Clinical 1: Chapter 13 CVD

A _____ mg sodium diet is a standard initial recommendation for individuals with heart failure.

2000

The DASH eating plan recommends daily servings of various foods including:

4-5 servings of fruits daily

Describe each of the components of nutrition intervention for heart failure, including sodium restriction, energy and protein requirements, fluid intake, and drug-nutrient interactions.

A 2000-mg sodium diet is a standard initial recommendation for individuals with HF. Adjustments to levels of 1500 mg or 1000 mg may be prescribed depending on the patient's individual medical condition, mainly fluid status. Protein: 1.1-1.4 g/kg Fluid: 1mL/kcal or 35mL/kg (restricted to <1-2L/d for HF patients with < 130 mEq/L serum sodium) Diuretics may lead to deficiency in potassium, magnesium, thaimin, riboflavin, folate, and B12

Which best describes surgical ventricular restoration?

A procedure that restores the normal geometry of the left ventricle by removing scarred areas of heart tissue.

As the atherosclerosis plaque grows, the artery at first compensates by expanding inward and decreasing the size of the lumen.

False As this plaque grows, the artery at first compensates by expanding outward and leaving the lumen size basically unchanged.

The causes of an acute MI or an unstable angina are plaque erosion, rupture of a plaque resulting in formation of a thrombus, and vasoconstriction.

True

The prevailing theory for the pathophysiology of atherosclerosis is that the disease begins as a response to injury that results in an inflammatory process.

True

The components of metabolic syndrome include elevated triglycerides, low HDL cholesterol, insulin resistance, elevated blood pressure, and:

abdominal obesity

_____ is a term used to describe the condition of persons who present with either an acute MI or unstable angina

acute coronary syndrome, ACS

The protein portion of the lipoprotein that provides structural integrity and allows for receptors to recognize the lipoprotein particle is called:

an apolipoprotein

It is not unusual for individuals to experience episodes of _____ in response to an increase in cardiac workload.

angina

A surgical procedure that typically uses the saphenous vein or internal mammary artery to "bypass' the blocked vessel is known as a _____.

coronary artery bypass graft, CABG

Which factor is associated with primary hypertension?

differences in genes that affect sodium retention

List the classifications of complications that can occur in a person who suffers a myocardial infarction.

disturbances of cardiac rhythm, heart failure, intracardial thrombi, pericarditis, cardiac rupture, papillary muscle dysfunction, and ventricular aneurysm

Which of the following is a physiologic contributor to intestinal ischemia?

exposure to endotoxin and inflammatory cytokine release

List the risk factors that are common in the development of coronary heart disease, peripheral vascular disease, and cerebrovascular accidents.

family medical history, age, sex, obesity, dyslipidemia, hypertension, diabetes, physical inactivity, and cigarette smoking

Gemfibrozil, a generic drug, that is used to reduce VLDL synthesis is classified as:

fibric acids

Immediate nutrition goals after a heart transplant are to supply adequate nutrients so the body can heal and:

fight infections

Write down the formula used for calculating blood flow and resistance.

flow = change in pressure / resistance resistance = (length of vessel x viscosity of the blood) / radius^2

Which is an example of a loop diuretic used in the treatment of hypertension?

furosemide (brand name: Lasix)

A _____ is a surgical procedure in which a person's failing heart is replaced with a healthy heart from a suitable deceased donor.

heart transplant

A dietician is educating a client on how to prevent infection after a heart transplant. Which foods would the dietician counsel a client to avoid?

homemade eggnog

The most common cause of heart failure in women is:

hypertension

Which lifestyle change is recommended to control hypertension?

increasing fruits, vegetables, and low-fat dairy to the diet

Postsurgery education on basic food safety after heart transplant should be provided since transplant patients are more susceptible to _____ due to immunosuppressant therapy.

infection

Typically, heart failure begins with the _____, the heart's primary pumping chamber.

left ventricle

A _____ is a medical device that mechanically pumps blood from the left side of the heart to the rest of the body in case of heart failure.

left ventricular assist device, LVAD

A dietician is helping a client with understanding the sodium content of food products to manage her hypertension. The label on a product reads "140 mg or less of sodium per serving." This product would be classified as:

low sodium

The right atrium and the right ventricle make up the right heart and pump blood through:

the pulmonary circulation

In the diet, _____ appear to behave similarly to saturated fatty acids in that they increase total cholesterol and LDL levels and perhaps lower HDL levels.

trans fatty acids, trans fats

What is the recommended amount of protein intake during the initial phase after a heart transplant?

1.5 - 2.0 g/kg

Describe the "5 A's" of nutrition counseling for hypertension.

Assess, Advise, Agree, Assist, Arrange focused on working with the patient instead of on the patient

Describe the components of the rapid eating assessment for patients (REAP) and give an example of a question applicable to each category of the assessment.

Assessment asks questions about different types of foods to assess average frequency of consumption

Discuss each of the following components when evaluating clinical hypertension: classification of blood pressure, major cardiovascular disease risk factors, and identifiable causes of secondary hypertension

Blood pressure classification: 1. Normal: <120 mm Hg systolic and < 80 mm Hg diastolic 2. Elevated: 120-129 mm Hg systolic and <80 mm Hg diastolic 3. Stage 1: 130-139 mm Hg systolic and 80-89 mm Hg diastolic 4. Stage 2: >/= 140 mm Hg systolic and >/= 90 mm Hg diastolic Major CVD risk factors include hypertension, obesity, dyslipidemia, diabetes mellitus, cigarette smoking, physical inactivity, microalbuminuria, eGFR <60 mL/min, increased age, and a family history of CVD Identifiable causes of secondary hypertension include obstructive sleep apnea, drug-induced states, chronic kidney disease, primary aldosteronism, renovascular disease, Cushing's syndrome, pheochromocytoma, coarctation of the aorta, and thyroid disease

_____ are medications that affect the movement of calcium, which causes the blood vessels to relax and therefore reduces vasoconstriction.

Calcium channel blocking agents, calcium channel blockers

List the components of the guide to medical nutrition therapy for CVD and dyslipidemia.

Choose whole grains, fruits and vegetables, low- and non-fat dairy, lean meats and limited egg yolks

Which information about fluid restriction is essential as part of educating a client with the risk of heart failure?

Count all beverages and foods such as soups, sherbet, and gelatin within the fluid allowance.

_____ geometries are subject to more abnormalities in blood flow and are more likely to suffer endothelial damage.

Curved and branching vessel

List examples of food items to choose and to avoid in the given categories to avoid cardiovascular disease: dairy products, fats and oils, and breads and cereals.

Dairy: choose low-fat cheese, 1% milk, yogurt, low-fat cottage cheese, low-fat or non-fat buttermilk and avoid regular cheese, cream, ice cream, whole-milk yogurt Fats & Oils: choose unsaturated oils, soft or liquid margarines, vegetable oil spreads salad dressings, seeds, and nuts and avoid food sources that contain trans-fat, saturated fat, butter, shortening, and stick margarine Breads & Cereals: choose whole grain breads, cereals, rice, pasta, low-fat crackers, and dry beans and peas ad avoid refined carbohydrates containing bakery products such as doughnuts, muffins, croissants, cakes, pastries, and baked goods

Current recommendations include maintenance of dietary fat intake within 10% - 15% of total caloric intake for patients with atherosclerosis.

False Current recommendations by the NCEP ATP III and the AND evidence-based guidelines include maintenance of dietary fat intake within 20% - 35% of total caloric intake.

An individual who is currently taking antihypertensive medication is not considered to have hypertension if the blood pressure normalizes as a result of the medication.

False If goal blood pressure is achieved with medication, the individual should continue current treatment and monitoring

Since the intakes of magnesium and calcium can directly impact the progression and management of HF, accurate assessment of both of these nutrients is essential.

False Since the intakes of sodium and fluid can directly impact the progression and management of HF, accurate assessment of both of these nutrients is essential.

Though many myocardial cells have the capability of generating spontaneous electrical activity, electrical activity us initiated in the atrioventricular (AV) node.

False Though many myocardial cells have the capability of generating spontaneous electrical activity, under normal conditions electrical activity is initiated in the heart at the sinoatrial (SA) node.

Which of the following statements is true of an echocardiogram?

It involves documenting the anatomy and function of the heart using sound waves

Which of the following statements best describes mean arterial pressure (MAP)?

It represents the resistance against which the ventricles must contract in order to eject blood into systemic circulation

_____ hypertension occurs as a result of another primary problem, such as kidney disease, other cardiovascular diseases, endocrine disorders, or neurogenic disorders.

Secondary

Name and briefly describe the stages of heart failure

Stage A: high risk, but no structural abnormality Stage B: structural heart disease but no symptoms Stage C: show symptoms and have underlying structural abnormalities Stage D: end-stage disease

Patients who have structural heart disease but demonstrate no symptoms of heart failure are classified as having which stage of the disease?

Stage B

Which is a true statement regarding a heart transplant?

The aorta and pulmonary arteries are not replaced as part of the surgery.

A comprehensive approach that addresses multiple lifestyle factors has the most significant effect on blood pressure control for hypertensive individuals

True

Clients with atrial fibrillation should be educated on foods that are high in vitamin K and how to check product labels for vitamin K contents.

True

Ischemic heart disease (IHD) is often misdiagnosed or undiagnosed in females because they tend to experience angina pain differently than men.

True

Which of the following medical procedures involves inserting a catheter from an artery in the groin to the site where blood flow is restricted?

angioplasty

Which of the following describes a noninvasive test used in patients with symptoms of PAD that measures the blood pressure in the ankles and compares it with the blood pressure in the arms at rest and after exercise?

ankle-brachial index

Signs of right-sided heart failure include distended neck veins, flushed face, and:

ascites

Which medication is recommended for a patient with atrial fibrillation?

aspirin

How do ACE inhibitors control hypertension?

by blocking the conversion of angiotensin II into angiotensin I

A long-term complication of heart transplant might be:

cancer

The repeating contraction and relaxation of the heart is termed the:

cardiac cycle

A dietician is using the CAGE questions to assess the intakes of saturated fat and cholesterol in a client's diet. The "C" in CAGE stands for:

cheese

_____ is used to determine the dosage of anticoagulant medication for patients with atrial fibrillation.

clotting rate, international normalized ratio, INR

Which is an example of a polyunsaturated fat source?

corn oil

PT, a 65-year-old-male, comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietician is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. Height: 5'9" Weight: 190 lbs Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 mg/dL LDL: 180 mg/dL HDL: 58 mg/dL TG: 234 mg/dL Diet routine: Breakfast- egg and sausage muffin, coffee Lunch- ham and cheese sandwich on white bread, potato chips, soda Dinner- chicken breast, mashed potatoes, iced tea, cheesecake Based on the available clinical data, what additional diagnosis might be made in this case?

metabolic syndrome

At the onset of atherosclerotic lesion formation, the damaged endothelial layer attracts platelets to the site of damage to form a small clot termed a _____.

mural thrombus

_____ produced in the endothelial cells controls the normal relaxation of smooth muscle in the arteries and arterioles.

nitric oxide, NO

As per research, how much daily intake of saturated fat is recommended?

no more than 7% of total kcal

PT, a 65-year-old-male, comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietician is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. Height: 5'9" Weight: 190 lbs Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 mg/dL LDL: 180 mg/dL HDL: 58 mg/dL TG: 234 mg/dL Diet routine: Breakfast- egg and sausage muffin, coffee Lunch- ham and cheese sandwich on white bread, potato chips, soda Dinner- chicken breast, mashed potatoes, iced tea, cheesecake Which is an example of a modifiable risk factor that contributed to PT's condition?

obesity

Atherosclerosis in the leg can result in _____ and possibly the tissue death associated with gangrene and even loss of a limb.

peripheral vascular disease, PVD

PT, a 65-year-old-male, comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietician is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. Height: 5'9" Weight: 190 lbs Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 mg/dL LDL: 180 mg/dL HDL: 58 mg/dL TG: 234 mg/dL Diet routine: Breakfast- egg and sausage muffin, coffee Lunch- ham and cheese sandwich on white bread, potato chips, soda Dinner- chicken breast, mashed potatoes, iced tea, cheesecake Which compound, when consumed twice daily, provides therapeutic effects against heart diseases?

plant sterols

During the development of atherosclerosis, platelets adhere to the subendothelial surfaces and secrete both adenosine diphosphate (ADP) and:

platelet-derived growth factor

The procedure that is used for the treatment of cardiac arrhythmias is called _____.

radiofrequency ablation

PT, a 65-year-old-male, comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietician is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. Height: 5'9" Weight: 190 lbs Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 mg/dL LDL: 180 mg/dL HDL: 58 mg/dL TG: 234 mg/dL Diet routine: Breakfast- egg and sausage muffin, coffee Lunch- ham and cheese sandwich on white bread, potato chips, soda Dinner- chicken breast, mashed potatoes, iced tea, cheesecake PT's diet is high in which component?

saturated fat

Symptoms of angina may include nausea, pain in the arm and neck, sweating, and:

shortness of breath

PT, a 65-year-old-male, comes to the emergency room complaining of chest pain. Several diagnostic tests conclude that he has suffered an MI. The registered dietician is consulted for nutrition education. PT reports that he has gained 30 pounds in the previous year due to his hectic work schedule, which forces him to eat out often. In addition, he is physically inactive. PT also reports that he has a family history of heart disease and his father died of an MI. Height: 5'9" Weight: 190 lbs Waist Circumference: 105 cm BP: 140/93 Cholesterol: 259 mg/dL LDL: 180 mg/dL HDL: 58 mg/dL TG: 234 mg/dL Diet routine: Breakfast- egg and sausage muffin, coffee Lunch- ham and cheese sandwich on white bread, potato chips, soda Dinner- chicken breast, mashed potatoes, iced tea, cheesecake A registered dietician may recommend which of the following additions to PT's diet to help decrease the absorption of cholesterol?

soluble fiber

The veins from the upper part of the body drain into the _____ vena cava.

superior

The force exerted by the blood on the walls of blood vessels during the contraction of the ventricle is termed _____.

systolic blood pressure

An _____ is defined as an unhealing break in the skin. Inadequate perfusion to the tissues (i.e., lack of oxygen) is the primary etiology for skin breakdown.

ulceration

Identify the pharmacologic therapy that is used to control symptoms of heart failure and limit damage to the heart.

using inotropic agents

Uncontrolled contractions of the heart ventricle that are often associated with myocardial infarction are known as:

ventricular fibrillation

A dietician is counseling a client with atherosclerosis on how to make therapeutic lifestyle changes. Which food item should the dietician advise the client to choose less often?

whole eggs