NHHC chapter 21 outline

1. Chapter 21 – Nutrition and Disorders of the Heart and Blood Vessels
Chapter Outline Instructor Resources
I. Introduction
A. Cardiovascular disease(CVD)
B. CVD is leading cause of death in U.S. & Europe; & cause of 30% of deaths worldwide
C. Coronary heart disease (CHD)
D. Atherosclerosis
E. Myocardial Infarction = “heart attack”
F. Stroke
II. Atherosclerosis
A. Overview
1. Artery walls becomeprogressively thickened due to accumulation of plaque
2. Occurs due to minimal but chronic injuries that damagethe inner arterial wall
3. First lesions tend to develop wherearteries branch or bend
B. Consequences of Atherosclerosis
1. Lumen narrows
2. Plaque can rupture,forming a clot (thrombus)
3. Thrombus can break free & shut off blood flow (embolism)
4. Ischemia occurs within thetissue
a. Coronary arteries (angina pectoris & heart attack)
b. Brain (stroke)
c. Legs (intermittent claudication)
5. Kidney disease
6. Aneurysm (sac-like distention of blood vessel wall)
C. Causes of Atherosclerosis
1. Shear Stress/Hypertension - provokes a low-gradeinflammatory state
2. Abnormal Blood Lipids
a. Elevated LDL & VLDL
b. Oxidized LDL & VLDL
c. HDL helps prevent oxidation
d. Smallest,most dense LDL = most atherogenic
3. Cigarette Smoking
4. Diabetes Mellitus - both initiates & accelerates development of atherosclerosis
5. Age and Gender
III. Coronary Heart Disease (CHD)
A. Symptoms of Coronary Heart Disease
1. Pain or discomfort in chest
2. Pain can radiateto neck, shoulders, left arm, back, or jaws
3. Pain often triggered by exertion
4. Shortness of breath,unusual weakness,lightheadedness or dizziness,nausea, vomiting,
lower abdominal discomfort, anxiety,or fatigue
B. Evaluating Risk for Coronary Heart Disease

2. 1. Coronary heart disease - classic risk factors are: smoking, high LDL cholesterol, HTN, &
diabetes
2. CHD Risk Assessment
a. Complete lipoprotein profile
b. Overweight/obesity
c. HTN
d. Cigarette smoking
e. Diabetes
f. How to Assess a Person’s Risk of Heart Disease; goal = lower LDL
3. Blood Cholesterol Levels and CHD Risk
C. Therapeutic Lifestyle Changes for Lowering CHD Risk
1. Overview - National Cholesterol Education Program: Therapeutic Lifestyle Changes
a. Cholesterol-loweringdiet
b. Regular physical activity
c. Weight reduction
2. Saturated Fat - Decrease saturated fat & replacewith high-fiber,complex carbohydrates
3. Polyunsaturated and Monounsaturated Fat
a. Polyunsaturated = 10% of calories
b. Monounsaturated = up to 20% of calories
4. Total Fat - Decrease total fat to 25-35% of kcalories
5. Trans Fat - Decrease trans fat; avoid partially hydrogenated oils
6. Dietary Cholesterol - <200 mg/d
7. Soluble Fibers - Increase soluble fiber
8. Plant Sterols and Stanols
9. Sodium and Potassium Intakes - Increased K & reduced Na may improveBP
10. Fish and Omega-3 Fatty Acids - Increase fattier fish for omega-3 fatty acids
11. Alcohol - Moderate alcohol
12. Regular Physical Activity
a. Reverses several riskfactors
b. Guideline: 150 minutes of moderate-intensityactivity or 75 minutes vigorous activity or
equivalent combination per week
13. Smoking Cessation
14. Weight Reduction
15. Successful Adherence to Lifestyle Changes: How toImplement a Heart-Healthy Diet
D. Lifestyle Changes for Hypertriglyceridemia
1. Hypertriglyceridemia is common with diabetes,obesity, and metabolic syndrome
2. Nutrition Therapy for Hypertriglyceridemia
a. Controlling body weight
b. Physical activity
c. Restrict alcohol
d. Limit refined CHO in diet
3. Severe Hypertriglyceridemia
a. Medication usually required
b. Same as for mild
c. Very-low-fat diet:<15% of kcalories
4. Fish Oil Supplements & Hypertriglyceridemia - 2-4 g/day EPA + DHA can lower triglyceride
levels 10-50%
E. Vitamin Supplementation and CHD Risk

3. 1. No conclusiveresearch results havebeen obtained for vitamins beingpreventativefor CVD
2. B Vitamin Supplements and Homocysteine - not recommended
3. Antioxidant Supplements - not recommended until more data are available
F. Drug Therapies for CHD Prevention
1. Statins - Reduce cholesterol synthesis in the liver
2. Bile acid sequestrants - Reduce LDL & bile absorption in small intestine
3. Fibrates & nicotinic acid - Lower triglycerides & raiseHDL
4. Anticoagulants & aspirin - Suppress blood clotting
5. Nitroglycerin for angina
G. Treatment of Heart Attack
1. Drug therapy
a. Thrombolytics
b. Anticoagulants
c. Aspirin
d. Painkillers
e. Blood pressuremedications
f. Rhythm stabilizers
2. No food until stable,only sips of clear liquids
3. Progress to small portions
a. Low in sodium
b. Low in saturated fat & cholesterol
4. Cardiac rehabilitation
IV. Stroke
A. Overview
1. 4th leading cause of death
2. Types:
a. Ischemic
b. Hemorrhagic
c. Transient ischemic attacks (TIA)
B. Stroke Prevention
1. Recognize risk factors
2. Lifestyle changes
C. Stroke Management
1. Thrombolytic drugs
2. Anticoagulant or antiplatelet drugs
3. Antihypertensives
4. Blood lipid-loweringdrugs
5. Maintain nutrition status
6. Problems
a. Lack of coordination
b. Difficulty swallowing
V. Hypertension - Affects 1/3 of adults in U.S.
A. BP guidelines
1. Desirable BP - <120/80
2. Prehypertension - 120-139/80-89
3. Hypertension - >140/90

4. B. Factors That Influence Blood Pressure
1. Cardiac output
2. Peripheral resistance
3. Secretion of hormones by kidneys
C. Factors That Contributeto Hypertension
1. 90-95%:cause unknown
2. Secondary hypertension - e.g., CKD alters kidney function & promotes fluid retention
3. Aging
4. Genetic factors - More prevalent in African Americans
5. Obesity
6. Salt sensitivity - 30-50% of cases
7. Alcohol - 3 or more drinks daily
8. Dietary factors:Modifications that increaseintake of potassium,calcium,& magnesium can
lower BP
D. Treatment of Hypertension
1. Weight Reduction
2. Dietary Approaches for Reducing Blood Pressure
a. DASH Diet - Limits:
1. Red meats
2. Sweets
3. Sugar-containingbeverages
4. Saturated fat to <7%
5. Cholesterol to 150 mg/day
b. More effective in combination with low-sodium diet
c. Sodium restriction
3. Drug Therapies for Reducing Blood Pressure - usually 2 or more medications
VI. Heart Failure - a.k.a. congestive heart failure
A. Description
1. Heart’s inability topump adequate blood
2. Fluids build up in veins & tissues
3. Heart enlarges
4. Most often occurs at ages 65 or older
B. Consequences of Heart Failure
1. Right side
a. Fluid accumulation in lower extremities,liver,& abdomen
b. Chest pain; difficult digestion; swellinglegs, ankles, feet
2. Left side
a. Pulmonary edema, SOB, & respiratoryfailure
b. Impaired liver & kidneys
3. Affects food intake & physical activity
4. Cardiac cachexia
C. Medical Management of Heart Failure
1. Drug Therapies for Heart Failure
a. Diuretics
b. ACE inhibitors
c. Angiotensin receptor blockers
d. Beta-blockers

5. e. Vasodialators
f. Digitalis
2. Nutrition Therapy for Heart Failure
a. Sodium restrictions
b. Sometimes fluid restriction
3. Other Dietary Recommendations
a. Adequate fiber to prevent constipation
b. Avoid alcohol
4. Cardiac Cachexia - Liquid supplements, tubefeedings, parenteral support
VII. Nutrition in Practice - Helping People with Feeding Disabilities
A. In what ways can disabilities impair a person’s ability toeat?
1. Interference with sitting,grasping,bringingfood to mouth, biting,chewing, or swallowing
2. Interference with procurement of food
3. Table 21-1 Conditions That May Lead to Feeding Problems
B. Can disabilities alter a person’s energy needs? - Yes, can increaseor decrease
C. Which health professionals typically workwith people who have feeding problems?
1. Nurses
2. Dietitians
3. Occupational therapists
4. Physical therapists
5. Speech-language pathologists
6. Dentists
7. Assess
a. Chewing
b. Sipping
c. Swallowing
d. Graspingutensils
e. Using utensils
8. Provide alternativefeeding strategies
9. Direct observation allows health careprofessionals to assess,demonstrate,monitor,&
evaluatethe care plan
D. Can special equipment be used to help people with certain feeding difficulties?
1. Specialized chairs - to improve posture
2. Bolsters under arms - to provide elbow stability
3. Raised trays or eatingsurfaces - to simplify hand-to-mouth movements
4. Tube feedings
5. Table 21-2 Interventions for Feeding-Related Problems
E. In what ways can feeding difficulties affect family life?
1. Emotional and social problems if unableto participate
2. Developmental failure in children
3. Can overwhelm caregivers