2010 McGraw-Hill Companies. All Rights Reserved.

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

2010 McGraw-Hill Companies. All Rights Reserved.

Pulmonary circulation
Systemic circulation Path of blood flow:
1. 2.
3. 4. 5. 6. 7. 8.

Blood to and from the lungs. Left side of the heart pumps blood through the rest of the body.

Venae Cavae Right Atrium

Sinoatrial node (pacemaker)

Right Ventricle Pulmonary Artery

To the lungs

Pulmonary Vein Left Atrium Left Ventricle Aorta

3

2010 McGraw-Hill Companies. All Rights Reserved.

Systole
The hearts contraction

Diastole.
The period of relaxation

2010 McGraw-Hill Companies. All Rights Reserved.

 2010 McGraw-Hill Companies. All Rights Reserved.

Heart, blood vessels, hormones, enzymes and wastes.

The Blood Vessels

Veins
Arteries
Carry blood to the heart Thin walls Carry blood away from the heart Thick elastic walls which expand and relax with the volume of blood Coronary artery

Capillaries Venules

Two large vessels that supply blood to the heart

One cell thick 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 circulates

about once each minute.

2010 McGraw-Hill Companies. All Rights Reserved.

 2010 McGraw-Hill Companies. All Rights Reserved.

 2010 McGraw-Hill Companies. All Rights Reserved.

Two categories of increased CVD

1. 2.

Major Risk factors Contributing Risk Factors

Controllable aspects of lifestyle that can be changed.

Major risk factors that can be changed

American Heart Association identified Six major risk

factors. 1. Tobacco use. 2. High blood pressure. 3. High levels of cholesterol. 4. Physical inactivity. 5. Obesity. 6. Diabetes.

2010 McGraw-Hill Companies. All Rights Reserved.

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 HDLs Raises triglycerides and LDLs Nicotine increases blood pressure CO displaces O2 Causes platelets to become sticky and increases blood thickness Speeds the development of fatty deposits in the arteries
10

2010 McGraw-Hill Companies. All Rights Reserved.

Hypertension
Too much pressure against arterial walls

Short periods of high blood pressure is normal but chronic 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
2010 McGraw-Hill Companies. All Rights Reserved. 11

 2010 McGraw-Hill Companies. All Rights Reserved.

12

Tachycardias.
100 or more beats per minute. Compromises the ability of the heart to

pump effectively.

Ventricles can not completely fill.

2010 McGraw-Hill Companies. All Rights Reserved.

13

Bradychardia
60 or less beats per minute Poor circulation of the blood

Lack of 02 throughout to body and brain

2010 McGraw-Hill Companies. All Rights Reserved.

14

Is a fatty, wax like substance that circulates through the 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

2010 McGraw-Hill Companies. All Rights Reserved.

15

 2010 McGraw-Hill Companies. All Rights Reserved.

16

 2010 McGraw-Hill Companies. All Rights Reserved.

17

40-60 million Americans are so sedentary that they are 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 LDLs Increasing HDLs Maintaining weight Improve the condition of blood vessels Helps prevent or control Diabetes

2010 McGraw-Hill Companies. All Rights Reserved.

18

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

2010 McGraw-Hill Companies. All Rights Reserved.

19

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

2010 McGraw-Hill Companies. All Rights Reserved.

20

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

2010 McGraw-Hill Companies. All Rights Reserved.

21

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; Asians Lower rates of CVD

2010 McGraw-Hill Companies. All Rights Reserved.

22

Inflammation and C-reactive protein (CRP) Insulin resistance and metabolic syndrome Homocysteine
Amino acid circulating in the blood

Infectious agents

Lipoprotein(a) Lp(a) LDL Particle size

Chlamydia pneumoniae flu-like respiratory infections Strong genetic component 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 6:00AM

and noon 50% more occur in winter months than in summer months

2010 McGraw-Hill Companies. All Rights Reserved.

23

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 of it 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

2010 McGraw-Hill Companies. All Rights Reserved.

24

 2010 McGraw-Hill Companies. All Rights Reserved.

25

Chest pain or pressure Arm, neck, or jaw pain Difficulty breathing Excessive sweating Nausea and vomiting Loss of consciousness

2010 McGraw-Hill Companies. All Rights Reserved.

26

 2010 McGraw-Hill Companies. All Rights Reserved.

27

Angina narrowed by disease, but under stress heart can not receive enough oxygen.
Angina pectoris Usually felt as an extreme tightness in the chest and

heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or back.

Arrhythmias and sudden cardiac death Electrical conduction system is disrupted

2010 McGraw-Hill Companies. All Rights Reserved.

28

Most die within 2 hours from initial symptoms Cardiopulmonary resuscitation (CPR) Refer to Box What to Do in Case of a Heart Attack, Cardiac Arrest, or Stroke.

2010 McGraw-Hill Companies. All Rights Reserved.

29

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

2010 McGraw-Hill Companies. All Rights Reserved.

30

780,000 Americans suffer strokes each year 2 million brain cells die per minute during a stroke. 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 the brain
Intracerebral hemorrhage Subarachnoid hemorrhage Aneurysm

2010 McGraw-Hill Companies. All Rights Reserved.

31

 2010 McGraw-Hill Companies. All Rights Reserved.

32

Interruption of the blood supply or any area of the brain prevents the nerve cells from functioning in some cases causing death. Those who survive have some lasting disability.

Paralysis Walking disability Speech impairment Memory loss Changes in behavior

2010 McGraw-Hill Companies. All Rights Reserved.

33

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 to Recognize a Stroke

2010 McGraw-Hill Companies. All Rights Reserved.

34

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

2010 McGraw-Hill Companies. All Rights Reserved.

35

PAD atherosclerosis in the leg (or arm) arteries, which can limit or block the blood flow. Patients 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
36

2010 McGraw-Hill Companies. All Rights Reserved.

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

2010 McGraw-Hill Companies. All Rights Reserved.

37

Congenital heart defects

Malformation of the heart or major blood vessel 1:500 people Most common cause of sudden death in athletes younger

Hypertrophic Cardiomyopathy (HCM)

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
38

2010 McGraw-Hill Companies. All Rights Reserved.

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

2010 McGraw-Hill Companies. All Rights Reserved.

39

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

2010 McGraw-Hill Companies. All Rights Reserved.

40

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

2010 McGraw-Hill Companies. All Rights Reserved. 41

 2010 McGraw-Hill Companies. All Rights Reserved.

42

 2010 McGraw-Hill Companies. All Rights Reserved.