Cardiovascular Disorders: Definition of Terms

Diet Therapy II _Unit 1-Cardiovascular Disorders
CARDIOVASCULAR DISORDERS
The normal heart
The heart is a muscular organ about the size of a fist. With every heartbeat, the heart pumps blood
that carries oxygen and nutrients to all parts of the body. The heart beats about 70 times per minute
in a person at rest.
The heart rate increases when a person is active or experiences strong emotions. Heart muscle
receives its own blood supply from a system of coronary arteries. A good blood supply is vital for
the normal function of the heart.
The normal brain
The brain is a complex organ that controls intellectual functions as well as other organ systems.
The centralized control of the brain allows the body to make rapid and coordinated responses to
changes in the environment.
Normal function of the brain depends on its blood supply. Two large vessels that run along either
side of the neck carry blood from the heart to the brain. The blood vessels branch off into cerebral
arteries and carry oxygen and nutrients to all parts of the brain. A good blood supply is vital for
the normal function of the brain.
CVDs include diseases of the heart, vascular diseases of the brain and diseases of blood vessels.
CVDs are responsible for over 17.3 million deaths per year and are the leading causes of death in
the world
Definition of terms
Angina pectoris – the chest pain, radiating down the left arm; due to reduced oxygen supply
Diastolic blood pressure (DBP) – blood pressure during the relaxation phase of the cardiac cycle
High-density lipoproteins (HDLs) - a group of plasma lipoproteins containing mostly protein
and less cholesterol and triglycerides, high levels of which are associated with a decreased risk of
coronary heart disease
Infarct – dead tissue resulting from blocked artery
Ischemia – Insufficient blood flow in a tissue resulting from functional constriction or actual
obstruction of a blood vessel. It is condition characterized by reduced blood flow causing an
inadequate supply of nutrients and oxygen delivery to and waste removal from the tissues
Lipoproteins – particles that, by containing varying amounts of triglyceride, cholesterol,
phospholipids, and protein, solubilize lipids for transport in the bloodstream
Congestive heart failure – inability of the heart to pump sufficient blood throughout the
circulatory system
1/23 Koruko@kmtc.ac.ke
Cardiac cachexia – a profound state of malnutrition characterized by loss of fat and muscle mass,
especially in the temporal and supraclavicular region.
Low-density lipoproteins (LDLs) – class of lipoproteins that are the predominant cholesterol
carriers in the blood and considered atherogenic; main target for interventions because high levels
are associated with increased risk of cardiovascular disease
Myocardial infarction (MI) – Ischemia in one or more of the coronary arteries resulting in
necrosis, tissue damage, and sometime sudden death
Systolic blood pressure (SBP) – blood pressure during the contraction phase of the cardiac cycle
Thrombus – is a blood clot [group of blood factors, primarily platelets and fibrin, which, if small,
can contribute to the growth of plaque and, if large, can obstruct a blood vessel resulting in angina,
myocardial infarction, or sudden death]
Very low-density lipoproteins (VLDLs) – primary triglyceride carrying lipoproteins that
transport endogenous lipid from the liver to the peripheral circulation
What is cardiovascular disease?

Cardio means of heart and vascular means of blood vessels. Thus cardiovascular diseases include
ailments of heart (CHD) and of blood vessels (atherosclerosis).
Cardiovascular disease refers to a class of diseases that involve the heart and/or blood vessels (e.g.
arteries). It is commonly related to atherosclerosis, a process whereby fatty deposits (“plaques”)
form in your arteries, causing them to narrow and possibly block completely.
When atherosclerosis affects the major arteries in the body it can cause a heart attack, stroke or
peripheral arterial disease. By recognizing the warning signs and symptoms and seeking medical
care promptly, you may be able to avert or reduce the severity of a critical lack of blood supply to
your heart (heart attack), brain (stroke) or hands and feet (peripheral arterial disease).
Cardiovascular diseases include hypertension, ischemic heart disease, leading to angina

pectoris and lastly myocardial infarction. Hypertension is increased blood pressure or high
BP. In ischemic heart disease, there is lack of blood to the heart muscle resulting in a heart
attack. In angina pectoris, there is reduction of blood supply to the heart muscle due to
narrowing of the artery wall.
Myocardial infarction is caused by thrombosis, which is coagulation of blood in blood vessel
or organ.
Cardiovascular diseases develop in three stages:
a) In the first stage, arterial damage begins due to fat oxidation products, hypertension and/or
smoking.
b) As it progresses, there is deposition of fatty material in the arterial wall, increasing its
thickness, making it narrow and rigid. The movement of oxygen and nutrients is made
more difficult as the arterial passage is narrowed. The heart must pump harder driving
blood pressure up high B.P. or hypertension).
c) Lastly there is heart attack, which is also known as coronary occlusion, coronary
thrombosis or myocardial infarction. It is virtually like a traffic jam, causing insufficient
supply of blood to the tissues of the body beyond the point of blockage. If the blockage is
in the artery connecting to the brain, it leads to stroke. As blood supply is crucial to the
sustenance of life, it is crucial that the patient gets immediate medical aid to minimize the
damage and save life.
Ailments of the heart are on the rise and even young persons succumb to these ailments. Hence it
is important to understand the contributing factors, to prevent these as far as possible and arrest
their progress to minimize the damage.
Risk Factors
The major risk factors are:
(i) elevated serum cholesterol

(ii) emotional stress
(iii) hypertension
(iv) lack of activity leading to obesity and
(v) smoking
 Heredity is an additional risk factor, for one inherits the food habits and often the life style
of one’s parents.
 High blood lipids levels are a primary cause which contribute to most serious heart
disorders.
 High sodium intake may be involved in hypertension.
Atherosclerosis
What is atherosclerosis?
 It is a type of artery disease characterized by accumulation of fatty material on the inner walls
of arteries.
Atherosclerosis, also called hardening or blockage of the arteries, is a very common condition
affecting the arteries, the thick-walled, high-pressure blood vessels that carry fresh oxygen-rich
blood from the heart to the rest of the body. In atherosclerosis, a fatty substance called plaque
builds up in the walls of arteries, causing thickening and loss of elasticity. Plaque can make arteries
narrower, leading to reduced or blocked blood flow. Plaques can also split open and cause blood
clots to form inside the artery. These blood clots can suddenly block all blood flow through the
artery, or can break off and travel through the bloodstream to block another artery elsewhere.
Atherosclerosis initially arises in response to minimal but chronic injuries that damage the inner
arterial wall. The first lesions tend to develop in regions where the arteries branch or bend because
the blood flow is disturbed in those areas. Damage to the artery elicits an inflammatory response,
attracting immune cells and increasing the permeability of artery walls. Low density lipoproteins
(LDL) slip under the thin layer of blood vessel cells, become oxidized by local enzymes, and
accumulate. Arterial macrophages engulf this altered LDL and become foam cells (swollen cells
in the artery wall that accumulate lipids); these fat-laden cells get deposited along artery walls,
known as fatty streak (initial lesions of atherosclerosis that form on the artery wall, characterized
by accumulation of foam cells, lipid material and connective tissue). Eventually, the plague
thickens and hardens as additional lipids, connective tissue, and calcium accumulate in the region.
Consequences of Atherosclerosis
Atherosclerosis can affect the medium-sized and large arteries of the brain, the heart, the kidneys
and the legs.
As atherosclerosis worsens, it can eventually narrow the lumen of an artery and interfere with
blood flow. Some plagues are highly susceptible to rupture, which promotes blood clotting within
the artery (thrombosis). A blood clot (thrombus) may enlarge in time and ultimately obstruct
blood flow. A portion of thrombus can also break free (embolus) and travel through the circulatory
system until it lodges in a narrowed artery and shuts off blood flow to the surrounding tissue
(embolism). Most complications of atherosclerosis result from the deficiency of blood and oxygen
within the tissue served by an artery (ischemia)
A partial blockage of an artery in the heart by atherosclerosis leads to a type of chest

pain/discomfort and surrounding areas called angina/angina pectoris. If that blockage becomes
complete and a part of the heart muscle dies, the result is called a heart attack also known in
medical terms as a myocardial infarction. When atherosclerosis causes the total obstruction of
an artery in the brain, the result is an injury to brain tissue or a stroke. Impaired blood circulation
in the legs can cause fatigue and pain while walking, known as intermittent claudication.
Blockage of the arteries that supply the kidney can result in kidney disease or even acute kidney
failure. Atherosclerosis is the most common cause of abnormal dilation of a blood vessel known
as aneurysm. This can occur because plague can weaken the blood vessel wall, allowing the
damaged regions to stretch and balloon outward. Aneurysms can rupture and lead to massive
bleeding and death particularly when large vessel such as the aorta is affected. In the arteries of
the brain, an aneurysm may lead to bleeding within the brain, coma, or a stroke. Atherosclerosis,
then, is the underlying cause of most serious heart and circulatory problems.
Atherosclerosis is a complex pathological process in the walls of blood vessels that develops over many
years. In atherosclerosis, fatty material and cholesterol are deposited inside the lumen of medium- and
large-sized blood vessels (arteries). These deposits (plaques) cause the inner surface of the blood vessels
to become irregular and the lumen to become narrow, making it harder for blood tom flow through. Blood
vessels also become less pliable as a result. Eventually, the plaque can rupture, triggering the formation
of a blood clot. If the blood clot develops in a coronary artery, it can cause a heart attack; if it develops in
the brain, it can cause a stroke.
Risk Factors (promoting the process) of atherosclerosis
Behavioural risk factors:
Tobacco use – chemicals in cigarette smoke are toxic to blood vessel cells, and the resulting
damage can initiate or contribute to arterial injury. Also, smoking can result to chronic
inflammation, enhanced blood coagulation, increased LDL cholesterol and decreased HDL
cholesterol – all effects that can promote the progression of atherosclerosis
Physical inactivity
Unhealthy diet (rich in salt, fat and calories)
Harmful use of alcohol
Metabolic risk factors (related Disease/syndrome):
Raised blood pressure (hypertension) – the stress of blood flow along the artery walls-
called shear stress¸ can cause physical damage to arteries. Hypertension intensifies the
stress of blood flow on arterial tissue.
Raised blood sugar (diabetes) – chronic hyperglycemia leads to the accumulation of
advanced glycation end products (AGEs) which can directly damage blood vesses cells
and disturb blood vessel function. AGEs also promote inflammation and oxidation stress
which contribute to plague’s progression.
Raised blood lipids (e.g. cholesterol) – high levels of LDL and VLDL can both initiate and
worsen atherosclerosis. When levels are high, LDL and VLDL are actively taken up and
retained in susceptible in regions in the artery wall. HDL help to prevent oxidation and also
remove cholesterol from circulation, therefore their low levels will contribute to the
development of atherosclerosis as well.
Overweight and obesity
Other risk factors:
Poverty and low educational status

Advancing age – as a person ages, arterial cells tend to degenerate and risk factors for CVD
accumulate.
Gender - Risk of atherosclerosis increases substantially in men aged ≥45 and women aged
≥55. After menopause, women’s risk increases because the reduction in estrogen levels
increases the tendency for plague formation.
Inherited (genetic) disposition
Psychological factors (e.g. stress, depression)
NB: There is strong scientific evidence that behavioural and metabolic risk factors play a key role
in the aetiology of atherosclerosis.
What is Angina?
Angina—also sometimes called angina pectoris—is a symptom of an underlying heart condition.

It means that the heart is not getting enough blood and as a result, not enough oxygen. This
decrease of oxygen being delivered to the muscle of the heart happens if one or more coronary
arteries are narrowed or blocked, a condition called atherosclerosis.
This type of blockage may result in chest pain. And while angina does not usually damage the
heart, and the pain might only last a few minutes, it is a warning sign that you should not ignore.
Your body is telling you that your risk for a heart attack or cardiac arrest is increased. Very simply,
angina is your heart's way of getting your attention.
An angina attack is not the same as a heart attack, although many of the symptoms are the same.
An angina attack may be provoked by extremes in emotion (being very angry or upset), eating a
large meal or eating it very quickly, doing more exercise than usual (overexerting yourself), being
exposed to extremes in temperature (too hot or too cold), or smoking. If the angina is a result of
physical activity, stopping the activity generally stops the pain. But no matter what the cause of
the chest pain or discomfort, it is important that you get medical attention as soon as possible.
Rheumatic heart disease

Rheumatic heart disease is caused by damage to the heart muscle and heart valves from rheumatic
fever, following a streptococcal pharyngitis/tonsillitis.
Hypertension
When blood pressure is chronically high, the condition is called hypertension (HTN).
Hypertension – refers to persistently high arterial blood pressure defined as systolic blood
pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg.
In 90 – 95% of hypertension cases, the cause is unknown, and the condition is called essential, or
primary, hypertension. Most likely, the cause is multifactorial; including a combination of
environmental and generic factors. The other 10 - 5% of the cases are called secondary
hypertension because the condition is caused by another problem, usually endocrine. Some causes
of secondary hypertension include kidney disease, problems of the adrenal glands, and use of oral
contraceptives.
The blood pressure commonly measured is that of the artery in the upper arm. This measurement
is made with an instrument called the sphygmomanometer. The top number is the systolic
pressure, taken as the heart contracts (the blood pressure during the contraction phase of the
cardiac cycle). The lower number is the diastolic pressure, taken when the heart is resting (the
pressure during the relaxation phase of the cardiac cycle). The pressure is measured in millimeters
of mercury (mm Hg). Hypertension can be diagnosed when, on several occasions, the systolic
pressure is 140 mm Hg or more and the diastolic pressure is 90 mm Hg or more. The blood pressure
categories are the following:
Classification of Blood Pressure for Adults Aged 18 Years and Older

Category Systolic (mm Hg) Diastolic (mm Hg)
Optimal/Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 hypertension 140-159 or 90-99
Stage 2 hypertension ≥160 or ≥ 100
Greater attention should be provided to the monitoring and evaluation of systolic blood pressure
as a major risk factor for cardiovascular disease. The increase in systolic blood pressure continues
throughout life, in contrast to diastolic blood pressure, which increases until 50 years of age and
then tends to level-off during the next decade. Systolic hypertension is the most common form of
hypertension in people older than 50 years. The diastolic blood pressure is a more potent
cardiovascular risk factor than systolic blood pressure prior to 50 years of age; thereafter, systolic
blood pressure is more important.
Hypertension contributes to heart attack, stroke, heart failure, and kidney failure.
Pathophysiology of hypertension
Blood pressure is a function of cardiac output multiplied by peripheral resistance (the resistance
in the blood vessels to the flow of blood). The diameter of the blood vessel markedly affects blood
flow. When the diameter is decreased (as in atherosclerosis) resistance and blood pressure increase.
Conversely, when the diameter is increased (as with vasodilator drug therapy), resistance decreases
and blood pressure is lowered.
Many systems maintain homeostatic control of blood pressure. The major regulators are the
sympathetic nervous system (for short-term control) and the kidney (for long-term control). In
response to a fall in blood pressure, the sympathetic nervous system secretes norepinephrine, a
vasoconstrictor, which acts on small arteries and arterioles to increase peripheral resistance and
raise blood pressure. The kidney regulates blood pressure by controlling the extracellular fluid
volume and secreting renin, which activates the renin-angiotensin system. When the regulatory
mechanisms falter, hypertension develops.
Causal factors for hypertension include:
 Excess body weight;

 Excess dietary sodium intake;
 Reduced physical activity;
 Inadequate intake of fruits, vegetables, and potassium;
 Excess alcohol intake
o Heredity and obesity are predisposing factors in hypertension.
o Smoking and stress also contribute to hypertension.
o A number of medications either raise blood pressure or interfere with the effectiveness of
antihypertensive drugs. These include oral contraceptives, steroids, nonsteroidal
antiinflammatory drugs, nasal decongestants and other cold remedies, appetite suppressants
cyclosporin tricyclic antidepressants, and monoamine-oxidase inhibitors
Evaluation
The evaluation of patients with documented hypertension has three objectives:
1) Assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that
affect prognosis and guide treatment,
2) Reveal identifiable causes of high blood pressure
3) Assess the presence or absence of target organ damage and cardiovascular disease.
Nutritional Assessment and Evaluation
Routine nutritional assessment should include blood pressure evaluation; assessment for signs of
edema; and review of laboratory tests that assess blood glucose, hematocrit, serum potassium,
calcium, creatinine or glomerular filtration rate, and lipid profiles. The patient’s height and weight
should be measured, and the patient’s body mass index should be evaluated to assess the need for
weight management as an adjunct to treatment. These parameters should be assessed to estimate
risk for disease and to identify treatment options.
The food and nutrition history should assess the patient’s intake of sodium, potassium, and calcium
and the frequency at which the patient consumes fruits, vegetables, low-fat dairy products, and
processed food items..
Interactions between antihypertensive medications and nutrients or foods should be examined
Hypertension in Children and Adolescents
In children and adolescents, hypertension is defined as elevated blood pressure that persists on
repeated measurement at the 95th percentile or greater for age, height, and sex. Chronic
hypertension is becoming increasingly common in adolescence and is associated with obesity, a
sedentary lifestyle, and a family history of hypertension or other cardiovascular diseases. Lifestyle
interventions should be recommended for all children and adolescents with hypertension.
Pharmacological therapy is recommended for children and adolescents who have higher levels of
blood pressure or who do not sufficiently respond to lifestyle modifications.
Dietary Treatment for Hypertension
The dietary approach to the prevention and treatment of hypertension is an integral part of the
lifestyle changes that are required to control BP.
Major lifestyle modifications that lower blood pressure include limiting sodium intake to no more
than 2,300 mg/day; weight reduction for individuals who are overweight or obese; adoption of the
Dietary Approaches to Stop Hypertension (DASH) eating plan, which is a diet rich in potassium
and calcium and lower in sodium, dietary cholesterol, saturated fat, and total fat (<27% of total
energy; physical activity; and moderation of alcohol consumption
The lifestyle measures that are widely agreed to lower BP or cardiovascular risk, and that should
be considered in all patients are:
Smoking cessation
Weight reduction in the overweight/obese or weight stabilization, thus a calorie-restricted
diet might be prescribed.
Moderation of alcohol consumption
Physical activity
Healthy dietary choices (adoption of the Dietary Approaches to Stop Hypertension
(DASH) eating plan, which is a diet rich in potassium and calcium and lower in sodium,
dietary cholesterol, saturated fat, and total fat (<27% of total energy), which include:
o Sodium-restricted diet frequently is prescribed for clients with hypertension (≤2300
mg/day)
o Increase in potassium intake through increase in fruit and vegetable consumption
o Decrease in saturated and total fat intake.
Dietary Approaches to Stop Hypertension (DASH) eating plan: is a diet rich in

potassium and calcium and lower in sodium, dietary cholesterol, saturated
fat, and total fat (<27% of total energy)
Benefits of Lifestyle modifications reduce blood pressure:
 Prevent or delay the incidence of hypertension,

 Enhance antihypertensive drug efficacy, and
 Decrease cardiovascular risk

 Modifiable lifestyle factors have significant blood pressure–lowering effects, and the
adoption of a healthy lifestyle is an indispensable part of the management of hypertension
Sodium-restricted diets
A sodium-restricted diet is a regular diet in which the amount of sodium is limited to ≤2300 mg
(2.3g) to ≥500mg/day. Such a diet is used to alleviate edema and hypertension. Most people obtain
far too much sodium from their diets. It is estimated that the average adult consumes 7 grams of
sodium a day. It is impossible to have a diet totally free of sodium:
o Meats, fish, poultry, dairy products, and eggs all contain substantial amounts of sodium
naturally.
o Cereals, vegetables, fruits, and fats contain small amounts of sodium naturally.
o Water contains varying amounts of sodium.
However, sodium often is added to foods during processing and cooking and at the table.
The following are examples of sodium-containing products frequently added to foods

that the consumer may not notice
 Salt (sodium chloride) — used in cooking or at the table and in canning and
processing.
 Monosodium glutamate (called MSG and sold under several brand names)—a
flavor enhancer used in home, restaurant, and hotel cooking and in many packaged,
canned, and frozen foods
 Baking powder—used to leaven quick breads and cakes
 Baking soda (sodium bicarbonate)—used to leaven breads and cakes; sometimes
added to vegetables in cooking or used as an “alkalizer” for indigestion
 Brine (table salt and water)—used in processing foods to inhibit growth of bacteria;
in cleaning or blanching vegetables and fruits; in freezing and canning certain foods;
and for flavor, as in corned beef, pickles, and sauerkraut
 Disodium phosphate—present in some quick-cooking cereals and processed cheeses
 Sodium alginate—used in many chocolate milks and ice creams for smooth texture
 Sodium benzoate—used as a preservative in many condiments such as relishes,
sauces, and salad dressings
 Sodium propionate—used in pasteurized cheeses and in some breads and cakes to
inhibit growth of mold
 Sodium sulfite—used to bleach certain fruits in which an artificial color is desired,
such as glazed or crystallized fruit; also used as a preservative in some dried fruit,
such as dried plums
Evidence Supporting Lifestyle Modifications to Manage Hypertension

Lifestyle Modification Rationale
Factor
Tobacco avoidance Although not directly related to hypertension, tobacco use may impair the
protective effect of antihypertensive medications on coronary heart disease
Weight reduction(if heavier There is a positive correlation between body weight or BMI and blood pressure.
than ideal weight) Weight reduction by energy restriction may result in a substantial decrease in blood
pressure. As little as 4.5 kg of weight loss is associated with reductions of 4 to 5 mm
Hg systolic and 2 to 4 mm Hg diastolic pressure. Reductions of 5 to 20 mm Hg
systolic blood pressure occur with every 10 kg of weight loss.
Moderate alcohol intake Moderate consumption of alcohol (<30 g of ethanol per day or two drinks per day)
is not associated with blood pressure increases.
 Larger amounts of alcohol ingestion have a dose-related effect on blood
pressure in both hypertensive and normotensive subjects. Consumption of
more than 2 oz of ethanol per day may cause elevated blood pressure and
resistance to antihypertensive treatment. Hypertensive patients should limit
their alcohol consumption.
 A reduction in alcohol consumption may reduce systolic blood pressure by
approximately 2 to 4 mm Hg.
 Rebound hypertension frequently occurs during alcohol withdrawal, but it
generally reverses within a few days to 6 weeks (17).
Physical activity  Regular aerobic activities, such as walking, jogging, or swimming, may aid in the
prevention and treatment of hypertension. Recommended at least 30 minutes
of aerobic activity on most days of the week
 Regular physical activity can enhance weight loss, reduce the risk of coronary
heart disease, and prevent the increase in blood pressure that is associated with
aging.
 Regular exercise can reduce systolic BP by approximately 4 to 9 mm Hg.
*Since exercise can initially increase blood pressure, patients should consult
their physician before beginning an exercise program.
Moderate sodium intake  Dietary sodium intake should be limited to 2,300 mg/day (100 mmol/day) or
less
 Persons who are 51 and older or have hypertension, diabetes or chronic kidney
disease should not consume more than 1,500 mg/day of sodium. Dietary
sodium reduction is associated with a 2 to 8 mm Hg reduction in systolic BP.
 If a patient demonstrates adherence to a 2,300 mg/day sodium diet but has not
achieved the treatment goal, then the DASH dietary pattern or a reduction in
sodium to 1,600 mg/day can further reduce BP
Adequate calcium intake  There is an inverse association between blood pressure and calcium intake.
However, no evidence suggests that the calcium intake should be increased
beyond the Dietary Reference Intake (DRI).
 Epidemiological studies have found that dietary patterns that do not meet the
DRI for calcium are associated with increased blood pressure. The DASH eating
plan, which significantly reduces blood pressure, provides 1,240 mg/day of
calcium based on a 2,000 kcal combination diet.
Adequate potassium intake  Increased consumption of potassium is associated with a lower incidence of
stroke. High potassium intake may also be protective against hypertension. The
diet should emphasize the consumption of foods rich in potassium, except when
contraindicated (eg, patients who receive angiotensin-converting enzyme
inhibitors or who have renal insufficiency).
 Recommended a potassium intake of 3,510 - 4,500 mg/day (90 mmol/day) for
adults from food sources such as fresh fruits and vegetables.
 Potassium intakes that do not meet the DRIs are associated with increased
blood pressure. The DASH eating plan, which significantly reduces blood
pressure, provides 4,700 mg/day of potassium based on a 2,000 kcal
combination diet.
 The Dietary Guidelines for Americans suggests that individuals who have
hypertension and older adults should meet the potassium recommendation of
4,700 mg/day from food sources.
 The best sources of potassium are fruits from vines, leafy green vegetables, and
root vegetables. Although meat, milk, and cereal products contain potassium,
the form of potassium in these foods is not as readily absorbed
Adequate magnesium  Because of its vasodilative properties, magnesium may have beneficial effects
intake on hypertension. However, no evidence suggests that patients should increase
their magnesium intake beyond the DRI.
 The DASH eating plan, which significantly reduces blood pressure, provides 500
mg/day of magnesium based on a 2,000 kcal combination diet.
 Dietary patterns that do not meet the DRI for magnesium may be associated
with increased blood pressure
DASH eating plan  The DASH clinical study demonstrated that a diet (referred to as a
combination diet) that is rich in fruits and vegetables (five to ten servings) and
low-fat dairy food and reduces the intake of saturated fat (6%), total fats
(<27% energy), and sodium (<2,400 mg/day and 1,500 mg/day) significantly
lowers blood pressure.
 The DASH eating plan that limits sodium intake to 1,500 mg/day provides the
greatest blood pressure reductions. Following the DASH eating plan is
associated with an 8 to 14 mm Hg reduction in systolic blood pressure. The
DASH 2,000 kcal combination diet also provides 31 g/day of fiber (21). The
serving sizes from the Dietary Guidelines for Americans are used as the
reference guide in the DASH eating plan.
 The DASH eating plan provides 2,000 kcal/day, however it can be modified to
meet lower or higher energy needs
DASH Eating Plan

Food Group Daily Serving Sizes Examples and Notes Significance to the DASH
Servings Eating Plan
Grains and 7-8 One slice of bread Whole wheat bread, English Major source of energy and
grain 1 oz dry cereala muffin, pita bread, bagel, fiber
products ½ cup cooked rice, cereals, grits, oatmeal, crackers, Select unsalted or lower
pasta, or cereal unsalted pretzels and popcorn sodium products
Vegetables 4-5 1 cup raw leafy Tomatoes, potatoes, carrots, Rich sources of potassium,
vegetables green peas, squash, broccoli, magnesium, and fiber
½ cup cooked turnip greens, collard, kale, Select lower salt canned
vegetables spinach, artichokes, green vegetables or tomato juice.
6 oz vegetable juice beans, lima beans, sweet
potatoes
Fruits 4-5 6 oz fruit juice Apricots, bananas, dates, Important sources of
One medium fruit grapes, oranges, orange juice, potassium, magnesium, and
¼ cup dried fruit grapefruit, grapefruit juice, fiber
½ cup fresh, mangoes, melons, peaches,
frozen, or canned pineapples, prunes, raisins,
fruit strawberries, tangerines
Low-fat or 2-3 8 oz milk Fat-free or low-fat (1%) milk, Major sources of calcium
fat-free dairy 1 cup yogurt fat-free or low-fat buttermilk, and protein
1½ oz cheese fat-free or low-fat regular or Monitor sodium content of
frozen yogurt, fat-free or low- processed cheeses (600 mg
fat cheese of sodium) and natural
cheeses (110-450 mg of
sodium)
Meats, ≤2 3 oz cooked meat, Select only lean meats; trim Rich sources of protein and
poultry, and poultry, or fish away visible fats; broil, roast, or magnesium
fish boil, instead of frying; remove Limit ham and processed
skin from poultry meats that contain sodium
Nuts, seeds, 4-5 per 1/3 cup or 1½ oz Almonds, filberts, mixed nuts, Rich sources of energy,
and dry week nuts peanuts, walnuts, sunflower magnesium, potassium,
beans 2 tbsp or ½ oz seeds, kidney beans, lentils protein, and fiber
seeds Select unsalted versions
½ cup cooked dry
beans or peas
Fats and 2-3 1 tsp soft Soft margarine, low-fat DASH has 27% of total
oilsb margarine mayonnaise, light salad energy as fat, including fat
1 tbsp low-fat dressing, vegetable oil (such as in or added to foods
mayonnaise olive, corn, canola, or safflower Select low-salt versions of
2 tbsp light salad oil) dressing
dressing
1 tsp vegetable oil
Sweets 5 per 1 tbsp sugar Maple syrup, sugar, jelly, jam, Sweets should be low in fat
week 1 tbsp jelly or jam fruit-flavored gelatin, jelly
½ oz jelly beans beans, hard candy, fruit punch,
8 oz lemonade sorbet, ices
aOne ounce equals ½ to 1¼ cups, depending on the type of cereal. Check the product’s Nutrition Facts label.
bFatcontent changes serving counts for fats and oils. For example, 1 tbsp of regular salad dressing equals one serving; 1 tbsp of low-fat
dressing equals one half of a serving; and 1 tbsp of fat-free dressing equals zero servings.
DASH Eating Plan–Number of Servings for Other Energy Levels

Food Group Servings per day for the Servings per day for the
1,600 kcal DASH Eating Plan 3,100 kcal DASH Eating Plan
Grains and grain products 6 12 - 13
Vegetables 3-4 6
Fruits 4 6
Low-fat or fat-free dairy foods 2-3 3-4
Meats, poultry, and fish 1-2 2-3
Nuts, seeds, and dry beans 3 per week 1
Fats and oils 2 4
Sweets 1 2
Heart Failure
Heart failure (also called congestive heart failure) is a condition characterized by the heart’s
inability to pump adequate blood, resulting in inadequate blood delivery and a buildup of fluids in
the veins and tissues.
Heart failure is often a consequence of chronic disorders that create extra work for the heart muscle
(e.g. hypertension and CHD). The heart tries to accommodate the extra workload by enlarging or
pumping faster or harder, but it eventually may weaken enough to fail completely.
Heart failure is the most common reason for hospitalization, morbidity, and mortality in the elderly
Consequences of Heart Failure
When the heart doesn’t pump strongly enough as it should, the body doesn’t get the right amount
of blood and oxygen it needs to work properly. Blood that should be pumped out of the heart can
cause fluid to backup (swelling or edema) into other organs or tissues, such as the lungs, stomach,
liver, intestines or legs (which explains the term congestive heart failure).
Heart failure can cause too much fluid to back-up in the lungs which can cause a life-threatening
condition called “acute pulmonary edema”. This condition can interfere with your breathing,
making one short of breath, and gives a cough that’s worse at night and when lying down. This
condition requires emergency treatment.
With inadequate blood flow, the functions of various organs, such as the liver and kidneys may
become impaired.
Heart failure also affects a person’s food intake and level of physical activity. In persons with
abdominal bloating and liver enlargement, pain and discomfort may worsen with meals. Limb
weakness and fatigue can limit physical activity.
End stage heart failure is often accompanied by cardiac cachexia, a condition of severe
malnutrition characterized by severe weight loss and tissue wasting.
Nutrition Therapy for Heart Failure
The primary objective of medical nutrition therapy is to complement pharmacotherapy in

maintaining fluid and electrolyte balance while preventing malnutrition and cardiac cachexia.
Nutrition interventions should be customized based on the patient’s individualized needs and the
nutrition diagnoses identified by the comprehensive nutrition assessment
Hypertension is often associated with heart failure; therefore, dietary and lifestyle management
strategies for treating hypertension should be applied to heart failure patients who have
hypertension
 The main dietary recommendation for heart failure is a sodium restriction to ≤2000 milligrams
daily to reduce the likelihood of fluid retention. Sodium restriction will improve the patient’s
quality of life and clinical symptoms such as edema and fatigue. Urinary sodium levels can be
assessed to determine the adherence to a low-sodium diet. Severely restricted sodium intake
(1,000 mg or less) is discouraged for home use. Dietary restriction at this extreme may be
unrealistic, leading to reduced patient compliance and compromised nutritional intake.
 Fluid requirements are based on the presence of edema, ascites, shortness of breath, and
hyponatremia (low level of sodium in blood) and the frequency of weight fluctuations. Fluid
restriction improves these clinical symptoms and the patient’s quality of life
o In patients with persistent or recurrent fluid retention, fluid intakes may be restricted to
≤2 (1.4 and 1.9 L) liters per day depending on clinical symptoms.
o Fluid should be restricted if serum sodium levels fall below 130 mEq/L. Sudden
increases in body weight of 3 to 5 lb (appr 1.4 – 2.2 kgs) suggest marked fluid retention.
(1 lb=0.45359 kg)
 Individuals who have difficulty in eating due abdominal or chest pain may tolerate small,
frequent meals better than large meals.
 Patients with heart failure may be prone to constipation due to diuretic use and reduced
physical activity; therefore maintain an adequate fibre intake to help minimize constipation
problems
 Avoid or restrict alcohol intake because of alcohol’s deleterious effect on blood pressure and
heart function
 Encourage heart failure patients to participate in exercise programs to avoid becoming
physically disabled and to improve endurance
Other Nutrients requirements
 Energy expenditure: The energy needs of patients who have heart failure should be
determined. A primary goal is to provide enough energy to maintain a reasonable body weight
and visceral protein status.
In some cases, the basal metabolic needs may be 18% higher than age-matched controls; this
increased metabolic need can contribute to malnutrition and cardiac cachexia. In obese
patients, weight loss improves cardiac output and shortness of breath
 Protein: The daily protein intake should be at least 1.37 g/kg in clinically stable depleted
patients and 1.12 g/kg in normally nourished patients to preserve their actual body composition
or limit the effects of hypercatabolism.
The literature suggests that patients with heart failure have significantly higher protein needs
than patients without heart failure, as measured by negative nitrogen balance. The patient’s
nitrogen balance should be evaluated if the adequacy of protein intake is in question
 Thiamin: Individuals who take more than 80 mg/day of loop diuretics, such as furosemide,
have increased urinary excretion of thiamin and may develop clinically significant thiamine
deficiency. Thiamin deficiency causes high-output cardiac failure (beriberi) and may
exacerbate cardiac function in patients who have heart failure. The patient should consume at
least the Dietary Reference Intake (DRI) for thiamin through food or supplements. Food
sources high in thiamin include fortified cereals, bran, bread, and meats.
 Folate: Heart failure patients should consume at least the DRI for folate through food or a
combination of vitamin B6, vitamin B12, and folate supplementation. Folate supplementation
given with other vitamins and minerals has beneficial clinical outcomes for patients who have
heart failure
 Vitamin B12: A multivitamin and mineral supplement containing vitamin B12 or a
combination of vitamin B6, vitamin B12, and folate is recommended for heart failure patients.
Vitamin B12 supplementation (200 to 500 mcg/day) provided with other vitamins and minerals
has beneficial clinical outcomes for heart failure patients.
 Minerals: Dietary minerals, including potassium, magnesium, and calcium, may be depleted
due to diuretic therapy. Food sources of these minerals include low-fat dairy products, fruits,
vegetables, and whole grain products. Heart failure patients should consume at least the DRI
for these minerals from food sources or supplements and should place a special emphasis on
their magnesium intake. Low levels of magnesium may be present in patients who have heart
failure and can result in irregular heart rhythms. The recommended potassium intake is 2 to
6 g/day, unless the patient has renal impairment or receives a potassium-sparing diuretic such
as spironolactone. The need for additional magnesium requirements in heart failure patients is
being evaluated
 Caffeine: Some studies have demonstrated that caffeine increases the heart rate and blood
pressure and causes dysrhythmias. More research is needed to assess the effect of caffeine on
specific conditions. The effects of caffeine intake on heart failure outcomes have not been
studied. Because information is limited, it is recommended that heart failure patients use
caffeine in moderation and do not exceed 300 mg/day.
Coronary Heart Disease CHD

 Also called Coronary Artery Disease, is a chronic progressive disease characterized by
obstructed blood flow in the coronary arteries
It is usually caused by atherosclerosis, which reduces blood flow in the coronary arteries and
deprives the heart muscles of oxygen and nutrients.
Symptoms
 Most common symptom is pain or discomfort in the chest region; the pain may radiate to
the shoulders, left arm, back, neck, jaw, or teeth
 Other possible symptoms include shortness of breath, weakness, lightheadedness,
sweating, nausea, and vomiting.
Risk factors
 Cigarette smoking
 High LDL cholesterol
 Hypertension
 Diabetes
Therapeutic Lifestyle Changes (TLC) for Lowering CHD Risk
People who have CHD are often advised to make dietary and lifestyle changes before considering
drug treatment
Main features of TLC plan include:
 A cholesterol-lowering diet
 Regular physical activity
 Weight reduction
Reducing risk of CHD with Therapeutic Lifestyle Changes

Dietary strategies
 Limit saturated fat to less than 7% of total Kcal and cholestrol to less than 200 milligrams
per day. Maintaining a fat intake of 25-35% of total Kcal may help with this goal
 Replace saturated fats with unsaturated fats from fish, vegetable oils, and nuts or with
carbohydrates from whole grains, legumes, fruits, and vegetables
 Avoid food products that contain trans-fatty acids
 Choose foods high in soluble fibres, including oats, barley, legumes, and fruit.
 To reduce blood pressure, limit sodium intake to 2300mg per day and choose a diet that is
high fruits, vegetables, and whole grains and includes low-fat milk products and nuts
 Fish can be consumed regularly as part of a CHD risk-reduction diet
 If alcohol is consumed, it should be limited to one drink daily for women and two drinks for
men
Lifestyle choices
 Physical activity: at least 30 minutes of moderate- intensity endurance activity should be
undertaken on most days of the week; eventual goal should be an expenditure of at least
2000 kcal weekly
 Smoking cessation – exposure to any form of tobacco smoke should be minimized
Weight reduction
 Weight reduction may improve other CHD risk factors. The general goals of a weight-
management program should be to prevent weight gain, reduce body weight, and maintain
a lower body weight over the long term. The initial goal of a weight –loss program should
be to lose no more than 10% of original body weight
Congenital heart disease

Malformations of heart structures present at birth are known as congenital heart defects. They may
be caused by: (i) a close blood relation between parents (consanguinity); (ii) maternal infections
(e.g. rubella); (iii) maternal use of alcohol and drugs (e.g. warfarin); and (iv) poor maternal
nutrition (e.g. deficiency of folic acid). In some cases the cause remains unknown. Examples of
congenital heart disease include holes in the septum of the heart, abnormal valves and
abnormalities in heart chambers.
Hyperlipidemia
It is a medical condition characterized by an elevation of any or all lipid profile and/or lipoproteins
in the blood.
Hyperlipidemia refers to elevated levels of lipids and cholesterol in the blood, and is also identified
as dyslipidemia, to describe the manifestations of different disorders of lipoprotein metabolism.
Although elevated low density lipoprotein cholesterol (LDL) is thought to be the best indicator of
atherosclerosis risk, dyslipidemia can also describe elevated total cholesterol (TC) or triglycerides
(TG), or low levels of high density lipoprotein cholesterol (HDL).
Classification of LDL and Total Cholesterol Levels in Adolescents

Total Cholesterol <170mg/dl 170-199mg/dl ≥200mg/dl
(mg/dl)
LDL Cholesterol <110mg/dl 110-123mg/dl ≥130mg/dl
(mg/dl)
Classification of hyperlipidemia
Primary hyperlipidemia - takes place as a result of genetic problems i.e., mutation within
receptor protein.
Secondary hyperlipidemia - arises as a result of other underlining diseases like diabetes.
Besides the above classifications i.e., primary and secondary hyperlipidemia subtypes,
hyperlipidemia also classified according to the type of lipid elevated which is
hypercholesterolemia, hypertriglyceridemia or both in combined hyperlipidemia
Managements used for Hyperlipidemia
The major treatment used for hyperlipidemia divided into three parts which are:
• Dietary control: This point focus on reducing intake of foods that contain high amount of
saturated fat and cholesterol i.e., foods of animal origin. On the other hand this point will encourage
intake of food or supplements that include fish oil or olive oil which include a very low
concentration of saturated fat. Or focusing on intake of vegetarian foods which are free of
cholesterol. These types of food will significant play role in reducing elevated triglyceride levels.
• Lifestyle change: This will include focusing on daily exercises, since regular exercises will lead
to an improvement within lipid concentrations i.e., daily walking will reduce triglyceride level by
an average of 10 mg/dL and elevation within HDL level by 5 mg/dL.
• Medical treatments: These treatments will be indicated for those patients who suffer from
hyperlipidemia since early childhood i.e., familial hyperlipidemia. These medications include:
HMG CoA reductase inhibitors (first line treatment for elevated LDL levels), Fibrates (first line
treatment for triglyceride elevation), Bile acid sequestrants (second line treatment for elevated
LDL levels), Nicotinic acid (niacin) (second line treatment for all lipid disorders) and Ezetimibe
and colesevelam (second line treatments to reduce absorption of cholesterol through
gastrointestinal tract).
Myocardial infarction
Myocardial infarction (MI) means that part of the heart muscle suddenly loses its blood supply.
Without prompt treatment, this can lead to damage to the affected part of the heart. An MI is part
of a range or disorders called ‘acute coronary syndrome’ (ACS).
 An infarct is an area of tissue/organ necrosis caused by ischemia

 Infarctions often result from sudden reduction of arterial (or occasionally venous) flow by
thrombosis or embolism
What happens when you have a myocardial infarction?
In MI, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart
muscle supplied by this artery loses its blood (and oxygen) supply bringing it at risk of dying
unless the blockage is quickly removed (the word ‘infarction’ means death of some tissue).
If one of the main coronary arteries is blocked, a large part of the heart muscle is threatened. If a
smaller branch artery is blocked, a smaller amount of heart muscle is affected. In people who
survive an MI, the part of the heart muscle that dies (’infarcts’) is replaced by scar tissue over the
next few weeks to months which can cause future problems such as heart failure or arrhythmia.
Preventable or treatable risk factors of myocardial infarction:
Smoking
Hypertension (high blood pressure)
High cholesterol level
Lack of exercise
A poor diet
Obesity
Excess alcohol
Heart attack
When the blood flow to the heart is cut off, due to a thrombus on a ruptured atherosclerotic plaque,
the decrease in the supply of oxygen and nutrients can damage the heart muscle, resulting in a
heart attack.
- Heart attack occurs when the blood supply to the heart muscle is blocked causing damage
or death too heart tissue
When the blood flow is decreased due to a blockage, it causes chest pain (angina) due to ischaemia
(Inadequate blood supply to a local area due to blockage of blood vessels leading to that area).
Ischemia occurs when the blood supply to a tissue is inadequate to meet the tissue’s metabolic
demands
Treatment of Heart Attack
 Drug therapies given immediately after heart attack may include thrombolytic drugs (clot
bursting drugs), anticoagulants, aspirin, painkillers, and medications that regulate heart rhythm
and reduce blood pressure.
 Patients are not given food or beverages, except for sips of water or clear liquids, until their
condition stabilizes.
 Once able to eat, they are initially offered small portions of food that are low in sodium,
saturated fat, and cholesterol. The sodium restriction helps to limit fluid retention but may be
lifted after several days if the patient shows no signs of heart failure.
Stroke
A stroke occurs when blood flow to the brain is interrupted by either: a blood clot blocking the
blood vessel (artery) that supplies blood to the brain (“ischaemic stroke”) a blood vessel in the
brain bursting (“haemorrahagic stroke”)
The pathophysiology of ischaemic stroke is more diverse and includes, besides thrombus
formation in atherosclerotic cerebral blood vessels (ischaemic stroke), small vessel disease in the
brain linked to vascular risk factors. Another cause of stroke is haemorrhage (bleeding) due to a
rupture of a blood vessel because of the presence of an aneurysm, for example, or due to damage
from uncontrolled high blood pressure or atherosclerosis (haemorrhagic stroke). In addition,
strokes can also be caused by a travelling blood clot. If a person has an irregular heartbeat, blood
clots may form in the heart and travel through the blood vessels to the brain. A clot carried to the
cerebral circulation in this way can be trapped in a cerebral blood vessel and block the blood flow
to an area of the brain.
A transient ischaemic attack (TIA) is referred to as a “mini-stroke”. It occurs suddenly and is

short-lived (lasting several minutes to an hour. TIAs disrupt blood flow to the brain caused by
atherosclerosis or a tiny clot. TIA symptoms are similar to stroke but shorter; they are therefore a
strong warning sign of an impending stroke/heart attack.
If not treated promptly, a stroke can lead to immediate death or long-term disabilities including
paralysis on one side of the body.
The underlying pathology of heart attacks and strokes
Atherosclerosis; the underlying basis of heart attacks and strokes
One of the main underlying pathological processes that leads to heart attacks (coronary heart
disease) and strokes (cerebrovascular disease) is known as atherosclerosis. The early changes of
atherosclerosis develop in childhood and adolescence due to the overall effect of a number of risk
factors (tobacco use, physical inactivity, unhealthy diet, harmful use of alcohol, hypertension,
diabetes, raised blood lipids, obesity, poverty, low educational status, advancing age, gender,
genetic disposition and psychological factors)
Atherosclerosis is an inflammatory process affecting medium- and large-sized blood vessels

throughout the cardiovascular system. When the lining (endothelium) of these blood vessels is
exposed to raised levels of low-density lipoprotein cholesterol (LDL cholesterol) and certain other
substances, such as free radicals, the endothelium becomes permeable to lymphocytes and
monocytes. These cells migrate into the deep layers of the wall of the blood vessel.
A series of reactions occur, attracting LDL cholesterol particles to the site. These particles are
engulfed by monocytes, which are then transformed into macrophages (foam cells).
Smooth muscle cells migrate to the site from deeper layers of the vessel wall (the media). Later, a
fibrous cap consisting of smooth muscle and collagen is formed. At the same time, the
macrophages involved in the original reaction begin to die, resulting in the formation of a necrotic
core covered by the fibrous cap. These lesions (atheromatous plaques) enlarge as cells and lipids
accumulate in them and the plaque begins to bulge into the vessel lumen. When the process
continues, there is thinning of the fibrous cap accompanied by fissuring of the endothelial surface
of the plaque, which may rupture. With the rupture of the plaque, lipid fragments and cellular
debris are released into the vessel lumen. These are exposed to thrombogenic agents on the
endothelial surface, resulting in the formation of a thrombus. If the thrombus is large enough, and
a coronary blood vessel or a cerebral blood vessel is blocked, this results in a heart attack or stroke.
Stroke Management
- Early diagnosis and treatment are necessary to preserve brain tissue and minimize long-
term disability. Ideally, thrombolytic (clot-bursting) drugs are used within the first few
hours following an ischemic stroke to restore blood flow and prevent further brain damage.
- The focus of nutrition care is to help patients maintain nutrition status and overall health
despite the disabilities caused by the stroke.
o Dysphagia (difficulty in swallowing) is a frequent complication of stroke and is
associated with a poorer prognosis (prospect of recovery from illness/injury)
o Difficulty with speech prevents patients from communicating their food preference
or describing the problems they may have with eating
o Coordination problems can make it hard for patients to grasp utensils or bring food
from the table to mouth
o In some cases, tube feeding may be necessary until the patient has regained these
skills.
o Adaptive feeding equipment can help patients with feeding disabilities gain
independence (see table below)
Interventions for feeding – related problems
Inability to suck
 Use squeeze bottles, which do not require suckling, to express liquids into the mouth
 Place spoon on the centre of the tongue, and apply downward pressure to stimulate
suckling
 Apply rhythmic, slow strokes on the tongue to alter tongue position and improve the
suckling response
Inability to chew
 Place foods between gums and teeth to promote chewing
 Improve chewing skills with foods of different textures, e.g. fruit leathers stimulate
movements but dissolve quickly enough to minimize chocking
 Provide soft foods that require minimal chewing or are easily chewed
Inability to swallow
 Provide thickened liquids, pureed foods, and moist foods that form boluses easily
 Provide cold formulas, frozen fruit juice bars, and ice; cold substances promote
swallowing movements by the tongue and soft palate
 Make sure the patient’s jaws and lips are closed to facilitate swallowing action
 Correct posture and head position if they interfere with swallowing ability
Inability to grasp or coordinate movements
 Provide utensils that have modified handles, or are small or larger as necessary
 Encourage the use of hands for feeding if utensils are difficult to maneuver
 Provide plates with food guards to prevent spilling
 Supply clothing protection
Impaired vision
 Place foods (meats, vegetables) in similar locations on the plate at each meal
 Provide plates with food guards to prevent spilling

Cardiovascular Disorders: Definition of Terms

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Diet Therapy II _Unit 1-Cardiovascular Disorders

The normal brain

What is cardiovascular disease?

Cardiovascular diseases include hypertension, ischemic heart disease, leading to angina

Cardiovascular diseases develop in three stages:

The major risk factors are:

(i) elevated serum cholesterol

A partial blockage of an artery in the heart by atherosclerosis leads to a type of chest

Risk Factors (promoting the process) of atherosclerosis

Behavioural risk factors:

Metabolic risk factors (related Disease/syndrome):

Other risk factors:

Poverty and low educational status

Angina—also sometimes called angina pectoris—is a symptom of an underlying heart condition.

Rheumatic heart disease

Classification of Blood Pressure for Adults Aged 18 Years and Older

Causal factors for hypertension include:

 Excess body weight;

The evaluation of patients with documented hypertension has three objectives:

Nutritional Assessment and Evaluation

Interactions between antihypertensive medications and nutrients or foods should be examined

Hypertension in Children and Adolescents

Dietary Treatment for Hypertension

Dietary Approaches to Stop Hypertension (DASH) eating plan: is a diet rich in

Benefits of Lifestyle modifications reduce blood pressure:

 Prevent or delay the incidence of hypertension,

 Decrease cardiovascular risk

The following are examples of sodium-containing products frequently added to foods

Evidence Supporting Lifestyle Modifications to Manage Hypertension

DASH Eating Plan

DASH Eating Plan–Number of Servings for Other Energy Levels

Consequences of Heart Failure

Nutrition Therapy for Heart Failure

The primary objective of medical nutrition therapy is to complement pharmacotherapy in

Other Nutrients requirements

Coronary Heart Disease CHD

Therapeutic Lifestyle Changes (TLC) for Lowering CHD Risk

Main features of TLC plan include:

Reducing risk of CHD with Therapeutic Lifestyle Changes

Congenital heart disease

Classification of LDL and Total Cholesterol Levels in Adolescents

Secondary hyperlipidemia - arises as a result of other underlining diseases like diabetes.

Managements used for Hyperlipidemia

 An infarct is an area of tissue/organ necrosis caused by ischemia

What happens when you have a myocardial infarction?

Preventable or treatable risk factors of myocardial infarction:

Treatment of Heart Attack

A transient ischaemic attack (TIA) is referred to as a “mini-stroke”. It occurs suddenly and is

The underlying pathology of heart attacks and strokes

Atherosclerosis; the underlying basis of heart attacks and strokes

Atherosclerosis is an inflammatory process affecting medium- and large-sized blood vessels

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