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

2. Mosby items and derived items © 2006 by Mosby, Inc. Slide 2 Chapter 19 Lesson 19.1

3. Mosby items and derived items © 2006 by Mosby, Inc. Slide 3 Key Concept Several risk factors contribute to the development of heart disease, most of which are preventable factors associated with lifestyle.

4. Mosby items and derived items © 2006 by Mosby, Inc. Slide 4 Coronary Heart Disease Atherosclerosis Acute cardiovascular disease Chronic heart disease

5. Mosby items and derived items © 2006 by Mosby, Inc. Slide 5 Atherosclerosis 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…)

6. Mosby items and derived items © 2006 by Mosby, Inc. Slide 6 Disease Process Disease 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

7. Mosby items and derived items © 2006 by Mosby, Inc. Slide 7 Normal Human Heart: Anterior View

8. Mosby items and derived items © 2006 by Mosby, Inc. Slide 8 Normal Human Heart: Posterior External View

9. Mosby items and derived items © 2006 by Mosby, Inc. Slide 9 Atherosclerotic Plaque in Artery

10. Mosby items and derived items © 2006 by Mosby, Inc. Slide 10 Relation 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

11. Mosby items and derived items © 2006 by Mosby, Inc. Slide 11 Types 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

12. Mosby items and derived items © 2006 by Mosby, Inc. Slide 12 Cholesterol and Lipoprotein Profile Classification

13. Mosby items and derived items © 2006 by Mosby, Inc. Slide 13 Multiple Risk Factors in Cardiovascular Disease

14. Mosby items and derived items © 2006 by Mosby, Inc. Slide 14 Diagnosing Metabolic Syndrome

15. Mosby items and derived items © 2006 by Mosby, Inc. Slide 15 Dietary Recommendations for Reduced 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…)

16. Mosby items and derived items © 2006 by Mosby, Inc. Slide 16 Dietary Recommendations for Reduced 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

17. Mosby items and derived items © 2006 by Mosby, Inc. Slide 17 American Heart Association and NCEP Recommendations for Lowering Cholesterol

18. Mosby items and derived items © 2006 by Mosby, Inc. Slide 18 Maximum Amount of Fat Allowed per Day on a Step I, Step II, and TLC Diet at Various Calorie Levels

19. Mosby items and derived items © 2006 by Mosby, Inc. Slide 19 Acute 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)

20. Mosby items and derived items © 2006 by Mosby, Inc. Slide 20 Chronic 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)

21. Mosby items and derived items © 2006 by Mosby, Inc. Slide 21 Chapter 19 Lesson 19.2

22. Mosby items and derived items © 2006 by Mosby, Inc. Slide 22 Key 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.

23. Mosby items and derived items © 2006 by Mosby, Inc. Slide 23 Essential 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”

24. Mosby items and derived items © 2006 by Mosby, Inc. Slide 24 Types of Hypertensive Blood Pressure 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

25. Mosby items and derived items © 2006 by Mosby, Inc. Slide 25 Classification of Blood Pressure for Adults

26. Mosby items and derived items © 2006 by Mosby, Inc. Slide 26 Principles of Nutrition 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

27. Mosby items and derived items © 2006 by Mosby, Inc. Slide 27 Servings per Day for Each Food Group According to DASH Diet

28. Mosby items and derived items © 2006 by Mosby, Inc. Slide 28 Education and Prevention Practical 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

29. Mosby items and derived items © 2006 by Mosby, Inc. Slide 29 Education 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