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Cardiovascular Disease: an Overview. Jon W. Wahrenberger, MD March 10, 2007. The Good News. We are living longer than ever!. So Why Worry about Cardiovascular Disease?. Cardiovascular disease is the number one killer About 42% of all deaths Nationwide: 921,819 annually NH: 3468

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Cardiovascular disease an overview l.jpg

Cardiovascular Disease: an Overview

Jon W. Wahrenberger, MD

March 10, 2007


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The Good News

We are living longer than ever!


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So Why Worry about Cardiovascular Disease?

  • Cardiovascular disease is the number one killer

    • About 42% of all deaths

    • Nationwide: 921,819 annually

    • NH: 3468

    • VT: 1751

  • Cardiovascular disease continues to strike young and middle-aged individuals

  • We are losing ground on several important risk factors



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Prevalence of Diabetes 1980-2004

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey.


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Smoking in Youth

2005 Youth Risk Behavior Survey (YRBS)


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Potential for Falling Longevity?

Life Extending Technology

Public Health Measures

Health adverse behavior


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Evolution of Cardiovascular Disease

Chain ofSurvival

TechnologyInfluences

MassMarketing of Junk Food

Tobacco

SurgicalProcedures

Suffering, Loss of QOL

Normal Child

Overweight

Inactive Child

Sick Adult

Overweight

Inactive Adult

Drugs

Premature Death

Devices

Food Overabundance

CulturalChanges

KnowledgeDeficits

We must tackle heart disease at all points!



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What is Cardiovascular Disease?

“Cardiovascular disease” refers to diseases involving the heart and blood vessels

Peripheral Vasculature

Heart

Brain

AnginaHeart Attack

ClaudicationUlcerationAmputation

StrokeTIA


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Cerebral Disease

Coronary Disease

25%

7%

30%

3%

4%

12%

19%

Peripheral VascularDisease

The heart, brain and extremities share a disease process


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Circulatory system (arteries, veins, etc.)

Susceptibility to atherosclerosis

The Common Thread?


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Atherosclerosis

AKA “Arteriosclerosis”, “hardening of the arteries”

  • Complex, self-sustaining inflammatory process

  • Thickens arterial wall

  • Occurs slowly over decades


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Ischemic Heart Disease

Cerebrovascular Disease

Peripheral Vascular Disease

No Symptoms Mild Symptoms Severe Symptoms

Atherosclerosis Progression

Time (years to decades)


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What causes atherosclerosis?

  • Smoking

  • High Blood Pressure

  • High Cholesterol

  • Diabetes

  • Hereditary Factors

  • Sedentary Lifestyle

  • Obesity

  • Other Factors


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Normal Coronary Arteries

Right Coronary Artery

Left Coronary Artery






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Suspected Stroke or Heart Attack?

Call 911

Time = saved heart muscle

Time = saved brain function


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Other Causes of Heart Disease

  • Heart failure

  • Heart rhythm disturbances (arrhythmias)

  • Congenital heart disease

  • Heart Valve Disease

  • Heart infections



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Heart Failure

Definition

  • state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues


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Heart Failure

Virus

Toxins

Hypertension

Post Partum

Ischemia

Valve Disease

Heart Muscle Injury

Heart Failure


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Heart Failure: Symptoms

  • Shortness of breath

  • Fatigue

  • Edema (swelling)



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Heart Electrical System

A wave of electrical discharge proceeds mechanical contraction of the heart.


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Types of Arrhythmias

  • Premature atrial contractions (PAC)

  • Atrial fibrillation

  • Atrial flutter

  • SVT

  • Wolf Parkinson White

  • Heart block

  • Premature ventricular contractions (PVC)

  • Ventricular tachycardia

  • Ventricular fibrillation


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Arrhythmia Symptoms

  • Palpitations (a feeling of thumping, fluttering, skipping or racing of the heart)

  • Lightheadedness/loss of consciousness

  • Chest pain or tightness

  • Shortness of breath

  • Fatigue

  • Anxiety


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Diagnosis of Arrhythmias

  • Electrocardiogram

  • Holter Monitor

  • Event Monitor

  • Loop record

  • Implantable loop record


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Treatment of Arrhythmia

  • Removal of precipitants

    • Caffeine

    • Electrolyte Imbalances

    • Thyroid abnormalities

  • Medications

Traditional

  • Ablation

  • Implantable defibrillator


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Ablation of Arrhythmias

  • Particularly useful with:

  • SVT

  • Atrial fibrillation

  • Atrial flutter

  • WPW

  • Some types of Ventricular Tachycardia


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Implantable Cardioverter/Defibrillator

Ventricular Fibrillation

View Defibrillator



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Valve Disease

Valves are intended to allow blood flow in only one direction from one heart chamber to another

  • Normal Function:

    • Allow blood to flow freely one direction and none backwards

  • Dysfunction:

    • Become narrow and impede forward flow (stenosis)

    • Become incompetent and allow backward flow (regurgitation)

Pulmonic Valve

Aortic Valve

Tricuspid Valve

Mitral Valve


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Shortness of breath

Fatigue

Chest Pain

Susceptibility to infection

Death

Valve Disease

Congenital Abnormality

Infection

Valve Dysfunction

Age Related Degeneration

Rheumatic Fever


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Treatment of Valve Disease

  • Medications

  • Surgery

  • Percutaneous repair



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Percutaneous Valvuloplasty

Mitral Valvuloplasty

Aortic Valvuloplasty





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Know your Enemies!

  • Inactivity

  • Obesity

  • Smoking

  • Elevated cholesterol

  • Diabetes

  • Hypertension


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Calculate Your Risk

Framingham Risk Calculator

Men

Women


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Make the right choices

  • Use the stairs; take a daily walk!

  • Stay away from all fast food restaurants!

  • Eat smaller portions

  • Read food labels

  • Choose foods made from whole grains

  • Stay away from restaurants that allow smoking


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Learn about Trans Fatty Acids

  • Low level presence in meat and milk of ruminant animals

  • High levels in “partially hydrogenated vegetable oils”

  • Lot of bad consequences:

    • Raise LDL & lower HDL

    • Increase risk of heart disease by 30%


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Saturated fats < 7% of total caloric intake

Trans fats to < 1% of total caloric intake

Cholesterol to < 300 mg per day

Total fat to 25-35% of total caloric intake

Trans Fatty Acids

AHA Recommendations:

FDA mandated trans fat food labeling after January 1, 2006



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Dark Chocolate

  • Raises HDL

  • Improves insulin sensitivity

  • Lowers blood pressure

  • Improves blood vessel reactivity

Rx: Recommended Dose – 100 gm per day

Dark Chocolate ≠ Milk Chocolate


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Elevation of HDL

Antithrombotic effects

Promote formation of nitric oxide (NO)

Reduced coronary heart disease

Alcohol

Rx: Recommended Dose – 1-2 drinks per day


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Increase in HDL

Reductions

Total Cholesterol

Total to HDL Ratio

Triglycerides

Reduction in oxidative stress markers

Olive Oil


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Decrease in total and cardiovascular mortality

Decrease in myocardial infarction

Decrease in stroke

Reduced mortality after MI

Increases coronary flow reserve

Improved endothelial function

Green Tea



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