Nutritional Considerations in Cardiovascular Disease

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Nutritional Considerations in Cardiovascular
Disease
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Occlusive Disease

• Denotes plaques of sufficient size to narrow
  lumen and compromise blood flow.
• May result in one or more of the Five Ds

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Five Ds of Occlusive Disease

• Pain
• Pallor
• Pulselessness
• Paresthesia
• Paralysis

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Intermittent Claudication

• Term denoting pain with exertion that is relieved
  by rest.
• Most common location calf pain
• Most common precipitating event walking
• Pain graded on distance walked before symptoms
  occur.

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Evaluation

• Patient with intermittent claudication will show
  some diminished blood flow to involved
  extremity.
• Suspect narrowing in other vessels as well
  (brain, heart, e.g.)

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Management

• Measures to lower cholesterol
• Weight Management
• Exercise to tolerance
• Chiropractic adjustments

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Role of Vitamin E

• Vitamin E will prevent platelet aggregation and
  thus prevent blockage of narrowed arteries.

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Venous Disease

• Venous Thrombosis (DVT)
• Former terms thrombophlebitis (pain, tenderness,
  erythemia and inflammation)
• or phlebothrombosis (swelling, little pain, less
  swelling)

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DVT

• High Risk
• Post surgical (especially hip replacement)
• Bed Ridden
• Other vein disease
• Pregnancy
• Obesity
• COMPLICATION Pulmonary Embolism

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DVT

• Calf pain (typically)
• No history of recent trauma
• Red, hot, localized point of pain
• Swelling measure circumference
• Homans Test (only 50 specific and 50
  sensitive)
• Lowenbergs Sign

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Lowenbergs Sign

• Sphyg cuff on both mid-calves
• Simultaneous inflation
• Most Sensitive thrombus
• Normally can tolerate 180 mm. Hg.

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Varicose Veins

• Permanent dilatations of superficial veins.
• Contributing factors
• Venous Disease
• Pregnancy
• Obesity
• Prolonged standing

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Varicose Veins

• Signs Symptoms
• Dull, aching heaviness of legs
• Itching
• Edema
• Trendelenburg Test

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Trendelenburgs Test

• Patient supine leg elevated
• Place tourniquet around upper thigh and ask
  patient to stand
• If veins remain empty for 30 seconds then fill
  slowly from below
• Incompetent valves in sephenous/femoral area
• If fill rapidly then communicating veins
  incompetent

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Vitamin C

• Vascular Diseases of all types vastly improved
  with regular Vitamin C supplementation.
• Use ascorbic acid with the complex factors such
  as bioflavonoids
• The flavonoids have a lot to do with collagen
  formation

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Risk Factors for CAD

• Age (male gt45 female gt55)
• Family History
• Cigarette Smoking
• Hypertension gt140/90
• Low HDL
• Diabetes Mellitus

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Coronary Artery Disease

• Following significant atherosclerotic
  accumulation in coronary arteries, symptoms will
  develop.
• Angina pectoris is the chest pain associated with
  coronary artery disease

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Angina

• Chest pain of lt20 minutes duration.
• Pain is brought on by exertion and relieved by
  rest
• Can be described as sharp and stabbing or
  pressure-like and squeezing
• Not all persons with CAD have this symptom

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Angina (continued)

• If blockage exists in the absence of angina it is
  termed silent ischemia.
• The pain of angina is due to lactic acid build up
  in ventricles as a result of poor oxygenation due
  to blocked vascular supply of nutrients to heart
  muscle.

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Stable Angina

• The previously described angina is called stable
  or simple angina.

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Pre-infarction Angina

• There is another form called unstable angina or
  pre-infarction angina.
• It can occur at any time (even at rest or during
  the night)
• Denotes worsening of narrowed arteries
• I.E. Pre-Infarction

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Prinzmetal Variant

• A third type is due to vasospasm, called
  prinzmetal variant.
• This is related closely to stress
• There may be little or no coronary artery
  occlusion
• There may be superimposed CAD

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Angina

• May be improved with Vitamin E supplementation
• Do NOT tell the patient this!
• Just recommend the E and see what happens
• As chiropractors we are NOT authorized to treat
  heart disease.

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Pain Relief

• Mechanism of pain relief offered by Vitamin E
  supplementation is that Vitamin E acts as an
  anti-platelet aggregation factor
• Platelets that aggregate form small clots,
  blocking arterioles, causing ischemia

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B-6

• Supplemental Vitamin B-6 lowers levels of
  homocystine. Homocystine is a major cause of
  atherosclerotic plaque formation

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Coenzyme Q-10

• Beneficial nutrient for heart muscle
• Administration following heart attack improves
  recovery and is related to reduced repeat attacks
• Maintenance with Co-Q-10 thought to be preventive
• Widely used in Europe

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Copper

• Trace amounts of copper needed for all elastic
  tissue.
• Relevant to aortic disease

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Vitamin C

• The antioxidant role of C is beneficial in
  preventing atherosclerosis and in preventing
  already existing disease from progressing.
• Collagen component keeps vessels healthy

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Multiple Minerals

• A good balance of minerals play a role in
  electrolyte balance and benefits heart
  performance.

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Other Recommendations

• Exercise on a regular basis
• Weight Loss
• Prevent glucose intolerance
• Stress Reduction
• PMA

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Nutritional Help

• Dont attempt or claim to help CAD with
  nutritional intervention
• However
• With proper counseling, however, pain relief may
  be a realistic goal.

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Aortic Dissection

• Younger patient
• May have collagen disease or Marfans
• History of hypertension
• Stroke-like symptoms may accompany
• Must be transferred via ambulance anyway

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Recommendations

• Coronary Artery Disease improves with
• Weight Loss
• Regular Exercise
• Stress Reduction
• Positive Mental Attitude
• Anecdotal evidence of help through adjustments

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Aortic Dissection

• A false channel is forged in aorta and blood
  travels down this false channel. Can be a lengthy
  dissection into abdomen or a rather small
  dissection exits lumen and re-enters in a
  relatively small area.

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Aortic Dissection

• A rare and often fatal condition
• Approximately 2000 cases in U.S. per year
  (although with better diagnosis this number is
  rising)
• Associated with hypertension
• Associated with aortic valve disease

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Signs Symptoms

• Sudden, severe retrosternal chest pain
• May faint or have paresis
• If arterial branches cut off, may suffer organ
  failure
• If brain loses blood supply, stroke symptoms
• May extend into abdomen with symptoms

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Treatment

• Emergency medical treatment necessary
• Transfer via ambulance
• Need immediate lowering of blood pressure
• Surgery sometimes required, but poor prognosis
• Generally a younger person than in M.I.
• Smokers are more prone

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Non-dissecting Aneurysms

• Abdominal aorta is most common
• Other vessels may have, especially popliteal
• In brain, often called berry aneurysm

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Abdominal Aneurysm

• Very common condition
• In men over 65 years old
• Especially in smokers
• Especially in obese
• Often diagnosed as an incidental finding on
  abdominal radiograph
• Lateral film most likely to demonstrate

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Signs Symptoms

• Often is asymptomatic
• May see as pulsating mass
• May have abdominal bruit upon auscultation
• Aortic pulsations may palpate as wider than normal

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Chiropractic Treatment

• Should plan to alter techniques used to prevent
  damages
• Refer for diagnostic ultrasound (for evaluation)
• Often surgery is performed, unless a poor risk
  then may watchit
• DC better watch it too!

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Techniques

• No abdominal suspension
• No lumbar rolls
• Padding for prone lying

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Copper

• Copper participates in elastic tissue formation.
  Its absence creates a non elastic component that
  causes the muscular arteries to break down, i.e.
  aneurysms.