forms of Cardiovascular Disease Hypertension Atherosclerosis Ischemic heart disease Peripheral vascular disease Heart failure Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Anatomy and Physiology of the Cardiovascular System What is the role of the cardiovascular system? Regulates blood flow to tissues Delivers oxygenated blood and nutrients Retrieves waste products Thermoregulation Hormone transport Maintenance of fluid volume Regulation of p H Gas exchange Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  The Heart Three layers of the heart wall Epicardium—Outer Endocardium—Inner Myocardium—Middle Responsible for muscle contraction Four chambers Upper two chambers—Left and right atria Lower two chambers—Left and right ventricles Electrical activity Originates at the sinoatrial (S A) node Measured with electrocardiogram (E C G) Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.1: Blood Flow through the Heart Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.2: Specialized Conduction System of the Heart Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Cardiac Cycle Repeating contraction/relaxation of the heart Includes two phases Systole (contraction) Diastole (relaxation) Force exerted on the walls of blood vessels during contraction Systolic blood pressure Force exerted during relaxation Diastolic blood pressure Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Figure 13.3: Measurement of Blood Pressure Using a Sphygmomanometer Source: Courtesy of Marcia Nelms. Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Cardiac Function Stroke volume: Volume of blood ejected with each contraction of L V Regulated by end diastolic volume (E D V), mean aortic blood pressure (M A P), and strength of ventricular contraction Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Regulation of Blood Pressure Mean arterial pressure (M A P) determined by cardiac output and total peripheral resistance Arterial blood pressure (A B P) is regulated by: Sympathetic nervous system Renin–angiotensin–aldosterone system (R A A S) Renal function Hormones involved Epinephrine, vasopressin, and angiotensin 2 Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.4: Factors Influencing Arterial Blood Pressure Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Hypertension Elevation in blood pressure where more than two consecutive readings are out of the normal range Indicated by readings equal to or greater than 140/90 m m H g Risk factor for many cardiovascular disorders as well as kidney disease Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Hypertension: Epidemiology and Pathophysiology Epidemiology One in three adult Americans had hypertension in 2016 Estimated direct and indirect costs total 46 billion dollars each year Rates vary by age, gender, and race/ethnicity Pathophysiology Primary or essential Idiopathic but influenced by lifestyle factors and inflammatory response Secondary Result of another chronic condition Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Hypertension: Specific Factors Excessive secretion of vasopressin and angiotensin II Smoking Renal disease Adrenal disorders Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Hypertension: Treatment Reduce risk of C V D and renal disease Lower B P to clinically appropriate level Comprehensive plan Weight reduction Physical activity Nutrition therapy Pharmacological interventions such as loop diuretics, thiazides, carbonic anhydrase inhibitors, and potassium-sparing diuretics Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.5: 2017 Diagnostic and Treatment Guidelines for Treatment of Hypertension Source: J Am Coll Cardiol. Sep 2017, 23976; DOI: 10.1016/j.jacc.2017.07.745 Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Nutrition Therapy for Hypertension: Assessment Identify dietary factors and patterns Evaluate need for weight control Prioritize methods to meet D A S H dietary goals Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Nutrition Therapy for Hypertension: Diagnosis Data for diagnosis should include: Excessive energy intake Excessive sodium intake Inadequate calcium, fiber, potassium, or magnesium intake Overweight/obesity Food- and nutrition-related knowledge deficit Physical inactivity Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Nutrition Therapy for Hypertension: Intervention Comprehensive approach that addresses multiple lifestyle factors Components of the current recommendations for blood pressure control D A S H: Dietary Approaches to Stop Hypertension Weight loss Sodium Alcohol Potassium, calcium, and magnesium Physical activity Smoking cessation Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Table 13.3: Lifestyle Modifications for Managing Hypertension Modification Recommendation Approximate S B P Reduction (Range) Reduce weight Maintain normal body weight (body mass 5–20 m m H g/10 k index 18.5–24.9 k g/m2) g Adopt D A S H, Consume a diet rich in fruits, vegetables, and 8–14 m m H g eating plan low-fat dairy products with a reduced content of saturated and total fat Lower sodium a) Consume no more than 2400 m g of 2–8 m m H g intake sodium/day b) Further reduction of sodium intake to 1500 m g/day is desirable since it is associated with even greater reduction in B P c) Reduce intake by at least 1000 m g/day since that will lower B P, even if the desired daily sodium intake is not achieved Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Table 13.3: Lifestyle Modifications for Managing Hypertension Continued 1 Modification Recommendation Approximate S B P Reduction (Range) Physical Engage in regular physical activity 150–300 4–9 m m H g activity minutes per week. Moderate to vigorous activity may lower B P for individuals with prehypertension and hypertension to a normal range for a major portion of the day. All activity appears to have a positive relationship with health even short bouts of physical activity of less than 10 minutes. It appears that there is also an inverse relationship for leisure time activity and blood pressure as well as more vigorous physical activity Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Table 13.3: Lifestyle Modifications for Managing Hypertension Continued 2 Modification Recommendation Approximate S B P Reduction (Range) Moderation of Limit consumption to no more than two 2–4 m m H g alcohol consumption drinks (e.g., 24 o z beer, 10 o z wine, or 3 o z 80-proof whiskey) per day in most men, and to no more than one drink per day in women and lighter- weight persons Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Atherosclerosis Thickening of the blood vessel walls caused by presence of plaque and a loss of vascular elasticity Results in restriction of blood flow Associated with: Myocardial infarction (M I) Cerebrovascular accident (C V A; stroke) Peripheral vascular disease (P V D) Coronary heart disease (C H D) Congestive heart failure (C H F) when severe C H D or M I occurs Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Atherosclerosis: Epidemiology About 630,000 Americans die from heart disease each year Coronary heart disease accounted for the most common type of heart disease Heart disease is the leading cause of death for people of most racial/ethnic groups in the United States Heart disease costs the United States about 329 billion dollars each year Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Atherosclerosis: Pathophysiology Complex process Involves endothelial cells, smooth muscle cells, platelets, and leukocytes Begins as a response to endothelial lining injury that results in an inflammatory process Results in restriction of arterial blood flow Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Atherosclerosis: Risk Factors Additive effect in their predictive power Family history Age and sex More prevalent in people over the age of 65 Males tend to develop atherosclerosis at a faster rate Obesity Positively associated with dyslipidemia, hypertension, physical inactivity, and diabetes Dyslipidemia Lipids are transported via lipoproteins composed of a lipid interior and protein shell Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Table 13.5: Chemical and Physical Properties of Plasma Lipoproteins in Humans Property Chylomicrons VLDL IDL LDL HDL Density (g/m L)