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Diseases of the

Cardiovascular
System
By: Jackie Ferretti and Najlaa Almohmadi

Agenda

Introduction

Anatomy and physiology of the cardiovascular system

Hypertension; nutrition therapy for hypertension

Atherosclerosis; nutrition therapy for atherosclerosis

Ischemic heart disease

Peripheral artery disease

Heart failure; nutrition therapy for heart failure

Case study

Objectives
Understanding the anatomy and physiology of the

cardiovascular system
Identify the causes, symptoms and nutritional

therapy for hypertension, atherosclerosis,


ischemic heart disease, peripheral artery disease,
and heart failure;

Introduction

Leading cause of death in the U.S.


Cardiovascular Disease (CVD)

Hypertension

Atherosclerosis

Ischemic Heart Disease or Coronary Artery

Peripheral Vascular Disease

Heart Failure

Transplant

Anatomy and Physiology of the


Cardiovascular System

Regulates blood flow to tissues

Delivers oxygenated blood and


nutrients

Retrieves waste products from cellular


metabolism

Thermoregulation

Hormone transport

Maintenance of fluid volume

Gas exchange

Regulation of pH

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Closed loop of blood vessels

Anatomy and Physiology of the


Cardiovascular System

The Heart

Blood vessels from a tubular network throughout the body


that allows blood to flow from the heart to every body cell
and then back to the heart

Three types of blood vessels

Arteries

Capillaries

Veins

Arteries smaller arteries arterioles capillaries (gas


exchange occurs)

Capillaries venules veins superior and vena cava

Anatomy and Physiology of the


Cardiovascular System

Electrical activity of the heart

Originates in the Sinoatrial


(SA) node

The change in electrical


membrane potential
(depolarization) in the SA
node causes the contraction
of the atria

Depolarization is carried
from the atria to the
ventricles through the AV
node and carried into
ventricles

https://books.google.com/books?id=B25GEf4Vz1AC&pg=PT326&lpg=PT326&dq=Sherwood
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Anatomy and Physiology of the


Cardiovascular System

http://empatheticmedic.blogspot.com

Anatomy and Physiology of the


Cardiovascular System

Cardiac cycle

Repeating contraction/relaxation of the heart

Systole (contraction)

Diastole (relaxation)

Exerted force on the walls of the blood vessels


termed systolic blood pressure and diastolic
blood pressure

Anatomy and Physiology of the


Cardiovascular System

Regulation of blood pressure

Sympathetic nervous system

Renin-angiotensin system

Renal function

All three affect cardiac output and consequently


blood pressure

Anatomy and Physiology of the


Cardiovascular System

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Anatomy and Physiology of the


Cardiovascular System

https://books.google.com/books?
id=5TJBBAAAQBAJ&pg=PT327&lpg=PT327&dq=Nelms+figure+13.4&source=bl&ots=uY3uSe4LdY&sig=TGsMuF8IMibkrii5D9LCHGl64xM&hl=en&sa=X&ved=0CB8Q6AEwAGo

Hypertension

Chronic elevation in blood pressure

140/80 or 120/90

Silent killer
Increases the risk for congestive heart failure,
kidney failure, myocardial infarction, stroke,
aneurysms, and vision problems

Hypertension

Etiology

Primary or essential

Idiopathic (90% of the cases)

Lifestyle factors smoking, lack of exercise, poor diet

High sodium and low potassium intake, alcohol

Secondary

Result of another chronic condition

Renal disease, CVD, endocrine disorders or neurogenic


disorders

Inflammatory response

Hypertension

Pathophysiology

Excessive secretion of vasopressin and angiotensin II

Causes vasoconstriction and fluid retention which increases blood


pressure

Smoking: interferes with nitrous oxide impairing endothelial


relaxation and vasodilation

Renal disease: angiotensin II is released to increase blood flow

Adrenal disorders: epinephrine and norepinephrine

Neurological disease: control of blood pressure may be altered

Hypertension

Treatment

Reduce risk of cardiovascular and renal disease

Lower BP to <140/80 or <130/80

Treat through

Weight reduction, increased physical activity, nutrition therapy,


pharmacological intervention

Medication classes

Loop diuretics

Thiazides

Carbonic anhydrase inhibitions

Potassium sparing diuretics

Nutrition Therapy for


Hypertension
Nutrition Assessment

Identify dietary factors and patterns

Evaluate need for weight control


Prioritize methods to meet DASH dietary goals
Decrease alcohol, sodium,
Increase potassium, magnesium, calcium, fiber

Nutrition Therapy for


Hypertension

Nutrition Diagnosis

Excessive energy intake (NI-.5)

Excessive or inappropriate intake of fats (NI-5.6.2 or NI-5.6.3)

Excessive sodium intake (NI-5.10.2)

Inadequate calcium, potassium, or magnesium intake (NI-5.10.1)

Inadequate fiber intake (NI-5.8.5)

Overweight/obesity (NC-3.3)

Food and nutrition knowledge deficit (NB-1.1)

Physical inactivity (NB-2.1)

Nutrition Therapy for


Hypertension
Nutrition Intervention

DASH Dietary Approaches to Stop Hypertension

Weight loss

Decrease sodium

Smoking and alcohol cessation

Increase potassium, calcium, magnesium, and fiber

Increase physical activity

Atherosclerosis

Thickening of the blood vessel walls caused by the

presence of plaque

Loss of vascular elasticity

Plaque begins as a fatty and fibrous growth, calcifies


overtime

Results in restriction of blood flow

Myocardial infarction (MI)

Coronary artery disease

Peripheral vascular disease (PVD)

Congestive heart failure

Atherosclerosis

Etiology

Risk factors have an additive effect

Family history

Age and sex

Obesity

Dypslipidemia

Hypertension

Physical inactivity

Atherogenic diet

Diabetes mellitus

Cigarette smoking

Atherosclerosis

Pathophysiology

Inflammation response

Injury to endothelial lining

Attracts platelets

Form small clot thrombi

Continued migration of
cells to that area

Proliferation of plaque

Rupture of fibrous cap can


occur

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Atherosclerosis

Clinical manifestations

Asymptomatic

May progress to ischemic heart disease

Medical Treatment

NCEP ATP-III guidelines

Modification of lipids and major risk factors

Medical Procedures

PCI (percutaneous coronary intervention)

Laser Angioplasty

CABG (coronary artery bypass graft)

Nutrition Therapy for Atherosclerosis

Nutrition Assessment

Use TCL (Therapeutic Lifestyle Changes) as nutrient


standard

Increases PUFA and MUFA

Decreased saturated fat

Nutrition Diagnosis

Prioritize nutrition problems


Nutrition diagnosis will focus on fat, fiber, weight,
food choices, and physical inactivity

Nutrition Therapy for Atherosclerosis

Nutrition Intervention

Weight loss

Physical activity
Total dietary fat
Saturated fat and cholesterol
Trans fatty acids
Monounsaturated fat

Omega-3 fatty acids, fiber, folate, sterols

Ischemic Heart Disease

Inadequate blood supply to the heart (inadequate

oxygen)
Occlusion caused by atherosclerosis
Angina (chest pain)

Can precipitate MI causing necrosis of tissue

Ischemic Heart Disease

Etiology

Acute coronary syndrome acute MI or unstable


Angina

Plaque erosions, rupture of plaque forming thrombus,


vasoconstuction

Traditional risk factors of atherosclerosis apply to


ischemic heart disease
C-reactive protein good predictor

Ischemic Heart Failure

Pathophysiology

Myocardial Infarction or angina from

Sudden blockage

Hemorrhage

Arterial Spasm

Increase in myocardial oxygen demand

All related to the occlusion of the lumen by


atherosclerosis

Ischemic Heart Disease

Pathophysiology

Complications of myocardial infarction:

Tachycardia

Heart failure

Intracardial thrombi

Pericarditis

Cardiac rupture

Paillary muscle disfunction

Ventricular aneurysm

Ischemic Heart Disease

Clinical Manifestations

Stable angina

Indigestion, nausea, vomiting, sweating, shortness of breath,


weakness, fatigue

Rythmic abnormalities

Sudden onset of bradychardia, palpitations, syncope, dizziness

Medical Diagnosis

Non-invasive tests

Imaging

Ischemic Heart Disease

Nutrition Intervention

Post MI

Limit oral intake

Progress oral diets liquids to soft

Small more frequent meals

TLC dietary recommendations

Peripheral Artery Disease

Definition

Occlusion of blood flow in non-coronary arteries

Strongest risk factor is uncontrolled diabetes

Pathophysiology

Similar to atherosclerosis and Ischemic heart disease

Eventually suffer from denervation of the affected


muscle and can cause ulceration

Common loss of foot or toes

Peripheral Arterial Disease

Clinical Manifestations and Medical Diagnosis

Intermittent claudication cramp like pain with


activity

Treadmill test
Major risk for amputation

Heart Failure

Definition

Impairment of the ventricles capacity to eject blood


from the heart or to fill with blood

End-Stage CVD

Heart Failure

Etiology/Pathophysiology

Stages of heart failure

Primary cause hypertension, dilated cardiomyopathy,


valvular disease

Begins with heart injury and blood pressure changes

Heart becomes weak and dilated

Progressive disease

Heart Failure

Clinical Manifestations

Decreased blood flow and oxygen

Causes dyspnea, fatigue, weakness, exerceise


intolerance, poor adaptation to cold

Fluid retention, pulmonary congestion, hepatomegaly,


splenometaly, ascites

Cardiac edema

Cardiac cachexia

Heart Failure

Treatment

Treat underlying causes and control symtpoms

Prevent continued damage


Medications
Prevention of respiratory infections
Exercise
Nutrition Therapy

Nutrition Therapy for Heart


Failure
Complications leading to nutrition problems

GI- slowed peristalsis and early satiety

Impairment of nutrient absorption


Side effects from drugs (Vitamin K and warfarin)
Nutrient deficiencies

Nutrition Therapy for Heart


Failure
Nutrition Assessment and Diagnosis

Sodium and fluid

Early satiety

Drug/nutrient interactions

Nutrition Intervention

Sodium and fluid restriction

Drug-nutrient interactions

Other nutrients of concern (calcium, zinc, thiamin,


potassium)

Case Study
GG is a 49-year-old African-American male

diagnosed with Stage 2 essential HTN six


months ago. He states: I really want to control
this blood pressuremy parents both died of
complications from blood pressure and heart
disease. Current treatment includes lower-salt
diet, smoking cessation, and a sporadic walking
program. His labs include the following: BP
160/100; T chol 300 mg/dL; HDL-C 35 mg/dL;
LDL-C 135 mg/dL; TG 250 mg/dL. GGs physician
has discussed starting both a thiazide diuretic

Case Study
1. What are the criteria for diagnosis with Stage

2 essential HTN. What factors allow for that


diagnosis for GG?
The diagnosis has been made for Stage 2

essential HTN according to the following criteria:


1) Systolic BP 160; 2) Diastolic 100. The
patients blood pressure reading was 160/100.
He is a smoker. Both of his parents have a
history of high BP and heart disease, and he is
African American. All of these factors put him at

Case Study
2. What complications would result from

untreated HNT?
Congestive heart failure can result from

hypertension. In addition kidney failure,


myocardial infarction, stroke, and aneurysms
can develop from untreated hypertension. When
blood vessels burst or bleed in the eyes, vision
problems can develop. Ventricular arrhythmias
and sudden cardiac death can also be caused by
hypertension.

Case Study
3. What are the mechanisms through which

thiazide diuretics treat high blood pressure?


Cardiac output or peripheral resistance must be

changed to alter BP. Thiazides, like


hydrochlorothiazide, lower blood pressure by
increasing the flow of urine. They impede
sodium and water reabsorption.

Case Study
4. Assess the clients usual intake using

appropriate nutrition criteria.


The client weight indicates that he has a caloric

intake that is too high. His diet is poor in


potassium, magnesium and fiber and calcium,
while he takes in too much total fat, saturated
fat, cholesterol and sodium.

Case Study
5. Evaluate the patients weight history. Is this a

risk factor? What other possible risk factors does


this patient present with?
The patient has a BMI of 31.5 30 which gives

him a classification of obese which is a risk


factor of HTN, and other health concerns. His
other risk factors are African American family
heritage, his own high blood pressure of
160/100, as well as a family history of high
blood pressure and heart disease, he is also a

Case Study

7- Estimate energy and protein requirement for GG.

Gender: Male, Age: 49 y Activity: sporadic walking


(sedentary) Height: 6 2
wt: 246 lbs.

Height in cm = 74x 2.54= 187.96 = 188 cm

Weight in kg = 246/ 2.2= 111.8 kg

BMI 111.8/ 3.53= 31.7 kg/ m2 obese

Case Study

REE= Male: (66.5 + 13.8 X weight) + (5.0 X height) - (6.8 X


age)

REE= Male: (66.5 + 13.8 X 111.8) + (5.0 X 188) - (6.8 X 49)

= 66.5+ 1542.84+940-333.2
=2216.32 kcal
He has sedentary = REE x 1.2

2216.32 x 1.2= 2660 500 = 2160 kcal

Case Study

8- Identify the nutrition prescription for GG by recommending the


appropriate nutrition therapy for his diagnosis.

The patient needs to lose weight by subtracting 500 kcal from his
caloric needs. In the meantime GG needs to increase his physical
activity. Since sodium has a negative impact on blood pressure
causing it to increase, GG needs to reduce his sodium intake by
1000 mg/day or follow DASH diet which would provide him with
less than 2400 mg/ day.

Case Study

9- List the data that should be collected for monitoring and


evaluate for each nutrition diagnosis that you identified.

For this patient there are three pieces of data that should be
collected and monitored: Weight, dietary intake, dash diet, and
blood pressure.

1. In term of weight, patient needs to lose weight and increase his


physical activity.

2. 24-dietary intake needs to be assessed then evaluated along


with following the dash diet.

3. His Blood pressure needs to be assessed and monitored.