G-0967 Coronary Heart Disease, Myocardial Infarction, And Heart Failure, A Review of the Basics

8/18/2019 G-0967 Coronary Heart Disease, Myocardial Infarction, And Heart Failure, A Review of the Basics

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Coronary HeartCoronary Heart

Disease, MyocardialDisease, MyocardialInfarction,Infarction,

and Heart Failureand Heart Failure

Provided Courtesy of Nutrition.com

Review Date 12/13 G-09!

A Review of theBasics



Dening Heart

Disease"eart disease is a #road term used todescri#e a ran$e of diseases t%at a&ect your%eart' suc% as()Coronary %eart disease *C"D+),t%eroscerosis)yocardia infarction *+

)"eart faiure *formery caed con$estive%eart faiure+



Risk Factors for

CHD and MI)moin$)"i$% intae of aco%o)#esity)edentary ifestye)Dia#etes)"yertension



Risk Factors for

CHD and MI cont!d")ore t%an 34 years of a$e for maes and

55 years of a$e for femaes *ris increasesafter menoause+

)6amiy %istory7$enetics)"yertension)tress

)C%ronic idney disease



Risk Factors for

CHD and MI cont!d")"i$% ow-density iorotein *8D8+

c%oestero)8ow %i$%-density iorotein *"D8+

c%oestero)8eft ventricuar %yertro%y



Risk Factors

for Heart Failure)#esity)"yertension)verwei$%t or o#esity)sc%emic %eart disease)C%an$es in cardiovascuar structure' suc%

as diseases to t%e %eart vaves or musce



Coronary Heart

Disease# An$verview)ood :ow to t%e vesses surroundin$t%e %eart is #oced

) ;%e ma<or underyin$ cause of C"D isat%eroscerosis or a #uidu of a=uein t%e arteries



%la&ue

Develo'(ent)any factors seed u a=ue deveoment( > ?evated c%oestero and tri$yceride eves > "yertension

> nfection t%at initiates t%e in:ammatory resonse > ?evated iron eves7carry free radicas t%at

dama$e inin$ > ?evated %omocysteine eve

> Ci$arette smoin$ > Dia#etes > #esity > @idiAed *8D8+ eves



)he Atherosclerotic

%rocess)uidu of smoot% musce ces'macro%a$es' and ym%ocytes

)moot% musce ces form a matri@ ofconnective tissue

)8iid and c%oestero accumuates in t%ematri@



)he Atherosclerotic

%rocess cont!d")8iid deosits and ot%er materias*incudin$ ceuar waste' B#rin' andcacium+ #uid u and form a a=ue

),fter in<ury' ateets ad%ere to t%earteria wa and reease $rowt% factors'w%ic% romote esion deveoment



Coronary Heart

DiseaseDevelo'(ent)tes to deveoment of C"D( > 6atty streas form' often in eoe youn$er t%an

30 years of a$e

> Peoe are asymtomatic durin$ t%is Brst sta$e ofC"D > Pasma 8D8 enters t%e in<ured endot%eia wa and

forms a a=ue t%at sometimes is rone to ruture > ,cute' comicated esions wit% ruture and eit%er

nonoccusive or occusive t%rom#us form *occusiveform often resuts in and sudden deat%+

> "emorr%a$e into a=ue roduces t%rom#i7t%rom#us formation wit% arteria umen initiated



Coronary Heart

DiseaseDevelo'(ent cont!d" )tes to deveoment of C"D *contd+( > Pro$ressive narrowin$ of umen > nsucient #ood :ow to myocardium *isc%emia+

resuts > C%est ain or an$ina ectoris occurs



*igns and *y('to(s

of Coronary HeartDisease)C%est ain)"yertension)ncreased use

)ncreased resiration)Dysnea on e@ertion)Paor of sin)

8i$%t-%eadedness wit% e@ertion)Diminis%ed eri%era uses)ntermittent caudication7cramin$ of t%e

ower e@tremities



)reat(ent of

Coronary HeartDisease),nti%yeriidemic a$ents)edications t%at ower tri$ycerides),ntiateets *asirin+

),nti%yertensives),ntian$inas *nitro$ycerin+),ntimicro#ias



Angina %ectoris#

An $verview)C%est ain caused #y myocardia isc%emiafrom reduced #ood :ow and/or reducedo@y$en suy to t%e myocardium

),n$ina is a warnin$ si$n t%at a %eart attac*+ may occur



Angina %ectoris#

An $verview cont!d"),ero#ic meta#oism switc%es to anaero#icmeta#oism(

> 8actic acid #uidu

> Reease of %istamine' #radyinins' and enAymes'w%ic% stimuate nerve B#ers in t%e myocardium'sendin$ ain imuses to t%e centra nervoussystem



Angina %ectoris#

An $verview cont!d")t%er causes of decreased o@y$en suy tot%e myocardium(

> Con$estive %eart faiure

> Con$enita %eart defects > Pumonary %yertension > 8eft ventricuar %yertro%y > Cardiomyoat%y

> evere %yertension > Narrowin$ of t%e aortic vave



Angina %ectoris#

An $verview cont!d")t%er causes of decreased o@y$en suy tot%e myocardium *contd+(

> 8eaa$e of t%e aortic vave

> Eentrice wa t%icenin$ > ,t%eroma eadin$ to arteria narrowin$

)ient isc%emia7decreased o@y$en suywit% no ain



Causes of Increased

$+ygen De(and)Causes of increased o@y$en demand on t%emyocardium(

> ,nemia

> ?@ercise > ;%yroto@icosis > u#stance a#use' articuary cocaine > "yert%yroidism

> ?motiona stress



Four )y'es of Angina

)ta#e( > Caused #y seciBc amount of activity > Predicta#e

> Reieved wit% rest and nitrates)Fnsta#e(

> Pain occurs wit% increasin$ fre=uency' severity'and duration over time

> Fnredicta#e > ay occur at rest > "i$% ris for



Four )y'es of Angina cont!d"

)PrinAmetas *variant+( > "as no identiBed cause > ay occur at same time of day

> ay intensify or worsen over time > s usuay caused #y coronary artery sasm

),n$ina decu#itus( > ccurs w%en a erson is yin$ down wit% no cause

> ccurs #ecause $ravity redistri#utes #ody :uids



*igns and *y('to(s

of Angina)Pressure or %eaviness in c%est #eneat%#reast#one7women are iey to %aveunusua tyes of c%est discomfort

)Pain may occur down s%ouder or inside ofarms' or in t%e t%roat' <aw' or teet%

)tomac% ain' eseciay after eatin$)weatin$



*igns and *y('to(s

of Angina cont!d" )8i$%t-%eadedness)"yotension)Puse c%an$es

)ndi$estion



)reat(ent of Angina

),ntian$inas *nitro$ycerin+),ntiateets *asirin+),C? in%i#itors

)eta-#ocers)Cacium c%anne #ocers) ;%rom#oytic t%eray *if t%rom#i are t%e

cause+

)@y$en administration)Percutaneous transumina coronary

an$ioasty or coronary artery #yass $raft torevent



Myocardial

Infarction# An$verview)Deat% of ces in t%e myocardium' usuayreated to roon$ed or severe isc%emia

)Necrosis' tissue dama$e' and sometimes

deat% resuts)Cause of incude( > udden onset of ventricuar B#riation > ?m#ous *most common cause+

> ;%rom#osis > ,t%eroscerotic occusion > Proon$ed vasosasm



Myocardial

Infarction%rogression)Ceuar in<ury occurs from ac of o@y$en( > f roon$ed' wi ead to ce deat%

)car reaces musce' #ut cannot contract

or conduct imuses( > 8ocation of dama$e is determined #y w%ic% artery

is #oced

)Dama$e #e$ins at su#endocardia eve(

> i ro$ress to t%e eicardium wit%in 1 to %ours



Myocardial

Infarction%rogression cont!d")Dama$ed ces ead to decreasedcontractiity(

> 8ess #ood e<ected #y eft ventrice wit% eac% #eat

> Decreased #ood ressure > Decreased tissue erfusion



)Pain' tyicay in midde of c%est' radiatin$to <aws' arms *usuay t%e eft+' a#domen'and/or s%ouders' and astin$ 20 minutes(

> Possi#e to %ave no ain or atyica an*articuaryin femaes+

> udden onset of ain' not associated wit% activity

Myocardial

Infarction# *igns and*y('to(s



Myocardial

Infarction# *igns and*y('to(s cont!d"

) ;ac%ycardia)?@cessive ersiration

)Painfu #reat%in$ and/or dicuty #reat%in$),n@iety/anic)Nausea/vomitin$)6ever)tomac% ain' often confused wit%

indi$estion



a-oratory

.valuation)Creatinine inase) ;ro%in)yo$o#in



Myocardial

InfarctionCo('lications)f more t%an 50H of %eart tissue is

dama$ed' severe disa#iity or deat% wiresut





)reat(ent Following

MyocardialInfarction

),ntian$inas *nitro$ycerin+),na$esics)?ectroyte reacement

)Cacium c%anne #ocers)eta-#ocers),nti%yertensives),nticoa$uants



)reat(ent Following

MyocardialInfarction cont!d"

),ntiarr%yt%mics) ;%rom#oytics

)@y$en)id antian@iety a$ents



Heart Failure#

An $verview)na#iity of t%e %eart to um sucienty tomeet meta#oic needs' eadin$ to decreasedtissue erfusion as a resut of decreased

cardiac outut),cute or c%ronic)8eft sided or ri$%t sided)ystoic or diastoic



Causes of Heart

Failure)"yertension))Cardiomyoat%ies

)Con$enita %eart disease)Eave disorders)ide e&ect of medication or aco%o



)y'es of HeartFailure

)ystoic dysfunction( > "eart contracts wit% ess force and cannot um

out as muc% #ood to t%e rest of t%e #ody as

norma > ood accumuates in t%e ventrices and veins

)Diastoic dysfunction( > "eart is sti& and does not rea@ after contractin$

> "eart does not aow as muc% #ood to enter itsc%am#ers from t%e veins' and t%e #oodaccumuates in t%e veins



)y'es of HeartFailure cont!d"

)8eft sided( > ore common > 6uid #acs into un$s

> i$ns and symtoms incude(•6ati$ue•,ctivityintoerance

•DiAAiness•

yncoe•Dysnea•Cou$%in$

•Pumonarycraces

• ;acycardia

•

urine outut•

%ortness of#reat% w%enyin$ down




)Ri$%t sided( > Caused #y umonary %yertension or ri$%t

ventricuar infarction

> 6uid #acs into rest of #ody' wit% a#dominaor$an con$estion and eri%era edema

> i$ns and symtoms incude(•8ower e@tremity edemain t%e am#uatory

•

acra edema in t%e#edridden

•8iver en$or$ement and ri$%tuer =uadrant ain

•

,nore@ia and nausea• Iu$uar venous distension




)iventricuar *si$ns and symtoms of #ot%eft and ri$%t %eart faiure+(

> i$ns and symtoms incude(•, symtoms of ri$%tand eft %eart faiure

•Dysnea at rest•"eatome$ay andsenome$ay

•,#domina ressure•,scites•,nore@ia

•Nausea and vomitin$

• di$estion and a#sortionof nutrients

•Dysr%yt%mias•Cardio$enic s%oc or acute

umonary edema



Cardiac Cache+ia

)10H to 15H of atients wit% %eart faiuredeveo cardiac cac%e@ia

)8oss of H of nonedematous #ody wei$%t

over mont%s)Concurrent oss of cardiac musce mass as

a resut



Cardiac Cache+iacont!d"

)any ot%er meta#oic c%an$es( > ncreased cata#oic catec%oamines > ;umor necrosis factor is increased' contri#utin$ to

a ower #ody mass inde@ and cata#oic state



)reat(ent ofCoronary HeartDisease)Diuretics

)Doamine),na$esics

),nti%yertensives),C? in%i#itors)Direct vasodiators),ntidysr%yt%mics)Cardiac $ycosides *di$itais+),dosterone a$onists



)reat(ent ofCoronary HeartDisease cont!d"),nti#iotics' if necessary

)ron suementation' if necessary)uementa o@y$en

)Nitrates)eta-#ocers),nticoa$uants



References

,cademy of Nutrition and Dietetics. Nutrition Care Manual J K#y su#scritionL. Nutrition Care anua e# site.www.nutritioncaremanua.or$. ,ccessed Decem#er 1' 2013.

Ceveand Cinic. ,cute myocardia infarction. Ceveand CinicCenter of Continuin$ ?ducation e# site.%tt(//www.ceveandcinicmeded.com/medicau#s/diseasemana$ment/cardioo$y/acute-myocardia-infarction/. ,ccessedDecem#er 1' 2013.

Ceveand Cinic. "eart faiure. Ceveand Cinic Center forContinuin$ ?ducation e# site.%tt(//www.ceveandcinicmeded.com/medicau#s/diseasemana$ement/cardioo$y/%eart-faiure. ,ccessed Decem#er 1' 2013.

http://www.nutritioncaremanual.org/

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/


http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/heart-failure






http://www.nutritioncaremanual.org/



References cont!d"

Raymond I8' Couc% C. edica nutrition t%eray forcardiovascuar disease. n( a%an' 8M' ?scott-tum 'Raymond I8. Krause’s Food and the Nutrition Care Process. 13t%ed. t 8ouis' ( ?sevier aunders 2012(!42-!O1.

;%e erc anua for "eat% Care Professionas. Cardiovascuardisorders. erc anuas e# site.%tt(//www.mercmanuas.com/rofessiona/cardiovascuardisorders.%tm. ,ccessed Decem#er 1' 2013.

%at is an$inaQ Nationa "eart' 8un$' and ood nstitute e#site.%tt(//www.n%#i.ni%.$ov/%eat%/%eat%-toics/toics/an$ina/.,ccessed Decem#er 1' 2013.

http://www.merckmanuals.com/professional/cardiovascular_disorders.html


http://www.nhlbi.nih.gov/health/health-topics/topics/angina/

http://www.nhlbi.nih.gov/health/health-topics/topics/angina/



Documents

G-0967 Coronary Heart Disease, Myocardial Infarction, And Heart Failure, A Review of the Basics