NUTRITION THERAPY

IN CARDIOVASCULAR
DISORDERS
Georgie S. De La Cruz BSND 3A
CORONARY HEART DISEASE (CHD)
 also known as ischemic heart disease (IHD), coronary artery disease
(CAD), coronary occlusion, atherosclerotic heart disease (ASHD), or
coronary thrombosis
 a common form of heart disease among individuals over 40 years of
age and is a leading cause of death.
 a condition in which the oxygen supply to the myocardium is
inadequate, usually due to atherosclerosis in the coronary circulation.
It can also result in hypertrophy of the cardiac muscle.
Modifiable and Unmodifiable Risk Factor
 Risk factors are conditions and habits that have been demonstrated to be
associated with an increased probability of cardiovascular disease.

Major risk factors for CHD other than LDL-C are the following:

• Age (men ≥ 45 years; women ≥ 55 years)

• Family history of premature CHD ( clinical CHD or sudden death
documented in first-degree male relatives before age 55 or in
the first- degree female relatives before age 65)
• Cigarette smoking
• Hypertension
• Low HDL-C (<40 mg/dL)
Risk Factors for Coronary Heart Disease

UNMODIFIABLE/IRREVERSIBLE

Hereditary A history of premature heart attacks in the

immediate family before age 55 can be a risk
factor.

Gender More common in men than women.

Age The likelihood of a heart attack before age

35 is very small. As a person ages, the risk
of developing CHD is greater. In a 65 year
old women, the risk is 2.5% and for men
5.3%.
MODIFIABLE/POTENTIALLY REVERSIBLE
Cigarette Smoking
High Blood Pressure
Obesity
Sedentary lifestyles
The major independent risk factor for a heart attack,
manifest as both fatal and non fatal myocardial
infarction and sudden cardiac death. Nicotine and by-
products of smoking are involved in the initiation and
progression of atherosclerosis. Smokers face two to four
times the risk of sudden cardiac death compared to
nonsmokers.
High blood pressure may be caused by narrowing or
tightening of the arteries. As systolic blood pressure
increases, the risk factor also increases.
Upper body and abdominal obesity compared with lower
body obesity is a risk factor in the development of CHD.
Obesity increases the workload of the heart by
interfering with chest
Physical inactivity makes a person more prone to CHD.
Regular exercise promotes conditioning heart, helps to
maintain weight, lowers blood pressure, increase HDL –
cholesterol improves glucose tolerance and insulin
sensitivity
Hyperlipidemia/hypercholesterolemia/ These conditions are associated with an intake of
hypertriglyceridemia fatty foods causing elevation of one or more of the
plasma lipids. These lipids becomes the fatty
deposits that cling to the arteries, eventually,
narrowing or blocking them. A 10-15% reduction of
blood cholesterol will reduce risk by 20-30%.
Diabetes mellitus The occurrence of CHD in individuals is twice that in
non-diabetics. Blood vessels are damaged by
diabetes mellitus, and damaged blood vessels are
more susceptible to hardening and subsequent
narrowing.
Emotional stress Persons who are subject to stress and strain or show
the type A behavior are associated with increased
risk of CHD.
ANGINA PECTORIS, TIAS
Angina pectoris, TIAs
 Characterized by pain in the region over the heart and stomach (precordial pain) which
may radiate to the neck, jaw, back, abdomen, and arms.
 Caused by myocardial ischemia and is associated with a disturbance of myocardial
function without myocardial necrosis.

STABLE ANGINA UNSTABLE ANGINA

- Precipitated by factors - Characterized by angina

that increase the oxygen
requirement of the heart,
which may include
exercise, smoking, eating,
anxiety, and exposure to
cold.
at rest as well as with
minimal exertion or the
occurrence of severe
angina superimposed on
a normal pattern of
stable, exertion-related
angina.
MYOCARDIAL INFARCTION
 Includes coronary infarction, coronary thrombosis, or heart attack. The ischemia
becomes so severe that the cardiac muscle cells become necrotic. The amount of
necrotic tissue (the size of the infarct) and the consequences depend on the
location of the occlusion.

 The principal symptom of an infarction is precordial pain, which the patient might
mistake for severe angina or indigestion. Changes in serum enzymes are
commonly used to diagnose an MI. Laboratory determination of serum glutamic
oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH), and creatinine
phosphokinase (CPK) are useful
Nutrition Therapy

 Diet modifications as indicated for atherosclerosis (TLC Diet) are

appropriate diet for angina patients, especially if hypercholesterolemia is
present.
 Patient should reach and maintain their DBW or be slightly underweight.
 The patient may also require stress management, activity, and proper
eating habits education.
 Small frequents feedings rather than three large meals are indicated.
 Adequate dietary fiber and fluid intake are necessary to avoid the
constipation with straining.
 If homocysteine levels are high, include more foods with folic acid,
thiamin, pyridoxine, cobalamin, and riboflavin.
 Caffeine intake is also restricted (less than 3 cups of coffee or equivalent
daily)
 The patient is initially given clear to full liquid diets to promote rest while
reducing the dangers of aspiration or vomiting is done.
 Caffeine intake is also reduced to avoid potential arrythmias.
 Fluid and dietary sodium (about 2 g daily) is individualized according to sodium
and fluid status.
 When solid foods are tolerated, the diet is progressed to soft, easily digested
foods that are low in saturated fats or cholesterol.
 Gas forming foods should be avoided.
 Small frequent feedings (3-6 meals) of soft easily digested foods that are low in
saturated fats or cholesterol are given to reduce cardiac work load.
 Adequate calcium, magnesium, and potassium will also be needed.
Maintenance diet after recovery from MI should be:

• Controlled calories to reduce the heart’s work and improve weight status in
overweight and obese.
• No more than 30% of calories as fat to be taken mostly in the form of unsaturated
fats.
• Sodium restriction at 2-4 g daily
• Adequate calcium, magnesium, and potassium
• Increased intake of folic acid, B1, B6, and B12 (when serum homocysteine levels are
elevated); and
• Enough fiber intake, 25-30 g daily.
CONGESTIVE HEART FAILURE (CHF)
 CHF is the condition when the heart fails to maintain a satisfactory circulation of the body’s
various metabolic needs.

 CHF results in reduced heart pumping efficiency in the lower two chamber leading to
inadequate blood circulation, congestion in liver and lungs or body circulation, pedal edema,
abdominal pain, ascites, and dyspnea. Although often seen in obese patients, it can also
occur with cardiac cachexia (anorexia and fat and muscle wasting with edema). Decreased
renal flow is common and BUN may be increased.

 CHF can be best treated by a combination of diet, rest, diuretics, digitalis, vasodilators and
oxygen therapy. It is best to treat the underlying cause of the condition if it can be identified.

 Primary diet for CHF is restricted in sodium.

NUTRITION THERAPY

 Aims to promote rest to the heart, control edema, control body weight, correct
nutrient deficit, and prevent severe malnutrition .
 Dietary concerns focus on restricting salt and fluid intake.
General Principles
 Dietary instruction regarding sodium intake is recommended in all patients with
CHF.
 Patients with CHF and diabetes, dyslipidemia, or obesity should be given specific
instructions regarding carbohydrate or caloric constraints.
 Dietary sodium restriction (2-3 g daily) is recommended for patients with the clinical
syndrome of CHF and preserved or depressed LVEF. Further restrictions (<2 g daily)
may be considered in moderate to severe HF.
 Restriction of daily fluid intake to <2 L is recommended in patients with severe
hyponatremia (serum sodium <130 mEq/L and should be considered for all patients
demonstrating fluid retention that is difficult to control despite high doses of diuretic
and sodium restriction.
 Measurement of nitrogen balance, caloric intake, and prealbumin will be useful in
determining appropriate nutritional supplementation. Caloric supplementation is
recommended. Anabolic steroids are not recommended for such patients.
SODIUM
 The degree of sodium restriction depends upon the severity of heart failure.
 About 1.0 to 2.4 g sodium is recommended in complicated cases. However,
providing 4-6 g sodium may be satisfactory to less severe cases.

Degree of Sodium Restriction Per Day

Degree of Restriction mg Na per day mEq Na

Severe 250 11
Very strict 500 22
Strict 1000 44
Moderate 2000 88
mild 3000 130
 Natural low-sodium seasonings, herbs and spices that can be substituted for salt:

For meat, Poultry, and Fish

Beef Bay leaf, dill, marjoram, thyme, nutmeg (in

meatloaf), onion, pepper, sage, basil, cumin
Lamb Mint, curry powder, rosemary, garlic, dill,
cinnamon
Pork Garlic, onion, sage, pepper, oregano, tamarind,
clove, coriander, ginger
Veal Tomatoes, bay leaf, curry powder, ginger,
marjoram, oregano, fresh mushroom
Chicken Lemon, ginger, thyme, marjoram, tarragon,
oregano, paprika, rosemary, sage, anise, garlic
Fish Bay leaf (for chowders), curry powder, chives,
dill, dry mustard, basil, marjoram, lemon juice,
paprika, pepper, rosemary, allspice, ginger,
thyme.
 For Vegetables:

Broccoli Lemon, garlic, oregano, rosemary

Carrots Rosemary, cinnamon, sage, cloves, marjoram,
nutmeg, caraway seeds, thyme,
Corn Parsley, cumin, curry powder, onion, paprika
Greens Garlic, pepper, onion
Green beans Dill, curry powder, lemon juice, marjoram, oregano,
tarragon, thyme
Peas Sage, ginger, parsley, marjoram, onion
Potatoes Rosemary, dill, garlic, onion, paprika, parsley, sage
Spinach Nutmeg, oregano, basil, rosemary, thyme, allspice,
lemon, mint
Squash Allspice, dill, marjoram, basil
Tomatoes Basil, dill, bay leaf, pepper, marjoram, onion,
vinegar, oregano, parsley, allspice, clove, sugar
For Rice and Pasta garlic, bay leaf, pepper, oregano, rosemary, sage
For Desserts Anise, cinnamon, nutmeg
ENERGY
 Provide small, frequent meals of soft-textured and easy to eat foods.

 Restrict calorie intake to reduce weight if the patient is obese or overweight and
maintain DBW.

 In severe failure with hypermetabolism, increase calories by 30-50% above basal

energy requirements. Calories should be distributed throughout the day in 5-6
small meals.

PROTEIN
 Protein intake may be increased from 1.1-1.5 g/kg body weight if malnutrition is
present.
FLUIDS AND BEVERAGES
 Generally 1-2 L of fluids is indicated for individuals with severe heart failure.
 Reduce or eliminate alcohol intake.
 Caffeine should be limited due to its potential to increases heart rate and cause
dysrhythmia.

VITAMINS AND MINERALS

 Drug nutrient interaction primarily associated with diuretics cause loss of nutrients,
which may require supplementation, especially of potassium, magnesium, zinc, folic acid,
and vitamin B6.
 Ensure that intakes of vitamins E, thiamin, pyridoxine, cobalamin, folic acid, and
riboflavin are adequate.
 The diet should be modified in consistency and texture: soft, bland, low roughage foods.
 Use of high calorie, low volume liquid supplements is also recommended to increase the
diet’s nutrient density
CARDIAC SURGERY
Two most common procedures are the coronary artery bypass grafts (CABG)
and percutaneous transluminal coronary angioplasty (PTCA).

 Atherectomy- shaved-off thin strips of the plaque.

 Laser angioplasty- which insert a catheter with a laser tip that burns or breaks down
the plaque.
 Bypass surgery- creates a new route for blood to flow around clogged arteries to the
heart. Bypass surgery relieves symptoms of heart disease but does not cure it.
 Angioplasty- opens clogged arteries by compressing plaque against the artery wall.
This is done by placing a catheter with a small balloon to the clogged artery.
 Cardiac transplant- is indicated in terminal CHF. Criteria for allowing this procedure
include younger than 55 years of age with normal liver and kidney functioning, non-
diabetic and free from pulmonary problems, PUD, and peripheral heart disorders.
 NUTRITION THERAPY

 The dietary management after cardiac surgery is designed to reduce the rate of
weight loss, maintain protein stores and support anabolism and healing.

Coronary Artery Bypass Grafts (CABG) and Percutaneous Transluminal Coronary Angioplasty (PTCA)

• Energy requirements are estimated using appropriate adjustments for activity and surgical stress
factor.
• Protein is given at 1.2 g/kg body weight during the catabolic postoperative phase and may return to
the usual requirements of 0.8-1.1 g protein/kg body weight.
• Modification of sodium, cholesterol, saturated fat, fluid and small frequent meals might also be
needed.
• The TLC diet is recommended as a maintenance diet at home and those who fail to lower lipids
after following the diet may require a more advanced regimen , limiting cholesterol further to 200
mg/day.
• Sodium limitation is often placed at 2000-3000 mg/day.
 Nutrition Therapy after a Cardiac Transplant
 Immediately after transplant, nutrient needs are increased. Given a high calorie,
high protein diets.
 Higher protein intake (1.2 to 2.0 g/kg body weight) is needed to counteract
catabolic effects of steroids and surgical stress.
 Ample protein is also needed for wound healing and tissue synthesis.
 Commercial nutrition supplements, given orally or by tube, will help increase nutrient
density of oral diets immediately after operation.
 Stimulant are omitted until full recovery.
 Fluids are limited to 1 L daily to avoid fluid overload.
 Intake of calcium, magnesium, and dietary fiber should be adequate.