Post on 14-Apr-2018
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Nutrition forCardiovascular Diseases
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Outline
I. Nutritional requirements
II. Essential Hypertension
III. Myocardial Infarction
IV. Case
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ANATOMI & FISIOLOGI
JANTUNG
Otot jantung termasuk otot
bergaris
Mempunyai miofibril
Otot jantung saling berhubungansatu sama lain /sinsisium
Sifatsinsisium apabila satu sel otot
jantung terangsang, potensial aksi
akan menyebar dari satu sel ke sel
lain
Sinsisium
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Cardiovascular Diseases
It is a general term for any disease of the heart
(cardio) and blood vessels (vascular)
When the blood flowing through the heart and tothe body is obstructed or when something goes
wrong with the specialized cells that promote
contraction of the heart, or when the blood itself
that supplies nutrients to the heart is blocked, thena disease condition develops.
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Diseases:
Myocardial Infarction
HypertensionCongestive Heart Failure
Atherosclerosis
Coronary artery disease
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In the Philippines, diseases of the heartand of the vascular system are classified
as second and third causes of death.
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Manifestations Dyspnea on exertion Weakness
Pain in the chest
Severe failure marked dilation of the
heart with enlargementof the liver
Impaired circulation tothe kidneys and tissues-edema develops
Edema fluid collectsfirst in theextremities, withincreasing failure in
the abdominal andchest cavities.
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Cardiovascular: Major risk
Factors
1. Hypertension2. Cigarette smoking
3. Obesity (BMI >= 30kg/m2)
4. Physical Inactivity
5. Dyslipidemia6. Diabetes Mellitus
7. Microalbuminuria or estimated GFR
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Energy Requirements
Mild degree ofweight loss even of
normal wt.
1000-1500 caloriediet-obese patient in
bed
This leads to
slowing of the heartrate, a drop in blood
pressure and
improved cardiac
efficiency
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Sodium requirements
A sodium-restricteddiet is indicated
when there is
retention of fluid and
sodium.
Sodium restriction-
500mg satisfactory
in CHF Moderately
restricted sodium-
1000mg, once
edema disappeared
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Sodium-Restricted Diet
Sodium-restricted diets are used for theprevention, control and elimination of edema
in many pathologic conditions, and
occasionally for the alleviation of
hypertension.
Sodium-restricted diets should be
prescribed in terms of milligrams of sodium
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Mild Sodium Restriction Moderate Sodium
Restriction
Strict Sodium Restriction
(2400mg or 1 tsp cruderock salt/day)
1200mg or tsp cruderock salt/day
600mg or tsp crude rocksalt/day
Salt may be used in
cooking, but no salty
foods are permitted; no
salt is used at the table
No salt in cooking
Permits slightly higher
protein level if neededMay include measured
amount of salt or salted
bread and butter
No salt is used in cooking
Careful selection of foods inmeasured amounts
This level is used as a
maintenance diet incadiac and renal
diseases
This level may be used for
Congestive heart failure,occasionally in renal diseases
with edema, cirrhosis of the
liver.
Levels of Sodium Restriction
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Fluid Requirements
Restriction of fluid is not required so
long as the sodium is restricted.
Water is retained only when there issufficient sodium to maintain
physiologic concentrations
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Food requirements
Abdominal distention must be avoided
Omit vegetable of the cabbage family,
onions,legumes, turnips, melon and
sweet potato. Constipation must be avoided
Use fruits and vegetables, prune juice,
and a sufficient food intake
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HYPERTENSION
BP= CardiacOutput X
PeripheralResistance
BLOOD VOLUME
Sodium
Mineralocorticoids
CARDIAC FACTORS
Heart rate
Stroke Volume
HUMORAL FACTORS
Constrictors Dilators
Angiotensin II ProstaglandinsCatecholamines Kinins
Thromboxane NO
endothelin
Neural Factors
Constrictors Dilators
-adrenergic B-adrenergic
LOCAL FACTORS
Autoregulation
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Classification of HypertensionBp
classification
Systolic BP
(mmHg)
Diastolic BP
(mmHg)
Lifestyle
Modification
Initial Drug
therapy
Normal 100 yes 2 drug
combination
for most
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Treatment
Goals of therapy:Ultimate goal: reduction of cardiovascular
and renal mortality and morbidity
Achieve SBP goal
Treating SBP and DBP to targets that are
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The Mediterranean diet
The Mediterraneandiet is recognized as
capable of reducing
the risk of
cardiovasculardisease and cancer.
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Treatment: Dietary Management
Carbohydrate: Decreased since it is the most source of energy
Fat:
Decreased to 25% of the energy requirement; more of
the polyunsaturated fats
Sodium:
Decreased to reasonable level
Fruits and Vegetab le:
Increased to supply vitamins, minerals and fibers
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Congestive Heart Failure
Heart fails to maintain a satisfactory circulation ofthe bodys various metabolic needs
It results in reduced heart pumping efficiency of the
ventricles, with less blood circulating.
CHF can best be treated by a combination of diet,
rest, diuretics, digitalis, and oxygen therapy.
The diet for CHF is restricted in Sodium
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Dietary Management
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AHA UPDATED DIETAY
GUIDELINES
CHOOSE 5 SERVINGS OF FRUITS ANDVEGETABLES PER DAY
CHOOSE FATS WITH 2GRAMS OF SATURATED FATOR LESS-CANOLA OIL OR OLIVE OIL AND TUBMARGARINE
INCLUDE FAT FREE OR LOW FAT MILK PRODUCTS,
FISH, BEANS, SKINLESS CHICKEN AND LEANMEATS
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PRIMARY SOURCES OF
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PRIMARY SOURCES OF
OMEGA 3
FATTY FISH-SALMON, TUNA , SARDINESMACKERAL
FLAXSEEDS
WALNUTST
CANOLA AND SOYBEAN OILS
FISH OILS-COROMEGA
OMEGA 3 ENRICHED EGGS AND MILK
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ANTIOXIDANT VITAMIN
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ANTIOXIDANT-VITAMIN
RECOMMENDATIONS
MULTIVITAMIN+MINERALS B6, B12,AND FOLIC ACID
VITAMIN C
VITAMIN E
COENZYME Q10
SELENIUM
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EMERGING RISK FACTORS
HOMOCYSTEINE-AN AMINO ACID FORMED INTHE BREAKDOWN OF DIETARY PROTEIN-MAY
SIGNIFICANTLY INCREASE THE RISK OF
HEART DISEASE AND STROKE
BLOOD LEVELS OF HOMOCYSTEINE DAMAGEARTERIAL WALLS
PLATELET AGGREGATION
THROMBOSIS
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Degree
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Degree
OverweightBMI Mortality Risk
Non-Obese less than 27 RR = 1.0
Mild Obesity 27-30 RR = 1.3
Moderate
Obesity30-37 RR = 1.4-2.2
Severe Obesity 37-45 RR = 3-5
Morbid Obesity greater than 45 RR = 6-13
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2nd & 3rd Hospital Day:
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2nd & 3rd Hospital Day:
Low-Fat Liquid Diet
Low-Fat Liquid Diet:
500-800 kcal
1000-1500 mL of liquid
Small frequent feeding
Slender Now Thick
Shake, ToppFast Diet
Plan, Slim Fast,
Medifast, and Optifast
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How To Make Liquid Diet
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Given 1200 ml of liquid= 1200 ml/4 pack
= 300 ml/pack
Feeding Frequency
7 am, 10 am, 1 pm
4 pm, 7 pm, 10 pm,
Avoid extreme temp food
arrhythmia
No caffeine
Stimulate the heart
Blender Protein powder (1 scoops =
15+ g of protein
Orange juice (100 ml=45kcal)
Whole milk (milk powder 4tspn=170 kcal)
Water
Energy = scoops proteinpowder + 100 ml OJ + 1tspn milk powder +200 mlH2O
= 8 g (4kcal/g) + 45 kcal + 43 kcal= 32 + 45 + 43 = 119kcal/feeding
Total Kcal per day=119kcal/feeding X 6 feeding/day=714 kcal/day
Average adult: 46 to 56 g ofprotein a day
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This Sample Diet Provides the
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This Sample Diet Provides the
Following
Calories: 1940 kcal Protein 73 gm (15%)
Carbohydrates: 302 gm (63%) Fat: 53 gm (23%)
Sodium: 1500 mg Fiber: 24 gm
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Thank You
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Thank YouBefore After