Cardiovascular Disease: an Overview

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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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Obesity in the USA
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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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(No Transcript)
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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
MassMarketing of Junk Food
TechnologyInfluences
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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Women are not immune to heart disease!
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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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The heart, brain and extremities share a disease
process
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The Common Thread?

• Circulatory system (arteries, veins, etc.)

• Susceptibility to atherosclerosis

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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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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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Diseased Coronary Artery
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Peripheral Vascular Disease
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Stroke Brain Attack
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Symptoms of Cardiovascular Disease
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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
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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 Val
ve Disease
Heart Muscle Injury
Heart Failure
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Heart Failure Symptoms

• Shortness of breath
• Fatigue
• Edema (swelling)

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Arrhythmias
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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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Heart Valve Disease
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Valve Disease
Valves are intended to allow blood flow in only
one direction from one heart chamber to another
Pulmonic Valve
Aortic Valve

• 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)

Mitral Valve
Tricuspid Valve
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Valve Disease
Congenital Abnormality

• Shortness of breath
• Fatigue
• Chest Pain
• Susceptibility to infection
• Death

Infection
Valve Dysfunction
Age Related Degeneration
Rheumatic Fever
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Treatment of Valve Disease

• Medications
• Surgery
• Percutaneous repair

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Open Heart Surgery
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Percutaneous Valvuloplasty
Mitral Valvuloplasty
Aortic Valvuloplasty
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Percutaneous Aortic Valve Replacement
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Percutaneous Aortic Valve Replacement
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What can you do to stay healthy?
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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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Trans Fatty Acids
AHA Recommendations

• Saturated fats
• Trans fats to
• Cholesterol to
• Total fat to 25-35 of total caloric intake

FDA mandated trans fat food labeling after
January 1, 2006
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Some Unlikely Friends?
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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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Alcohol

• Elevation of HDL
• Antithrombotic effects
• Promote formation of nitric oxide (NO)
• Reduced coronary heart disease

Rx Recommended Dose 1-2 drinks per day
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Olive Oil

• Increase in HDL
• Reductions
• Total Cholesterol
• Total to HDL Ratio
• Triglycerides
• Reduction in oxidative stress markers

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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

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Where are we heading?