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Cardiovascular Disease (CVD)
› Leading cause of death in the U.S.
› Affects nearly 81 million Americans› Claims one life every 37 seconds
› About 2400 Americans every day
› CVD is due to our way of life
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Pulmonary circulation› Blood to and from the lungs.
Systemic circulation› Left side of the heart pumps blood through the rest of the body.
Path of blood flow:1. Venae Cavae2. Right Atrium
Sinoatrial node (pacemaker)3. Right Ventricle4. Pulmonary Artery
To the lungs5. Pulmonary Vein6. Left Atrium7. Left Ventricle8. Aorta
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Systole
› The hearts contraction
Diastole.
› The period of relaxation
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Heart, blood vessels, hormones, enzymes and wastes. The Blood Vessels
› Veins Carry blood to the heart Thin walls
› Arteries Carry blood away from the heart Thick elastic walls which expand and relax with the volume of blood Coronary artery
Two large vessels that supply blood to the heart
› Capillaries One cell thick
› Venules Blood empties from the capillaries into the venules which connect to
veins that return the blood back to the heart
› 150-pound person has about 5 quarts of blood, which circulatesabout once each minute.
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Two categories of increased CVD1. Major Risk factors
2. Contributing Risk Factors Controllable aspects of lifestyle that can be changed.
Major risk factors that can be changed› American Heart Association identified Six major riskfactors.
1. Tobacco use.2. High blood pressure.
3. High levels of cholesterol.4. Physical inactivity.5. Obesity.6. Diabetes.
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1 in 5 deaths from CVD is a smoker Smokers have 2 to 3 times higher risk of death from
a heart attack, than non-smokers
Damages the lining of arteries
Reduces HDL’s Raises triglycerides and LDL’s
Nicotine increases blood pressure
CO displaces O2
Causes platelets to become sticky and increasesblood thickness
Speeds the development of fatty deposits in thearteries
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Hypertension› Too much pressure against arterial walls
Short periods of high blood pressure is normal butchronic high blood pressure is a health risk
Atherosclerosis› Heart has to work harder, weakens, enlarges, arteries
narrow, scar and harden
About 33% (73 million) of adults have hypertension
37% of adults have prehypertension Test your blood pressure at least once every two
years
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Tachycardias.
› 100 or more beats per minute.
› Compromises the ability of the heart topump effectively.
Ventricles can not completely fill.
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Bradychardia
› 60 or less beats per minute
› Poor circulation of the blood› Lack of 02 throughout to body and brain
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Is a fatty, wax like substance that circulates throughthe bloodstream› Important component of:
Cell membranes Sex hormones Vitamin D Fluid that coats the lungs
Protective sheaths around nerves Excessive cholesterol clogs the arteries› Increased risk of CVD
Good versus Bad Cholesterol› Low –density lipoproteins (LDL)
Shuttle cholesterol from the liver to eh organs and tissues› High-density lipoproteins (HDL)
Shuttle unused cholesterol back to the liver for recycling By removing cholesterol from blood vessels, HDL helps
protect against atherosclerosis Benefits of controlling cholesterol
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40-60 million Americans are so sedentary that theyare at high risk for developing CVD
Exercise reduces risk by:› Closest thing we have to a magic bullet against
heart disease› Controlling Blood pressure and resting heart rate› Lowering LDL’s › Increasing HDL’s ›
Maintaining weight› Improve the condition of blood vessels› Helps prevent or control Diabetes
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Risk of death from CVD is two to three times more
likely in obese people (BMI > 30) Increase strain on the heart.
Strongly associated with:› Hypertension
› High cholesterol
› Insulin resistance
› Diabetes physical inactivity
› Increasing age
› Endothelial cell dysfunction
Coronary arteries constrict instead of dilating
› Inflammatory markers
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Doubles the risk of CVD for men. Triples the risk of CVD for women. Loss of 5-10 years off your life Higher risk:
›
Hypertension› Obesity› Unhealthy blood lipid levels› Elevated blood glucose and insulin can
damage the endothelial cells lining the arteries› More vulnerable to atherosclerosis
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High Triglyceride Levels› Reliable predictor of heart disease
Psychological and Social factors› Stress
› Chronic hostility and anger› Suppressing psychological distress› Depression› Anxiety› Social isolation› Low socioeconomic status
Alcohol and Drugs
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Heredity› CVD has genetic component; high cholesterol levels,
blood clotting and obesity
Aging
› Over the age of 65 Being male
› Men have higher risk earlier in life
Ethnicity› African Americans have higher risk of hypertension;
Hispanics greater risk of HBP and Angina; AsiansLower rates of CVD
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Inflammation and C-reactive protein (CRP) Insulin resistance and metabolic syndrome Homocysteine
› Amino acid circulating in the blood Infectious agents
›
Chlamydia pneumoniae – flu-like respiratory infections Lipoprotein(a) – Lp(a)
› Strong genetic component LDL Particle size
› Particles differ in shape and size Blood Viscosity and Iron
Uric Acid Time of day and time of year
› More heart attacks and sudden death occur between 6:00AMand noon
› 50% more occur in winter months than in summer months
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Atherosclerosis - narrowed by fatty deposits.› Starts during childhood fat.› Coronary heart disease (CHD)› Coronary artery disease (CAD)› Peripheral arterial disease (PAD)
Heart Attack – heart tissue is damaged and part ofit may die from lack of blood› Myocardial infarction (MI)› American Heart Association
600,000 people have a first heart attack each year 320,000 people have recurrent attack 190,000 people suffer a symptomless or “silent” heart attack
each year
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Chest pain or pressure
Arm, neck, or jaw pain
Difficulty breathing Excessive sweating
Nausea and vomiting
Loss of consciousness
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Angina – narrowed by disease, but under stressheart can not receive enough oxygen.› Angina pectoris
› Usually felt as an extreme tightness in the chest andheavy pressure behind the breastbone or in theshoulder, neck, arm, hand, or back.
Arrhythmias and sudden cardiac death –
Electrical conduction system is disrupted
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Most die within 2 hours from initialsymptoms
Cardiopulmonary resuscitation (CPR) Refer to Box “What to Do in Case of a
Heart Attack, Cardiac Arrest, or Stroke”.
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Electrocardiogram (ECG or EKG)
Electron-beam computed tomography (EBCT)
Echocardiograph – sound waves
Magnetic Resonance Imaging (MRI) Nuclear myocardial perfusion imaging
Positron Emission Tomography (PET)
Angiogram
Balloon Angioplasty Coronary Bypass Surgery
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780,000 Americans suffer strokes each year
2 million brain cells die per minute during astroke.
Ischemic stroke – blockage in blood vessels
› Thrombotic stroke clot forms in a cerebral artery;hypertension
› Embolic Stroke - wandering blood clot
Hemorrhagic stroke- blood vessel ruptures in thebrain› Intracerebral hemorrhage› Subarachnoid hemorrhage› Aneurysm
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Interruption of the blood supply or any area ofthe brain prevents the nerve cells fromfunctioning in some cases causing death.
Those who survive have some lasting disability.› Paralysis› Walking disability› Speech impairment› Memory loss› Changes in behavior
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Prompt recognition of symptoms
› Sudden numbness or weakness of face,arm, leg or one side of the body
› Loss of Speech or difficulty speaking
› Dimming or loss of vision in one eye
› Unexplained dizziness in relation to other symptoms
› Refer to “Three Simple Ways toRecognize a Stroke”
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Transient ischemic attack (TIA)› Temporary stroke like symptoms.
Computed tomography (CT) MRI
Ultrasound Drugs Carotid endarterectomy surgery – plaque is
removed from the artery Rehabilitation
› Physical therapy› Speech and Language therapy› Occupational therapy
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PAD – atherosclerosis in the leg (or arm) arteries,which can limit or block the blood flow.
Patient’s typically also have coronary artery
disease. 8-12 million people in the U.S. have PAD
Risk factors:› Smoking
› Diabetes
› Hypertension
› High cholesterol
Symptoms› Claudication and rest pain
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Number of conditions› High blood pressure› Heart attack› Atherosclerosis› Alcoholism› Viral infections
› Rheumatic fever› Birth defects
Pulmonary edema - Fluid accumulates in the lungs.
› Heart can not maintain regular pumping rate; fluid backs up.
Controlled by:
› Reducing cardiac load› Eliminating excess fluid› Restriction of salt› Drug therapy
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Congenital heart defects› Malformation of the heart or major blood vessel
Hypertrophic Cardiomyopathy (HCM)› 1:500 people› Most common cause of sudden death in athletes younger
than 35› Mummur
Rheumatic Heart Disease› Streptococcal infections causes damage to the heart
muscle and valves.› Strep throat needs to be treated, primary cause if not
treated. Heart Valve Disorders
› Congenital heart defects and certain types of infections› Mitral valve prolapse
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Eat heart-healthy
Decreased Fat and Cholesterol› Total Fats less than 30% of total calories
› Low Saturated Fats Increased fiber intake
Decreased sodium intake and increased
potassium intake Moderation of Alcohol
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Omega-3 fatty acids Plant stanols and sterols Folic acid Vitamins B-6 and B-12
Calcium Soy protein Healthy carbohydrates Total calories
DASH› Dietary Approaches to Stop Hypertension
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Moderate physical activity
Avoid Tobacco
Know and manage your blood pressure(monitored once every two years)
Know and manage your Cholesterol
levels Effective means of controlling stress and
anger
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