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8/2/2019 Insel11e_ppt15 Cardiovascular Disease

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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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