THE RISK FACTORS OF NUTRITIONAL DISORDERS TO THE CARDIOVASCULAR SYSTEM

The disease of the heart 1. Ischaemic heart disease2. Hypertensive heart disease3. Rheumatic heart disease4. Pulmonary heart disease5. Congenital heart disease6. Thyrotoxic heart disease7. Heart disease in other forms

Heart ; Blood Suplly Vascular Myocardium/Nutrient)

In other to perform the heart work, the myocardium needs to be Nourished and Oxygenated from an adequate suplly of blood through the aorta and coronary arteries.

ISCHAEMIC HEART DISEASE (IHO)(CORONARY HEART DISEASE = CHO)

The failure of the coronary arteries to suplly sufficient blood to the myocardium, whichare almost invariably associated with athero sclerosis of the coronary arteries.

1. MYOCARDINAL INFARCTION

Myocardial Ischaemia sudden death

Heal with scar

- severe- return to normal life- increase risk of second infarct

Thrombus Blocks the lumen of coronary artery Atherosclerosis Narrowed the lumen

The blood flow is insufficient to suplly the oxygen

2. ANGINA PECTORIS(Pain in the chest)

severe cardiac pain limits the activity - remain live and free of any disability so long as the patient keeps within the

limits of exercise tolerance.- Increase risk of - sudden death

- infarction

Due to ; - unusual exertion - emotional stress

3. SUDDEN DEATH

Have : - Angina Pectoris- Myocardinal infarction

The death presumed to be due to IHD Sometimes the death is unexpected

But in autopsy ; - old infarct - exstensive atheroma

However - the cause of the “suddendeathly of the death still remains unexplained.

Might be - minor painless ischaemia interrupt the electrical conduction

- release of stored regulatory hormones (catecholamine) - disturbance of regulatory ions (hypoxic disionism)

Note :

The pain of ;

Angina pectoris : - directly - quatitativately releated to exertion- induced by emotion

Myocardial infarction - - occurs at rest- induced by prolonged exertion or acute anxiety

ATHEROSCLEROSIS

- Degenerative arterial disease- Habitual diet the presenting of the fatty acid in the lipid of serum

and tissues

THE DEVELOPMENT OF ATHEROMA

4 Stages (WHO)

1. Fatty spot : - in tunica intima of the vessel- thickenings of the intima- slightly raised a long flattened yellow streak- the elevation of the intima due to the formation of connective tissues

cells, distended, contains cholesterol within the fat droplets.

2. Fibrous Plaque : - between tunica intima and tunica media- circumscribed, firm, grey/pearly white- diameters, 1-several mm, irregular - the plaques become larger, project into the lumen (medium size of

artery)

3. soft plaque- contains large amounts of fatty material, softened

4. break down- plaque surface -, break dowm- atheroatous ulcer – ragged irregular edges- fibrous tissue at the base of the ulcer scarring- vessel – narrowed and distort – slowing down the flow of blood- deposited of calcium haemorrhages occure in the base

Thrombus - ulcer debris /fibrin- fat, cholesterol- calcium - blood corpuscles

(clotting mechanism)

THE PREDISPOSITIN OF THE THICKENING OF INTIMA ;

- Intima injury (platelet aggregation)- Lipid accumulation (irreversible)

Fibrin in the process of the ulcer formation – traps red corpuscles thrombus

A minute clotsdissolved by fibrinolytic system

Previous meal, physical exercise, smoking, e.t.c. may affect platelet adhasiveness and fibrinolytic activity.

Eidemiology of IHD- man in well to do classes- men ± 45 yr, women – unknown (> 50 yr)- the greater percentage of death, 35-40 yr- the lower incidence is from the poor immigrants and under/develop countries

(Include ASEAN)

AETILOGY

Familial ; - inherited- environmental experience of hypertension, diabetes, gout and

exanthomatosis.

PREVENTION

1. DIET Fats ; hyperlipidemia, hypercholesterolemia

- decrease intake of animal fat (SFA)- correlation - incidence IHO - total dietary fat

- total fat - saturated fat

- no proof that dietary fats have an important role in the aetilogy of IHD- more depend on the plasma cholesterol concentration- intake saturated fat >> plasma cholesterol IHD

CARBOHYDRATES

Intake sucrose Atherosclerosis

Plasma triglyceride >> deposit fat (FA)

Carbohydrate fat

Increase plasma fat Atherosclerosis

PROTEIN

In animal research : Not to be important in the genesis of atherosclerosis

2. SEDENTARY LIFE

Exercise : - keep the balance between food intake and energy expenditure- physically active jobs protects against IHD

3. SMOKING

- Pheriperal Vascular disease

IHD (Part myoc infaction)

Heavy Cig.smokers > do not smoke(Death Incidence 1,5 -2,5 times)

- the mechanism of nicotine or other tobaccos constituete causes this adverse effect is still not clear

maybe due to :- vasoconstrictor action - undesirable effect on the level of plasma lipids - blood coalagualation- the survival of platelet

4. STRESS AND STRAIN

- Suggested to be predisposed to the atherosclerotic formation- No difference between the have and the poor group of people and also from

the modern and undevelope communities- It is likely more close to the behaviour (The emotion)

5. POLUTIONhigher concentration of carbon disulphide and sulphur dioxide from in the

process the facture of rayon may cause anoccupational toxic –to be the aetilogy of IHD.

COMMUNITY PROPHYLAXIS- food technology changes the costumary diet of the people - the anxious promotin of the new product of food industry - looks to the medical profession for guidance - health education- in daily food intake

REDUCE- calorie (to prevent overweight)- total consumption of fat

40%-30% of the total number calories

- saturated fat increase the consumption of polyunsaturated fat- the consumption of sugar/sugar product

INCREASE- vegetables, fruits, potatoes, milk, fish, lean meat, cereal/cereal product- take regular exercise

The program require the co-operation among doctors health workers, catering (in school, military forces, hospital, restaurants and other similar institution. Food industries have to pay attention to the recommendation of the raw products and in its composition an processing.