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Understanding the Cardiovascular System Chapter 4 Refers to Heart – Lung Functioning. Sub-Components of the Cardio-respiratory System. Heart Blood Blood Vessels Lungs. Function of Cardio-Respiratory Systems. Primarily to: Transport and exchange gases(O 2 and CO 2 )

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function of cardio respiratory systems
Function of Cardio-Respiratory Systems
  • Primarily to:
    • Transport and exchange gases(O2 and CO2)
    • Deliver nutrients to cells
    • Deliver hormones and nutrients
    • Removes waste
    • Balance fluids
    • Temperature regulation
anatomical considerations of the heart
Anatomical Considerations of the Heart
  • Size of a closed fist
  • Located in the mediastium of the chest cavity
basics of heart anatomy
Basics Of Heart Anatomy
  • It is a four chambered structure
    • Two upper chambers: atria or atrium
    • Two lower chambers: ventricles
  • It is divided into right and left sides by muscular tissue known as theseptum
basics of heart anatomy 2
Basics Of Heart Anatomy #2
  • By being divided into right and left sides, the heart is able to serve two systems:
    • Pulmonary
    • Systemic
  • Explanation of basic blood flow
cardiovascular disease
Cardiovascular Disease
  • 60-70 million Americans have one or more forms of CVD
cardiovascular disease8
Cardiovascular Disease
  • 1 million deaths each year
  • 330 billion dollars
cardiovascular disease9
Cardiovascular Disease
  • Cardiovascular disease (CVD) is the number one cause of death in the United States.
cardiovascular disease10
Cardiovascular Disease
  • 2600 Americans die each day from CVD
    • 1 death every 33 seconds
  • Claims more lives each year than the next 7 causes of death combined (AHA ’99)
forms of cardiovascular disease often preventable and lifestyle related
Forms of Cardiovascular Disease(Often preventable and lifestyle related)
  • Coronary artery disease (CAD or CVD)
  • Hypertension (high blood pressure)
  • Cerebral vascular accidents (strokes)
  • Angina pectoris
  • Peripheral vascular disease
  • Valve disease
  • Rheumatic heart disease
  • Congenital heart disease
  • Congestive heart failure
coronary artery disease cad
Coronary Artery Disease (CAD)
  • Primary form of heart disease
  • May be caused by a variety of conditions, however most cases are associated with:
    • Waxy plaque build-up in the arteries
    • Atherosclerosis
cardiovascular disease14
Cardiovascular Disease
  • Has anyone in your family had bypass surgery?
  • Blocked arteries?
    • Plaque build-up
    • Related to high cholesterol levels sustained over time
    • Occurs, primarily, in vessels closest to the heart
cardiovascular procedures
Cardiovascular Procedures
  • Angioplasty
  • Roto-Blade
  • Stints
  • Keyhole Surgery
  • Radiation
  • Bypass Surgery (7 yr.average)
cad post op patient
CAD Post-Op Patient
  • What behavioral and dietary changes are suggested for the patient?
can one be fit but not healthy
Can One Be FIT But Not Healthy?
  • Personal profile example
  • Run 3 miles daily
  • Lift weights
  • Stretching exercises
  • Smokes, stress, excessive alcohol, fatty foods, drugs, etc.
jim fixx
Jim Fixx
  • 36 years old, 215 pounds
  • 2 pack a day smoker
  • No regular exercise
  • Family history of heart disease
    • father had a heart attack at 35, died at 43
  • Began to exercise at age 36
  • Ran 60-80 miles per week
  • Was FIT but not HEALTHY
coronary risk factors
Coronary Risk Factors
  • Primary Risk Factors:Factors that have been definitively associated with or directly cause coronary artery disease.
  • Secondary Risk Factors:Factors believed to contribute to or advance the severity of atheroschlerosis and CAD.
primary risk factors alterable
Primary Risk Factors (Alterable)
  • Smoking
  • Hypertension (high blood pressure)
  • High serum cholesterol (hyperlipidemia)
  • Physical inactivity
  • Diabetes mellitus
  • Obesity
    • (drug use)
secondary risk factors
Secondary Risk Factors
  • Stress
  • Age
  • Gender (male vs. female)
  • Family history
arkansas stats from the center for disease control mortality rates
Arkansas Stats from the Center for Disease Control/Mortality Rates
  • Males #2 in deaths from CAD
  • Males #2 in deaths from lung cancer
  • Males and Females # 1 in deaths from stroke
additional ark stats
Additional Ark. Stats
  • 1/3 of deaths in AR related to CVD (l998)
  • 90% of adults report no vigorous activity
  • 36% do not engage in any physical activity
  • Arkansans are gaining weight 3 times faster than the rest of the nation
  • 40% AR youths carry excessive weight
smoking 1
Smoking #1
  • The single most important, preventable cause of illness and early death
smoking 2
Smoking #2
  • 400,000 related deaths per year
  • >$50 billion
  • Cancer, heart disease, respiratory diseases (emphysema)
  • Cigarette smoking and passive smoke inhalation are highly related to CAD.
smoking 3
Smoking #3
  • Smokers have a 70% greater level of coronary risk than nonsmokers.
  • Magnitude of risk is related to number of cigarettes smoked.
  • Pipe, cigar, pot
  • Personal economics of smoking
secondary smoke
Secondary Smoke
  • 53,000annual deaths
  • For each pack of cigarettes smoked, the non smoker, sharing the same air, will inhale the equivalent of 3 to 5 cigarettes.
smokeless tobacco
Smokeless Tobacco
  • Chewing tobacco
  • Overheads
smoking benefits
Smoking Benefits??
  • Injures the inner lining of the arteries
  • Increases the risk of blood clotting
  • Increases the risk of heart attack
  • Increases risk of sudden death
  • Allows for consumption of 63 cancer causing chemicals
smoking benefits 2
Smoking Benefits #2 ???
  • 87% of lung cancer caused by smoking
  • Most emphysema and chronic bronchitis caused by smoking
  • Lowers HDL cholesterol
  • Increases facial wrinkles
  • Increases risk of many other diseases
  • Reduces length of life by as much as 17 years
    • Depends on amount smoked and years smoked
        • Stop smoking
          • Heart disease risk drops in a matter of months
          • Cancer risk drops slowly and may take 10 years
hypertension high blood pressure
Hypertension / High Blood Pressure
  • Blood Pressure:
    • The driving force that moves blood throughout the body.
    • The pressure exerted by the blood on the walls of the arteries.
blood pressure
Blood Pressure
  • 120/80 or less is optimal
  • 120-139/80-89 is Pre-hypertension
  • 140-159/90-99 is stage 1
  • 160/100 or higher is stage 2
systolic blood pressure 120 80
Systolic Blood Pressure 120/80
  • The highest pressure or value
  • Occurs during heart contraction phase (ventricular contraction)
diastolic blood pressure 120 80
Diastolic Blood Pressure 120/80
  • The lowest pressure or value
  • Occurs during heart relaxation phase (resting or refilling stage of the contraction)
hypertension high blood pressure37
Hypertension (High Blood Pressure)
  • A silent killer
  • 140/90 : considered mild stage of hypertension
  • Which is more problematic? 140/80 or 130/95
  • Potentially leads to stroke
  • Causes the heart muscle to overwork
hypertension 2
Hypertension #2
  • Related to stroke / aneurysms
  • Hypertension may be the result of another health problem
factors affecting blood pressure
Factors Affecting Blood Pressure
  • Hypertensive medications
  • Time of day
  • Full bladder content
  • Body posture
  • Recent intake of caffeine
  • Nicotine
  • Alcohol
  • Recent strenuous activity
impact of hypertension
Impact of Hypertension
  • 25% or 50 million Americans are hypertensive
  • 67% are not treated
  • 1/2 are unaware of the complication
factors contributing to hypertension
Factors Contributing To Hypertension
  • Age
  • Race
  • Sodium sensitivity
  • Chronic alcohol abuse
  • Oral contraceptives
  • Sedentary living
lifestyle interventions to maintain or lower blood pressure
Lifestyle Interventions to Maintain or Lower Blood Pressure
  • Body weight reduction or maintenance
  • Smoking cessation
how to lower blood pressure
How To Lower Blood Pressure
  • Aerobic exercise
  • Reduce stress
  • Reduce cholesterol, sodium, high fat diet (saturated)
  • Medications
hyperlipidema high serum cholesterol
Hyperlipidema / High Serum Cholesterol
  • Definition of Cholesterol
    • A type of lipid (fat) found in animal tissues
    • This fat (Lipid) is insoluble in blood
    • It binds to proteins (lipoproteins) in order to be transported in the body
cholesterol 3 basic facts
Cholesterol: 3 basic facts
  • Provides for basic functions of the metabolic process
  • Is manufactured in the liver – non-essential
  • The body makes additional cholesterol (LDL) from saturated fats
what is so bad about having high cholesterol levels
What Is So Bad About Having High Cholesterol Levels??
  • High levels lead to a waxy, plaque build-up in the arteries, especially those near the heart.
  • The result can be increased risk ofCoronary Artery Disease (CAD)
more about plaque
More About Plaque
  • Affects all of us
  • May begin as early as 10 years of age
  • May be genetic
  • Medications??
  • Low density lipoproteins (BAD)
    • enhances plaque build up in the arteries
    • increases with a diet high in saturated and trans-fatty acids (hydrogenated products)
    • Undesirable, increases risk of CAD
  • High density lipoproteins (GOOD)
    • Offers protection from CAD
    • May remove plaque from the arteries
    • Aerobic activity will raise HDL level
    • Can be raised by consuming small amounts of alcohol daily
  • Very low density lipoproteins (VLDL)
    • undesirable and are associated with increase risk of CAD
cholesterol information
Cholesterol Information
  • Dietary Cholesterol
    • Refers to foods high in cholesterol
    • Example:
      • Shrimp
        • High in cholesterol
        • Low in fat
cholesterol information53
Cholesterol Information
  • Saturated fats
    • Can significantly raise LDL levels (“bad” cholesterol) and total serum cholesterol levels
    • Found in animal sources and by products
cholesterol information54
Cholesterol Information
  • Plants are NEVER sources of cholesterol, but can be sources of saturated fat.
    • Examples:
      • Tropical oils (palm, coconut)
      • Examples of sources: Movie popcorn, commercially baked goods
  • Ingestion of dietary cholesterol
serum cholesterol levels
Serum Cholesterol Levels
  • Desirable below 200
  • Borderline high 200-239
  • Risk for CVD 240 or >
  • Some guidelines call for desirable to be 170
high serum cholesterol 2
High Serum Cholesterol #2
  • If your cholesterol is 250, your risk of heart attack is twice that of 200
  • If your cholesterol is 300, your risk of heart attack is four times that of 200
understanding total serum cholesterol values
Understanding Total Serum Cholesterol Values
  • Knowing an individual’s total cholesterol is not always adequate when determining coronary risk
understanding cholesterol ratios
Understanding Cholesterol Ratios
  • Determine the ratio of total cholesterol to HDL’s
  • Formula: TC/HDL
  • Example: Male, TC = 190, HDL = 34 (5.4)
    • 190 divided by 34 = 5.4
  • Values equal to or greater than 5.0 for men and 4.5 for women are associated with risk.
  • 6.0 = increased risk
  • 4.0 = low risk
  • Usually, if HDL is less than 35, heart attack risk is indicated
cholesterol value examples

TC: 210 HDL: 32

Divide 210 by 32 = 6.56

6.56 : 1 ratio

Ratio is >5.0

Increased risk of CAD


TC: 220 HDL: 49

Divide 220 by 49 = 4.49

4.49 : 1 ratio

Ratio is <5.0

Low risk of CAD

Cholesterol Value Examples
cholesterol value examples60

TC: 195 HDL: 36

Divide 195 by 36 = 5.42

5.42 : 1 ratio

Ratio is >4.5

Increased risk of CAD


TC: 195 HDL: 40

Divide 195 by 40 = 4.9

4.9 : 1 ratio

Ratio is > 4.5

Increased risk of CAD

Cholesterol Value Examples
cholesterol value actual example
Cholesterol Value Actual Example
  • Female
  • TC 207 HDL 74
  • 207 divided by 74= 2.8
  • 2.8 : 1 ratio
  • < 4.5
  • Very low risk CAD
how to control or lower cholesterol
How To Control Or Lower Cholesterol
  • Avoid saturated fats
    • fats from animal sources
    • red meats
    • animal fats
    • animal by-products
controlling cholesterol 2
Controlling Cholesterol #2
  • Avoid dietary cholesterol
  • Exercise
  • Consume a low fat diet (20% or less)
  • Watch egg consumption
  • Limit red meats (fewer than 3 times per week)
  • Avoid commercially baked goods (tropical oils and trans-fatty acids/hydrogenation)
  • Use skim milk
controlling cholesterol 3
Controlling Cholesterol #3
  • Eat fish 2-3 times per week
  • Bake, broil, steam
  • Remove excess fat (soup, chili)
    • Is ground turkey better?
controlling cholesterol 4
Controlling Cholesterol #4
  • Avoid fatty sauces (fettuccini alfredo)
  • Substitute in recipes
    • Egg whites for eggs
    • Applesauce for oil in cakes
    • Salsa instead of butter for baked potatoes
    • Are there substitutions you make?
  • Maintain proper body weight
physical inactivity
Physical Inactivity
  • Physical activity levels and CAD are strongly inversely related.
physical inactivity 2
Physical Inactivity #2
  • Sedentary individuals have:
    • 2-3 times greater risk of CAD than active individuals.
    • Twice the risk of fatal heart attacks
physical activity
Physical Activity
  • Physical activity is argumentably be the single best method of controlling or reducing CAD.
  • Collateralization
physical activity 2
Physical Activity #2
  • Increases strength of the heart
  • Helps to establish and maintain normal blood pressure.
  • Helps to control obesity due to increase in caloric expenditure
physical activity 271
Physical Activity #2
  • Raises HDL levels, while lowering LDL, triglyceride and total cholesterol levels.
  • Decreases resting heart rates
  • Helps to manage stress levels
physical activity 3
Physical Activity #3
  • Increases resting and exercising stroke volumes
    • Amount of blood pumped by the heart in a single beat
  • Reduces the risk of diabetes
diabetes mellitus
Diabetes Mellitus
  • Arkansas ranks 11th in the prevalence of diabetes
  • New trends:
    • Increased cases of Type 2 diabetes children
    • Increase in adults in the 30’s.
diabetes mellitus74
Diabetes Mellitus
  • A condition in which glucose is unable to enter the cells
  • A disease associated with problems in controlling blood glucose or blood sugar
  • The disease results when the pancreas has problems producing insulin or the body can no longer use insulin properly
  • Insulin is the “taxi” that carries sugar from the blood to the cells
blood sugar levels
Blood Sugar Levels
  • Normal blood sugar levels: 65-110
  • Hyperglycemia
    • High levels of blood sugar
    • When sugar levels remain high, over time, it damages the walls of the vessels
    • Leads to impairment of the circulatory system
    • Affects functioning of most organs
    • Problems healing (small cuts, amputations)
    • Blindness
  • Low levels of blood sugar
  • It is appropriate to give sugar to the diabetic in a hypoglycemic emergency
  • Some may experience hypoglycemia but are not diabetic
    • protein is often recommended
types of diabetes
Types of Diabetes
  • Type I: insulin dependent or juvenile onset
  • Type II: maturity or adult onset, usually non-insulin dependent
  • Gestational onset
diabetes mellitus adult onset
Diabetes Mellitus: Adult Onset
  • The pancreas does not produce enough insulin or has just forgotten how
  • Directly related to obesity
  • 90% of all cases are Type II
adult onset 2
Adult Onset #2
  • An 20% increase in body weight doubles the chances of developing diabetes
  • Example:
    • Appropriate weight = 160
    • 20% weight gain = 192
how to avoid adult onset diabetes
How To Avoid Adult Onset Diabetes
  • Control cholesterol
  • Control weight
  • Control blood pressure
  • Exercise regularly (aerobic)
    • Diabetics must plan for meals, insulin injections, and exercise
  • 64% Americans are overweight
    • 25% obese
  • 60% Arkansans at unhealthy weight
    • 37% obese
  • Arkansas: 77% increase in obesity from 1991 to 2000
  • 117 billion spent on obesity-related illnesses
obesity 2
Obesity #2
  • 38% Arkansas school children overweight
  • Young adult obesity can shorten life span by 5 to 20 years
obesity is related to
Obesity Is Related To:
  • High cholesterol
  • Hypertension / stroke
  • Elevated LDL levels
  • Lower HDL levels
  • Physical Inactivity
  • Diabetes
  • Obesity is also related to joint problems
obesity fat distribution
Obesity: Fat Distribution
  • “Apples” Android Obesity
    • Fat distributed in upper body
    • Higher risk of CAD, strokes, diabetes
  • “Pears” Gynoid Obesity
    • Fat is distributed in the hips and legs
other diseases associated with obesity
Other Diseases Associated With Obesity
  • Renal disease
  • Gallbladder disease
  • Pulmonary disease
  • Degenerative arthritis
  • Psychological problems
  • Some cancers
    • Post menopausal obese women 5 times more likely to develop uterine cancer
  • Problems administering anesthesia
what constitutes obesity
What Constitutes Obesity?
  • BMI > 25
  • > 20 lbs overweight
  • Body fat percentages
    • Men > 20% (25)
    • Women > 25% (30)
secondary risk factors not alterable
Secondary Risk Factors (Not alterable)
  • Stress (secondary but is alterable to some degree)
  • Age
  • Gender
  • Family History
  • Unmanaged stress is related to CAD.
  • Type A personality is related to CAD.
  • Men : 45 and over
  • Women: 55 and over
family history primary or secondary
Family History: Primary or Secondary?
  • The risk is greater when:
    • Father or other first degree relative has a MI or sudden death prior to 55
    • Mother or another female family member has a MI or sudden death prior to 65
    • Family history of diabetes, hypertension
  • Men have a greater history of CAD earlier in life.
  • CAD is a disease of “equal opportunity”
new information homocysteine levels
**New Information: Homocysteine Levels
  • An amino acid (level becomes too high)
  • Causes heart disease (sudden blockage)
  • Birth defects
  • Testing is involved and expensive
  • Consume folic acid
    • Vegetables, fruits, vitamins E, C, B- complex and selenium
new information
**New Information
  • High triglyceride levels are associated with increase in CAD (fall 2000)
new information94
**New Information
  • Blood tests for C-Reactive Protein
  • Presence of protein indicated inflamed arteries
  • Inflammation may cause plaque to break away (plaque rupture)
  • Prescribe an antibiotic??