CARDIOVASCULAR HEALTH

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CARDIOVASCULAR HEALTH
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Cardiovascular Risk Factors That Can Be Changed

• High cholesterol
• High blood pressure
• Inflammation
• Physical inactivity
• Smoking
• Diabetes
• Obesity
• Diet
• Periodontal disease

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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

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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

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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

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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

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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

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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

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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

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Hypertension

• Signs and symptoms
• No signs initially, until the pressure becomes
  very high
• Headache
• Irritability
• Dizziness
• Blurred vision

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Hypertension

• Medical problems associated with high blood
  pressure
• Stroke
• Coronary artery disease
• Kidney failure
• Blindness
• Dementia
• Heart failure

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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

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Hypertension

• Medications
• Diuretics - to remove fluid
• Vasodilators to enlarge the size of the blood
  vessels
• Side effects
• Impotence
• Fatigue
• Muscle weakness

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Hypertension

• Blood pressure reduction
• Weight reduction
• Exercise
• Reduce salt intake
• Diet high in fruits and vegetables

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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

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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

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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

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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

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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

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Diet

• Limit saturated fats
• Beef, ham, pork
• Dairy products
• Palm and coconut oils
• Use more polyunsaturated fats
• Corn oil
• Safflower oil

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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

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Periodontal Disease

• Chronic infections from gum disease increase the
  CRP levels
• Toxins and bacteria enter your bloodstream
  causing inflammation of the vessels

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Types Of Heart Disease

• CAD coronary artery disease
• Hypertension
• Stroke
• Congenital heart disease
• Congestive heart disease
• Rheumatic heart disease

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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

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Coronary Artery Disease

• Angina
• Chest pain
• Decreased blood supply to coronary arteries
• Nitroglycerin

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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

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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

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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

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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

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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

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Heart Attack
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Heart Attack
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Ventricular Fibrillation
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Ventricular Fibrillation
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Coronary Artery Disease

• Hospital Care
• Anticoagulants (blood thinner)
• aspirin
• TPA tissue plasminogen activator
• Angioplasty
• Bypass surgery

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Angioplasty
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Stent Placement
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Bypass Surgery
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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

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StrokeCerebral Vascular Accident (CVA)

• Decreased blood supply to the brain
• Types of CVAs
• Cerebral hemorrhage
• Cerebral occlusion
• Cerebral aneurysm

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Stroke

• Cerebral hemorrhage
• Blood vessel burst inside the brain

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Stroke

• Cerebral occlusion
• Floating clot or cerebral emboli
• Cerebral thrombosis
• Gradual narrowing

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Stroke

• Cerebral aneurysm
• Weakness in the vessel

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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

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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

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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

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Congenital Heart Defects
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Congenital Heart Defects
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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

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Congestive Heart Failure
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Congestive Heart Failure
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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

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Rheumatic Heart Disease
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Cardiovascular Health Rules

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