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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

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
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
prevalence of diabetes 1980 2004
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.

smoking in youth
Smoking in Youth

2005 Youth Risk Behavior Survey (YRBS)

potential for falling longevity
Potential for Falling Longevity?

Life Extending Technology

Public Health Measures

Health adverse behavior

evolution of cardiovascular disease
Evolution of Cardiovascular Disease

Chain ofSurvival


MassMarketing of Junk Food



Suffering, Loss of QOL

Normal Child


Inactive Child

Sick Adult


Inactive Adult


Premature Death


Food Overabundance



We must tackle heart disease at all points!

what is cardiovascular disease
What is Cardiovascular Disease?

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

Peripheral Vasculature



AnginaHeart Attack




Cerebral Disease

Coronary Disease








Peripheral VascularDisease

The heart, brain and extremities share a disease process


AKA “Arteriosclerosis”, “hardening of the arteries”

  • Complex, self-sustaining inflammatory process
  • Thickens arterial wall
  • Occurs slowly over decades
atherosclerosis progression

Ischemic Heart Disease

Cerebrovascular Disease

Peripheral Vascular Disease

No Symptoms Mild Symptoms Severe Symptoms

Atherosclerosis Progression

Time (years to decades)

what causes atherosclerosis
What causes atherosclerosis?
  • Smoking
  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Hereditary Factors
  • Sedentary Lifestyle
  • Obesity
  • Other Factors
normal coronary arteries
Normal Coronary Arteries

Right Coronary Artery

Left Coronary Artery


Suspected Stroke or Heart Attack?

Call 911

Time = saved heart muscle

Time = saved brain function

other causes of heart disease

Other Causes of Heart Disease

  • Heart failure
  • Heart rhythm disturbances (arrhythmias)
  • Congenital heart disease
  • Heart Valve Disease
  • Heart infections
heart failure25
Heart Failure


  • state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues
heart failure26
Heart Failure




Post Partum


Valve Disease

Heart Muscle Injury

Heart Failure

heart failure symptoms
Heart Failure: Symptoms
  • Shortness of breath
  • Fatigue
  • Edema (swelling)
heart electrical system
Heart Electrical System

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

types of arrhythmias
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
arrhythmia symptoms
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
diagnosis of arrhythmias
Diagnosis of Arrhythmias
  • Electrocardiogram
  • Holter Monitor
  • Event Monitor
  • Loop record
  • Implantable loop record
treatment of arrhythmia
Treatment of Arrhythmia
  • Removal of precipitants
    • Caffeine
    • Electrolyte Imbalances
    • Thyroid abnormalities
  • Medications


  • Ablation
  • Implantable defibrillator
ablation of arrhythmias
Ablation of Arrhythmias
  • Particularly useful with:
  • SVT
  • Atrial fibrillation
  • Atrial flutter
  • WPW
  • Some types of Ventricular Tachycardia
implantable cardioverter defibrillator
Implantable Cardioverter/Defibrillator

Ventricular Fibrillation

View Defibrillator

valve disease
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

valve disease38
Shortness of breath


Chest Pain

Susceptibility to infection


Valve Disease

Congenital Abnormality


Valve Dysfunction

Age Related Degeneration

Rheumatic Fever

treatment of valve disease
Treatment of Valve Disease
  • Medications
  • Surgery
  • Percutaneous repair
percutaneous valvuloplasty
Percutaneous Valvuloplasty

Mitral Valvuloplasty

Aortic Valvuloplasty

know your enemies
Know your Enemies!
  • Inactivity
  • Obesity
  • Smoking
  • Elevated cholesterol
  • Diabetes
  • Hypertension
calculate your risk
Calculate Your Risk

Framingham Risk Calculator



make the right choices
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
learn about trans fatty acids
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%
trans fatty acids
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

dark chocolate
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

Elevation of HDL

Antithrombotic effects

Promote formation of nitric oxide (NO)

Reduced coronary heart disease


Rx: Recommended Dose – 1-2 drinks per day

olive oil
Increase in HDL


Total Cholesterol

Total to HDL Ratio


Reduction in oxidative stress markers

Olive Oil
green tea
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