THE RISK FACTORS OF NUTRITIONAL DISORDERS

TO THE CARDIOVASCULAR SYSTEM

The disease of the heart

1. Ischaemic heart disease
2. Hypertensive heart disease
3. Rheumatic heart disease
4. Pulmonary heart disease
5. Congenital heart disease
6. Thyrotoxic heart disease
7. Heart disease in other forms

Heart ; Blood Suplly Vascular Myocardium/Nutrient

In other to perform the heart work, the myocardium needs to be nourished

and oxygenated from an adequate suplly of blood trough the aorta
and coronary arteries.

ISCHAEMIC HEART DISEASE (IHD)

(CORONARY HEART DISEASE = CHD)

The failure of the coronary arteries to suplly sufficient blood to the

myocardium, which
are almost invariably associated with arthero sclerosis of the coronary
arteries.

1. MYOCARDINAL INFRACTION
* Myocardial Ischaemia sudden death

heal with scar

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 - severe
- return to normal life
- increase risk of second infarct
*Thrombus Blocks the lumen of coronary artery
*Atherosclerosis narrowed the lumen
the blood flow is insufficient to suplly the
oxygen

2. ANGINA PECTORIS

(Pain in the ceast)

severe cardiac pain limits the activity

- remain live and free of any disability so long as the patient
keeps within the limits of exercise tolerance.
- increase risk of - sudden death
- infraction

Due to ; - unusual exertion

- myocardinal infraction

3. SUDDEN DEATH

Have : - angina Pectoris

- myocardinal infraction

The death presumed to be due to IHD

Sometimes the death is unexpected
But in autopsy ; - old infract
- exstensive atheroma

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 However the cause of the suddenthly of the death still remains
unexplained.
Might be - minor painless ischaemia interrupt the
electrical conduction
- release of stored regulatory hormones
(catecholamine)
- disturbanceof regulatory ios (hypoxic disionism)

Note :

The pain of ;
Angina pectoris : - directly
- quatitativately releated to exertion
- induced by emotion

Myocardial infacrction - occurs at rest

- induced by prolonged exertion or acute
anxiety

ATHEROSCELEROSIS

- Degenerative arterial disease

- Habitual diet the presenting of the fatty acid in the lipid
of serum and tissues

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THE DEVELOPMENT OF ATHEROMA

4 Stages (WHO)

1. Fatty Spot :
- in tunica intima of the vessel
- thickenings of the intima
- slightly raised a long flattened yellow streak
- the elevation of the intima due to the formation of connective
tissues cells, distended, contains cholesterol within the fat
droplets.

2. Fibrous Plaque :
- between tunica intima and tunica media
- circumscribed, firm, grey/pearly white
- diameters, 1- several mm, irregular
- the plaques become larger, project into the lumen (medium size
of artery)

3. Soft Plaque
- contains large amounts of fatty material, softened

4. Break Down
- plaque surface, break down
- atheromatous ulcer ragged irregular edges
- fibrous tissue at the base of the ulcer scarring
- vessel narrowed and distort slowing down the flow of blood
- deposit of calcium haemorrhages occure in the base

Thrombus - ulcer debris / fibrin

- fat, cholesterol
- calcium
- blood corpucles
(clotting mechanism)

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THE PREDISPOSITION OF THE THICKENING OF INTIMA;

- Intima injury (platelet aggregation)

- Lipid accumulation (irreversible)

Fibrin in the process of the ulcer formation traps red corpucles

Thrombus

A minute clots dissolved by fbrinolytic system

Previous meal, physical exercise, smoking, e.t.c may effect platelet

adhesiveness and fibrinolytic activity.

Epidemiology of HD
- man in well to do classes
- men + 45 yr, women unknown (>50 yr)
- the greater percentage of death, 35 40 yr
- the lower incidence is from the poor immigrants and under /
develop countries (include ASEAN)

AETIOLOGY

Familial ; - inherited
- environmental experience of hypertension, diabetes,
gout and axanthomatosis.

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PREVENTION

1. DIET
Fats ; hyperlipidemia, hyper

- decrease intake of animal fat (SFA)

- correlation - incidence IHD - total dietary fat
- total fat - saturated fat
- no proof that dietary fats have an important role in the aetilogy of
IHD
- more depend on the plasma cholesterol concentration
- intake saturated fat >> plasma cholesterol >> IHD

CARBOHYDRATES

Intake sucrose Atherosclerosis

Plasma triglydrat >> deposit fat (FA)

Carbohydrate fat

Increase plasma fat Atherosclerosis

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PROTEIN

In animal research : not to be important in the genesis of atherosclerosis

2. SEDENTARY LIFE

Exercise : - keep the balance between food intake and energy

expenditure
- physically active jobs protects against
IHD

3. SMOKING

- Pheriperal Vascular disease

IHD (Part myoc infraction)

Heavy Cig.smokers > do not smoke

(Death Incidence 1,5 2,5 times)

- the mechanism of nicotine or other tobaccos sonstituent causes this

adverse effect is still not clear

maybe due to :
- vasoconstrictor action
- undesirable effect on the level of plasma lipids
- blood coagulation
- the survival of platelet

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4. STRESS AND STRAIN

- Suggested to be predisposed to the atherosclerotic formation

- No difference between the have and the poor group of people and
also from the modern and undeveloped communities
- It is likely more close to the behaviour (the emotion)

5. POLUTION

Higher concentration of carbon dishulphide and sulphur

dioxide from the process in the manufacture of rayon may cause an
occupational toxic to be the aetilogy of IHD.

COMMUNITY PROPHYLAXIS

- food technology changes the costumary diet of the people

- the anxious promotion of the new product of food industry
- looks to the medical profession for guidance
- health education
- in daily food intake

REDUCE

- calorie (to prevent overweight)

- total consumption of fat
40% - 30% of the total number of calories
- saturated fat, increase the consumptionof polyunsaturated fat
- the consumption of sugar / sugar product

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INCREASE

- vegetables, fruits, potatoes, milk, fish, lean meat, cereal/cereal

product
- take regular exercise

The program require the co-operation among doctors health

workers, catering (in school, military forces, hospital, restaurants and
other similar institution.

Food industries have to pay attention to recommendation of the raw

products ad in its composition and processing.