cardiovascular system - medical nutrition therapy portfolio · nutrition therapy intervention...

Cardiovascular System

KNH 406

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

Cardiovascular System

Anatomy & Physiology

Regulates blood flow to tissues

Retrieves waste products

Thermoregulation

Gas exchange

Closed loop of blood vessels

Hypertension

Chronic elevation in blood pressure

> 140/90 mmHg

“Silent killer”

Increases risk for CHF, kidney failure, MI, stroke,

aneurysms, vision problems

Hypertension

Etiology

Primary or essential – idiopathic

Secondary – result of another chronic condition

Lifestyle factors – smoking, exercise, diet

Sodium intake

Inflammatory response

Hypertension

Pathophysiology

Excessive secretion of vasopressin & angiotensin II

Smoking

Renal disease

Adrenal disorders

Neurological disease

Hypertension

Treatment

Reduce risk of CD and renal disease

Lower BP to < 140/90

Through:

Weight reduction, physical activity, nutrition therapy,

pharmacological intervention

Medication

Hypertension

Nutrition Therapy

DASH – Dietary Approaches to Stop Hypertension

Decrease sodium, saturated fat, alcohol

Increase calcium, potassium, fiber

Lifestyle modifications

Weight loss

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

Hypertension

Nutrition Therapy

Alcohol in moderation

Potassium, calcium, and magnesium inversely related to BP

from food intake vs. supplements

Hypertension

Nutrition Therapy

DASH

Comprehensive dietary method

Variety of foods – high fruit & vegetable intake

Hypertension

Nutrition Therapy

Physical activity

At least 30 minutes per day

Smoking

Cessation - single most important factor

Hypertension

Nutrition Therapy Prescription

Weight reduction

Assess dietary intake

Meet DASH dietary goals

Tailor exercise goals

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

Atherosclerosis

Etiology - risk factors; additive effect

Family history

Age and sex

Obesity

Dyslipidemia

Hypertension

Atherosclerosis

Etiology - risk factors cont.

Physical inactivity

Atherogenic diet

Diabetes mellitus

Impaired fasting glucose/ metabolic syndrome

Cigarette smoke

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 15.11 for summary, complete guidelines in Appendix

E9

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

Atherosclerosis

Nutrition Therapy - Other

Increase sources of soluble fiber

Increase intake of plant sterols

Weight loss – BMI 18.5-24.9

Regular physical activity

Atherosclerosis

Nutrition Therapy Prescription

Assessment of dietary fat intake, saturated fat intake

MEDFICTS assessment tool

Dietary CAGE questions – Table 15.12

REAP –Table 15.13

Target weight calculated

Prioritize nutrition problems

Multiple planned visits with R.D.

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


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


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


Nutrition Therapy

Post MI

Decrease oral intake

Clear liquids, no caffeine

Progress to soft, more frequent meals

Individualized – use TLC recommendations

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

Peripheral Arterial Disease

Clinical manifestations/diagnosis

Intermittent claudication – cramp-like pain with activity

Ankle Brachial Index (ABI)

Treadmill test

Major risk for amputation

Heart Failure

Impairment of the ventricles’ capacity to eject or fill

with blood

Underlying cause – structural or functional

End-stage CVD

Heart Failure

Etiology/pathophysiology

Stages of heart failure – see Table 15.15

Primary cause – IHD, htn., dilated cardiomyopathy, valvular disease

Begins with heart injury or LVH

BP changes

Heart becomes weak and dilated

Progressive

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

Heart Failure

Treatment

Treat underlying cause

Control symptoms

BP control

Prevent continued damage

Medications

Prevention of respiratory infections

Exercise

Nutrition therapy

Heart Failure

Nutrition Therapy Implications

Increased workload/difficulty eating

Cardiac cachexia – malnutrition/ wasting, fatigue, anorexia

L-carnitine, CoQ10, creatine, thiamin, taurine

Heart Failure

Nutrition Therapy Intervention

Control signs and symptoms

Promote overall nutritional status rehabilitation – see Table 15.16

Sodium and fluid restriction

2000 mg Na

Fluid 1 mL/kcal or 35 mL/kg

Correction of deficiencies

Increase nutrient density

Enhance oral intake

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

cardiovascular system - medical nutrition therapy portfolio · nutrition therapy intervention...

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