* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download G-0967 Coronary Heart Disease, Myocardial
Remote ischemic conditioning wikipedia , lookup
History of invasive and interventional cardiology wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Electrocardiography wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Rheumatic fever wikipedia , lookup
Cardiovascular disease wikipedia , lookup
Heart failure wikipedia , lookup
Jatene procedure wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Cardiac surgery wikipedia , lookup
Antihypertensive drug wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Provided Courtesy of Nutrition.com Coronary Heart Disease, Myocardial Infarction, and Heart Failure A Review of the Basics Review Date 12/13 G-0967 Defining Heart Disease Heart disease is a broad term used to describe a range of diseases that affect your heart, such as: • Coronary heart disease (CHD) • Atherosclerosis • Myocardial infarction (MI) • Heart failure (formerly called congestive heart failure) Risk Factors for CHD and MI • Smoking • High intake of alcohol • Obesity • Sedentary lifestyle • Diabetes • Hypertension Risk Factors for CHD and MI (cont’d) • More than 34 years of age for males and 55 years of age for females (risk increases after menopause) • Family history—genetics • Hypertension • Stress • Chronic kidney disease Risk Factors for CHD and MI (cont’d) • High low-density lipoprotein (LDL) cholesterol • Low high-density lipoprotein (HDL) cholesterol • Left ventricular hypertrophy Risk Factors for Heart Failure • Obesity • Hypertension • Overweight or obesity • Ischemic heart disease • Changes in cardiovascular structure, such as diseases to the heart valves or muscle Coronary Heart Disease: An Overview • Blood flow to the vessels surrounding the heart is blocked • The major underlying cause of CHD is atherosclerosis or a buildup of plaque in the arteries Plaque Development • Many factors speed up plaque development: ̶ Elevated cholesterol and triglyceride levels ̶ Hypertension ̶ Infection that initiates the inflammatory response ̶ Elevated iron levels—carry free radicals that damage lining ̶ Elevated homocysteine level ̶ Cigarette smoking ̶ Diabetes ̶ Obesity ̶ Oxidized (LDL) levels The Atherosclerotic Process • Buildup of smooth muscle cells, macrophages, and lymphocytes • Smooth muscle cells form a matrix of connective tissue • Lipid and cholesterol accumulates in the matrix The Atherosclerotic Process (cont’d) • Lipid deposits and other materials (including cellular waste, fibrin, and calcium) build up and form a plaque • After injury, platelets adhere to the arterial wall and release growth factors, which promote lesion development Coronary Heart Disease Development • Steps to development of CHD: ̶ Fatty streaks form, often in people younger than 30 years of age ̶ People are asymptomatic during this first stage of CHD ̶ Plasma LDL enters the injured endothelial wall and forms a plaque that sometimes is prone to rupture ̶ Acute, complicated lesions with rupture and either nonocclusive or occlusive thrombus form (occlusive form often results in MI and sudden death) ̶ Hemorrhage into plaque produces thrombi—thrombus formation with arterial lumen initiated Coronary Heart Disease Development (cont’d) • Steps to development of CHD (cont’d): ̶ Progressive narrowing of lumen ̶ Insufficient blood flow to myocardium (ischemia) results ̶ Chest pain or angina pectoris occurs Signs and Symptoms of Coronary Heart Disease • Chest pain • Hypertension • Increased pulse • Increased respiration • Dyspnea on exertion • Pallor of skin • Light-headedness with exertion • Diminished peripheral pulses • Intermittent claudication—cramping of the lower extremities Treatment of Coronary Heart Disease • Antihyperlipidemic agents • Medications that lower triglycerides • Antiplatelets (aspirin) • Antihypertensives • Antianginals (nitroglycerin) • Antimicrobials Angina Pectoris: An Overview • Chest pain caused by myocardial ischemia from reduced blood flow and/or reduced oxygen supply to the myocardium • Angina is a warning sign that a heart attack (MI) may occur Angina Pectoris: An Overview (cont’d) • Aerobic metabolism switches to anaerobic metabolism: ̶ Lactic acid buildup ̶ Release of histamine, bradykinins, and enzymes, which stimulate nerve fibers in the myocardium, sending pain impulses to the central nervous system Angina Pectoris: An Overview (cont’d) • Other causes of decreased oxygen supply to the myocardium: ̶ Congestive heart failure ̶ Congenital heart defects ̶ Pulmonary hypertension ̶ Left ventricular hypertrophy ̶ Cardiomyopathy ̶ Severe hypertension ̶ Narrowing of the aortic valve Angina Pectoris: An Overview (cont’d) • Other causes of decreased oxygen supply to the myocardium (cont’d): ̶ Leakage of the aortic valve ̶ Ventricle wall thickening ̶ Atheroma leading to arterial narrowing • Silent ischemia—decreased oxygen supply with no pain Causes of Increased Oxygen Demand • Causes of increased oxygen demand on the myocardium: ̶ Anemia ̶ Exercise ̶ Thyrotoxicosis ̶ Substance abuse, particularly cocaine ̶ Hyperthyroidism ̶ Emotional stress Four Types of Angina • Stable: ̶ Caused by specific amount of activity ̶ Predictable ̶ Relieved with rest and nitrates • Unstable: ̶ Pain occurs with increasing frequency, severity, and duration over time ̶ Unpredictable ̶ May occur at rest ̶ High risk for MI Four Types of Angina (cont’d) • Prinzmetal’s (variant): ̶ Has no identified cause ̶ May occur at same time of day ̶ May intensify or worsen over time ̶ Is usually caused by coronary artery spasm • Angina decubitus: ̶ Occurs when a person is lying down with no cause ̶ Occurs because gravity redistributes body fluids Signs and Symptoms of Angina • Pressure or heaviness in chest beneath breastbone—women are likely to have unusual types of chest discomfort • Pain may occur down shoulder or inside of arms, or in the throat, jaw, or teeth • Stomach pain, especially after eating • Sweating Signs and Symptoms of Angina (cont’d) • Light-headedness • Hypotension • Pulse changes • Indigestion Treatment of Angina • Antianginals (nitroglycerin) • Antiplatelets (aspirin) • ACE inhibitors • Beta-blockers • Calcium channel blockers • Thrombolytic therapy (if thrombi are the cause) • Oxygen administration • Percutaneous transluminal coronary angioplasty or coronary artery bypass graft to prevent MI Myocardial Infarction: An Overview • Death of cells in the myocardium, usually related to prolonged or severe ischemia • Necrosis, tissue damage, and sometimes death results • Cause of MI include: ̶ Sudden onset of ventricular fibrillation ̶ Embolus (most common cause) ̶ Thrombosis ̶ Atherosclerotic occlusion ̶ Prolonged vasospasm Myocardial Infarction Progression • Cellular injury occurs from lack of oxygen: ̶ If prolonged, will lead to cell death • Scar replaces muscle, but cannot contract or conduct impulses: ̶ Location of damage is determined by which artery is blocked • Damage begins at subendocardial level: ̶ Will progress to the epicardium within 1 to 6 hours Myocardial Infarction Progression (cont’d) • Damaged cells lead to decreased contractility: ̶ Less blood ejected by left ventricle with each beat ̶ Decreased blood pressure ̶ Decreased tissue perfusion Myocardial Infarction: Signs and Symptoms • Pain, typically in middle of chest, radiating to jaws, arms (usually the left), abdomen, and/or shoulders, and lasting 20 minutes: ̶ Possible to have no pain or atypical pan (particularly in females) ̶ Sudden onset of pain, not associated with activity Myocardial Infarction: Signs and Symptoms (cont’d) • Tachycardia • Excessive perspiration • Painful breathing and/or difficulty breathing • Anxiety/panic • Nausea/vomiting • Fever • Stomach pain, often confused with indigestion Laboratory Evaluation • Creatinine kinase • Trophin • Myoglobin Myocardial Infarction Complications • If more than 50% of heart tissue is damaged, severe disability or death will result Myocardial Infarction Complications (cont’d) • Pericarditis may develop up to 2 months later: ̶ Fever ̶ Pericardial effusion ̶ Pleurisy ̶ Pleural effusion ̶ Joint pain ̶ Rupture of heart muscle ̶ Ventricular aneurysm ̶ Blood clots ̶ Hypotension Treatment Following Myocardial Infarction • Antianginals (nitroglycerin) • Analgesics • Electrolyte replacement • Calcium channel blockers • Beta-blockers • Antihypertensives • Anticoagulants Treatment Following Myocardial Infarction (cont’d) • Antiarrhythmics • Thrombolytics • Oxygen • Mild antianxiety agents Heart Failure: An Overview • Inability of the heart to pump sufficiently to meet metabolic needs, leading to decreased tissue perfusion as a result of decreased cardiac output • Acute or chronic • Left sided or right sided • Systolic or diastolic Causes of Heart Failure • Hypertension • MI • Cardiomyopathies • Congenital heart disease • Valve disorders • Side effect of medication or alcohol Types of Heart Failure • Systolic dysfunction: ̶ Heart contracts with less force and cannot pump out as much blood to the rest of the body as normal ̶ Blood accumulates in the ventricles and veins • Diastolic dysfunction: ̶ Heart is stiff and does not relax after contracting ̶ Heart does not allow as much blood to enter its chambers from the veins, and the blood accumulates in the veins Types of Heart Failure (cont’d) • Left sided: ̶ More common ̶ Fluid backs into lungs ̶ Signs and symptoms include: • Fatigue • Activity intolerance • Dizziness • Syncope • Dyspnea • Coughing • Pulmonary crackles • Tacycardia • urine output • Shortness of breath when lying down Types of Heart Failure (cont’d) • Right sided: ̶ Caused by pulmonary hypertension or right ventricular infarction ̶ Fluid backs into rest of body, with abdominal organ congestion and peripheral edema ̶ Signs and symptoms include: • Lower extremity edema in the ambulatory • Sacral edema in the bedridden • Liver engorgement and right upper quadrant pain • Anorexia and nausea • Jugular venous distension Types of Heart Failure (cont’d) • Biventricular (signs and symptoms of both left and right heart failure): ̶ Signs and symptoms include: • All symptoms of right and left heart failure • Dyspnea at rest • Hepatomegaly and splenomegaly • Abdominal pressure • Ascites • Anorexia • Nausea and vomiting • digestion and absorption of nutrients • Dysrhythmias • Cardiogenic shock or acute pulmonary edema Cardiac Cachexia • 10% to 15% of patients with heart failure develop cardiac cachexia • Loss of 6% of nonedematous body weight over 6 months • Concurrent loss of cardiac muscle mass as a result Cardiac Cachexia (cont’d) • Many other metabolic changes: ̶ Increased catabolic catecholamines ̶ Tumor necrosis factor is increased, contributing to a lower body mass index and catabolic state Treatment of Coronary Heart Disease • Diuretics • Dopamine • Analgesics • Antihypertensives • ACE inhibitors • Direct vasodilators • Antidysrhythmics • Cardiac glycosides (digitalis) • Aldosterone agonists Treatment of Coronary Heart Disease (cont’d) • Antibiotics, if necessary • Iron supplementation, if necessary • Supplemental oxygen • Nitrates • Beta-blockers • Anticoagulants References Academy of Nutrition and Dietetics. Nutrition Care Manual ® [by subscription]. Nutrition Care Manual Web site. www.nutritioncaremanual.org. Accessed December 1, 2013. Cleveland Clinic. Acute myocardial infarction. Cleveland Clinic Center of Continuing Education Web site. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/ cardiology/acute-myocardial-infarction/. Accessed December 1, 2013. Cleveland Clinic. Heart failure. Cleveland Clinic Center for Continuing Education Web site. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/ cardiology/heart-failure. Accessed December 1, 2013. References (cont’d) Raymond JL, Couch SC. Medical nutrition therapy for cardiovascular disease. In: Mahan, LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:742-781. The Merck Manual for Health Care Professionals. Cardiovascular disorders. Merck Manuals Web site. http://www.merckmanuals.com/professional/cardiovascular_disorders.ht ml. Accessed December 1, 2013. What is angina? National Heart, Lung, and Blood Institute Web site. http://www.nhlbi.nih.gov/health/health-topics/topics/angina/. Accessed December 1, 2013.