NUTRITIONAL

MANAGEMENT OF
CORONARY HEART
DISEASES
Submitted by: Nisha Yadav
61079
CORONARY HEART
DISEASES (CHD)
Coronary heart disease (CHD) encompasses a range of heart
and circulation disorders.
Common terms like coronary heart disease, coronary artery
disease (CAD), and ischemic heart disease (IHD) are often used
interchangeably but have distinct meanings.
CHD includes all heart diseases related to blood, circulation, and
structure.
CAD specifically refers to artery diseases, often due to
blockages.
IHD is typically a result of CAD, such as myocardial infarction
from atherosclerosis.
Major forms of acquired CHD
include dyslipidemias,
atherosclerosis, hypertension,
angina pectoris, myocardial
infarction, congestive cardiac
failure, and rheumatic heart
disease.
Cardiovascular diseases are
increasingly common and
significantly contribute to adult
mortality and morbidity, now also
affecting younger individuals.
 Overweight is a risk factor for
cardiovascular disease (CVD).
PREVALENCE
Obesity, a major risk factor for hyperlipidemia and
atherosclerosis, affects 14% of the rural and 27% of the urban
population.
 Urban populations are more affected due to a sedentary
lifestyle and preference for refined foods.
 Hypertension, a risk factor for IHD, affects 5% of the rural and
5-15% of the urban population.
 Diabetes mellitus, linked to cardio-myopathies like congestive
heart failure.
 CARDIOVASCULAR RISK
FACTORS
Factors are classified as modifiable and non-modifiable risk
factors.
A. Modifiable Risk Factors
[Link]
Smoking
Sedentary Lifestyle Habits
Dietary errors
2. Physiological
Hyperlipidemia
Hypertension
Obesity
Diabetes Mellitus
Hyperuricaemia and Gout
Fibrinogen
Platelet Aggregation
Lipoprotein (a)
Homecystiene Levels
 Low Birth Weight
3. Psychological
Stress
Low Socio-Economic Status
 Type A Personality: Competitive, ambitious, high stress, impatient,
achievement-oriented, prone to multitasking, difficulty relaxing,
associated with increased health risks.

4. Geographic
Soft Drinking Water
 Cold Weather
B. Non-Modifiable Risk Factors
Age
Sex
Heredity
Endomorphic Body Build: Endomorphic body build, identified by William H.
Sheldon, is characterized by a round or soft physique, tendency to store fat
easily, wider waist and hips compared to shoulders, shorter limbs, and a
challenge to lose weight with a slower metabolism.
DIAGNOSIS
Medical history, physical examination,
and various diagnostic tests are crucial
for identifying and assessing heart
disease.
Electrocardiogram (ECG): The ECG
is one of the simplest and most routine
tests used to diagnose heart diseases.
It provides information about heart
rhythms and electrical configurations.
ECG is the graph of the potential
difference induced by the heart muscle
activity. It shows signs of heart
damage due to heart disease and
signs of previous or current heart
attack.
X-ray: It provides the anatomical view of heart. It also reveals
signs of heart failure.
Echocardiography (ECHO): When the heart is seen with an
ultrasound it is called echocardiography. It provides information
about the size and shape of heart. Echo also shows areas of
poor blood flow and the areas of heart muscle that are not
contracting properly.
Stress testing: It is also called a treadmill test. In this test the
ECG is done while an individual walks on a treadmill. It is used
to determine the functioning capability of heart. It evaluates
chest pain with exertion and establishes severity of coronary
disease.
Blood tests: These are used to check the levels of
triglycerides, cholesterol (total, HDL, LDL), and sugar in the
blood. Abnormal levels of any component may be a sign that
risk for heart disease is increasing.
COMMON DISORDERS OF
CORONARY HEART
DISEASES AND THEIR
MANAGEMENT
 COMMON DISORDERS AND COMPLICATIONS OF
CORONOARY HEART DISEASES
Disorder/Compilation of CHD
(CHD)
Definition

Dyslipidemia Abnormal lipid levels in blood

Atherosclerosis A thickening and narrowing of the wall of the

large and medium sized blood vessels caused
due elevated to lipids and cholesterol
Hypertension Higher than normal blood pressure

Angina Pectoris A characteristic pain or discomfort in the chest

Myocardial Infraction An area of necrosis in a tissue

Congestive Cardiac Failure A clinical syndrome caused by heart disease

characterized by breathlessness, chest pain and
abnormal sodium and water retention
Rheumatoid Heart Disease (RHD) A complication of rheumatic fever and occurs
after attacks of this fever.
DYSLIPIDEMIA OR
HYPERLIPIDEMIA
Dyslipidemia is a medical condition
characterized by abnormal levels of
lipids (fats) in the blood, such as high
cholesterol, high triglycerides, or low
levels of high-density lipoprotein
(HDL).
It is a risk factor for cardiovascular
diseases.
There are five classes of lipoproteins in the blood. These
include:
1. Chylomicrons: It contains nearly 90% of triglycerides and
5% cholesterol.
2. Very Low Density Lipoproteins (VLDL): It contains about
60% of triglycerides and 10% cholesterol.
3. Intermediary Density Lipoprotein (IDL): This is rich in
cholesterol and Triglyceride. It contains about 40% of
triglycerides and 10% cholesterol.
4. Low Density Lipoproteins (LDL): It contains about 10%
of triglycerides and 45% of cholesterol.
5. High Density Lipoprotein (HDL): The high HDL content is
associated with decrease in the risk of atherosclerosis. It
contains about 3% triglycerides and 20% cholesterol.
Symptoms
1. Xanthomas : Yellowish deposits of fat underneath the
skin, often around the eyes, elbows, knees, and
tendons.
2. Xanthelasmas : Yellowish plaques on the eyelids.
3. Corneal Arcus : A white or gray ring around the cornea of the
eye.
4. Pancreatitis : Severe abdominal pain, nausea, and vomiting
due to very high triglyceride levels.
5. Cardiovascular Symptoms : Chest pain, shortness of breath,
or heart attack symptoms due to the development of
atherosclerosis (narrowing of the arteries).
Possible causes of elevated triglycerides:Possible causes of reduced Seriun HDL
levels:
Obesity Cigarette smoking
Uncontrolled diabetes Obesity
Genetic factors
Alcohol Hypertriglyceridemia
Genetic Lack of exercise
Uncontrolled diabetes
Liver disease Liver disease
Drugs Drugs (Progestational agents, steroids etc.)

Possible causes of elevated cholesterol:

Excess fat in the diet (saturated and cholesterol)
Overweight/Obesity
DIETARY MANAGEMENT
Energy: Caloric needs should be individualized based on age, sex, weight, height, and
physical activity level. A balanced diet is crucial.
Dietary Fats. Both the quantity and quality of fat are directly associated with the
elevation of most blood lipids. Particularly LDL.
It has largely been observed that high intake of fat particularly saturated fat results in
elevation of total cholesterol particularly LDLC. The foods that we consume contain
cholesterol, saturated, monosaturated and polyunsaturated fatty acids.
A) Cholesterol: It is a natural component of foods such as mutton, pork, ham,
sausages, lamb, chicken, eggs (yellow), whole milk, cheese, ice-cream, butter and desi
ghee. Cholesterol is present only in animal kingdom and does not exist in vegetable
kingdom. Increased cholesterol in blood is called hypercholesterolaemia, which leads to
atherosclerosis.
Fat: <15-20% of total energy
Dietary cholesterol: <200-300 mg/day
B) Saturated Fatty Acids (SFA): These are found mostly in animal fats as white
marble-like solid at room temperature. Red meats are rich in it. The energy
provided from saturated fats should always be 10% of the total calories.
Foods rich in saturated fatty acids (SFA: Milk fat, butter, pure ghee, coconut oil,
palm oil, margarine, vanaspati, red meats(mutton)
C) Monounsaturated fats (MUFA): These are liquid at room temperature. MUFA is
an excellent fat as it reduces the LDL levels and increases the good HDL levels
and cholesterol, thus preventing atherosclerosis. Oleic acid is a
monounsaturated fatty acid of great clinical relevance.
Oils high in monounsaturated fatty Acid (MUFA): Canola oil, olive oil and
rapeseed oil.
D) Polyunsaturated Fatty Acids (PUFA): These are also liquid at room
temperature. There are two main types of dietary PUFA’s of significance:
a) Linoleic acids (LA/n-6) present in good amounts in sunflower, corn and
sesame oil.
B) Alpha linolenic (ALNA/n-3) fish oils, to some extent olive oil, mustard and
rapeseed oil.
The ratio of n-6:n-3 between 5-10 is considered healthy.
Carbohydrates: Provide 60-70% of our total calorie needs of the body. If
taken in excess, it is converted to fat in the body.
Monosaccharides gel absorbed the fastest and polysaccharides get absorbed
the slowest. This is because polysaccharides contain more fibre.
Fibre is beneficial for cardiovascular disease and is found as water-insoluble
and water-soluble type. Soluble fibre like pectin, gums reduce cholesterol
levels. Intake of about 20-40g of soluble fibre has proven to be beneficial.
Proteins: While the quantity of protein does not impose any significant
impact on the serum lipoproteins. Consume plant origin proteins over those
of animal origin in view of the fact that plant origin foods, which are good
sources of pre generally rich sources of dietary fibre, have low amounts of
saturated fat and devoid of cholesterol. Egg white and lean meats (meat
without fat) should be the preferred options in case of animal foods.
Vitamins:
Vitamins E, C, and A act as antioxidants that scavenge cell-damaging free
radicals.
-Vitamin A is found in green and yellow fruits and vegetables, lycopene in
tomatoes, and anthocyanin in grapes and berries.
- Vitamin E-rich foods include buckwheat, corn, almonds, sunflower seeds,
spinach, and soybeans.
Minerals: The three most important minerals are chromium, zinc and
magnesium. These minerals play a critical role in maintaining proper insulin
function.
Low intakes of calcium can also be a risk for cardiac disorder. Sodium added
to the food or sodium-rich foods need to be restricted in cardiovascular
diseases.
Dietary guidelines fur hyperlipidemic patients-A summary.
Calories: to maintain ideal body weight.
Carbohydrates should constitute 55-65% of calories with emphasis on
polysaccharides (complex carbohydrates)
Sugar less than 10% of total calories
Dietary fiber: > 40 g/day
Proteins: 15-20% of modified energy
Fat: <15-20% of total energy
Dietary cholesterol: <200-300 mg/day
Cholesterol and fat intake could be decreased by:
Avoiding whole milk, cheese, curds made from whole milk. Skimmed milk or
toned milk may be used.
Organ meats (brain, liver, kidneys), egg yolks, cold meats, canned and
sausages, ham, frankfurters, peanut butter should be avoided instead fish
and poultry (baked and steamed) can be taken.
Baked foods made with refined flour (maida) like cookies, patties, pastries,
cakes, samosas etc. must be avoided. Whole wheat flour snacks may be
encouraged.
 All fats especially butter, margarine, cream, coconut oil, hydrogenated fats
must be avoided. Instead, oils rich in polyunsaturated fatty acids
(safflower, soyabean, sunflower) and monounsaturated fatty acids (olive
oil, peanut oil, rapeseed oil) may be used.
 Fresh fruits, canned or dried fruits (limited amounts) could be consumed
and fruits with cream, butter, ice creams or dips avoided. Vegetables could
be consumed except root vegetables in large quantities.
Triglycerides could be decreased by:
limiting foods high in fats
decreasing sugar and sugar containing foods (carbonated beverages, fruit
drinks, sweet snacks and desserts, honey, jam, jelly, chocolates and candy)
decreasing alcohol intake
reducing portion size
striving for reducing weight, and
 increased physical exercise
2. ATHEROSCLEROSIS: A
CORONARY ARTERY DISEASE
Atherosclerosis is a condition
where the arteries become
narrowed and hardened due to
a buildup of plaque, which is
made up of fat, cholesterol,
calcium, and other substances
found in the blood. This can
restrict blood flow and lead to
serious cardiovascular
problems, including heart
attacks, strokes, and peripheral
artery disease.
Etiology
Various factors are responsible for atherosclerosis. These
include:
1. Hyperlipidemia: Excess circulating fats in blood especially the low density
lipoprotein (LDL) and low levels of high density lipoprotein (HDL) can predispose
to atherosclerosis.
2. Hypertension: HT can accelerate atherosclerosis and cause complications.
3. Diabetes mellitus: An important risk factor commonly associated with
hypertension, due to abnormalities of coagulation, platelet adhesion and
aggregation, increased oxidative stress, and abnormalities in vessel vasomotion
can be a high risk for atherosclerosis.
4. Obesity: Excessive triglycerides (hyperglyceridemia) and LDLC levels ore
commonly present in obese and lower HDL levels are a great independent risk
factors for atherosclerosis.
5. Lifestyle: Low physical activity, cigarette smoking could affect tlie rate of
atherosclerosis, increased CAD risk, On the other hand, regular exercise is seen lo
be protective
Symptoms
 Excessive weight
 Hypertension
 High levels of cholesterol and triglycerides.

Complications
 Myocardial infarction
 systolic and diastolic dysfunction
 inflammatory problems
 stroke, gangrene (death and decay of body tissue) and aneurism (blood
filled dilation of a blood vessel).
NUTRITIONAL MANAGEMENT
GOALS
The nutritional management goals include:
Reduction of weight if overweight or obese
Reduction in the intake of total fat, saturated fat and cholesterol
Medication if required for treating lipid disorders and controlling BP
Lifestyle changes-increase in physical exercise, moderation in alcohol intake.
No smoking, restricting coffee
Consuming a balanced adequate diet, rich in calcium, chromium, iron and
zinc
 Medical management is through various lipid lowering drugs
HYPERTENSION (HT)
Hypertension, or high blood
pressure, is a condition
where the force of the blood
against the artery walls is
consistently too high, often
defined as having a blood
pressure reading of 140/90
mmHg or higher. It can lead
to serious health problems
like heart disease, stroke,
and kidney failure if not
managed properly.
Major complications of hypertension includes:
Kidney disease Left ventricular hypertrophy
Kidney failure Heart failure
End-stage renal disease Left-side heart failure
Stroke
Heart disease Cerebrovascular disease
Hardened arteries Eye complications
Cerebral haemorrhage
Cardiovascular disease Impaired vision
Angina Retinal damage
 Heart attack • Death
CLASSIFICATION OF
HYPERTENSION
Primary hypertension : High blood pressure in absence of any underlying disease.
 Benign hypertension : When hypertension remains in its early stages for a prolonged
period of time and without a specific known cause.
 Malignant hypertension : Malignant hypertension is a term that has been used to describe
patients with elevated blood pressure (BP) and multiple complications (End organ damage)
with a poor prognosis.

Secondary hypertension : Elevated blood pressure due to some underlying disease.

 Cardiovascular hypertension
 Endocrine Hypertension
 Renal Hypertension
 Neurogenic Hypertension
 Pregnancy induced hypertension
Etiology
1. Genetic factors: Currently it is believed that there is
polygenic inheritance and when environmental factors are
not healthy, hypertension is precipitated.
2. Body weight and height: Hypertension increases with
increase in the weight and height. Hence those who are
obese have higher blood pressure values. Increase in BMI
increases hypertension.
3. Age: Increases steeply with age. Now scientists have
found shifts in BP. It is found in adolescents and the
young as well.
4. Gender: Rise is greater in men than women but after
menopause, the difference decreases.
5. Factors that may increase reabsorption by sodium can
cause hypertension.
6. Changes in rennin-angiotensin: Aldosterone system and
excretion of adrenocorticoids and prolactin may affect blood
7. Hyperinsulinemia of obese may influence blood pressure
susceptibility through renal sodium reabsorption and transport.
8. Dietary factors: Excess calories, fats especially saturated fat
and cholesterol in large quantities can increase blood pressure.
Possible role of chloride, low potassium (K) and high sodium
diets is a suspect. Less calcium and magnesium in diet could
cause hypertension.
9. Modern lifestyle: Sedentary life devoid of exercise, stress,
smoking, tobacco intake, alcohol are pointing towards increases
in blood pressure.
Treatment and Management of Hypertension

- Primary hypertension is first treated with diet and lifestyle changes.

- If these changes aren’t enough, medications are prescribed.
- Even with medications, dietary management remains crucial to minimize
drug dependency, side effects, and dosage.
NUTRITIONAL MANAGEMENT
Energy: Calorie requirement should be based on the concept of maintaining
an ideal body weight. Excess calories through fats and carbohydrates have
to be reduced so that the weight is maintained.
Proteins: Normal protein intake is recommended. Protein should contribute
15-20% of the total energy needs. Excess non-vegetarian foods especially
red meat and egg yolks could be avoided as it has greater proportion of
saturated fatty acids.
Fats: The fats incorporated in the diet should be rich in unsaturated fatty
acids and should not provide more than 20% of the total energy (refer
dietary management of dyslipidemiafor details).
Carbohydrates: About 60-65% energy should be provided from
carbohydrates which are polysaccharides (complex carbohydrates) rather
than simple sugars (monosaccharides and disaccharides).
Minerals and Electrolytes: Minerals and electrolytes of clinical significance include
calcium, sodium and potassium.
Calcium (Ca): Adequate calcium intake is an essential part of the treatment and this
could be ensured through intakes of milk and milk products and green vegetable as well
as adequate cereals and pulse intakes,
Sodium: Studies have shown that sodium restrictionalong with weight reduction. Is
effective in controlling mild to moderate hypertension (1-2 g/day) along with diuretics
recommended. Depending on the severity of hypertension, different levels of sodium
intake can be recommended. These include:
Mild Sodium restriction:2-3 g sodium (2000-3000 mg). Salt may be used lightly in
cooking, but no salt at the table is allowed. There is no restriction on naturally occurring
fresh foods but processed foods should be avoided.
Moderate Sodium restriction: 1 g sodium (1000 mg). In addition to the above restrictions,
some control in naturally occurring fresh foods and no salt in cooking is added.
Vegetables with high sodium content are limited in use, canned vegetables and baked
products are avoided. Meat and milk products are used in moderate amounts.
Strict Sodium restriction: 0.5 g sodium (500 mg). Apart from the restrictions stated
above, meat, milk and eggs are allowed in small portions and vegetables with higher
sodium content are avoided.
Severe Sodium restriction: 0.25 g sodium (250 mg). This level is too restrictive and
nutritionally inadequate and realistic to be used practically. In this, restricted quantities of
meat and eggs are used only occasionally.
Patient care plan for hypertension
Lifestyle changes: Avoiding smoking, use of tobacco, and
excess alcohol intake. Physical activity like walking, 4 times a
week for 40 minutes, is beneficial.
Medications: Diuretics, calcium channel blockers and others
should be consumed regularly.
Nutritious balanced diet: The diet of a hypertensive should be
nutritious. It should be low in calories (if required) and fat with a
normal protein content. It should be low in sodium but rich in
potassium, calcium, magnesium and fibre. Currently the DASH
diets are recommended. These are rich in fruits and vegetables,
non-fat dairy products and low in total as well as saturated fats.
ANGINA PECTORIS
Chest discomfort is often reported by most patients especially those which
are chronic cases of dyslipidemia and/or hypertension. Like diarrhoea and
fever, angina pectoris is a symptom and can appear in any cardiovascular
disease condition. It is a tight choking feeling in the chest brought about by
effort or less often by excitement. It is worse in cold weather or after heavy
meals and is due to lack of blood to heart muscles. The angina could be
stable or unstable. The stable angina shows no changes in the patterns of
frequency or severity. The unstable angina becomes increasingly severe and
the pain develops with less and less effort. It is sometimes called the brittle
angina’.
Most common causes associated with angina pectoris are
enumerated herewith:

The usual cause of angina is the narrowing of the major

coronary artery due to atherosclerosis.
Systemic hypertension increases myocardial demand and if the
supply of blood to the heart muscles is less, it can cause
angina.
Heart disease: In late stages of aortic stenosis (narrowing of
aorta) it can precipitate an anginal attack.
Anaemia: The heart gets less oxygen due to’lack of
haemoglobin in anaemia.
 Thyroid disease: Thyroid disease is associated with angina.
Symptoms
- Chest pain or discomfort, often described as pressure, squeezing,
or heaviness
- Pain in the shoulders, arms, neck, jaw, or back
- Shortness of breath
- Nausea
- Fatigue
- Dizziness
- Sweating
Treatment and dietary management
Dietary management is the key component in
preventing the progression of underlying
disease condition.

The most vital objectives of dietary and life style management include:
To maintain ideal weight for age
To lower blood pressure through drugs and diet control
To avoid exertion and unnecessary stress
 To follow a prudent diet/DASH diet
MYOCARDIAL INFARCTION
(MI)
It is an initial acute phase of cardiovascular disease caused by the blockage
of a coronary artery supplying blood to the heart.
Myocardial infarction, commonly known as a heart attack, occurs when blood
flow to a part of the heart muscle is blocked for a long enough time that part
of the heart muscle is damaged or dies. This is usually caused by a blockage
in one or more of the coronary arteries due to plaque buildup, leading to
severe oxygen deprivation in the heart tissue.
Symptoms of a myocardial infarction (heart attack) include:

- Chest pain or discomfort, often described as pressure, squeezing, or

tightness
- Pain or discomfort in the arms, back, neck, jaw, or stomach
- Shortness of breath
- Nausea or vomiting
- Feeling lightheaded or dizzy
- Sweating
- Anxiety or a sense of impending doom
Energy: The calorie requirements for myocardial infarction (heart attack)
patients depend on factors such as age, sex, weight, height, activity level,
and overall health status. In general, it’s important to ensure an adequate
calorie intake to support recovery and overall well-being while maintaining a
healthy weight.
For adult males, calorie needs typically range from 2,000 to 3,000 calories
per day, while for adult females, they range from 1,600 to 2,400 calories per
day, depending on factors mentioned earlier.
Protein: The protein intake generally remains the same as per the RDI i.e.
0.8 gm protein per kg body weight per day. Adequate amount of proteins are
necessary to promote regeneration of the necrotic tissues in the
myocardium, As we had mentioned earlier emphasis should be laid on plant
proteins and low fat animal products (skimmed milk, low-fat paneer, chicken,
fish and other marine foods).
Fat: Majority of MI patients are also hyperlipidemic and have elevated serum
triglyceride levels. In such cases, the calorie contribution from fat should not
be above 20% and the dietary cholesterol intake should remain below 200
Carbohydrates:
mg per day. Carbohydrates should provide 60% of the total energy.
However, emphasis should be laid on the inclusion of easy-to-digest simple
carbohydrates, which are low in fibre. Low fibre cereals, roots and tubers
should be served in a soft well cooked/ blended form (purees etc.).
CONGESTIVE CARDIAC
FAILURE (CCF)
Congestive cardiac failure (CCF), also known as congestive heart failure
(CHF), is a chronic medical condition where the heart is unable to pump
blood effectively to meet the body’s needs. This results in a buildup of fluid
(congestion) in the body’s tissues, particularly the lungs and legs.
Symptoms include shortness of breath, fatigue, swelling in the legs, ankles,
or abdomen, and difficulty exercising.
It can be caused by various conditions such as coronary artery disease,
hypertension, and heart valve disorders. Treatment typically involves
lifestyle changes, medications, and in some cases, medical procedures or
surgery.
Etiology
The causes of this disorder can be numerous. The risk factors which
are known are:
Chronic hypertension
Left ventricular hypertrophy
Coronary heart disease (recurrent episodes of IHD particularly
myocardial infarction)
Diabetes
Advancing age
Viral damage
Alcohol abuse
Injury
Symptoms
The most common symptoms seen are:
Fatigue, faintness and weakness
Swelling of feet and ankles
Shortness of breath even after lying down, loss of appetite,
indigestion, nausea
and vomiting
Inadequate cardiac output
 Altered fluid balance (oedema)
 Cardiac cachexia (severe malnutrition)
 Decreased urine production
DIETARY MANAGEMENT
Energy: Energy requirements for congestive cardiac failure patients are
determined by residual cardiac function and usual body weight, considering
the need for oxygen support; a balance is sought to prevent nutritional
deterioration and excess weight gain, aiming for around 10-25 Kcal/kg IBW
or usual body weight per day. Patients on artificial oxygen support systems
or obese individuals may be prescribed a 1200 Kcal diet to alleviate cardiac
workload and prevent excessive weight gain.
Protein: Protein requirements remain the same for healthy adults, about 0.8 g per
kg of body weight. Good amounts of dietary proteins, especially high biological
value proteins, are essential for congestive cardiac failure to support tissue
synthesis. Emphasis should be on plant proteins, low in sodium, rather than animal
proteins.
Carbohydrates: Carbohydrate quantity remains around 60% of total energy
intake, but quality needs modification. The diet should be low in fiber and include
simple carbohydrates like semolina, refined flour, rice, dehusked pulses, papaya,
mango, brinjal, pumpkin, and gourd. Avoid whole cereals and pulses, legumes,
lotus-stem, cabbage, and soya flour.
Fat: The type and amount of fat should be tailored to the severity of
hyperlipidemia and adiposity, emphasizing oils rich in monounsaturated and
polyunsaturated fats while avoiding saturated fats, with total fat intake not
exceeding 20% of total energy, and the diet being low in cholesterol (<200
mg/day) based on the patient’s lipid profile.
Minerals: Sodium intake should be 135-145 meq/L and potassium intake
3.5-5.0 meq/L, with mild to moderate sodium restriction (2.0-3.0 g Na per
day) advised for most patients, including avoidance of table salt, cooking
salt, high sodium fruits and vegetables, processed foods, and preserves, with
the extent of sodium restriction determined by severity of sodium and water
retention.
Vitamins: The requirements of all vitamins remains the same as per the
RDI. If the patient is also suffering from hyperlipidemia/atherosclerosis,
liberal intake of vitamin A, vitamin C and folic acid may be helpful.
RHEUMATIC HEART DISEASE
(RHD)
Rheumatic heart disease (RHD) is a condition that develops as a
complication of rheumatic fever, which is caused by an untreated
streptococcal infection, usually strep throat or scarlet fever. In RHD, the
heart valves are damaged by the body’s immune response to the
streptococcal infection, leading to inflammation and scarring of the heart
valves. This can result in valve dysfunction, causing symptoms such as chest
pain, shortness of breath, fatigue, and palpitations. If left untreated, RHD can
lead to serious complications such as heart failure, stroke, or infective
endocarditis. RHD is largely preventable with prompt treatment of
streptococcal infections with antibiotics.
Symptoms
Symptoms generally appear after 1 to 6 weeks of the fever and
sometimes the infection may have been too mild to have been
recognized. The symptoins are fever, fatigue, shortness of breath, fainting,
palpitation and chest pain. Swollen, tender, red, painful nodules or small
protuberances may appear. There could be red, raised, lattice-like sash and
uncontrolled movements of arms, legs and facial muscles.
Complications
Inflammation of lining of heart (pericarditis), anaemia, heart
enlargement, valve deformities (mitral and tricuspid valves),
embolism, arrythmia, abdominal pain, fever, arthritis etc.
Dietary recommendations for the prevention of coronary heart
disease (WHO)
REFERENCES
 Raghuvanshi, R. S., & Mittal, M. (2014). Diet in cardiovascular disease. Food
nutrition and diet therapy (1st ed., pp. 196-226). Westville Publishing House.
 Sharma, R. (2019). Nutritional management of Coronary Heart
[Link] Management of Coronary Heart Diseases.(pp.243-277).
New Delhi: Indira Gandhi National Open University. Retrieved from
[Link]
THANK YOU