Download - Mosby items and derived items © 2006 by Mosby, Inc. Slide 1 Chapter 19 Coronary Heart Disease and Hypertension.

Mosby items and derived items © 2006 by Mosby, Inc. Slide 1

Chapter 19 Chapter 19 Coronary Heart Disease and Hypertension


Chapter 19Chapter 19

Lesson 19.1Lesson 19.1


Key ConceptKey Concept

• Several risk factors contribute to the development of heart disease, most of which are preventable factors associated with lifestyle.


Coronary Heart DiseaseCoronary Heart Disease

• Atherosclerosis

• Acute cardiovascular disease

• Chronic heart disease


AtherosclerosisAtherosclerosis

• Disease process Fatty fibrous plaques develop into fatty streaks on

inside lining of major blood vessels. If affected vessel is major artery supplying heart

muscle, result could be myocardial infarction. If affected vessel is major artery supplying brain,

result could be cerebrovascular accident.

(Cont'd…)


Disease ProcessDisease Process(…Cont’d)

Identified as coronary heart disease Common symptom is angina pectoris, chest

pain usually radiating down the arm, sometimes brought on by excitement or physical effort


Normal Human Heart: Normal Human Heart: Anterior ViewAnterior View


Normal Human Heart: Normal Human Heart: Posterior External ViewPosterior External View


Atherosclerotic Plaque Atherosclerotic Plaque in Arteryin Artery


Relation to Fat MetabolismRelation to Fat Metabolism

• Elevated blood lipids associated with coronary heart disease Triglycerides—simple fats in body or food Cholesterol—fat-related compound produced

in body; also in foods from animals Lipoproteins—“packages” wrapped with

protein that carry fat in the blood stream


Types of LipoproteinsTypes of Lipoproteins

• Very low-density lipoproteins (VLDL) Carry large load of fat to cells

• Low-density lipoproteins (LDL) Carry two thirds of total plasma cholesterol to

body tissues

• High-density lipoproteins (HDL) Carry less total fat and more protein


Cholesterol and Lipoprotein Cholesterol and Lipoprotein Profile ClassificationProfile Classification


Multiple Risk Factors in Multiple Risk Factors in Cardiovascular DiseaseCardiovascular Disease


Diagnosing Metabolic Diagnosing Metabolic SyndromeSyndrome


Dietary Recommendations for Dietary Recommendations for Reduced RiskReduced Risk

• Dietary Guidelines for Americans Reduce total amount of fat—no more than 30% of

total energy (kilocalories) intake from fat Reduce use of animal fat—no more than one third

of total fat kilocalories from saturated animal fat Reduce intake of cholesterol—limit to 300 mg/day

(Cont'd…)


Dietary Recommendations for Dietary Recommendations for Reduced RiskReduced Risk

(…Cont’d)

• NCEP Guidelines Energy intake should reflect energy expenditure Total fat intake no more than 25%-35% of total

kilocalories Carbohydrates make up 50%-60% of total energy

intake per day Total protein intake should be 15% of total energy

intake Less than 200 mg dietary cholesterol per day


American Heart Association and NCEP American Heart Association and NCEP Recommendations for Lowering CholesterolRecommendations for Lowering Cholesterol


Maximum Amount of Fat Allowed per Day Maximum Amount of Fat Allowed per Day on a Step I, Step II, and TLC Diet at Various on a Step I, Step II, and TLC Diet at Various Calorie LevelsCalorie Levels


Acute Cardiovascular DiseaseAcute Cardiovascular Disease

• Objective: cardiac rest

• Principles of diet therapy Reduced energy intake (1200-1500 kcal) Soft food texture Controlled amount and type of fat Mild sodium restriction (2-3 g/day)


Chronic Heart DiseaseChronic Heart Disease

• Objective: control of cardiac edema

• Principles of diet therapy Mild sodium restriction (2-3 g/day) Moderate sodium restriction (1000 mg/day) Strict sodium restriction (500 mg/day)


Chapter 19Chapter 19

Lesson 19.2Lesson 19.2


Key ConceptsKey Concepts

• Essential hypertension, believed to be predominantly a genetic risk factor for heart disease, has very few symptoms but can be identified and controlled.

• Most cardiovascular risk factors are associated with nutrition and can be reduced by changing food habits and lifestyles.


Essential HypertensionEssential Hypertension

• Incidence and nature 23% of American adults have high blood

pressure (hypertension) Injury to inner lining of blood vessel wall

appears to be underlying link to cause Secondary hypertension is symptom or side

effect of another primary condition Hypertension called the “silent disease”


Types of Hypertensive Blood Types of Hypertensive Blood Pressure LevelsPressure Levels

• Stage 1 hypertension Focus on diet therapy, without drugs

• Stage 2 hypertension Diet therapy and drugs, as needed

• Stage 3 hypertension Diet therapy and vigorous drug therapy


Classification of Blood Classification of Blood Pressure for AdultsPressure for Adults


Principles of Principles of Nutrition TherapyNutrition Therapy

• Weight management—lose weight and maintain appropriate weight for height

• Sodium control

• Other minerals—calcium, magnesium

• DASH diet—lower blood pressure through diet alone

• Additional lifestyle factors


Servings per Day for Each Food Servings per Day for Each Food Group According to DASH DietGroup According to DASH Diet


Education and PreventionEducation and PreventionPractical Food GuidesPractical Food Guides

• Food planning and purchasing Control energy intake; read labels Eat fresh foods with small selection of

processed foods

• Food preparation Use less salt and fat Use seasonings instead (herbs, spices, lemon,

onion, garlic, etc.)

• Special needs


Education PrinciplesEducation Principles

• Start early Prevention begins in childhood, especially with

children in high-risk families

• Focus on high-risk groups Direct education to people and families with

risk of heart disease and hypertension

• Use variety of resources National organizations, community programs,

registered dieticians