Objectives Identify factors that contribute to heart

disease

Explain why cholesterol and saturated fats

are limited in some cardiovascular conditions

Identify foods to avoid or limit in a

cholesterol-controlled diet

Explain why sodium is limited in some

cardiovascular conditions

Identify foods that are limited or prohibited in

sodium-controlled diets

Cardiovascular Disease

Affects heart and blood vessels.

Leading cause of death and permanent disability

in many countries.

Can be acute (sudden) or chronic.

Acute: myocardial infarction (MI, heart attack)

Chronic: develops over time, loss of heart

function

Heart may or may not maintain circulation.

Heart may beat faster and enlarge to

compensate.

Congestive heart failure occurs when the heart

cannot maintain blood circulation to all body

tissues.

The heart muscle (myocardium), the valves, the

lining (endocardium), the outer covering

(pericardium), or the blood vessels may be

affected by heart disease.

Arteriosclerosis: arteries become thick and hard

making the passage of blood difficult and

sometimes impossible.

Atherosclerosis: affects inner lining of arteries

where deposits of cholesterol, fats, and other

substances accumulate over time, thickening and

weakening artery walls. Deposits are called

plaque.

Plaque may cause a reduced blood flow beyond the

obstruction; ischemia occurs.

Ischemia may cause pain.

Angina pectoris: Chest pain; may radiate down left arm.

If lumen of vessel narrows completely in a coronary

artery, a heart attack occurs.

Coronary artery bypass graft (CABG): procedure

to bypass circulation around a clogged artery.

Cerebrovascular accident (CVA): blood flow to

brain is blocked or blood vessel bursts (stroke).

Peripheral vascular disease: vessels in

extremities affected.

Atherosclerosis

* Major:Hyperlipidemia: (Cholesterol; high LDL, low HDL)

Hypertension

Smoking

* Contributory factors:

Obesity

Diabetes mellitus

Male sex

Heredity

Personality type (ability to handle stress)

Age (risk increases with age)

Sedentary lifestyle

Primary treatment for hyperlipidemia.

Involves reducing the quantity and types of fats

and often kcal in the diet.

American Heart Association guidelines:

blood cholesterol 200 mg/dl or less is desirable

200 to 239 mg/dl is borderline high

240 mg/dl and greater is high

American Heart Association recommendations for prevention:

*Adult diets contain less than 200 mg of cholesterol per day

*No more than 30% of kcal from fat; maximum of 7% from saturated fats, 8% from polyunsaturated fats, 15% from monounsaturated fats

*Proteins 12 to 20% of kcal, and carbohydrates 50 to 55% of kcal

It takes 2 to 3 months to adjust to a low-fat diet.Change should be made gradually if physician allows.Provide client with information about the fat content of foods and methods to prepare it.

Encourage client to select whole, fresh foods and to prepare them without addition of fat.

Lean meat should be selected and all visible fat removed.

Use fat-free milk and fat-free skim cheeses.

Gradually introduce 25-35 grams of fiber.

Discuss challenges with a dietitian and the M.D.

If appropriate blood lipid levels cannot be attained

within 3 to 6 months by use of fat-restricted diet

alone, the physician can prescribe a cholesterol-

lowering drug.

Example: simvastatin (Zocor)

Client teaching: Zocor interacts with grapefruit

and its juice; total avoidance is necessary.

Caused by blockage of a coronary artery

supplying blood to heart.

Heart tissue beyond blockage dies.

Causes: atherosclerosis, hypertension, abnormal

blood clotting, infection such as that caused by

rheumatic fever (damages heart valves).

After the attack, the client is in shock.

Fluid shift occurs, and client may be thirsty.

Client should be NPO (nothing by mouth).

IV fluids may be given.

After several hours, client may begin to eat.

Liquid diet usually recommended first 24 hours.

Then, a low-cholesterol, low-sodium diet.

Foods should not be extremely hot or cold.

Food that is easy to chew and digest prescribed.

Percentage of energy nutrients will be based on

particular needs of the client.

Sodium limited to prevent fluid overload.

Restriction on caffeine the first few days after an

MI.

Injury to the heart muscle occurs from

atherosclerosis, high BP, rheumatic fever.

When damage is extreme and the heart cannot

provide adequate circulation, the amount of

oxygen taken in is insufficient for body needs.

Shortness of breath is common and chest pain

can occur on exertion.

Tissues retain fluid that would normally be

carried off by the blood.

• Sodium builds up, and more fluid is retained,

resulting in edema.

• Heart beats faster and enlarges to compensate.

• Death can occur in severe cases.

• Body tissues do not receive sufficient amounts of

nutrients.

• Edema may mask the problems of malnutrition and

underweight.

• Fluid restriction may be ordered.

• Diuretics aid in the excretion of water and sodium,

and a sodium-restricted diet typically prescribed.

• Diuretics can cause excessive loss of potassium.

• Blood potassium levels should be carefully watched

to prevent hypokalemia which can upset the

heartbeat.

• Fruits, especially oranges, bananas, and prunes are

excellent sources of potassium.

Chronically high blood pressure.

Essential, or primary hypertension: 90% of cases;

cause is unknown.

Secondary hypertension: 10% of cases; caused

by another condition.

Causes of secondary hypertension include kidney

disease, problems of the adrenal glands, use of

oral contraceptives.

• Contributes to heart attack, stroke, heart failure, and

kidney failure.

• “Silent disease” because sufferers can be

asymptomatic.

• Frequency increases with age and is more prevalent

among African Americans.

• Heredity and obesity.

• Smoking and stress.

• Weight loss usually lowers blood pressure and,

consequently, clients are often placed on weight-

reduction diets.

• Sodium and fluid collect in body tissue, causing edema, extra pressure is placed on the blood vessels.

• Sodium-restricted diet, often accompanied by diuretics, can be prescribed to alleviate this condition.

• Increasing fruits and vegetables to 6 to 10 servings per day helps to lower blood pressure.

Weight loss

Sodium-restricted diet

Diuretics

When diuretics are given together with a sodium-

restricted diet, the client may lose potassium via the

urine. So, amount of potassium-rich foods in the diet

should be increased.

Daily intake of sodium be limited to no more than 2,400

mg to avoid edema and hypertension.

Food and Nutrition Board recommends .

Board set a safe minimum at 500 mg/day for adults.

Impossible to have a diet totally free of sodium.

Meats, fish, poultry, dairy products, and eggs all contain substantial amounts of sodium naturally.

Cereals, vegetables, fruits, and fats contain small amounts of sodium naturally.

Water contains varying amounts of sodium.Many products contain sodium.

Some over-the-counter medicines contain sodium.

Physician’s permission should be obtained before using

any medication or salt substitute.

Most people are accustomed to salt in their food

and transition to sodium-restricted diet may be

difficult.

It will help the client if the reduction in sodium can

be gradual.

Remind the client of the numerous herbs, spices,

and flavorings allowed.

Most of the cardiac clients will be told they must

reduce the fats, sodium, and sometimes, the

amount of kcal in their diets.

Help the cardiac client want to learn how to help

himself or herself via nutrition.

Cardiovascular disease represents the

leading cause of death in many countries.

May be acute, as in myocardial infarction, or

chronic, as in hypertension and

atherosclerosis.

Hypertension may be a symptom of another

disease.