Diseases of Cardio Vascular System Heart Heart The

Diseases of Cardio Vascular System

Heart � Heart : The most hard-working muscle of our body – pumps 4 -5 liters of blood every minute during rest � Supplies nutrients and oxygen rich blood to all body parts, including itself � Coronary arteries surrounding the heart keep it nourished with blood

Structure � Chambers: The heart is divided by a septum into two halves. � � The halves are in turn divided into chambers. The upper two chambers of the heart are called atria and the lower two chambers are called ventricles. Valves allow blood to flow in one direction between the chambers of the heart.

Flow of blood

Diseases � Atherosclerosis � Hyperlipidemias � Coronary heart disease � Myocardial infraction � Congestive heart failure � Hypertension

Prevalence � No. 1 killer disease worldwide ◦ 12 Million deaths annually � During last 30 years large declines in developed countries -rising health awareness and government programmes � Alarming India increase in developing countries especially

Development of atherosclerosis

Hyperlipidemia � It is a general term that denotes an elevation of one or more lipids in the blood. � Hypercholesterolemia: is a serum cholesterol in excess of 260 mg/dl. � Hypertriglyceridemia when fasting triglyceride level exceeds 250 mg/dl. � These elevated levels results in rapid & severe development of atherosclerosis & in turn coronary disease.

� Coronary artery disease (CAD), These are diseases of the arteries that supply the heart muscle with blood. � Coronary heart disease (CHD), a disease of the heart itself caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium.

Symptoms � No symptoms for long period � Severe Chest pain for short period on exertion also known as Angina Pectoris or minor heart attack � Infract is localized area of necrosis result when blood supply is inadequate. An infract oh heart is known as Myocardial Infarction or major heart attack-Severe chest pain, death of heart muscle, heart failure, irregular heart beats � Sudden Ischaemic Death (deficient blood supply)

� Heart failure , often called congestive heart failure, is a condition in which the heart can't pump enough blood to the body's organs and tissues. � It doesn't mean the heart has failed and can't pump blood at all. With this less effective pumping, vital organs don't get enough blood � Causing signs and symptoms as: 1. shortness of breath 2. fluid retention (edema) in extremities first & with increasing failure to abdomen & chest 3. and fatigue.

Risk factors � Genetic predisposition � Poor handling of fats � Metabolic syndrome ◦ Diabetes, obesity, high BP, Coronary artery disease � Urbanization � Sudden change in lifestyle

Role of fat in CVD Cholesterol Two sources of cholesterol: Food & made in your body � Too much cholesterol can deposit in the arteries in the form of plaque and block them � Hypercholesteraemia exceed 240 mg/dl � Cholesterol occurs when cholesterol level & Triglyceride are the main forms of fat carried in blood with the help of lipoproteins.

Lipoproteins are made up of protein & lipids. 1. Chylomicrons, carry triglyceride, monogylcerides, glycerol & small amount of cholesterol & phospholipids. 2. VLDL also transport triglyceride but mainly endogenous triglyceride formed in liver. They travel through blood vessels & circulate fat throughout the body.

Way of action

� LDL main carrier of cholesterol, it stuck to blood vessels � HDL takes away cholesterol from tissues to liver for conversion or excrete

Saturated fats � Saturated fats raise LDL & total cholesterol levels � Increase the risk of CVD

Trans fatty acids Sources: � Meat & dairy products � Hydrogenated fats: hydrogenation of vegetable oils alter the geometric structure of PUFA from natural ‘cis’ to ‘trans’ form.

� Trans fats raise LDL � Lowers HDL � Thus are atherogenic

Dietary management � Low calorie, low fat, low CHO, high fiber diet � Energy: patient whose weight is normal, maintenance level of calorie. Loss of weight for obese people is advisable A 1000 -1200 kcal diet is suitable for obese patient in bed. � Fats: first step is restriction of fat to not more than 20% of total calories ü Important n-3 PUFA are a-linolenic acid, EPA & DHA n-6 are linoleic acid & arachidonic acid They are also known as omega 6 & omega 3.

Benefits: � Promote esterification of cholesterol � Reduces thrombosis � Prevent accumulation of cholesterol in blood � Decrease synthesis of VLDL, triglycerides � Specially food rich in ω-3 fatty acid have cardio protective effects � Such as fish, specially salmon, fish oil � Vegetable sources: flaxseed, canola oil, mustard oil, walnuts

MUFA � Present in vegetable sources such as olive oil, canola, almond oil. � Lower LDL without lowering HDL � & do not raise triglyceride levels Cholesterol level should not exceed 300 mg in diet as liver also synthesis cholesterol

� CHO: Include complex CHO in diet. About 60% of total calorie from CHO � Protein, vitamins & minerals Normal allowances are recommended Avoid animal protein � Sodium is restricted when there is hypertension. Usually a restriction of Na of 1600 -2300 mg is satisfactory for CHD patients. When Na is restricted other sources of iodine should be given. It also reduces intake of vit A.

Levels of sodium restriction � WHO recommends 6 gm of salt for normal person. Very low Sodium diet: 250 mg sodium diet, salt is not used for cooking, selection of low sodium foods Strict sodium restriction: 500 mg Na diet, no salt for cooking Moderate Na restriction: 1000 mg Na diet Mild Na restriction: 2400 -4500 mg Na diet

Hypertension � Hypertension is elevated blood pressure. impairs the pumping action of heart & if untreated damages heart, brain & kidneys.

Causes Predisposing factors Other factors � Heredity � CVD � Stress � Obesity � Smoking � High viscosity of blood � Narrowing of blood vessel � Renal disease � Tumor of brain � Thyroidism

Types � Mild hypertension: DBP is 90 to 104 mm Hg. � Moderate Hypertension: DBP is 105 to 119 mm Hg. � Severe above Hypertension: DBP 120 - 130 mm Hg &

Symptoms � Many person have no symptoms � Headache � Dizziness � Impaired vision � Failing memory � Shortness of breath � GIT disturbances � Unexplained tiredness

Diet management � Low calorie, low fat, low sodium diet � Energy : Obese patient must be reduced to normal body weight with low calorie diet. � Protein: normal allowance � Fats: about 20 gm vegetable oil is permitted. as they are at risk of atherosclerosis, too much fats should be avoided � Sodium restriction � Include high amount of fruit & vegetables for fiber, potassium

Do not use � Table salt or excess salt in cooking � MSG (Monosodium glutamate) � Baking powder � Salt preserved foods, pickles canned foods � Highly salted foods, potato chips � Salted butter, cheese � Biscuits, cakes etc � In strict sodium restriction, choose vegetables judicly

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