CARDIOLOGY MODULE

Objectives Satisfactory Not

Completion Applicable
Review
1.The student will discuss with the rotation coordinator the role of nutrition
for cardiology (including HTN, hyperlipidemia, atherosclerosis and
CH!. "nclude in the discussion, but not limited to, all the following that
are applicable#
a. etiology and treatment
b. pathophysiology
c. metabolic$nutritional alterations
d. current medical treatments$trends

%. &iscuss the dietitian's role as part of the health care team
Assess
(. )sing height$weight$labs and other pertinent information the student will
assess the appropriateness of#
a. the *&'s order
b. diet
c. energy$protein$nutrient re+uirements
,. The student will obtain diet histories.
-....... (/oal of ( or more!
0. The student will complete nutrition care plans.
-...... (/oal of ( or more!
Educate
1.The student will utili2e the diet history and care plan as well as any
other pertinent educational material to instruct patients and$or family
member on his$her specific dietary regimen.
- ...... (/oal of ( or more!
Document
3. )sing the format appropriate for the site, the student will document all
pertinent information in the medical record.
-........(/oal of ( or more!
Observe/Optional
4. 5bser6e one of the following procedures# cardiac catheteri2ation,
echocardiogram, 7TT, CA8/, heart transplant, 6al6e replacement, or
other diagnostic procedure.
4/11
CARDIOLOGY
1. Describe the flow of blood throuh the he!rt.
The heart is a muscle charged with pumping blood to all aspect of the body. "t is di6ided into right and left sides,
separated by a piece of tissue called the septum. The heart is further di6ided into four chambers, the right atrium
and 6entricle, and the left atrium and 6entricle. 9egulating the blood mo6ing from chamber to chamber, and to and
from the heart itself, is four 6al6es.
The cycle begins when low o:ygenated blood from the body returns to the heart 6ia the superior and inferior 6ena
ca6a to fill the right atrium chamber. 5nce the right atrium is filled with blood it contracts, opening the tricuspid
6al6e, which pumps the blood into the right 6entricle. This mo6ement is referred to as the atrial systole. The
tricuspid 6al6e closes once the right 6entricle is filled with blood, pre6enting blood from mo6ing bac; into the right
atrium and ensuring a unidirectional flow. The right 6entricle will then contract opening the pulmonary 6al6e
pumping blood into the pulmonary artery and onto the lungs, referred to as 6entricular systole. The pulmonary
6al6e closes +uic;ly, and li;e the tricuspid 6al6e, ;eeps blood mo6ing unidirectional.
Simultaneously, o:ygenated blood returns from the lungs through the pulmonary 6eins and fills the left atrium.
5nce the left atrium is filled with blood it contracts opening the mitral 6al6e and blood is pumped into the left
6entricle. The mitral 6al6e closes once the left 6entricle chamber is filled to pre6ent blood from re<entering the
upper left atrium. The simultaneous opening of the mitral and tricuspid 6al6e contributes to the =lub> sound of the
heartbeat. The left 6entricle contracts opening the aortic 6al6e which pumps o:ygenated blood into the aorta and
into systematic circulation. The aortic 6al6e closes +uic;ly to pre6ent bac; flow of blood in to the left 6entricle
chamber. The left 6entricle contraction ta;es places simultaneously with the contraction of the right 6entricle
contractions, which contributes to the =dub> heartbeat sound.
Additionally, the heart beat has two basic parts, the diastole and systole. &iastole is when the left and right atria
and 6entricles rela: and begin to fill with blood. &iastole ends when the atria contract and pump blood into the
6entricles. ?hen the heart contracts this is referred to as atrial (blood pumped to 6entricle from atrium! or
6entricular (blood pumped out of heart! systole.
1

". Defi#e the followi# ter$s rel!ted to he!rt dise!se%
A#i#! &ectoris< a disease mar;ed by brief paro:ysmal attac; of chest pain precipitated by deficient o:ygenation
of the heart muscle
U#st!ble !#i#! 'U(A)* angina pectoris characteri2ed by sudden changes (as an increase in the se6erity r
length of angina attac;s or a decrease in the e:ertion re+uired to precipitate an attac;! especially when symptoms
were pre6iously stable
Atherosclerotic c!rdiov!scul!r dise!se 'A(C+D)* the blood 6essels that carry o:ygen and nutrients from your
heart to the rest of your body 6ia arteries become thic; and stiff @ sometimes restricting blood flow to your organs
and tissues, caused by buildup of fats, cholesterol and pla+ues (other substances in and on your artery walls!.
The pla+ues can burst triggering a blood clot.<mayo clinic
Coro#!r, !rter, dise!se 'CAD)* a condition and especially one caused by atherosclerosis that reduces the
blood flow through the coronary arteries to the heart muscle and typically results in chest pain or heart damage@
called also coronary disease, coronary heart disease
E#teric co!ted !s&iri# 'ECA(A)* 5TC, coating pre6ents dissol6ing in the stomach, but dissol6e in the small
intestines, to reduce irritation to stomach for daily aspirin therapy for heart health and stomach safety.
'Acute) $,oc!rdi!l i#f!rct'io#) 'A)MI* heart attac;, which is an acute episode of heart disease mar;ed by the
death or damage of heart muscle due to insufficient blood supply to the heart muscle usually as a result of a
coronary thrombosis or a coronary occlusion and that is characteri2ed especially by chest pain
-o$oc,stei#e* an amino acid C,HAN5%S that is produced in animal metabolism by the de<methylation of
methionine and forms a comple: with serine that brea;s up to produce cysteine and homoserine and that appears
to be associated with an increased ris; of cardio6ascular disease when occurring at high le6els in the blood
Aortic i#sufficie#c, 'AI)* lea;age of blood from the aorta bac; into the left 6entricle during diastole because of
failure of an aortic 6al6e to close properly@called also aortic incompetence, aortic insufficiency, Corrigan's
disease
Aortic ste#osis 'A()* a condition usually the result of disease in which the aorta and especially its orifice is
abnormally narrow
.r!d,c!rdi!* relati6ely slow heart action whether physiological or pathological
C!rdio$,o&!th,* any structural or functional disease of heart muscle that is mar;ed especially by enlargement
of the heart, by hypertrophy of cardiac muscle, or by rigidity and loss of fle:ibility of the heart walls and that may
be idiopathic or attributable to a specific cause (as heart 6al6e disease, untreated high blood pressure, or 6iral
infection!
Di!stolic blood &ressure* the lowest arterial blood pressure of a cardiac cycle occurring during diastole of the
heart@called also diastolic pressure; ( when atria and ventricles relax and fill with blood)
Atri!l fibrill!tio#* 6ery rapid uncoordinated contractions of the atria of the heart resulting in a lac; of
synchronism between heartbeat and pulse beat@called also auricular fibrillation
Defibrill!tor* an electronic de6ice used to defibrillate a heart by applying an electric shoc; to it
C!rdi!c e#/,$es* Cardiac biomar;ers or en2ymes are released into the blood when the heart is damaged or
stressed. *easurement of these biomar;ers is used to help diagnose, ris; stratify, monitor and manage people
with suspected acute coronary syndrome (ACS! and cardiac ischemia. ACS include# Troponin " or T, CB, CB<*8C
other tests (myoglobin, 8ND or NT<pro8ND, hs<C9D!C test which accompany biomar;ers include# blood gases,
C*D, 8*D, electrolytes and C8C.
Left coro#!r, !rter, 'LCA)* is an artery that arises from the aorta abo6e the left cusp of the aortic 6al6e and
feeds blood to the left side of the heart, and di6ides into two branches# circumfle: artery which supplies blood to
the left atrium and side and bac; of left 6entricleC and, the left anterior descending (EA&! artery, which supplies
blood to the front and bottom of the left 6entricle and the front of the septum.!
Mitr!l ste#osis 'M()* a condition usually the result of disease in which the mitral 6al6e is abnormally narrow
Mitr!l v!lve 'M+)* a 6al6e in the heart that guards the opening between the left atrium and the left 6entricle,
pre6ents the blood in the 6entricle from returning to the atrium, and consists of two triangular flaps attached at
their bases to the fibrous ring which surrounds the opening and connected at their margins with the 6entricular
walls by the chordae tendineae and papillary muscles@called also bicuspid valve, left atrioventricular valve
Riht coro#!r, !rter, 'RCA)* right coronary artery specifically supplies blood to the right atrium, right 6entricle,
bottom portion of the left 6entricle, bac; of septum and the cells in the right atrial wall, which are called the
sinoatrial node. "nFuries to the arteries or a poor functioning artery can cause a heart attac;.
(,stolic blood &ressure* the highest arterial blood pressure of a cardiac cycle occurring immediately after
systole of the left 6entricle of the heart
0!ch,c!rdi!* relati6ely rapid heart action whether physiological (as after e:ercise! or pathological
1!ce$!2er* a group of cells or a body part (as the sinoatrial node of the heart! that ser6es to establish and
maintain a rhythmic acti6ity "% an electrical de6ice for stimulating or steadying the heartbeat or reestablishing the
rhythm of an arrested heart@called also pacer
D,s&#e! o# e3ertio# 'DOE)* cardiology shortness of breath, difficult or labored respiration which occurs with
effort or elicited by physical acti6ity, often a sign of heart failure or ischemia
4. .e f!$ili!r with the followi# l!b v!lues. 5#ow #or$!l v!lues !#d the si#ific!#ce of
!b#or$!l v!lues !s the, rel!te to c!rdi!c dise!se.
L!b M!r2ers 6or$!l +!lues Ab#or$!l 7 (i#ific!#ce
6! 1(1<1,0m7+$E
Hyponatremia (low le6els! due to decreased dietary inta;e , in "G fluids, or
e:cess fluid accumulation due to H. Hypernatremia (high le6els! due to
dehydration or e:cessi6e dietary inta;eC and de6elops hypertension (8D!.
"ncreases ris; of H&<related mortality, stro;e and ;idney damage, esp. in
o6erweight pt
. %<(
C5*M.
(Heart and skeletal
muscle) replaced by
troponin bc skeletal
C!"#$ can mask heart
damage%
(<0H (H of total CB !or 0<%0 ")$E
High CB<*8, and ration of h CB.*8 to total CB (creatinine ;inase! is I %.0<(
indicates damage to heart muscle cells.
,<0
tot!l cholesterol
measure when pt not ill
1%J<1AAmg$dE
&esirable
%JJ<%(A mg$dE
8orderline high
%,J mg$dE and abo6e High
High le6els estimate ris; of CG&, atherosclerosis, increases ris; of death
from A*". Eow following *", illness or during stress
High during pregnancy or due to medications.
0
-DL cholesterol
I,0 mg$dE men
I00 mg$dE women
Eow le6els increase ris; of CG&. H&E is higher in females.
Should ha6e 0#1 ratio for total cholesterol to H&E.
%
8.C ,.1<1J.A :1J
(
$E High ?8C indicates A*".
%,0
59 (.3<0.% m7+$E
8oth hyper;alemia decreases heart muscle acti6ity K hypo;alemia lead to
irregular heartbeat or electrical malfunction of heart.
%,1
0ril,cerides
0J<10J mg$dl &esirable
10J< 1AA mg$dE 8orderline
High
%JJ to ,AA mg$dE High
I0JJ mg$dE Gery High
High le6els estimate increase ris; of CG&.
%
LDL cholesterol
L1(J mg$dEC &esirable
1(J<10A mg$dE 8orderline
high#
M 11J mg$dE High
High le6els estimate increase ris; of CG&.
%
0ro&o#i# 0:
order when suspected
&#' ( specific to heart
J<J.1 Ng$E
Slight ele6ations indicate heart damage, myocarditis, congesti6e heart failure,
or strenuous e:ercise. High le6els indicate heart attac;.
%
;. Describe the followi# di!#ostic tests<sureries th!t !re rel!ted to he!rt
dise!se% )eferencing" #edline *lus
C!rdi!c !#ior!$* a conscious patient is gi6en a dye through cardiac cauteri2ation in which a catheter is
placed in the arm, groin or nec; and threaded into the coronary artery, which ma;e the coronary arteries 6isible by
O<ray that ta;e place will dye mo6es through the arteries.
C!rdi!c c!theteri/!tio# 'CA0-)* a catheter is placed in the arm, groin or nec; and threaded into the coronary
artery to release dye for O<ray 6isuali2ation of coronary arteries.
Coro#!r, !rter, b,&!ss r!ft 'CA.G)* open heart surgery, which a healthy artery or 6ein from the body is
connected or grafted to the bloc;ed coronary artery, to bypass the bloc;ed portion of the coronary artery to supply
heart muscle with o:ygenated blood
Echoc!rdior!&h* an in6asi6e test, which uses &oppler ultrasound to send sound wa6es to create mo6ing
picture of heart, which shows blood flow through the heart chambers and 6al6es, in addition to the si2e and shape
of the heartC it is capable of detecting blood clots, fluid build<up in the pericardium (sac surrounding the heart!, or
problems with the aorta.
E3ercise toler!#ce test* screening tool used to test effect of e:ercise on the heart in which 1J electrodes
attached to an electrocardiogram (7C/! are placed on chest which monitors the electrical acti6ity while Dt wal;s
on treadmill or pedals on bicycle, blood pressure is also monitored during this test. Test continues until Dt reaches
target rate, chest pain or undesirable changes in blood pressure de6elop, 7C/ show low o:ygen le6els to heart,
or Dt tires or other symptoms such as leg pain discontinue test.
Mitr!l v!lve re&l!ce$e#t 'M+R)* Surgery to repair or replace mitral 6al6eC due to calcification (hardening! which
pre6ent blood from mo6ing forward through 6al6e or if 6al6e is loose which allows blood to flow bac;wards. "t can
be performed 6ia in6asi6ely.
1ercut!#eous tr!#slu$i#!l c!rdi!c !#io&l!st, '10CA)* *inimally in6asi6e surgical procedure which uses a
needle inserted into the femoral artery, which a guide wire is inserted in to the needle and the wire is remo6ed.
The guide wire is co6ered by san introducer and the guide wire is remo6ed. A diagnostic catheter is inserted in the
introducer in to blood 6essel and onto the aorta's ostium a dye is inFected and :<rays are ta;en. 8loc;ages are
noted, and a new guiding catheter is inserted with a new guide wire across the bloc;age. A balloon catheter is
inflated to compress bloc;ages against the artery wall and deflated, and repeated. Stents may be used to ;eep
6essels open during procedure.
C!rdi!c ste#t* A stent is a metal or fabric mesh tube, which may be coated with medicine (drug<eluting! to
pro6ide arterial support to narrow or wea; arteries. "t placed during a percutaneous coronary inter6ention (DC"! or
coronary angioplasty. Stents assist to restore blood flow through narrowed or bloc;ed arteries, and in the case of
drug<eluting stents to pre6ent arteries from becoming bloc;ed again.
C!rdi!c MRI* "maging method which uses powerful magnets and radio wa6es to create picture of heart (without
radiation!. "mages are referred to as slices, which hundreds are produced. All metal must be remo6ed from bodyC
and, pt with internal pins or metal plates are not eligible. "n some cases dyes are used and administered 6ia "G
E5G* &iagnostic test which use electrodes attached to the electrocardiogram (7C/ or 7B/! placed on chest,
which monitors the electrical acti6ity. As the heart repeatedly beats an electrical signal spreads from top of heart
to bottom. This electrical signal set the heart rhythm, which the 7B/ show the pace, regularity, strength of
electrical current and timing of the electrical signals for each part of the heart. )sed to determine heart attac;s,
arrhythmias and heart failure.
=. Ide#tif, the followi# $edic!tio#s used i# the tre!t$e#t of he!rt dise!se.
>


Ge#eric<0r!de 6!$e Cl!ssific!tio# 6utritio# Rel!ted (ide Effects
Acet,ls!lic,lic Acid<As&iri# Analgesic antipyretic, antiarthritic,
NSA"&, to pre6ent CGA or *"
"nsure ade+uate fluid inta;e$hydrationC P foods high in Git C K ol w$long
term high dose A6oid natural products that affect coagulation (garlic,
ginger, ging;o, ginseng, horse chestnut!C limit caffeine to Q /" effect?
6utr% anore:ia
C!&to&ril<C!&ote# AC7 inhibitorC antihypertensi6e "nsure ade+uate fluid inta;e$hydrationC AG5"& natural licorice, QNa and
;cals may be recommended, AG5"& salt subs, caution w$B suppl.C e,
*g or Al Q absorption, ta;e oral e or *g K captopril separately by % hrs,
Al$*g antacids$supp Q captopril absorption<ta;e separatelyC 6utr%
anore:ia, Q wt reported to captopril
Cholest,r!$i#e<@uestr!#
Anti<hyperlipidemic, anti<diarrheal, bile
acid se+uestrant Q fat, chol and P fiber, Q ;cals if needed. Nutr# *ay Q absorption of fat,
Ca, e, Rn, *g, 8eta<carotene, Gits A,&,7,B, folate. 6utr% Anore:ia, Q or
P wt.
Dio3i#<Dio3i# Cardiotonic, anti<arrhythmic *aintain diet with P B and Q Na, ade+uate *g K CaC Caution w$some
herbal products# aloe, fo:glo6e, hawthorn and others. AG5"& St. SohnTs
?art and natural licoriceC 6utr# anore:ia, Q wt. Ca K Git & induced
hypercalcemia may P drug effects
Dilti!/e$<C!rdi/e$ Antiangina, antihypertensi6e, Ca
Channel 8loc;er
Q ;cals may be neededC AG5"& natural licorice, strict Q Na diet may blunt
antihypertensi6e effect of drug. No significant interaction w$grapefruit or
citrus. 6utr% anore:ia
Aurose$ide<L!si3 Eoop diuretic, anti<hypertensi6e (B
depleting!
QNa and ;cals may be recommended, P B and P*g (or suppl!C AG5"&
natural licorice. 6utr% Anore:ia, P thirst.
-,dr!l!/i#e<A&resoli#e Anti<hypertensi6e, CH treatment,
Gasodilator
QNa and ;cals maybe recommendedC AG5"& natural licorice. Dyr
supplement (1JJ<%JJ mg! may correct drug induced peripheral
neuropathy (interferes w$Dyr metabolism<possible Dyr deficiency!C 6utr%
anore:ia, Q or P wt, P thirst
-,drochlorothi!/ide<-,droDiuril Anti<hypertensi6e, diuretic *ay need QNa, ;cals, P B and *g (or supplement!, AG5"& natural
licorice, Caution# w$Ca K$or Git & supp < ris; of hyper;alemia. 6utr%
anore:ia, P thirst
Meto&rolol t!rtr!te<Lo&ressor

Anti<hypertensi6e, antiangina
Q Na and ;cals may be recommended. AG5"& natural licorice.
6ifedi&i#e<1roc!rdi!

Anti<angina, anti<hypertensi6e, Ca
Channel bloc;er
Q Na and ;cals may be recommended. AG5"& grapefruit$related citrus,
natural licorice, ginger, ging;o, ginseng and St. SohnTs ?art$melatonin
6itrol,ceri#<6itrost!t Anti<angina N$A
1ro&r!#olol<I#der!l

Anti<arrhythmic, anti<angina, anti<
hypertensi6e, anti<migraine
Q Na and ;cals may be recommended. AG5"& natural licorice
(&ir!#ol!cto#e<Ald!cto#e Anti<hypertensi6e, diuretic, primary
hyperaldosteronism treatment
Q Na and ;cals may be recommended. AG5"& e:cessi6e B inta;e, B
supp or salt substitutes, AG5"& natural licorice. 6utr% Anore:ia, Q wt, P
thirst, dehydration.
8!rf!ri#<Cou$!di# Anticoagulation Diet% Consistent inta;e of Git. B is essentialC too much decreases drug
effect, too little increases drug effect. See pg. (44 ood *ed "nteractions
for dietary sources. &o not e:ceed )E for Git. A (increases ris; for
bleeding!. AG5"& or limit garlic, ginger, gin;go, ginseng, saw palmetto or
horse chestnut which affect coagulationC Caution# M 1J g raw, fried or
boiled onions, Q platelet aggregation$P fibrinolytic acti6ity
Dobut!$i#e Sympathomimetic$inotropic agent "G drug used to impro6e heart function by impro6ing blood flow and
easing symptoms of H
Do&!$i#e &opamine (inFection! "ntropin, produced naturally in the brain, also a6ailable by inFection to
increase heart rate and blood pressure
C,clos&ori#e<(!#di$$u#e "mmunosuppressant (pre6ent organ
reFection!
No B suppl or salt subs. AG5"& grapefruit$related citrus. Git 7 may P
absorption of drug. AG5"& St. Sohn's ?ort, caution w$red wine. 6utr%
Anore:ia.
1red#iso#e<1red#iso#e corticosteroids, anti<inflammatory,
immunosuppressant
QNa, P Ca, Git & and pro. *ay need P B, Gits A,C and P D (or suppl!. Ca
and Git & suppl recommended with long<term use. Caution with
grapefruit$related citrus with methyl prednisone. 6utr% P appetite, wt
(e:cept anore:ia w$triamcinolone!. Negati6e N balance due to pro
catabolism. Ca wasting w$long<term use, Cr deficiency may P ris; for
steroid induced diabetes.
(i$v!st!ti#<Bocor H*/<CoA reductase inhibitor (statin!C
antihyperlipidemic
AG5"& grapefruit$related citrus K St. SohnTs ?ort
0!croli$us<1ror!f
immunosuppressant (pre6ent organ
reFection! Diet% AG5"& B or salt subs, AG5"& grapefruit$related citrus and St. SohnTs
?ort. 6utr% Anore:ia, P appetite, Q e. Dru% High fat or high CH5 Q
absorption of drug.

C. Ide#tif, the s,stolic !#d di!stolic blood &ressure re!di#s used for the di!#osis of
h,&erte#sio# '-06). List the ris2 f!ctors for esse#ti!l h,&erte#sio#.
Hypertension is a measure of the force e:erted per unit area on the artery walls. "t is measured using#
systolic blood pressure (S8D!< blood pressure during the contraction phase of the cardiac cycle
diastolic blood pressure (&8D!< blood pressure during the rela:ation phase of cardiac cycleC
Cl!ssific!tio# of h,&erte#sio#%
D
(.1 '$$ -) D.1 '$$ -)
6or$!l L1%J L4J
1re*h,&erte#sive 1%J<1(A 4J<4A
(t!e 1 -,&erte#sio# 1,J<10A AJ<AA
(t!e " -,&erte#sio# M11J M1JJ
Ris2 f!ctors%
African American race, age, male gender, persistent diastolic pressure I110 mm Hg, poor diet (high Na, low
$G inta;e!, smo;ing, physical inacti6ity, stress, obesity, e:cessi6e alcohol inta;e, contracepti6es, hormone
therapy, narcotics and hypercholesterolemia.
>. 0he h,&erte#sive &!tie#t receivi# diuretic $edic!tio# is !t ris2 for develo&i# !
deficie#c, of wh!t #utrie#tE
Datients ta;ing potassium<sparing diuretic mediation (such as spironolactone or triamterene! are as ris; for
de6eloping hyper;alemia a condition of higher than normal serum potassium le6els. Dotassium is critical to the
function of ner6e and muscle cells including those of the heart. Normal potassium le6els are (.1<0.% mmol$E.
Ee6els of greater than 3.J mmol$E are considered dangerous and treatment is critical.
Datients ta;ing thia2ide diuretics (Easi:, Eo2ol, Clorpres, Hydrodiuril *icro2ide! may de6elop hypo;alemia, a
condition of low serum potassium, due to e:cessi6e urinary e:cretions. A potassium supplement may be re+uired
to regulate potassium le6els and to pre6ent hypo;alemia. 5ther deficiencies include may include decreased
sodium and 6itamin C le6els.
A<1J

D. Describe the DA(- diet !#d its role i# the tre!t$e#t of -06.
The National Heart, Eung and 8lood "nstitute (NHE8"! de6eloped the low<fat eating plan referred to as &ASH
(&ietary Approaches to Stop Hypertension!. The &ASH diet has been statistically shown to reduce hypertension
and impro6e blood lipids. Therefore, &ASH can help reduce the ris; of de6eloping cardio6ascular disease (CG&!.
&ASH emphasi2es specific minerals such as calcium, potassium, and magnesium to lower blood pressure when
consumed together. "t re+uires patients to reduce sodium le6els to %,(JJ milligrams per day. 5btaining a goal of
1,0JJ milligrams of sodium per day was found to be e6en better at lowering blood pressure, particularly in middle
aged and older indi6iduals, African Americans, and those already with high blood pressure.
The &ASH eating plan emphasi2es fruits and 6egetables, fat free or low fat dairy products, whole grains, fish
poultry, seeds, nuts and 6egetables oils. The &ASH diet plan de<emphasi2es sweets, sugary be6erages and read
meats.
Rese!rch v!lid!ti# the reco$$e#d!tio#s of%
The 5mniHeart study focused on 8D and serum lipids obser6ing the original &ASH plan, a high protein 6ersion
(%0H energy from protein, mainly of plant bases sources such as nuts!, and a plan high in unsaturated fat ((1H
calories from monounsaturated fats!. 9esearch showed that patients following a high protein diet or the
monounsaturated plan had the most significant reduction in blood pressure and blood cholesterol.
11
Additionally the &ASH sodium trials studies obser6ing dietary plans loo;ing at le6els of sodium inta;e (10JJ, %(JJ
or ((JJ milligram, respecti6ely! combined with a typical )S diet or &ASH diet plan. The most significant reduction
in blood pressure was obser6ed from patients following a 10JJ milligram &ASH plan, which subse+uently reduced
S8D by 3 to 1% mm Hg.
1%
The Trials of Hypertension Dre6ention also ha6e indicated that the incidence of long term cardio6ascular e6ents
can be reduced by %0<(JH by lowering daily inta;e by 30J to 1JJ milligrams for 14 months to , years. Eastly, the
7ncore study has suggested that a hypocaloric<&ASH diet plan incorporating lifestyle changes, such adding
physical acti6ity, can greatly reduce blood pressure and promote weight loss when compared to a standard &ASH
eating plan.
1(
Aood Grou& D!il, (ervi#s (ervi# (i/es
Gr!i#sF C*D 1 slice bread
1 o2 dry cerealU
1$% cup coo;ed rice, pasta, or cereal
+eet!bles ;*= 1 cup raw leafy 6egetable
1$% cup cut<up raw or coo;ed 6egetable
1$% cup 6egetable Fuice
Aruits ;*= 1 medium fruit
1$, cup dried fruit
1$% cup fresh, fro2en, or canned fruit
1$% cup fruit Fuice
A!t*free or low*f!t
$il2 !#d $il2
&roducts
"*4 1 cup mil; or yogurt
11$% o2 cheese
Le!# $e!ts:
&oultr,: !#d fish
C or less 1 o2 coo;ed meats, poultry, or fish
1 eggV
6uts: seeds: !#d
leu$es
;*= &er wee2
1$( cup or 11$% o2 nuts
% Tbsp peanut butter
% Tbsp or 1$% o2 seeds
1$% cup coo;ed legumes (dry beans
and peas!
A!ts !#d oils "*4 1 tsp soft margarine
1 tsp 6egetable oil
1 Tbsp mayonnaise
% Tbsp salad dressing
(weets !#d !dded
su!rs
= or less &er wee2 1 Tbsp sugar
1 Tbsp Felly or Fam
1$% cup sorbet, gelatin
1 cup lemonade
+ ,hole grains are recommended for most grain servings as a good source of fiber and nutrients%- .erving si/es vary between 01 cup and 002
cups, depending on cereal type% Check the product's 3utrition 4acts label%
G. 8h!t !re the !dv!#t!es<co#cer#s with the use of s!lt substitutesE 8ith fish oilE
Descri&tio# Adv!#t!es Co#cer#s
Salt substitution
1,
Eow in sodium
)se for pts on Eoop or Thia2ide
diuretics, which deplete B, good source
of potassium
Hyper;alemiaC if potassium<sparing diuretics
are part of the treatment.
9egular monitoring of potassium le6els may
be re+uired in pts on diuretics using salt
substitutes if potassium inta;e from food is
insufficient<
*odify inta;e as appropriate for serum le6els.
ish 5il (omega (, D)As, 7DA K
&HA!
3,1,,10
Eowers proinflammatory fatty acid
arachidonic acid and urine thrombo:ane
8%
&ecreases E&E and triglyceride le6els
&ecreases blood pressure by increasing
N5 to cause 6asodilation
&ecreases ris; of death from cardiac
e6ent
*ay cause /" discomfort, belching, bad
breath, and altered tasteC
No &A regulated so safety$potency
1H. 8hich foods should be o$itted fro$ ! ; $ sodiu$ dietE A " r!$ sodiu$ dietE
Descri&tio# Co#sider!tio#s
NAS (,JJJmg$daily!# Eeast restricti6e of Na
diets
No table salt
Eimit salt in coo;ingC smo;ed, cured or dried meat and
cheesesC condiments and seasoningsC salted snac;s, canned
or dried soupsC bouillons
%JJJ mg$daily (0 g NaCl!
7liminate processed and prepared foods and be6erages.
No table salt
No coo;ing with salt
Eimit mil; and mil; products to 11 o2$day
)ses of commercially salt<free foods only
11. Defi#e the !#!to$ic!l<&h,sioloic!l ch!#es !ssoci!ted with co#estive he!rt
f!ilure. List the ris2 f!ctors for the develo&$e#t of co#estive he!rt f!ilure.
1=
A#!to$ic!l% "n congesti6e heart failure or heart failure (H!, the heart cannot pro6ide ade+uate blood flow to the
rest of the body, causing symptoms of fatigue, dyspnea and fluid retention. &iseases of the heart (6al6es, muscle,
blood 6essels! can lead to H. Heart failure can affect the right, left, or both sides of the heart. H is further
categori2ed as systolic failure when the heart can't pump or eFect blood efficiently out of the heart, or diastolic
failure when the heart cannot fill with blood as it should.
1h,sioloic!l% H is initiated by damage or stress to heart muscle of acute *" or insidious onset (hemodynamic
pressure or 6olume o6erloading!, which alters the function and shape of the left 6entricle such that it hypertrophies
in an effort to sustain blood flow. This alteration of shape is referred to as cardiac remodeling. The most common
cause of H is coronary artery disease (CA&!. To restore homeostatic function, many compensatory mechanisms
are acti6ated from the sympathetic ner6ous system (SNS!, which acti6ates fight or flight responseC rennin<
angiotensin system (9AS!, which regulates blood pressure and fluid balanceC and, cyto;ine system, which are
chemicals made by immune system cells that are crucial in controlling the growth and acti6ity of other immune
system cells and blood cells in the body. urthermore, proteins such as pro<inflammatory cyto;ines (such as TN
W XX, "E<1 and "E<1! are increased in the blood and the myocardium, and ha6e been found to regulate cardiac
remodeling. 8<natriuretic peptide (8ND! is secreted by the 6entricles in response to pressure and is predicti6e of
H and mortality at any 8*" le6el. 3ote5 $3* is often elevated in patients with H4; $3* 6 077 pgm8 warrants
investigation. Eastly, Norepinephrine, angiotensin "", aldosterone, endothelin and 6asopressin are ele6ated in H
patients. All of these are neurohormonal factors that increase the hemodynamic stress on the 6entricle by
causing sodium retention and peripheral 6asoconstriction. The heart can compensate for poor cardiac output by
increasing the force of contraction, increasing in si2e, pumping more often, and stimulating the ;idneys to
conser6e sodium and water.
Ris2 A!ctors 1h,sioloic!l s,$&to$s
<Hypertension
<Antecedent hypertension present in 30H H
cases
<&iabetes (especially for women!
<CH&
<Eeft 6entricular hypertrophy (EGH!
1". Defi#e c!rdi!c c!che3i!. Ide#tif, the f!ctors th!t co#tribute to the develo&$e#t of
C!rdi!c c!che3i!. Describe the #utritio#!l reco$$e#d!tio#s for the $!#!e$e#t
of C!rdi!c c!che3i!.
1=
Cardiac cache:ia is the end stage for 1J to 10H of patients with heart failure (H!. Dhysiologically, the patient will
ha6e in6oluntary weight loss of I1JH of lean body mass, or body weight loss of 3.0H of their pre6ious dry body
weight during the pre6ious si: months. Cardiac cache:ia patients suffer from substantial loss of lean mass, as
well as, fat and bone tissue. Additional structural, inflammatory, and neuroendocrine changes in the s;eletal
muscle of patients also occur.
Symptoms associated with cardiac cache:ia result from insufficient blood flow to abdominal organs and include
nausea, fullness, constipation, anore:ia, abdominal pain, malabsorption, hepatomegaly, and li6er tenderness, all
of which result in se6ere nutritional deficits. This leads to critical decline in the health and function of the heart
muscle and o6erall gut health. "nade+uate inta;e of protein and energy results in sarcopenia and subse+uently
poor prognosis for patients in terminal stages of chronic H.
actors that contribute to the de6elopment of cardiac cache:ia include ris; factors for H# hypertension, diabetes,
CH&, and left 6entricular hypertrophy. &iabetes is an especially strong ris; factor for H in women, and both
waist circumference and percent body fat are strong ris; factors for men and women. inally, the wasting
associated with chronic H is an independent predictor of mortality, ma;ing the prognosis for patients with end
stage H (and subse+uent cardiac cache:ia! particularly poor. Thus, a6oiding H is the best way to reduce the
ris; of cardiac cache:ia. 5nce H is diagnosed, minimi2ing muscle wasting, malnutrition, and malabsorption is
crucial to reducing the ris; of cache:ia. Nutritional inter6entions are critical, as e6idenced by cache:ia's nutritional
acuity rating of a le6el ,# se6ere.
FFFF(ee !tt!ched $et!bolic s,#dro$e c!se stud, for $ore refere#cesFFFFFF
Nutritional recommendations for patients with cardiac cache:ia include the following# 7nergy 1.1 to 1.4 977 or up
to 0JH higher than normal inta;eC protein inta;e at a rate of 1.J<1.0 g$;g body weight depending on renal or
hepatic statusC small, fre+uent meals to pre6ent abdominal discomfortC increased saturated fat may be beneficialC
offer preferred foods to impro6e inta;e and appetiteC tube feeding or parenteral nutrition as appropriateC
antio:idant<rich foods (fish, fruits, green tea, nuts, etc.!C sodium restriction (% to %.0 g per day! or the &ASH diet as
appropriate (modify potassium as needed!C and monitor for the potential need for increased folate, magnesium,
2inc, iron, 6itamins 7, 81, 81%C thiamin should be supplemented to reduce cardiac beriberi, a common
comorbidity.
11<13
14. List the three ris2 c!teories !#d r!#es for tot!l blood cholesterol: LDL: -DL !#d
tril,cerides 'desir!ble: borderli#e: hih).
Ris2 C!teor, Desir!ble .orderli#e -ih
Total blood cholesterol L%JJ mg$dE %JJ<%(A mg$dE %JJ<%(A mg$dE
<atigue
<Shortness of breath
5n e:ertion of effort intolerance it worsens,
orthopnea, paro:ysmal nocturnal dyspnea
<luid retention
*anifest as pulmonary congestion or peripheral
edema
Eow density Eipoproteins
(E&E!
L1JJ mg$dE 1(J<10A mg$dE 1(J<10A mg$dE
High &ensity = = (H&E! *I,JC ?I0J mg$dE
Y Y
Triglycerides L10J mg$dE 10J<1AA mg$dE 10J<1AA mg$dE
YSince H&E le6els are more desirable when higher, they are e6aluated differently. Eow le6el denotes increased
ris;# Eess than ,J mg$dE for men and less than 0J mg$dE for women. High le6el denotes less than a6erage ris;#
1J mg$dE or higher for both men and women
1;. 8h!t is ! co$$o# effect of !# MI o# seru$ cholesterol levelE
*yocardial infractions cause a rapid decline in serum le6els of total cholesterol, E&E cholesterol, and H&E
cholesterol between the 1
th
and A
th
day of illness.
14
This lowering effect thereby in6alidates any pre<*" serum
cholesterol 6alues in patients suffering from an acute myocardial infarction. 8aseline control le6els should be
ta;en 1 wee;s after *".
1A

1=. M!2e ! ch!rt showi# the differe#ces i# the (te& 1: (te& " !#d the 0LC '6!tio#!l
Cholesterol Educ!tio# 1ror!$) diets. I#clude tot!l f!t: s!tur!ted f!t: 1UAA:
$o#ou#s!tur!ted f!t: !#d cholesterol.
"H*"1
Descri&tio# 0ot!l f!t (!t. f!t 1UAA MUAA Cholesterol
(te& 1
!
L(JH
total ;cal
L1JH
total ;cal
)p to 1JH of total
;cal
)p to 10H of total
;cal
L(JJ mg per day
(te& "
!*b
%0<(0H total
;cal
L3H
total ;cal
)p to 1JH of total
;cal
)p to %JH of total
;cal
L%JJ mg
per day
0LC Diet
c
%0<(0H total
;cal
L3H
total ;cal
)p to 1JH of total
;cal
)p to %JH of total
;cal
L%JJ mg per day
a
The Step 1 and Step % diets ha6e been upgraded$replaced by the Therapeutic Eifestyle Changes (TEC! diet.
b
The Step % diet is now called the TEC diet.
c
The TEC diet also recommends % g of plant sterols$stanols per day, %0<(J grams of 6iscous fiber, and 2ero trans
fats. Carbohydrates should comprise 0J<1JH of the diet, and protein should be about 10H of total calories.
1C. Describe the co##ectio# betwee# Di!betes Mellitus !#d he!rt dise!se.
""

&iabetes should be considered as a coronary artery disease e+ui6alent, rather than a ris; factor for CG&.
9esearch shows that high blood glucose le6els damage ner6es and blood 6essels, leading to complications such
as heart disease and stro;e, which are the leading causes of death among people with both, type " and type ""
diabetes. High blood glucose le6els ha6e the potential to increase atherosclerosis of arteries of the 6ascular
system, by increasing the chance of hyper coagulation of platelets that affect blood flow, clogging and hardening
and increasing chance of 6ascular occlusion and cardiac e6ents.
Additionally, macro6ascular diseases due to atherosclerosis increase ris; of CG&, e6en when glucose le6els are
under control, thereby increasing the ris; of stro;e and death. Deople with type % diabetes, because it is paired
with metabolic syndrome, often ha6e the following conditions that contribute to their ris; for de6eloping ischemic
diseases, stro;e or death from CG&# hypertension, high E&E$low H&E$high triglycerides, obesity, a lac; of
physical acti6ity, poorly controlled blood glucose le6els, and a smo;ing habit. ?omen with Type " diabetes I,J
years or older are at higher ris; of death from CG&.
There are also micro6ascular complications such as nephropathy, neuropathy and retinopathy which can be
predictors of cardiac e6ents as well. &iabetic nephropathy is the leading cause of renal failure in the )nited
States. "t is defined by proteinuria I 0JJ mg in %, hours in the setting of diabetes. &iabetic nephropathy is
preceded by lower degrees of proteinuria, or =microalbuminuria,> which is albumin e:cretion of (J<%AA mg$%,
hours. ?ithout inter6ention, diabetic patients with microalbuminuria typically progress to proteinuria and o6ert
diabetic nephropathy. This progression occurs in both type 1 and type % diabetes.
&iabetic neuropathy is recogni2ed by the American &iabetes Association (A&A! as =the presence of symptoms
and$or signs of peripheral ner6e dysfunction in people with diabetes after the e:clusion of other causes.> As with
other micro6ascular complications, ris; of de6eloping diabetic neuropathy is proportional to both the magnitude
and duration of hyperglycemia, and some indi6iduals may possess genetic attributes that affect their
predisposition to de6eloping such complications. "n addition diabetic autonomic neuropathy cause neurological
dysfunction in in most organs and can manifest in the heart as e:ercise intolerance, resting tachycardia, silent
ischemia or cardiac death.
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