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  2. OUTLINE • Introduction • Cardiovascular Diseases (CVD) • General risk factors of CVD • General symptoms of CVD • Hypertension • Medical Nutrition Therapy
  3. INTRODUCTION • The cardiovascular, or circulatory, system supplies the body with blood. It consists of the heart, arteries, veins, and capillaries. • The cardiovascular (cardio – heart, vascular – blood vessels) system is divided for descriptive purposes into two main parts: • the heart, whose pumping action ensures constant circulation of the blood • the blood vessels, which form a lengthy network through which the blood flows. The heart pumps blood into two anatomically separate systems of blood vessels: • the pulmonary circulation • the systemic circulation.
  4. INTRODUCTION • The right side of the heart pumps blood to the lungs (the pulmonary circulation) where gas exchange occurs, i.e. the blood collects oxygen from the air sacs and excess carbon dioxide diffuses into the air sacs for exhalation. The left side of the heart pumps blood into the systemic circulation, which supplies the rest of the body. Here, tissue wastes are passed into the blood for excretion, and body cells extract nutrients and O2. • The circulatory system ensures a continuous flow of blood to all body cells, and its function is subject to continual physiological adjustments to maintain an adequate blood supply. The heart weighs between 200g to 425g. Each day, the average heart beats 100,000 times, pumping about 2000gallons (7571 litres) of blood. • Should the supply of oxygen and nutrients to body cells become inadequate, tissue damage occurs, and cell death may follow. Disease of the cardiovascular system is likely to have significant consequences, not only for the heart and blood vessels, but also for other body systems,.
  5. Direction of blood flow through the heart.
  6. INTRODUCTION The relationship between the pulmonary and the systemic circulations.
  7. CARDIOVASCULAR DISEASE (CVD) • Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. • Cardiovascular diseases (CVDs) are the leading cause of death globally. • An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. • Over three quarters of CVD deaths take place in low- and middle-income countries. • Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2019, 38% were caused by CVDs. • Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol. • It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin.
  8. TYPES OF CVD • CVD comprises many different types of condition. Some of these might develop at the same time or lead to other conditions or diseases within the group. • Diseases and conditions that affect the heart include: Coronary Artery Disease occurs when the flow of oxygen-rich blood to the heart muscle is blocked or reduced resulting from the narrowing of the coronary arteries by a gradual build – up of fatty materials within their walls. Coronary arteries are the arteries that supply the heart muscle with oxygen – rich blood. This puts an increased strain on the heart, and can lead to: Angina Pectoris Angina pectoris involves chest pain or discomfort from decreased blood flow to the myocardium from decreased oxygen supply (often during exertion). Angina is a warning sign that a heart attack (Myocardial Infarction) may occur.
  9. TYPES OF CVD Myocardial Infarction Myocardial infarction is the technical name for a heart attack. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart does not get enough blood or oxygen. Therefore, M.I is necrosis in the heart muscle caused by prolonged inadequate blood supply or oxygen deficit. Heart (cardiac) failure The heart is described as failing when the cardiac output is unable to maintain the circulation of sufficient blood to meet the needs of the body. In mild cases, cardiac output is adequate at rest and becomes inadequate only when increased cardiac output is required, e.g. in exercise. Heart failure may affect either side of the heart, but since both sides of the heart are part of one circuit, when one half of the pump begins to fail it frequently leads to increased strain on, and eventual failure of, the other side. • Acute heart failure • Chronic heart failure.
  10. TYPES OF CVD Angina Pectoris
  11. TYPES OF CVD Myocardial infarction
  12. TYPES OF CVD Heart Failure
  13. TYPES OF CVD Atherosclerosis Atherosclerosis involves progressive narrowing and loss of elasticity in the blood vessel wall caused by accumulation of plaques. The heart, brain and leg arteries are most often affected. Strokes and TIAs • A stroke is where the blood supply to part of the brain is cut off, which can cause brain damage and possibly death. • A transient ischaemic attack (also called a TIA or "mini-stroke") is similar, but the blood flow to the brain is only temporarily disrupted. Peripheral arterial disease Peripheral arterial disease occurs when there's a blockage in the arteries to the limbs, usually the legs. Cardiac arrhythmia refers to a group of conditions that cause the heart to beat irregular, too slowly, or too quickly. There are several categories of arrhythmia, including: bradycardia, or a slow heartbeat. tachycardia, or a fast heartbeat. irregular heartbeat, also known as a flutter or fibrillation.
  14. TYPES OF CVD Aortic disease • Aortic diseases are a group of conditions affecting the aorta. This is the largest blood vessel in the body, which carries blood from the heart to the rest of the body. • One of most common aortic diseases is an aortic aneurysm, where the aorta becomes weakened and bulges outwards. • This doesn't usually have any symptoms, but there's a chance it could burst and cause life-threatening bleeding. Hypertensive Heart Disease Hypertensive heart disease refers to heart problems that occur because of high blood pressure. In general, the heart problems associated with high blood pressure relate to the heart’s arteries and muscles. The types of hypertensive heart disease include:
  15. TYPES OF CVD • Narrowing of the arteries Coronary arteries transport blood to your heart muscle. When high blood pressure causes the blood vessels to become narrow, blood flow to the heart can slow or stop. This condition is known as coronary heart disease (CHD), also called coronary artery disease. • Thickening and enlargement of the heart High blood pressure makes it difficult for your heart to pump blood. Like other muscles in your body, regular hard work causes your heart muscles to thicken and grow. These changes usually happen in the main pumping chamber of the heart, the left ventricle. The condition is known as left ventricular hypertrophy (LVH). Congenital Heart Disease An abnormality in the heart that develops before birth. The problem can affect: • the heart walls • the heart valves • the blood vessels
  16. RISK FACTORS OF CVD High blood pressure High blood pressure (hypertension) is one of the most important risk factors for CVD. If your blood pressure is too high, it can damage your blood vessels. Smoking Smoking and other tobacco use is also a significant risk factor for CVD. The harmful substances in tobacco can damage and narrow your blood vessels. High cholesterol Cholesterol is a fatty substance found in the blood. If you have high cholesterol, it can cause your blood vessels to narrow and increase your risk of developing a blood clot. Diabetes Inactivity Being overweight or obese Family history of CVD
  17. RISK FACTORS OF CVD Ethnic background CVD is more common in people of south Asian and an African or Caribbean background. This is because people from these backgrounds are more likely to have other risk factors for CVD, such as high blood pressure or type 2 diabetes. Other risk factors Other factors that affect your risk of developing CVD include: • age – CVD is most common in people over 50 and your risk of developing it increases as you get older • gender – men are more likely to develop CVD at an earlier age than women • diet – an unhealthy diet can lead to high cholesterol and high blood pressure • alcohol – excessive alcohol consumption can also increase your cholesterol and blood pressure levels, and contribute to weight gain
  18. SYMPTOMS OF CVD Heart disease symptoms depend on the type of heart disease. • Chest pain, chest tightness, chest pressure and chest discomfort (angina) • Shortness of breath • Pain, numbness, weakness or coldness in legs or arms if the blood vessels in those parts of the body are narrowed • Pain in the neck, jaw, throat, upper abdomen or back • Breathlessness with activity or at rest • Swelling of the legs, ankles and feet • Irregular heartbeats that feel rapid, pounding or fluttering • Dizziness, lightheadedness and fainting • Fatigue • Fluid build up • Abdominal pain, nausea, vomiting
  19. SYMPTOMS OF CVD Symptoms of congenital heart disease • Pale gray or blue skin color (cyanosis) • Swelling in the legs, abdomen or areas around the eyes • In an infant, shortness of breath during feedings, leading to poor weight gain • Easily getting short of breath during exercise or activity • Easily tiring during exercise or activity • Swelling in the hands, ankles or feet
  20. HYPERTENSION Hypertension also referred as high blood pressure is a condition in which the arteries have persistently elevated blood pressure above 140/90mmHg. Blood pressure is the force of blood pushing up against the blood vessel walls. The higher the pressure, the harder the heart pumps. Hypertension can lead to damaged organs, as well as several illnesses, such as renal failure, aneurism, heart failure, stroke or heart attack. Classification of hypertension: • Essential- hypertension of unknown cause, It is the most common chronic disease of industrialized societies, particularly among the middle and old age group. It is the major contributor to the development of cardiovascular disease, stroke and renal failure. • Secondary- hypertension with a known direct cause, such as Kidney diseases, tumors or birth control pills.
  21. RISK FACTORS ASSOCIATED WITH HIGH BLOOD PRESSURE Smoking Nicotine raises blood pressure by constricting the blood vessels. Obesity or being over weight Diabetes Sedentary life style Lack of Physical activity High level of salt intake (sodium sensitivity). Insufficient calcium, potassium and magnesium consumption. High level of alcohol consumption Stress • Aging • Medicines such as birth control drugs. • family history of hypertension/heredity • Chronic kidney disease. • Adrenal and thyroid problems or tumors. • Sex males have high BP than females.
  22. SYMPTOMS OF HYPERTENSION About 33% of people with hypertension do not know that they have high blood pressure and this ignorance can last for years, for this reason, it is advisable to undergo periodic blood pressure screenings even when no symptoms are present. • Severe headache • Fatigue or confusion • Dizziness • Nausea • Problems with vision • Chest pain • Breathing problems • Irregular heart beat • Blood in urine.
  23. CLASSIFICATION OF BLOOD PRESSURE FOR ADULT AGE OF 18 YEARS OR OLDER Source: Whelpton PK. Epidemiology of hypertension. Lancet Category Systolic Bp (mmHg) Diastolic Bp (mmHg) Optimal <120 <80 Normal 120-129 80-84 High normal 130-139 85-89 Hypertension Stage 1 140-179 70-99 Stage 2 160-179 100-109 Stage 3 180-209 110-119 Stage 4 > 210 > 120
  24. MANAGEMENT OF HIGH BLOOD PRESSURE Non Drug Treatment • Weight reduction – weight reduction in the obese lowers blood pressure. • Exercise • Stop smoking • Stop intake of alcohol • DASH Diet • Low Sodium Diets 2.3g = 100mmol = mild low sodium diet 1.2g = 50mmol = moderately low sodium diet 0.6g = 25mmol = restricted low sodium diet • Increase Potassium Intake • Increase Vegetable Intake
  25. DASH DIET(DIETARY APPROACHES TO STOP HYPERTENSION) • This emphasizes a diet rich in fruits, vegetables and low fat or non-fat dairy products that provide high intake of potassium, magnesium and calcium sources. Sodium intake should be between 1500mg to 2400mg per day,(the lower the better). Weight loss, regular exercise and limiting alcohol.
  26. TOP CATEGORIES OF HIGH –SODIUM FOODS • Smoked, processed, or cured meats and fish (eg., ham, bacon, corned beef, hot dogs, sausage, salt pork, chipped beef, tuna and sardines). • Tomato juices and tomato sauce (ketchup), unless labeled otherwise. • Meat extracts, bouillon cubes, meat sauces, Monosodium glutamate and taco seasoning. • Salted snacks (potato chips, tortilla chips, corn chips, salted nuts, popcorn and crackers). • Prepared salad dressings, condiments, relishes, ketchup, barbecue sauce, cocktail sauce, soy sauce, commercial salad dressings, etc. • Packaged mixes for sauces, gravies, casseroles, and noodle, rice, or potato dishes; macaroni and cheese; stuffing mix. • Cheese (processed and cheese spreads). • Canned soups. • Foods eaten away from home.
  27. MEDICAL NUTRITION THERAPY OF CVD • Consumption of omega-3 fatty acids (e.g., walnuts, soybean oil, fatty fish). Restrict saturated fats, dietary cholesterol and sodium as necessary according to the individual profile. A very low fat diet can be quite effective • Increase consumption of dietary fiber and whole grains (17-30g/day). • Consumption of plant proteins. Use fewer animal proteins and more legumes or vegetable protein sources. Fish may be used 3 or 4 times weekly, especially sources rich in omega 3 fatty acids. Remove chicken skin before cooking or just before serving. • Stop/limit intake of alcohol • DASH Diet • Weight reduction. Use a calorie-controlled diet if weight loss is needed. • Increase fruits and vegetables (5 – 10 servings daily) for their flavonoid, phytochemical, potassium content and properties. • Small, frequent feedings rather than three large meals are indicated • Limit stimulants such as caffeine