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Clinical I > Lecture 8 > Flashcards

Lecture 8 Flashcards

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1
Q

What is CVD?

A

Cardiovascular disease - umbrella term for anything affecting heart and blood vessels
-group of disorders

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2
Q

What are the major forms of CVD?

A
  • Hypertension (HTN)
  • Atherosclerosis
  • Ischemic heart disease (IHD) •Peripheral vascular disease (PVD)
  • Heart failure (HF)
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3
Q

What % of CVD is preventable?

A

Up to 80% of premature CVD is preventable

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4
Q

What is atherosclerosis?

A

Thickening of the blood vessel walls caused by accumulation of plaque, narrowing of the arteries and a loss of vascular elasticity
◦ Results in restriction of blood flow
◦ Pieces can break off and form clots

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5
Q

What is atherosclerosis associated with?

A 
MI
CVA (cerebrovascular accident)
PVD (peripheral vascular disease)
CHD
CHF
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6
Q

What is the pathophysiology of atherosclerosis?

A
  • Complex process
  • Involves endothelial cells, smooth muscle cells, platelets, and leukocytes
  • Begins as a response to endothelial lining injury that results in an inflammatory process
  • Results in restriction of arterial blood flow
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7
Q

What is ischemia?

A

decrease blood flow to tissue or organ

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8
Q

What is IHD?

A

Ischemic heart disease

Due to decrease blood flow

• Coronary arteries are occluded to the point that blood flow to distal portions is compromised
◦ May experience angina
◦ Severe and prolonged myocardial ischemia can cause a myocardial infarction

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9
Q

What is angina?

A

pain in chest because bloos isnt carrying enough O2 to cells in heart

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10
Q

What is HF?

A

Heart Failure
◦ Insufficiency of the heart as a pump, usually damaged
or weakened by other heart diseases or other medical conditions
◦ Used to be called congestive heart failure (CHF)

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11
Q

What is MI?

A

Myocardial infraction: Heart attack

Blocked coronary arteries by plaque to such an extent that little or no blood can get through to the heart leading to necrosis of area of heart muscle due to obstruction of blood flow

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12
Q

What can blood flow be disrupted by?

A
  • A thrombus – a blood clot that forms in a vessel
  • An embolus – a general term for any mass that travels through the bloodstream and can clog vessels
  • A thromboembolism is a blood clot (thrombus) that breaks off and clogs a vessel (embolus)
  • Angina: Insufficient blood and oxygen to the heart resulting from a blockage of one or more coronary arteries causing pain in the chest. Angina is not a heart attack.
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13
Q

What are the risk factors for atherosclerosis?

A

Fam history

Age and sex

Obesity

Dyslipidemia

Hypertension

Physical inactivity

Poor Diet

DM

Imparied fastng glucose and metabolic syndrome

Cigarette smoke

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14
Q

What is dyslipidemia?

A

◦ Lipids are transported via lipoproteins composed of a lipid interior and protein shell
◦ ↑Serum [LDL-chol.] and [TG] ◦ decrease Serum [HDL-chol.]

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15
Q

When should people start being screened for CVD?

A

Men & women 40+ or poostmenopausal

-or unless any other risk factors

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16
Q

How can you evaluate the level of risk for CVD?

A

Framingham Risk Scores
◦ Low: 0-9%
◦ Intermediate: 10-19%
◦ High: 20% +

Cardiovascular life expectancy model
-guidance for determining cardiovascular age

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17
Q

How often should you assess CVD risk?

A

Every 5 years of when patients expected risk status changes

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18
Q

How can you manage atherosclerosis?

A

• Lifestyle change intervention program

Meds

Surgery

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19
Q

What are some of the non fasting serum lipid concentrations we can look at?

A 
• Total cholesterol (TC)
• Total triglycerides (TG)
• HDL cholesterol (HDL-C)
• LDL cholesterol (LDL-C)
• Non-HDL cholesterol (Non-HDL-C)
• calculated 
•Possibly also:
-Serum apoB
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20
Q

What are the ehalth targets for those with high risk for CAD?

A

•LDL-c < 2.0 mmol/L
◦ or at least 50%  LDL-c

  • ApoB < 0.80 g/L
  • Non – HDL-c < 2.6 mmol/L
  • TG < 1.7 mmol/L
  • hs-CRP* < 2.0 mg/L
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21
Q

What are the lipid altering meds?

A

HMG-CoA reductase inhibitors ◦ Statins (HMG-CoA Reductase Inhibitors)
◦ Usually first to be prescribed

Add-on Therapy to Statins
◦ Ezetimibe
◦ Bile acid sequestrants (BAS) ◦ PCSKP Inhibitors

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22
Q

How do stating work in altering lipid numbers?

A
  • decrease cholesterol synthesis in liver
  • Inhibit enzyme and limit production of cholesterol in the liver
  • Help increase LDL clearance from the blood

◦ E.g. Simvastatin (Zocor®), Atorvastatin
◦ Drug-nutrient interaction with grapefruit

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23
Q

What are cholesterol absorption inhibitors?

A

Decrease cholesterol absorption in intestines

• E.g. Ezetimibe (Ezetrol®)

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24
Q

What are bile acid sequestrants?

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A
  • decrease bile salts and cholesterol reabsorption in ileum (cholesterol in bile salts)
  • decrease serum LDL-chol
  • E.g. Cholestyramine (Questran®),
25
What are PCSK9 Inhibitors?
(Proprotein convertase subtilisin kexin 9) • Receptors present longer in larger amounts help to reduce LDL in the blood ◦ Reduces degradation of LDL receptors and increases removal of LDL from circulation ◦ Alirocumab (Praluent®) ◦ Evolocumab (Repatha®) - Subcutaneous injection
26
What are fibrates?
◦ decrease serum TG (targets them) ◦ Does not generally lower LDL ◦ E.g. Fenofibrate (Lipidil®, Fenofibrate®)
27
What re Niacin derivatives?
◦decrease serum TG & LDL-chol, &  HDL-chol ◦ E.g. Niacin (Niacin®) ◦ More than 100 x RDA ◦ Not well-tolerated; mild to severe side-effects
28
What are lifestyle interventions to reduce CVD?
* Smoking cessation * Healthy diet * Weight reduction & maintenance * Exercise daily * Moderate alcohol consumption * Sufficient sleep
29
What % of PUFAs make up the total energy intake?
10% or less
30
What are characteristics of omega 6 FA?
* Linoleic acid (EFA), arachidonic acid * Sources: corn, sunflower, walnuts, safflower & soybean oils * increase LDL clearance by increasing LDL receptor activity * However can decrease HDL-c If in too high amounts can lower HDL
31
What are characteristics of omega 3 FA?
* alpha-linolenic acid (EFA) * sources: walnuts, canola, flaxseed, & sesame oils * EicosaPentanoic Acid (EPA) & DocosaHexanoic Acid (DHA) * sources of EPA & DHA: fatty fish & fish oil, sardines, salmon, mackerel, trout, herring, etc.
32
What cardio protects effects does omega 3 have?
Decrease fasting [TG] & [VLDL] ◦ Moderate increase [HDL-c] ◦ Antithrombotic effect: ◦ decrease blood platelet reactivity ◦ decrease plasma viscosity ◦ Inhibitory effect on inflammation & atherosclerosis ◦ Improved endothelial relaxation ◦ increase vasodilation ◦ Anti-arrhythmic
33
What % MUFA should make up the daily diet?
increase up to 15-20% E • e.g. oleic & eicosenoic acids • sources: olive, canola & sesame oils • decrease blood [TC] by decrease [LDL-c] when replacing SFA
34
How much cholesterol should ou have?
less than 300mg/day | - but they removed the guidelines that say less than 300mg/day
35
What are sources of cholesterol?
Egg yolk Shrimp Organ meats - Cholesterol from diet has little impact
36
How much fibre should be consumed ?
>25-35g/d:high fibre diet • AI for adults=25g/d♀&38g/d♂ Soluble. fibres decrease elevated blood TC
37
Why is fibre important for CVD?
Soluble. fibres decrease elevated blood TC * Binding & enhancing the excretion of bile acids * Fermentation of soluble fibre by colonic bacteria thereby producing short-chain FA which may inhibit chol. synthesis
38
What are plant sterols/stanol?
•Functional foods such as enriched margarine spreads, yogurts mayonnaise and salad dressings -helos reduce LDL
39
How much plant sterols/stanols do you need?
* Intakes of 2-3 grams/day of plant stanol/sterol esters will decrease LDL-C by 6-15 % * Normal daily intake of 200-400 mg/day
40
What does soy protein do for CVD?
* decrease blood [TC] by decrease [LDL-c] * decrease blood [TG] * significant amount required in diet (=or greater 25 g/d)
41
What is the mediterranean diet based on?
Plant-based: increase fruits & veg., grains, beans, nuts - decrease red meat & sugars - decrease SFA, increase MUFA & Omega-3 fats, red wine * Emphasizes eating whole, natural foods, therefore extremely low in trans FA * Olive oil is major component * Nuts, which contain fibre, Vit. E, folic acid, potassium, magnesium & selenium
42
What happens when you drink a lot of alcohol?
Its converted to triglycerides
43
What are the 2 kinds of people and what can they do with coffee?
Slow and fast metabolizers
44
What gene metabolizes caffeine?
CYP1A2 gene | - half population is slow other half is fast
45
How much coffee can fast caffeine metabolizers do?
no increased risk HTN and MI with up to 4 cups coffee/day
46
How much coffee can slow caffeine metabolizers do?
increased risk HTN and MI with >2 cups coffee/day
47
Whats HF?
Heart failure •Impairment of the ventricles’ capacity to eject blood from the heart or to fill with blood ◦ Underlying cause – structural or functional ◦ End-stage CVD ◦ Heart becomes weak and dilated ◦ Progressive
48
What are clinical manifestations of HF?
◦ Decreased blood flow and oxygen ◦ Dyspnea, fatigue, weakness, exercise intolerance, poor adaptation to cold -Short of breath with minimal movement ◦ Fluid retention, pulmonary congestion, edema, hepatomegaly, splenomegaly, ascites -if right sided failure -Advised to weight yourself to catch water retieention in lungs tog et fluid out of lungs ◦ Cardiac edema ◦ Cardiac cachexia
49
What is cachexia?
losing fat stores and lean body mass, becoming malnurishede and not something that can be reveresed with just nturition, it’s the disease that contributing to this
50
What is the treatment for HF?
``` ◦ Treat underlying cause ◦ Control symptoms ▪BP control ◦ Prevent continued damage ◦ Medications ◦ Prevention of respiratory infections ◦ Exercise ◦ Nutrition therapy to prevent or correct malnutrition ▪Sodium and fluid ▪Often high-energy, high protein, nutrient dense NCP required ```
51
What are the complicatioons leading to nutrition problems in HF?
◦ GI- slowed peristalsis and early satiety ◦ Impairment of nutrient absorption ◦ Side effects from drugs ◦ Nutrient deficiencies
52
What is cardiac cachexia?
Syndrome of malnutrition ◦ Extreme skeletal muscle wasting ◦ Fatigue ◦ Anorexia
53
What is the recommended nutrition therapy for HF?
``` ◦ Sodium – standard 2000mg/d ◦ Fluid – standard 1500ml/d ◦ Early satiety ◦ Drug-Nutrient Interactions ◦ Other nutrients of concern - Consider multivitamin and assess for oral supplements ```
54
What are antiarrhythmic agents?
* Controls irregular or abnormal heart rhythms | * All work in different ways to help control irregular and abnormal hearth rythms
55
Whata re the different kind oof antiarrhythmic agents?
Beta blockers Calcium channel bloockers Digitalis
56
What doo nitrates do?
* Works by widening coronary arteries * increase blood supply & oxygen to heart muscle * Helps relieve & prevent angina * Spray under tongue or patch on skin
57
What are ACE inhibitors?
•Angiotensin-Converting Enzyme Inhibitors o Vasodilator - Helps the blood vessels to dilate & open up o Used to treat HTN & heart failure o Causes loss of sodium & water o Shown to decrease the risk of MI, stroke & death in people with CAD and CHF
58
What are platelet in inhibitors?
* Anti-platelet agents * Prevent clots from forming by preventing platelets from sticking together * increase risk of MI and cardiac death * E.g. Aspirin, Plavix (Clopidogrel)
59
What are anticoagulants?
* Prevent the formation of blood clots | * Interfere with blood clotting mechanisms

Clinical I (17 decks)

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