Chapter 12Chapter 12Cardiovascular DiseaseReducing Your Risks

NON-COMMUNICABLE DISEASES

Degenerative Diseases:

• diseases that diseases that significantly threaten significantly threaten health/wellnesshealth/wellness

• chronic illnesschronic illness

• lifestyle / genetic lifestyle / genetic factors factors

Cardiovascular DiseasesFound in Heart and Blood Vessels

20002000• responsible for > 50% of responsible for > 50% of

all deaths in Canadaall deaths in Canada

• female deaths = male female deaths = male deathsdeaths

• declined by 52% / males declined by 52% / males & 64% females ( 1950 – & 64% females ( 1950 – 1993)1993)

Blood Vessels

• Arteries - large Arteries - large vesselsvessels

• Arterioles - smallerArterioles - smaller• Capillaries - O2 / Capillaries - O2 /

CO2 exchange, CO2 exchange, nutrients other nutrients other stuff.stuff.

• VenuesVenues• VeinsVeins

RELATED TERMINOLOGYRELATED TERMINOLOGY

• Calcium Channel Blockers – reduce muscular contractions + reduce heart rate

• Diuretics: drugs that increase the amount of urine produced + excreted

• Beta Blockers – block some of the nervous impulses to the heart muscle / prevent over activity of the heart

RELATED TERMINOLOGYRELATED TERMINOLOGY

• Occlusion: blockage of artery

• Vasodilators: (Nitroglycerin)

drugs that cause widening of blood vessel

• Cyanosis: lack of oxygen, resulting in blueness of skin

• Necrosis: tissue death

• CPR: Cardio-Pulmonary Resuscitation

Common Forms of Cardiovascular Diseases

Angina Pectoris: (Ischemia) – chest

pain

• Blood flow not totally occludedBlood flow not totally occluded

• Insufficient to meet MVOInsufficient to meet MVO22 (oxygen (oxygen

consumption of myocardial muscle)consumption of myocardial muscle)

Arrhythmia:Arrhythmia: irregular heartbeat irregular heartbeat

• Tachycardia and FibrillationTachycardia and Fibrillation

• Bradycardia (abnormally slow heart Bradycardia (abnormally slow heart rate)rate)

Clogging the Pipes!Atherosclerosis

• (fatty plaque buildup in (fatty plaque buildup in arteries) – hardening of the arteries) – hardening of the arteriesarteries

• deposits of fatty deposits of fatty substances / substances / cholesterol / cellular cholesterol / cellular waste products / waste products / calcium / fibrincalcium / fibrin = = plaqueplaque

• can lead to a complete blockage

Heart Attack!

• Myocardial Infarction heart attack - occlusion is complete and muscle has permanent damage

• Coronary thrombosis – blood clot

• Collateral circulation – physiological response to adapt to the heart attack

Stroke: a heart attack in the brain – cerebrovascular

Thrombus (blood clot) / Embolus (wondering blood clot) / Aneurysm (blood vessel weakness)

• Damage location of brain effected

• Speech, memory, loss of motor control or death (location of heart and lung regulation)

• Transient ischemic attacksTransient ischemic attacks ( mild stroke) indicator of a greater problem ?

Heart Disease

• Congestive Heart Failure - weak / damaged heart – fluid build up = poor heart performance (heart chokes)

• Congenital Heart Disease - development of heart disease before birth (1 in 125 births) e.g. murmurs – valve irregularities

Rheumatic Heart Disease:• childhood illness childhood illness

(predisposition) (predisposition) inflammatory disease / inflammatory disease / effects effects

• connective tissues heart, connective tissues heart, joints, joints, brain & joints, joints, brain & skinskin

• streptococcal infection streptococcal infection – (strep throat) – – (strep throat) – reduction in immune reduction in immune responseresponse

RISK FACTORS OF CORONARY HEART DISEASE

BIOLOGICAL FACTORS:BIOLOGICAL FACTORS:

cannot modify these factorscannot modify these factors

Family history:Family history:• If grand-parents die of CHD If grand-parents die of CHD

before 60 - 3-6 times risk of before 60 - 3-6 times risk of CHDCHD

• Genetic predisposition for Genetic predisposition for hypertension, obesity, and hypertension, obesity, and diabetes = increased diabetes = increased incidence of CHDincidence of CHD

Sex• Males: greater risk / stress / lifestyleMales: greater risk / stress / lifestyle

• Women before menopause risks of Women before menopause risks of CHDCHD

• protective characteristic of estrogen on protective characteristic of estrogen on CHDCHD

• Women after menopause risks of CHDWomen after menopause risks of CHD

• 60yrs. women = 50yrs. male // late 70’s yr. 60yrs. women = 50yrs. male // late 70’s yr. = male= male

• Hormone Replacement Therapies / Hormone Replacement Therapies / reduce risks 12% to 25% /reduce risks 12% to 25% /

• Increase HDL and decrease LDLIncrease HDL and decrease LDL

Women and Cardiovascular Disease

• HA - Kills 9500 / yearHA - Kills 9500 / year

• Stroke - Kills 8500/yearStroke - Kills 8500/year

• Breast Cancer - kills 5000/yearBreast Cancer - kills 5000/year

• Men have greater incidence Men have greater incidence but survive more oftenbut survive more often

• Women lower incidence but Women lower incidence but survival rate is lowersurvival rate is lower

• Research has been MALEResearch has been MALE orientatedorientated

Symptoms

Men and women show differentMen and women show different

symptomssymptoms• men chest pain - first sign is men chest pain - first sign is

MIMI• women - chest discomfort/not women - chest discomfort/not

pain (angina)pain (angina)• severe abdominal pain / severe abdominal pain /

indigestionindigestion• physicians ignore conditionphysicians ignore condition

Neglect of Symptoms

Physicians:Physicians:• may be gender-biased - notmay be gender-biased - not

looking for heart diseaselooking for heart disease

• view male heart disease as a view male heart disease as a more severe problem in menmore severe problem in men

• women decline major women decline major procedures more often then procedures more often then menmen

Age……….• 80% of heart problems – 80% of heart problems –

65yrs. more years of wear ‘n 65yrs. more years of wear ‘n tear / lifestyletear / lifestyle

PHYSIOLOGICAL ANDPHYSIOLOGICAL AND

METABOLIC FACTORS:METABOLIC FACTORS:

• HypertensionHypertension (High (High Blood Pressure) – 90% Blood Pressure) – 90% essential no specific cause / essential no specific cause / 10% secondary due to 10% secondary due to specific factors = kidney specific factors = kidney disease, obesity or tumors of disease, obesity or tumors of the adrenal glandsthe adrenal glands

Blood Pressure• Sphygmomanometer:

instrument measuring blood pressure

• Systolic BP: pressure when the blood leaves the heart and enters the aorta

• Diastolic BP: just before contraction of left ventricle (or when the heart is relaxing); peripheral resistance

Hyperlipidemia • increased cholesterol levels + increased cholesterol levels +

increased blood clotting potential increased blood clotting potential – making blood sludgy in hours!!– making blood sludgy in hours!!

Diabetes:Diabetes:• prolonged effects of insulin / prolonged effects of insulin /

CADCAD• if overweight increased blood fat if overweight increased blood fat

levels & atherosclerosislevels & atherosclerosis• tendency towards deterioration tendency towards deterioration

of small blood vesselsof small blood vessels• eyes and extremitieseyes and extremities

Blood Pressures and What they Mean to You!

Classification Systolic Diastolic Action

Normal Below 130 below 85 Check Every Two Years

High Normal 130 to 139 85 to 89 Check Every Year

Mild Hypertension 140 to 159 90 to 99 Check in Two Months

Moderate

Hypertension

160 to 179 100 to 109 See Physician in a Month

Severe

Hypertension

180 and

above

110 and above See Physician Immediately

Obesity………...

Obesity:• Is it the high fat /

sugar / calorie diet or• heart strain by

pumping blood through many more Km’s of extra blood vessels!

LIFESTYLE FACTORS:

• Smoking

• Alcohol abuse

• Stress

• Physical Inactivity

Diagnostic / Assessment Procedures:

• ECG – Electrocardiogram – a record of the heart’s performance during stress testing

• Angiography: a diagnosis procedure examines to blockages a catheter is inserted / dye released and X-ray

Positron Emission Tomography (PET Scan):

Positron Emission Tomography (PET Scan):

• 3-D view of heart – radioactive tracer injected

• scanner picks up emissions and provide image

Radionuclide Imaging:

• injected Radionuclides are injected and produce info. on chamber functioning/ blood flow to the heart / parts damaged

Magnetic Resonance Imaging: (MRI or NMR)

• powerful magnets produce computer-generated images of the aorta, heart, heart damage, and congenital defects

Digital Cardiac Angiography:• computer-aided imaging /

records pictures of heart & blood vessels

How To Fix the Problem?Coronary Bypass Surgery:

• procedure that reroutes the blood supply in a coronary artery after that artery was completely blocked

Angioplasty: a balloon catheter is inserted into a blocked artery

• 1% - die

• 3 to 7% - blood vessel collapse spontaneously (need bypass)

• 30% - clogged after 6 months

Aspirin:

• low dose (325mg) per low dose (325mg) per day or every other day or every other day beneficialday beneficial

• gastrointestinal gastrointestinal intolerance a intolerance a common problem!common problem!

Thrombolysis

If person is diagnosedIf person is diagnosed

quickly then TPA (tissuequickly then TPA (tissueplasminogen activator) canplasminogen activator) canbe used to dissolve some ofbe used to dissolve some ofthe clotthe clot

return some blood flow / savereturn some blood flow / save

some of the heart musclesome of the heart muscle

tissue / brain tissuetissue / brain tissue

Or be Preventative………...Or be Preventative………...

• Adopt health and lifestyle Adopt health and lifestyle practices that will reduce the practices that will reduce the odds of developingodds of developing

CHD / CAD / Stroke / DiabetesCHD / CAD / Stroke / Diabetes• Nutritional AwarenessNutritional Awareness• Active LifestyleActive Lifestyle• ExerciseExercise• Stress ManagementStress Management• Weight ManagementWeight Management