Cardiovascular health
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CARDIOVASCULAR HEALTH. Causes of Death. Top three causes of death Heart disease Someone suffers a coronary event every 29 seconds in the US Someone dies from a coronary event every minute Cancer Infectious disease. Cost to Society. 274 billion per year on cardiovascular disease

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CARDIOVASCULAR HEALTH

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CARDIOVASCULAR HEALTH


Causes of Death

Top three causes of death

  • Heart disease

    • Someone suffers a coronary event every 29 seconds in the US

    • Someone dies from a coronary event every minute

  • Cancer

  • Infectious disease


Cost to Society

  • 274 billion per year on cardiovascular disease

  • 99 billion per year on alcohol related disease

  • 72 billion on smoking related diseases

  • 67 billion spend on drug abuse


Physiology of the Heart

  • Four chambered pump

  • Size of a fist

  • Weighs about 1 pound

  • Creates pressure to circulate blood throughout the body

  • Located between the lungs, left of center in the thorax


Blood flow through the heart

  • Deoxygenated blood from the inferior and superior vena cava empties into the right atrium

  • Continues past the tricuspid valve into the right ventricle

  • Leaves the right ventricle and heads toward the lungs to pick up oxygen and returns to the heart as oxygenated blood


Blood flow through the heart

  • Oxygenated blood returns to the left side of the heart entering the left atrium

  • Flows past the mitral valve into the left ventricle

  • Leaves the left ventricle through the aorta out to the rest of the body


Important features of the heart

  • Valves ensure that the blood flows in one direction

  • Left ventricle is more muscular then the other chambers

  • Septum divides the heart in half


Electrical Stimulation of the Heart

  • Signal sends impulses from the brain to the heart

  • SA node (pacemaker of the heart) creates an electrical impulse that contracts the atria

  • AV node picks up the signal and sends it on to the ventricles

  • EKG picks up the electrical signals from the heart and is able to detect abnormalities in the conduction


Function of the blood

  • Transportation of nutrients, oxygen, waste products and hormones

  • Regulation of water content for cells

  • Regulation of body temperature

  • Buffers to maintain pH level

  • Clotting capabilities

  • Protection against pathogens by circulating antibodies

  • Average person has 6 quarts of blood


The Vascular System

  • Refers to the blood vessels

  • Arteries carry blood away from the heart

  • Veins carry blood back into the heart

  • Coronary arteries carry blood to the heart

  • Carotid arteries carry blood to the brain

  • Iliac and femoral arteries carry blood to the abdomen and legs


Permanent Risk Factors for Heart Disease

  • Age – as you age, the greater the risk

  • Gender – men are more at risk then premenopausal women

  • Ethnicity –African Americans more at risk due to the increased rates of high blood pressure

  • Heredity – if you have a family history of CVD your risk is greater


Cardiovascular Risk Factors That Can Be Changed

  • High cholesterol

  • High blood pressure

  • Inflammation

  • Physical inactivity

  • Smoking

  • Diabetes

  • Obesity

  • Diet

  • Periodontal disease


Cholesterol

  • Cholesterol manufactured in the liver and small intestines

  • Needed for the production of sex hormones, cell membranes, bile salts and nerve fibers

  • Cholesterol attaches itself to lipoproteins


Cholesterol

  • Two types of lipoproteins

    • LDL-low density lipids

      • Bad cholesterol

      • Average levels

        • Less the 100 is optimal

        • 100-129 is near optimal

        • 130 or higher is dangerous

        • New study indicates even lower levels of LDL may be necessary ie; 60-70

      • Carries cholesterol to coronary arteries

      • Agitate arterial walls and form lesions that allow plaque buildup


Cholesterol

  • HDL-high density lipids

    • Good cholesterol

    • Average level

      • Men – 40-50

      • Women – 50-60

    • Carries cholesterol away from arteries to the liver

    • Offer protection against heart disease

    • Pick up LDL and bring them to the liver for removal


Cholesterol

  • Total cholesterol above 200 is high

    • Combines HDL and LDL

  • HDL above 60 is healthy, below 40 is dangerous

  • LDL below 130 is healthy , above 190 is dangerous


Cholesterol Reduction

  • Exercise

    • Single most effective way to increase HDLs

  • Weight reduction

  • Diet

    • Limit saturated fats

    • Increase your intake of fatty fish

    • High fiber diet

  • Smoking

  • Moderate alcohol intake

    • Phenols in red wine

  • Genetic predisposition


Blood Pressure

  • Pressure exerted on the walls of the arteries

  • Systolic

    • Highest pressure

    • Pressure exerted when left ventricle is contracting

  • Diastolic

    • Lowest pressure

    • Left ventricle is filling with blood

  • Normal range

    • 120/80

    • 120/80 to 139/89 now is called pre-hypertension


Hypertension (High Blood Pressure)

  • Decreased elasticity of blood vessels makes is more difficult for the heart to pump the blood and increases the blood pressure

  • Higher incidence in non-whites

  • 65 million Americans have hypertension

    • Approx 35% of the population


Hypertension

  • Signs and symptoms

    • No signs initially, until the pressure becomes very high

    • Headache

    • Irritability

    • Dizziness

    • Blurred vision


Hypertension

  • Medical problems associated with high blood pressure

    • Stroke

    • Coronary artery disease

    • Kidney failure

    • Blindness

    • Dementia

    • Heart failure


Hypertension

  • Known as the “silent killer”

  • Symptoms only appear when the blood pressure is dangerously high

  • You must take you medications even if you feel fine


Hypertension

  • Medications

    • Diuretics - to remove fluid

    • Vasodilators – to enlarge the size of the blood vessels

  • Side effects

    • Impotence

    • Fatigue

    • Muscle weakness


Hypertension

  • Blood pressure reduction

    • Weight reduction

    • Exercise

    • Reduce salt intake

    • Diet high in fruits and vegetables


Inflammation of Blood Vessels

  • Inflammation in the vessels causes the plaque to break free

  • May contribute to heart attacks

  • Measured by C reactive proteins (CRP)

  • Average reading of CRP is 1.5

  • High levels come from chronic infections (gum disease), sedentary lifestyle, HTN

  • Normally produced by the body to fight infections and promote healing


Physical Inactivity

  • Exercise is the single most effective way to increase your HDL levels

  • Exercise decreases your blood pressure

  • Exercise contributes to weight reduction

  • Exercise strengthens your heart muscle and increases the efficiency

  • Exercise can increase your longevity

    • Walked 30 min/day for five days/week live 1.3-1.5 years longer

    • Running 30 min/day (or equivalent) live 3.5-3.7 years longer


Smoking

  • The most dangerous risk factor for heart disease

  • Increases your heart rate and constricts your blood vessels

  • Doubles the risk of heart attack for a person who smokes one pack per day


Diabetes

  • More then 80% of people with diabetes die from cardiovascular disease

  • If not well controlled can contribute to high cholesterol levels

  • Can be managed through diet, exercise and medications


Obesity

  • Increases the strain on the heart

  • Increases blood pressure

  • May trigger diabetes

  • Weight loss increases your HDL and lowers your LDL

  • Weight gain of 11-18 lbs in adult life had 25% increase in risk of MI, increase over 25 lbs increased risk of MI by 200-300%


Diet

  • Limit saturated fats

    • Beef, ham, pork

    • Dairy products

    • Palm and coconut oils

  • Use more polyunsaturated fats

    • Corn oil

    • Safflower oil


Diet

  • Increase fatty fish such as salmon, mackerel

    • High in omega 3 fatty acids

  • High fiber diet

    • Men who ate 29 gms of fiber/day (one cup bran cereal) 36% decreased risk of MI

  • Keep fat to 30% of diet

    • Americans eat 46% fat in diet


Periodontal Disease

  • Chronic infections from gum disease increase the CRP levels

  • Toxins and bacteria enter your bloodstream causing inflammation of the vessels


Types Of Heart Disease

  • CAD – coronary artery disease

  • Hypertension

  • Stroke

  • Congenital heart disease

  • Congestive heart disease

  • Rheumatic heart disease


Coronary Artery Disease

  • Atherosclerosis – hardening of the arteries

  • Fatty deposits build up inside the vessels that slow the flow of blood or completely occlude it


Coronary Artery Disease

  • Angina

    • Chest pain

    • Decreased blood supply to coronary arteries

    • Nitroglycerin


Myocardial InfarctionHeart Attack

  • MIs are getting smaller secondary to better medications and active lifestyles

  • Men are 20% more likely to have MI on birthday

  • Higher incidence in winter versus summer

  • More likely on Monday

  • more likely to be fatal at night

  • Four times more likely if you are depressed

  • Weekend warriors at greater risk


Myocardial Infarction

  • Women and heart attacks

    • First MI 10-20 years later then men, but 70% more likely to die

    • Women take one hour longer to get to the ED

    • Women do not exhibit classic symptoms of MI, tends to be a spasm, not a blockage of the coronary arteries

    • 30% less likely to get the proper medications


Myocardial Infarction

  • Premenopausal women usually protected but 9000 women younger then 45 die each yr

  • More women die from heart attacks and strokes then breast cancer, 500,000 women vs 40,000/yr

  • Women on HRT have an increased chance of MI/stroke/blood clots

    • Doubles risk of MI during first year


Myocardial InfarctionHeart Attack

  • Heart Attack or Myocardial Infarction (MI)

    • Death of the cardiac muscle secondary to a lack of oxygen

    • Cause is a blockage of the coronary arteries by a floating piece of plaque or eventual closure due to cholesterol

    • Extent of damage depends on the size of the artery affected


Coronary Artery Disease

  • Heart Attack Signs and Symptoms

    • Crushing substernal chest pain

    • Sweating, short of breath

    • Pain radiating to the jaw or left arm

    • Indigestion

  • Get the person to the hospital, time is muscle

  • Ask if they use NTG

  • CPR

  • Ventricular fibrillation


Heart Attack


Heart Attack


Ventricular Fibrillation


Ventricular Fibrillation


Coronary Artery Disease

  • Hospital Care

    • Anticoagulants (blood thinner)

      • aspirin

    • TPA – tissue plasminogen activator

    • Angioplasty

    • Bypass surgery


Angioplasty


Stent Placement


Bypass Surgery


New Areas of Research

  • Synthetic form of HDL

    • Found to reverse plaque build up in the arteries

  • Genetic link

    • Identified gene that may cause coronary artery disease

    • Identified gene variant that reduces inflammation thereby reducing heart disease

  • Medication

    • New drug to increase the HDL level

  • Risk factors

    • Men who were hostile and contemptuous of other people were 30% more likely to develop irregular heart beats

    • Explore anger management modifications


StrokeCerebral Vascular Accident (CVA)

  • Decreased blood supply to the brain

  • Types of CVAs

    • Cerebral hemorrhage

    • Cerebral occlusion

    • Cerebral aneurysm


Stroke

  • Cerebral hemorrhage

    • Blood vessel burst inside the brain


Stroke

  • Cerebral occlusion

    • Floating clot or cerebral emboli

  • Cerebral thrombosis

    • Gradual narrowing


Stroke

  • Cerebral aneurysm

    • Weakness in the vessel


Stroke

  • Signs and Symptoms

    • May have no warning, sudden collapse

    • TIAs – transient ischemic attacks

    • Numbness or weakness in limbs

    • Slurred speech

    • Dizzy

  • Diagnosis

  • Treatment

    • Clot buster drugs

    • Surgery


Stroke

  • Prevention

    • Detection and control of diabetes

    • Stop smoking

    • Control hypertension

    • Low cholesterol diet

    • Diet high in fruits and vegetables

    • Antioxidant vitamins C,E, beta carotene, folic acid

    • Report TIAs to MD

    • Daily ASA


Congenital Heart Disease

  • Abnormalities present at birth

  • May be due to environmental factors or illness contracted during pregnancy

  • 8 out of 1000 infants have CHD

  • Blue baby


Congenital Heart Defects


Congenital Heart Defects


Congestive Heart Failure

  • Enlarged heart due to lack of strength

  • Causes include MI, HTN, defective valves

  • Blood backs up into the body and the lungs

  • Treatment includes medications such as diuretics and vasodilators as well as reduction of salt in diet


Congestive Heart Failure


Congestive Heart Failure


Rheumatic Heart Disease

  • Damage due to rheumatic fever via strep throat

  • Caused by streptococcal bacteria

  • Damages the valves of the heart

  • Surgery may be required to correct the defect


Rheumatic Heart Disease


Cardiovascular Health Rules

  • Follow these rules and reduce your chance for heart disease by 82%

    • Don’t smoke

    • Avoid obesity

    • Get at least 30 min of moderate to vigorous exercise every day

    • Drink moderately

    • Eat healthy foods

      • Avoid saturated fats

      • Eat fish oil, folate, fiber, vegetable oils, whole grain products


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