Identify factors that contribute to heart
Explain why cholesterol and saturated fats
are limited in some cardiovascular conditions
Identify foods to avoid or limit in a
Explain why sodium is limited in some
Identify foods that are limited or prohibited in
Affects heart and blood vessels.
Leading cause of death and permanent disability
in many countries.
Can be acute (sudden) or chronic.
Acute: myocardial infarction (MI, heart attack)
Chronic: develops over time, loss of heart
Heart may or may not maintain circulation.
Heart may beat faster and enlarge to
Congestive heart failure occurs when the heart
cannot maintain blood circulation to all body
The heart muscle (myocardium), the valves, the
lining (endocardium), the outer covering
(pericardium), or the blood vessels may be
affected by heart disease.
Arteriosclerosis: arteries become thick and hard
making the passage of blood difficult and
Atherosclerosis: affects inner lining of arteries
where deposits of cholesterol, fats, and other
substances accumulate over time, thickening and
weakening artery walls. Deposits are called
Plaque may cause a reduced blood flow beyond the
obstruction; ischemia occurs.
Ischemia may cause pain.
Angina pectoris: Chest pain; may radiate down left arm.
If lumen of vessel narrows completely in a coronary
artery, a heart attack occurs.
Coronary artery bypass graft (CABG): procedure
to bypass circulation around a clogged artery.
Cerebrovascular accident (CVA): blood flow to
brain is blocked or blood vessel bursts (stroke).
Peripheral vascular disease: vessels in
Hyperlipidemia: (Cholesterol; high LDL, low HDL)
* Contributory factors:
Personality type (ability to handle stress)
Age (risk increases with age)
Primary treatment for hyperlipidemia.
Involves reducing the quantity and types of fats
and often kcal in the diet.
American Heart Association guidelines:
blood cholesterol 200 mg/dl or less is desirable
200 to 239 mg/dl is borderline high
240 mg/dl and greater is high
American Heart Association recommendations for
*Adult diets contain less than 200 mg of
cholesterol per day
*No more than 30% of kcal from fat; maximum
of 7% from saturated fats, 8% from
polyunsaturated fats, 15% from
*Proteins 12 to 20% of kcal, and carbohydrates
50 to 55% of kcal
It takes 2 to 3 months to adjust to a low-fat diet.
Change should be made gradually if physician
Provide client with information about the fat
content of foods and methods to prepare it.
Encourage client to select whole, fresh foods and
to prepare them without addition of fat.
Lean meat should be selected and all visible fat
Use fat-free milk and fat-free skim cheeses.
Gradually introduce 25-35 grams of fiber.
Discuss challenges with a dietitian and the M.D.
If appropriate blood lipid levels cannot be attained
within 3 to 6 months by use of fat-restricted diet
alone, the physician can prescribe a cholesterol-
Example: simvastatin (Zocor)
Client teaching: Zocor interacts with grapefruit
and its juice; total avoidance is necessary.
Caused by blockage of a coronary artery
supplying blood to heart.
Heart tissue beyond blockage dies.
Causes: atherosclerosis, hypertension, abnormal
blood clotting, infection such as that caused by
rheumatic fever (damages heart valves).
After the attack, the client is in shock.
Fluid shift occurs, and client may be thirsty.
Client should be NPO (nothing by mouth).
IV fluids may be given.
After several hours, client may begin to eat.
Liquid diet usually recommended first 24 hours.
Then, a low-cholesterol, low-sodium diet.
Foods should not be extremely hot or cold.
Food that is easy to chew and digest prescribed.
Percentage of energy nutrients will be based on
particular needs of the client.
Sodium limited to prevent fluid overload.
Restriction on caffeine the first few days after an
Injury to the heart muscle occurs from
atherosclerosis, high BP, rheumatic fever.
When damage is extreme and the heart cannot
provide adequate circulation, the amount of
oxygen taken in is insufficient for body needs.
Shortness of breath is common and chest pain
can occur on exertion.
Tissues retain fluid that would normally be
carried off by the blood.
• Sodium builds up, and more fluid is retained,
resulting in edema.
• Heart beats faster and enlarges to compensate.
• Death can occur in severe cases.
• Body tissues do not receive sufficient amounts of
• Edema may mask the problems of malnutrition and
• Fluid restriction may be ordered.
• Diuretics aid in the excretion of water and sodium,
and a sodium-restricted diet typically prescribed.
• Diuretics can cause excessive loss of potassium.
• Blood potassium levels should be carefully watched
to prevent hypokalemia which can upset the
• Fruits, especially oranges, bananas, and prunes are
excellent sources of potassium.
Chronically high blood pressure.
Essential, or primary hypertension: 90% of cases;
cause is unknown.
Secondary hypertension: 10% of cases; caused
by another condition.
Causes of secondary hypertension include kidney
disease, problems of the adrenal glands, use of
• Contributes to heart attack, stroke, heart failure, and
• “Silent disease” because sufferers can be
• Frequency increases with age and is more prevalent
among African Americans.
• Heredity and obesity.
• Smoking and stress.
• Weight loss usually lowers blood pressure and,
consequently, clients are often placed on weight-
• Sodium and fluid collect in body tissue, causing
edema, extra pressure is placed on the blood vessels.
• Sodium-restricted diet, often accompanied by
diuretics, can be prescribed to alleviate this condition.
• Increasing fruits and vegetables to 6 to 10 servings
per day helps to lower blood pressure.
When diuretics are given together with a sodium-
restricted diet, the client may lose potassium via the
urine. So, amount of potassium-rich foods in the diet
should be increased.
Daily intake of sodium be limited to no more than 2,400
mg to avoid edema and hypertension.
Food and Nutrition Board recommends .
Board set a safe minimum at 500 mg/day for adults.
Impossible to have a diet totally free of sodium.
Meats, fish, poultry, dairy products, and eggs all contain
substantial amounts of sodium naturally.
Cereals, vegetables, fruits, and fats contain small
amounts of sodium naturally.
Water contains varying amounts of sodium.
Many products contain sodium.
Some over-the-counter medicines contain sodium.
Physician’s permission should be obtained before using
any medication or salt substitute.
Most people are accustomed to salt in their food
and transition to sodium-restricted diet may be
It will help the client if the reduction in sodium can
Remind the client of the numerous herbs, spices,
and flavorings allowed.
Most of the cardiac clients will be told they must
reduce the fats, sodium, and sometimes, the
amount of kcal in their diets.
Help the cardiac client want to learn how to help
himself or herself via nutrition.
Cardiovascular disease represents the
leading cause of death in many countries.
May be acute, as in myocardial infarction, or
chronic, as in hypertension and
Hypertension may be a symptom of another