Heart Failure/Metabolic Syndrome

Question 1

impairment of the capacity of ventricles to eject blood from the heart or to fill with blood, end stage of all forms of CVD

Answer 1

heart failure

Question 2

2 most common causes of HF

Answer 2

CHD and hypertension

Question 3

____ receives blood from tissues around body. ___ pumps through pulmonary artery to lungs, lungs add oxygen and ____ receives oxygenated blood ____ pumps out to rest of body

Answer 3

hight atrium ; right ventricle ; left atrium ; left ventricle

Question 4

pathophysiology with myocardial infarction:

Answer 4

damage to part of heart and impairs contractility of left ventricle, leading to less cardiac output (L ventricle hypertrophies)

Question 5

pathophysiology with chronic hypertension

Answer 5

heart must pump against higher pressure chronically, resulting in L ventricle hypertrophy , reduce contractility and less cardiac output

Question 6

accumulation of blood in venous circulation at expense of arterial volume causes:

Answer 6

decreased CO –> decreased blood flow to kidneys –> release of renin –> ^ adrenal secretion of aldosterone –> ^ Na reabsorption –>^ Na and fluid retention –> ^ BV and worsens situation

Question 7

how come edema happens?

Answer 7

with blood backing up behind the heart (venous circulation) the organs become congested with blood –> ^ hydrostatic pressure –> interstitial fluid not reabsorbed at venous ends of capillaries –> ^ fluid in ISF –>edema

Question 8

most common symptoms of HF?

Answer 8

dyspnea, orthopnea, fatigue, weakness, exercise intolerance, poor adaptation to cold temps

Question 9

treatment goals of HF

Answer 9

removal of underlying cause, control of symptoms, prevent continued damage to heart

Question 10

examples of med management:

Answer 10

treat hypertension with lifestyle/drug therapy, provide O2 therapy for SOB in advanced states, alter physical activity (decrease later stage, increase earlier stage), reduce negative remodelling of heart with beta blockers and ACE inhibitors, control excessive Na and fluid retention using diet/drugs (diuretics)

Question 11

treatment of volume overload in acute decompensated heart failure includes:

Answer 11

intravenous diuretics, <2g Na restriction, < 2 L fluid a day

Question 12

why decrease physical activity late stage and increase early stage?

Answer 12

reduce cardiac workload; improve heart function and prevent progression

Question 13

most common type of heart failure:

Answer 13

chronic and stable

Question 14

why wt loss if obese?

Answer 14

decrease the cardiac workload

Question 15

why na restricted diet?

Answer 15

decrease availability of Na cuz kidney is reabsorbing too much Na and water

Question 16

1-2 g Na is recommended for ____ HF

Answer 16

refractory

Question 17

what is refractory HF?

Answer 17

fluid overload that cannot be controlled by diuretics

Question 18

why is <1g Na hard?

Answer 18

lack of palatable foods (no bread, soup, celery, processed foods)

Question 19

is fluid restriction indicated for chronic and stable HF?

Answer 19

usually not cuz Na intake decrease = thirst decrease (decreasing fluid intake appropriately), but needed if refractory HF or hyponatremia

Question 20

this happens in 10-20% of HF patients, usually those with advanced/refractory HF, characterized by negative energy balance, loss of LBM, anorexia, wt loss

Answer 20

cardiac cachexia

Question 21

summary of mechanisms that cause malnutrition in HF:

Answer 21

Anabolic-catabolic imbalance

• ^ symp nervous system activity
• ^ stress hormones
• some pt have ^ RMR (unless muscle wasting extensive)

Dyspnea
-increases workload of inspiratory muscles

Poor appetite-anorexia

• early satiety from gut/liver edema
• depression

GI malabsorption

• edema of GIT
• poor blood perfusion of GIT -poor blood flow to major arteries supplying GIT due to venous congestion

Question 22

general supportive treatment strategies for malnutrition:

Answer 22

screen/monitor nutrition status and treat accordingly, high energy high protein diet (1.2-1.5g/kg BW for older adults chronic disease), small frequent feedings, supplements

Question 23

newer approaches to malnutrition?

Answer 23

appetite stimulants, exercise/rehabilitation when possible (skeletal muscle preservation)

Question 24

best evidence for micronutrient deficiency existing is for :

Answer 24

thiamin, riboflavin, pyridoxine (roles in energy metabolism, loss in urine)

Question 25

what is conditionally essential nutrient?

Answer 25

not usually essential (body synthesizes) but under some circumstances (ie. disease) becomes essential

Question 26

example of conditionally essential nutrient?

Answer 26

taurine (children don't produce enough, but adults usually can synth enough)

Question 27

constellation of interrelated risk factors that cluster in an individual and ^ risk for:

Answer 27

CHD and Type 2 Diabetes

Question 28

major risk factors in metabolic syndrome:

Answer 28

-- abdominal obesity -- insulin resistance and ^ plasma glucose – atherogenic dyslipidemia – hypertension – prothrombotic state – proinflammatory state

Question 29

What is the difference between insulin resistance and Type 2 diabetes?

Answer 29

If have IR, not necessarily have ^ plasma glucose cuz insulin still may be effective enough to keep glucose range normal (^ insulin production in pancreas, hyperinsulinemia); type 2 have both

Question 30

A harmonized definition for diagnosis for metabolic syndrome agreed upon by several organizations (including IDF, AHA, and WHO):

Answer 30

1) High blood pressure (≥ 130/85 mm Hg, or receiving medication) 2) High blood glucose levels (≥ 5.6 mmol/L, or receiving medication) 3) High serum triglycerides (≥ 1.7 mmol/L, or receiving medication) 4) Low HDL-Cholesterol (< 1.0 mmol/L in men or < 1.3 mmol/L in women) 5) Large waist circumference (≥ 102 cm in men, 88 cm in women; ranges vary according to ethnicity)

Question 31

Whether diagnosing MetS predicts increased risk for CHD and diabetes better than adding up the individual risk factors is still debated. Why diagnose MetS then?

Answer 31

- signal to treat all the risk factors -- not just an isolated risk factor - focuses attention on need for lifestyle therapies that target all metabolic factors concurrently

Question 32

^ ___ believed to be central in causing metabolic abnormalities

Answer 32

visceral adipose tissue

Question 33

why visceral adipose tissue?

Answer 33

genetic predisposition, decreased physical activity, adverse diet factors; source of pro-inflammatory molecules (cytokines); insulin-resistant so secretes high concentration of nonesterified fatty acids; inability of subcutaneous fat to act as protective metabolic sink

Question 34

why NEFAs problematic?

Answer 34

cause metabolic abnormalities, resulting in insulin resistance in skel muscle and liver-->hyperinsulinemia-->endothelial dysfunction and atherogenesis-->drained by portal vein, expose liver to high concentration of these-->rids these by ^ VLDL production, fat accumulation in liver

Question 35

diet specifically recommended for MetS?

Answer 35

no single diet, choice should target reduction of identified risk factors (smoking, alcohol, Na, kcal restriction, exercise, stress, diabetes, DASH, Mediterranean)

Question 36

why visceral worse than subcutaneous fat?

Answer 36

deposits fat in undesirable places (liver, heart, muscle)

Question 37

what is CHANGE program?

Answer 37

- Canadian Health Advanced by Nutrition and Graded Exercise Program - 12 month personalized diet and exercise program led by family physicians, dietitians, kinesiologists - Mediterranean diet and exercise

Question 38

5 keys to success?

Answer 38

- central role of pt’s family doctor - team approach - personalization - gradual intervention - close and repeated followup over 12 months

Question 39

additive vs. synergistic?

Answer 39

1+1=2 vs. 1+1=>2