Chronic Diseases and Comorbid Conditions: Cardiovascular Disease for ACE® Health Coach

True or False:

Coronary artery disease affects veins, arteries, and capillaries of the body.

False

CAD only affects the arteries.

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What are some intermediate tests used to check for CVD?

Exercise stress tests
Pharmacologic stress tests
Echocardiogram

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When a client previously diagnosed with CVD starts an exercise program, what is the recommended intensity level (in METs)?

2-3 METs

This can gradually increase over the span of 2-3 months, provided that they stay asymptomatic.

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True or False:

Those exercising at a vigorous activity level are at higher risk for reoccurring heart attacks than those who exercise at a moderate intensity.

True

Research has found that there is a potential for a plateau or decline in survival benefit at more extreme levels of endurance exercise. More research is needed, but it is believed to occur because excessive exercisers place more stress on the heart at one time and may also partake in other additional risks.

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Clients with hypertension and are at increased risk for CVD should follow what diet: vegetarian, American, or DASH?

DASH

The Dietary Approaches to Stop Hypertension (DASH) diet consists primarily of fruits, vegetables, lean protein sources such as chicken and fish, and low-dairy. This diet is naturally low in sodium, cholesterol, and fat, and has been shown to reduce blood pressure and decrease the risk of developing CVD.

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Cardiovascular disease is an umbrella term used to identify what other diseases?

Coronary artery disease
Stroke
Angina pectoris
Congestive heart failure

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What foods are shown to have cardioprotective properties?

Fish
Shellfish
White poultry and occasionally lean red meat such as bison
Minimally processed whole grains such as quinoa and brown rice
Fruits
Vegetables
Nuts and legumes such as beans
Vegetable oils including olive, canola, and soybean oil
Egg whites
High fiber foods such as beans, oats, and oatmeal
Water

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Which diet is better for individuals who have ischemic heart disease: vegetarian, Mediterranean, or the DASH diet?

Vegetarian

Research shows people who have ischemic heart disease that decrease the amount of red meat in the diet or consume a vegetarian diet have a lower risk of death, even after adjusting for potential confounding variables.

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Fill in the blank:

Each 10 bpm reduction in resting heart rate is found to reduce the risk of death by ____%.

30%

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True or False:

In the COACH trial, it was determined that dietitians and other non-drug-prescribing health professionals were less effective than traditional medicine at improving risk factors.

False

During the COACH (Coaching patients on achieving cardiovascular health), people working with non-drug-prescribing health professionals had a greater improvement in total cholesterol levels and other risk factors.

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Inactive clients with CVD should avoid what kind of activities?

High-intensity activity
Raquet sports
Skiing
Highly competitive sports such as basketball or football
Deer hunting
Snow shoveling

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What foods are shown to have anti-cardioprotective properties?

Dairy
Egg yolks
Refined grains such as white bread and rice
Processed meats such as hotdogs, deli meat, or bacon
Sugar
Sweetened beverages or diet sodas
Bakery goods
Fats, oils, or foods with partially hydrogenated vegetable oils
Tropical oils such as avocado or coconut oil
Salt
Alcohol

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What are the 5 A’s to healthcare?

Arrange
Assist
Agree
Advise
Assess

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Physical activity is considered to be anti-atherosclerotic. What does this mean?

Physical activity helps prevent atherosclerosis. It has this effect by:

Improving blood lipid levels
Decreasing blood pressure
Decreasing body fat
Decreasing inflammation
Increasing insulin sensitivity

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Fill in the blank:

Quitting smoking by age 50 can decrease a person’s risk of CVD by ____.

Half

People who quit smoking by age 50 cut their risk of CVD in half. Those who quit smoking by age 30 have the same risk for CVD as someone who has never smoked.

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What are the recommended treatments for precursor conditions that lead to CVD?

Behavior modification including regular exercise, quitting smoking, decreasing body weight, getting adequate sleep, and making healthier dietary choices.
Treating other precursor conditions with their respective medication (ie taking beta-blockers, aspirin, statins, or ACE inhibitors as prescribed to treat underlying conditions such as hypertension and high cholesterol)

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What causes atherosclerosis?

A combination of genetic, behavioral, and environmental factors that lead to high cholesterol levels.

Between 75 and 85% of the cholesterol in the human body is naturally made in the liver. Having high cholesterol from genetics is referred to as Familial Hypercholesterolemia and is caused by a genetic mutation where the body cannot remove LDL from the blood, regardless of how high HDL levels are.

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Fill in the blank:

Cardiovascular disease is responsible for one out of every _____ deaths each year.

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Three

CVD remains the leading cause of death in the US and most other developed countries worldwide.

What are some basic tests used to check for CVD?

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Chest x-rays
Resting EKG
Heart and vascular screenings
Risk factor profiling including blood pressure, blood work, and body measurements

Physical activity is considered to be antithrombotic. What does this mean?

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Physical activity reduces the ability of blood to clot while flowing through blood vessels. This is achieved by:

Decreasing platelet adhesiveness
Decreasing blood viscosity
Increasing fibrinolysis and fibrinogen

What are some potential cardioprotective effects of regular physical activity?

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Anti-atherosclerotic
Psychologic
Antithrombotic
Anti-ischemic
Anti-arrhythmic

Define:

Coronary Artery Disease

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Partially or completely obstructed arteries.

75-90% of heart attacks were caused by what?

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Lifestyle-related conditions including hypertension, diabetes, obesity, and chronic stress.

What are the AHAs Life’s Simple 7?

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Smoking
Hypertension
Obesity
Physical inactivity
Blood glucose levels
High LDL
Dietary risks

The AHAs Life’s Simple 7 refers to 7 simple changes that could decrease the risk of CVD significantly.

What are some of the risk factors for identifying CVD?

* Age * Family history * Hypertension * High cholesterol * Diabetes * Obesity * Stress * Air pollution

# Define: Congestive Heart Failure

The inability of the heart to pump blood effectively.

# True or False: Health coaches can give activity guidelines and write workouts for clients with CVD.

False ## Footnote *All clients should be referred to an exercise professional when starting an exercise routine. Health coaches can only prescribe exercise if they are exercise professionals with additional certifications. For more information on studying to become a certified personal trainer, [click here](https://www.brainscape.com/learn/nasm-cpt)!* *Clients with CVD should meet with an Exercise Physiologist in a controlled environment such as a hospital exercise clinic where the patient can be properly monitored.*

What are some **advanced** tests used to check for CVD?

* CT scans * Angiograms

What do ACE inhibitors do?

They are medications that dilate blood vessels which can lower heart rate and blood pressure. ## Footnote *ACE inhibitors are medications that usually end in -pril and are used to treat individuals who just had a heart attack, have congestive heart failure, diabetes, or chronic kidney disease.*

Physical activity is considered to be _psychologic_. What does this mean?

Physical activity decreases stress and depression and increases social support.

Physical activity is considered to be _anti-arrhythmic_. What does this mean?

Physical activity promotes normal heart rhythms by: * Increasing vagal tone * Increasing heart rate variability * Decreasing adrenergic activity

Who is more likely to benefit from an exercise program as it directly links to decreasing the risk of CVD: those at the lower end of the health spectrum or those who are at average health status?

Those at the lower end of the fitness/activity spectrum. ## Footnote *People who are just starting a fitness program will see the most drastic change. As the individual becomes more fit, the improvements will slow due to the body adapting to the demands being placed on it. This is why the principle of progressive overload is important.*

Physical activity is considered to be _anti-ischemic_. What does this mean?

Physical activity increases oxygen-rich blood to the tissues of the body more efficiently. This happens by: * Decreasing myocardial oxygen demand * increasing coronary flow * Decreasing endothelial dysfunction * Increasing EPCs, CACs, and nitric oxide

What are the 'Big 4' cardioprotective medications?

* Beta-blockers * ACE inhibitors * Blood thinners * Statins

What is the 1:1 sodium rule?

Foods should have no more than 1mg of sodium per calorie. ## Footnote *It is important that individuals with CVD decrease meals that come from packaged foods or eating at restaurants as more than 75% of sodium consumption come from these types of foods.*

# Define: Atherosclerosis

When cholesterol accumulates in the arteries and forms plaque that can obstruct blood flow in the artery. ## Footnote *Arterial inflammation has a key role in developing atherosclerosis as well as having high cholesterol levels, in particular having high levels of LDL.*

What do beta-blockers do?

They slow the heart rate and lower blood pressure by affecting the response of nerve impulses throughout the body. ## Footnote *Most beta-blockers end in -olol and are commonly used to treat coronary artery disease, thickened or weak heart muscles, or abnormal heart rhythms. Beta-blockers are reported to lower the risk of recurrent heart attacks by 25%.*

# Fill in the blanks: The American Heart Association recommends individuals between the age of \_\_\_\_\_ and \_\_\_\_\_ assess their risk for CVD.

40 to 79

# Define: Angina pectoris

Chest pain or pressure.

The AHA recommends people with CVD eat a diet with what kinds of foods?

* Fish * Vegetables * Fruits * Whole grains * High fiber ## Footnote *Individuals with CVD should also eat reduced levels of saturated and trans fats, cholesterol, and sodium.*

# Fill in the blank: People with a walking speed less than \_\_\_\_ mph have an increased risk of early mortality.

2 mph

What do statins do?

They lower cholesterol (usually LDL), lower triglycerides, and decrease vascular inflammation. ## Footnote *Statins can lower LDL by 55% and usually help lower LDL and total cholesterol by which increasing HDL (the good cholesterol needed to help remove LDL).*

What do blood thinners, like aspirin, do?

They decrease the inflammation in the arteries and prevent blood clots. ## Footnote *Blood thinners are usually prescribed to individuals with CAD and those who have gotten a stent inserted as well as patients with peripheral vascular disease.*

Chronic Diseases and Comorbid Conditions: Cardiovascular Disease Flashcards