Heart : The most hard-working muscle of our body – pumps 4-5 liters of blood every minute during rest Supplies nutrients and oxygen rich blood to.

Diseases of Cardio Vascular System

Heart : The most hard-working muscle of our body – pumps 4-5 liters of blood every minute during rest

Supplies nutrients and oxygen rich blood to all body parts, including itself

Coronary arteries surrounding the heart keep it nourished with blood

Heart

Chambers: The heart is divided by a septum into two halves.

The halves are in turn divided into chambers. The upper two chambers of the heart are called atria and the lower two chambers are called ventricles .

Valves allow blood to flow in one direction between the chambers of the heart.

Structure

Flow of blood

Atherosclerosis Hyperlipidemias Coronary heart disease Myocardial infraction Congestive heart failure Hypertension

Diseases

No. 1 killer disease worldwide◦ 12 Million deaths annually

During last 30 years large declines in developed countries -rising health awareness and government programmes

Alarming increase in developing countries especially India

Prevalence

Development of atherosclerosis

It is a general term that denotes an elevation of one or more lipids in the blood.

Hypercholesterolemia: is a serum cholesterol in excess of 260mg/dl.

Hypertriglyceridemia when fasting triglyceride level exceeds 250mg/dl.

These elevated levels results in rapid & severe development of atherosclerosis & in turn coronary disease.

Hyperlipidemia

Coronary artery disease (CAD), These are diseases of the arteries that supply the heart muscle with blood. 

Coronary heart disease (CHD), a disease of the heart itself caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium.

No symptoms for long period Severe Chest pain for short period on

exertion also known as Angina Pectoris or minor heart attack

Infract is localized area of necrosis result when blood supply is inadequate. An infract oh heart is known as Myocardial Infarction or major heart attack-Severe chest pain, death of heart muscle, heart failure, irregular heart beats

Sudden Ischaemic Death (deficient blood supply)

Symptoms

Heart failure , often called congestive heart failure, is a condition in which the heart can't pump enough blood to the body's organs and tissues.

It doesn't mean the heart has failed and can't pump blood at all. With this less effective pumping, vital organs don't get enough blood

Causing signs and symptoms as: 1. shortness of breath2. fluid retention (edema) in extremities first

& with increasing failure to abdomen & chest

3. and fatigue. 

Genetic predisposition Poor handling of fats Metabolic syndrome

◦ Diabetes, obesity, high BP, Coronary artery disease

Urbanization Sudden change in lifestyle

Risk factors

Cholesterol

Two sources of cholesterol: Food & made in your body

Too much cholesterol can deposit in the arteries in the form of plaque and block them

Hypercholesteraemia occurs when cholesterol level exceed 240mg/dl

Cholesterol & Triglyceride are the main forms of fat carried in blood with the help of lipoproteins.

Role of fat in CVD

Lipoproteins are made up of protein & lipids. 1. Chylomicrons, carry triglyceride,

monogylcerides, glycerol & small amount of cholesterol & phospholipids.

2. VLDL also transport triglyceride but mainly endogenous triglyceride formed in liver. They travel through blood vessels & circulate fat throughout the body.

Lipoproteins

Way of action

LDL main carrier of cholesterol, it stuck to blood vessels

HDL takes away cholesterol from tissues to liver for conversion or excrete

Saturated fats raise LDL & total cholesterol levels

Increase the risk of CVD

Saturated fats

Sources: Meat & dairy products Hydrogenated fats: hydrogenation of

vegetable oils alter the geometric structure of PUFA from natural ‘cis’ to ‘trans’ form.

Trans fatty acids

Trans fats raise LDL Lowers HDL Thus are atherogenic

Low calorie, low fat, low CHO, high fiber diet

Energy: patient whose weight is normal, maintenance level of calorie.Loss of weight for obese people is advisableA1000-1200 kcal diet is suitable for obese patient in bed.

Fats: first step is restriction of fat to not more than 20% of total calories

Important n-3 PUFA are a-linolenic acid, EPA & DHAn-6 are linoleic acid & arachidonic acid

They are also known as omega 6 & omega 3.

Dietary management

Promote esterification of cholesterol Reduces thrombosis Prevent accumulation of cholesterol in blood Decrease synthesis of VLDL, LDL,

triglycerides Specially food rich in ω-3 fatty acid have

cardio protective effects Such as fish, specially salmon, fish oil Vegetable sources: flaxseed, canola oil,

mustard oil, walnuts

Benefits:

Present in vegetable sources such as olive oil, canola, almond oil.

Lower LDL without lowering HDL & do not raise triglyceride levels

Cholesterol Cholesterol level should not exceed 300mg in

diet as liver also synthesis cholesterol

MUFA

CHO: Include complex CHO in diet. About 60% of total calorie from CHO

Protein, vitamins & minerals Normal allowances are recommendedAvoid animal protein

Sodium is restricted when there is hypertension. Usually a restriction of Na of 1600-2300mg is satisfactory for CHD patients. When Na is restricted other sources of iodine should be given. It also reduces intake of vit A.

WHO recommends 6gm of salt for normal person.

Very low Sodium diet: 250mg sodium diet, salt is not used for cooking, selection of low sodium foods

Strict sodium restriction: 500mg Na diet, no salt for cooking

Moderate Na restriction: 1000mg Na dietMild Na restriction: 2400-4500mg Na diet

Levels of sodium restriction

Hypertension is elevated blood pressure.

Hypertension impairs the pumping action of heart & if untreated damages heart, brain & kidneys.

Hypertension

Causes

Predisposing factors Other factors

Heredity Stress Obesity Smoking High viscosity of blood Narrowing of blood

vessel

CVD Renal disease Tumor of brain Thyroidism

Mild hypertension: DBP is 90 to 104mm Hg.

Moderate Hypertension: DBP is 105 to 119mm Hg.

Severe Hypertension: DBP 120- 130mm Hg & above

Types

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

Symptoms

Low calorie, low fat, low sodium diet Energy : Obese patient must be reduced to

normal body weight with low calorie diet. Protein: normal allowance Fats: about 20gm vegetable oil is permitted.

as they are at risk of atherosclerosis, too much fats should be avoided

Sodium restriction Include high amount of fruit & vegetables

for fiber, potassium

Diet management

Table salt or excess salt in cooking MSG (Monosodium glutamate) Baking powder Salt preserved foods, pickles canned foods Highly salted foods, potato chips Salted butter, cheese Biscuits, cakes etc In strict sodium restriction, choose

vegetables judicly

Do not use

Thank you