Cardiovascular Health


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Cardiovascular Health

  2. 2. Causes of Death <ul><li>Top three causes of death </li></ul><ul><li>Heart disease </li></ul><ul><ul><li>Someone suffers a coronary event every 29 seconds in the US </li></ul></ul><ul><ul><li>Someone dies from a coronary event every minute </li></ul></ul><ul><li>Cancer </li></ul><ul><li>Infectious disease </li></ul>
  3. 4. Cost to Society <ul><li>274 billion per year on cardiovascular disease </li></ul><ul><li>99 billion per year on alcohol related disease </li></ul><ul><li>72 billion on smoking related diseases </li></ul><ul><li>67 billion spend on drug abuse </li></ul>
  4. 5. Physiology of the Heart <ul><li>Four chambered pump </li></ul><ul><li>Size of a fist </li></ul><ul><li>Weighs about 1 pound </li></ul><ul><li>Creates pressure to circulate blood throughout the body </li></ul><ul><li>Located between the lungs, left of center in the thorax </li></ul>
  5. 10. Blood flow through the heart <ul><li>Deoxygenated blood from the inferior and superior vena cava empties into the right atrium </li></ul><ul><li>Continues past the tricuspid valve into the right ventricle </li></ul><ul><li>Leaves the right ventricle and heads toward the lungs to pick up oxygen and returns to the heart as oxygenated blood </li></ul>
  6. 11. Blood flow through the heart <ul><li>Oxygenated blood returns to the left side of the heart entering the left atrium </li></ul><ul><li>Flows past the mitral valve into the left ventricle </li></ul><ul><li>Leaves the left ventricle through the aorta out to the rest of the body </li></ul>
  7. 13. Important features of the heart <ul><li>Valves ensure that the blood flows in one direction </li></ul><ul><li>Left ventricle is more muscular then the other chambers </li></ul><ul><li>Septum divides the heart in half </li></ul>
  8. 15. Electrical Stimulation of the Heart <ul><li>Signal sends impulses from the brain to the heart </li></ul><ul><li>SA node (pacemaker of the heart) creates an electrical impulse that contracts the atria </li></ul><ul><li>AV node picks up the signal and sends it on to the ventricles </li></ul><ul><li>EKG picks up the electrical signals from the heart and is able to detect abnormalities in the conduction </li></ul>
  9. 17. Function of the blood <ul><li>Transportation of nutrients, oxygen, waste products and hormones </li></ul><ul><li>Regulation of water content for cells </li></ul><ul><li>Regulation of body temperature </li></ul><ul><li>Buffers to maintain pH level </li></ul><ul><li>Clotting capabilities </li></ul><ul><li>Protection against pathogens by circulating antibodies </li></ul><ul><li>Average person has 6 quarts of blood </li></ul>
  10. 18. The Vascular System <ul><li>Refers to the blood vessels </li></ul><ul><li>Arteries carry blood away from the heart </li></ul><ul><li>Veins carry blood back into the heart </li></ul><ul><li>Coronary arteries carry blood to the heart </li></ul><ul><li>Carotid arteries carry blood to the brain </li></ul><ul><li>Iliac and femoral arteries carry blood to the abdomen and legs </li></ul>
  11. 20. Permanent Risk Factors for Heart Disease <ul><li>Age – as you age, the greater the risk </li></ul><ul><li>Gender – men are more at risk then premenopausal women </li></ul><ul><li>Ethnicity –African Americans more at risk due to the increased rates of high blood pressure </li></ul><ul><li>Heredity – if you have a family history of CVD your risk is greater </li></ul>
  12. 21. Cardiovascular Risk Factors That Can Be Changed <ul><li>High cholesterol </li></ul><ul><li>High blood pressure </li></ul><ul><li>Inflammation </li></ul><ul><li>Physical inactivity </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes </li></ul><ul><li>Obesity </li></ul><ul><li>Diet </li></ul><ul><li>Periodontal disease </li></ul>
  13. 22. Cholesterol <ul><li>Cholesterol manufactured in the liver and small intestines </li></ul><ul><li>Needed for the production of sex hormones, cell membranes, bile salts and nerve fibers </li></ul><ul><li>Cholesterol attaches itself to lipoproteins </li></ul>
  14. 23. Cholesterol <ul><li>Two types of lipoproteins </li></ul><ul><ul><li>LDL-low density lipids </li></ul></ul><ul><ul><ul><li>Bad cholesterol </li></ul></ul></ul><ul><ul><ul><li>Average levels </li></ul></ul></ul><ul><ul><ul><ul><li>Less the 100 is optimal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>100-129 is near optimal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>130 or higher is dangerous </li></ul></ul></ul></ul><ul><ul><ul><ul><li>New study indicates even lower levels of LDL may be necessary ie; 60-70 </li></ul></ul></ul></ul><ul><ul><ul><li>Carries cholesterol to coronary arteries </li></ul></ul></ul><ul><ul><ul><li>Agitate arterial walls and form lesions that allow plaque buildup </li></ul></ul></ul>
  15. 24. Cholesterol <ul><ul><li>HDL-high density lipids </li></ul></ul><ul><ul><ul><li>Good cholesterol </li></ul></ul></ul><ul><ul><ul><li>Average level </li></ul></ul></ul><ul><ul><ul><ul><li>Men – 40-50 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Women – 50-60 </li></ul></ul></ul></ul><ul><ul><ul><li>Carries cholesterol away from arteries to the liver </li></ul></ul></ul><ul><ul><ul><li>Offer protection against heart disease </li></ul></ul></ul><ul><ul><ul><li>Pick up LDL and bring them to the liver for removal </li></ul></ul></ul>
  16. 25. Cholesterol <ul><li>Total cholesterol above 200 is high </li></ul><ul><ul><li>Combines HDL and LDL </li></ul></ul><ul><li>HDL above 60 is healthy, below 40 is dangerous </li></ul><ul><li>LDL below 130 is healthy , above 190 is dangerous </li></ul>
  17. 26. Cholesterol Reduction <ul><li>Exercise </li></ul><ul><ul><li>Single most effective way to increase HDLs </li></ul></ul><ul><li>Weight reduction </li></ul><ul><li>Diet </li></ul><ul><ul><li>Limit saturated fats </li></ul></ul><ul><ul><li>Increase your intake of fatty fish </li></ul></ul><ul><ul><li>High fiber diet </li></ul></ul><ul><li>Smoking </li></ul><ul><li>Moderate alcohol intake </li></ul><ul><ul><li>Phenols in red wine </li></ul></ul><ul><li>Genetic predisposition </li></ul>
  18. 27. Blood Pressure <ul><li>Pressure exerted on the walls of the arteries </li></ul><ul><li>Systolic </li></ul><ul><ul><li>Highest pressure </li></ul></ul><ul><ul><li>Pressure exerted when left ventricle is contracting </li></ul></ul><ul><li>Diastolic </li></ul><ul><ul><li>Lowest pressure </li></ul></ul><ul><ul><li>Left ventricle is filling with blood </li></ul></ul><ul><li>Normal range </li></ul><ul><ul><li>120/80 </li></ul></ul><ul><ul><li>120/80 to 139/89 now is called pre-hypertension </li></ul></ul>
  19. 28. Hypertension (High Blood Pressure) <ul><li>Decreased elasticity of blood vessels makes is more difficult for the heart to pump the blood and increases the blood pressure </li></ul><ul><li>Higher incidence in non-whites </li></ul><ul><li>65 million Americans have hypertension </li></ul><ul><ul><li>Approx 35% of the population </li></ul></ul>
  20. 29. Hypertension <ul><li>Signs and symptoms </li></ul><ul><ul><li>No signs initially, until the pressure becomes very high </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Blurred vision </li></ul></ul>
  21. 30. Hypertension <ul><li>Medical problems associated with high blood pressure </li></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Kidney failure </li></ul></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Dementia </li></ul></ul><ul><ul><li>Heart failure </li></ul></ul>
  22. 31. Hypertension <ul><li>Known as the “silent killer” </li></ul><ul><li>Symptoms only appear when the blood pressure is dangerously high </li></ul><ul><li>You must take you medications even if you feel fine </li></ul>
  23. 32. Hypertension <ul><li>Medications </li></ul><ul><ul><li>Diuretics - to remove fluid </li></ul></ul><ul><ul><li>Vasodilators – to enlarge the size of the blood vessels </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>Impotence </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Muscle weakness </li></ul></ul>
  24. 33. Hypertension <ul><li>Blood pressure reduction </li></ul><ul><ul><li>Weight reduction </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Reduce salt intake </li></ul></ul><ul><ul><li>Diet high in fruits and vegetables </li></ul></ul>
  25. 34. Inflammation of Blood Vessels <ul><li>Inflammation in the vessels causes the plaque to break free </li></ul><ul><li>May contribute to heart attacks </li></ul><ul><li>Measured by C reactive proteins (CRP) </li></ul><ul><li>Average reading of CRP is 1.5 </li></ul><ul><li>High levels come from chronic infections (gum disease), sedentary lifestyle, HTN </li></ul><ul><li>Normally produced by the body to fight infections and promote healing </li></ul>
  26. 35. Physical Inactivity <ul><li>Exercise is the single most effective way to increase your HDL levels </li></ul><ul><li>Exercise decreases your blood pressure </li></ul><ul><li>Exercise contributes to weight reduction </li></ul><ul><li>Exercise strengthens your heart muscle and increases the efficiency </li></ul><ul><li>Exercise can increase your longevity </li></ul><ul><ul><li>Walked 30 min/day for five days/week live 1.3-1.5 years longer </li></ul></ul><ul><ul><li>Running 30 min/day (or equivalent) live 3.5-3.7 years longer </li></ul></ul>
  27. 36. Smoking <ul><li>The most dangerous risk factor for heart disease </li></ul><ul><li>Increases your heart rate and constricts your blood vessels </li></ul><ul><li>Doubles the risk of heart attack for a person who smokes one pack per day </li></ul>
  28. 37. Diabetes <ul><li>More then 80% of people with diabetes die from cardiovascular disease </li></ul><ul><li>If not well controlled can contribute to high cholesterol levels </li></ul><ul><li>Can be managed through diet, exercise and medications </li></ul>
  29. 38. Obesity <ul><li>Increases the strain on the heart </li></ul><ul><li>Increases blood pressure </li></ul><ul><li>May trigger diabetes </li></ul><ul><li>Weight loss increases your HDL and lowers your LDL </li></ul><ul><li>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% </li></ul>
  30. 39. Diet <ul><li>Limit saturated fats </li></ul><ul><ul><li>Beef, ham, pork </li></ul></ul><ul><ul><li>Dairy products </li></ul></ul><ul><ul><li>Palm and coconut oils </li></ul></ul><ul><li>Use more polyunsaturated fats </li></ul><ul><ul><li>Corn oil </li></ul></ul><ul><ul><li>Safflower oil </li></ul></ul>
  31. 40. Diet <ul><li>Increase fatty fish such as salmon, mackerel </li></ul><ul><ul><li>High in omega 3 fatty acids </li></ul></ul><ul><li>High fiber diet </li></ul><ul><ul><li>Men who ate 29 gms of fiber/day (one cup bran cereal) 36% decreased risk of MI </li></ul></ul><ul><li>Keep fat to 30% of diet </li></ul><ul><ul><li>Americans eat 46% fat in diet </li></ul></ul>
  32. 41. Periodontal Disease <ul><li>Chronic infections from gum disease increase the CRP levels </li></ul><ul><li>Toxins and bacteria enter your bloodstream causing inflammation of the vessels </li></ul>
  33. 42. Types Of Heart Disease <ul><li>CAD – coronary artery disease </li></ul><ul><li>Hypertension </li></ul><ul><li>Stroke </li></ul><ul><li>Congenital heart disease </li></ul><ul><li>Congestive heart disease </li></ul><ul><li>Rheumatic heart disease </li></ul>
  34. 43. Coronary Artery Disease <ul><li>Atherosclerosis – hardening of the arteries </li></ul><ul><li>Fatty deposits build up inside the vessels that slow the flow of blood or completely occlude it </li></ul>
  35. 46. Coronary Artery Disease <ul><li>Angina </li></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Decreased blood supply to coronary arteries </li></ul></ul><ul><ul><li>Nitroglycerin </li></ul></ul>
  36. 47. Myocardial Infarction Heart Attack <ul><li>MIs are getting smaller secondary to better medications and active lifestyles </li></ul><ul><li>Men are 20% more likely to have MI on birthday </li></ul><ul><li>Higher incidence in winter versus summer </li></ul><ul><li>More likely on Monday </li></ul><ul><li>more likely to be fatal at night </li></ul><ul><li>Four times more likely if you are depressed </li></ul><ul><li>Weekend warriors at greater risk </li></ul>
  37. 48. Myocardial Infarction <ul><li>Women and heart attacks </li></ul><ul><ul><li>First MI 10-20 years later then men, but 70% more likely to die </li></ul></ul><ul><ul><li>Women take one hour longer to get to the ED </li></ul></ul><ul><ul><li>Women do not exhibit classic symptoms of MI, tends to be a spasm, not a blockage of the coronary arteries </li></ul></ul><ul><ul><li>30% less likely to get the proper medications </li></ul></ul>
  38. 49. Myocardial Infarction <ul><ul><li>Premenopausal women usually protected but 9000 women younger then 45 die each yr </li></ul></ul><ul><ul><li>More women die from heart attacks and strokes then breast cancer, 500,000 women vs 40,000/yr </li></ul></ul><ul><ul><li>Women on HRT have an increased chance of MI/stroke/blood clots </li></ul></ul><ul><ul><ul><ul><li>Doubles risk of MI during first year </li></ul></ul></ul></ul>
  39. 50. Myocardial Infarction Heart Attack <ul><li>Heart Attack or Myocardial Infarction (MI) </li></ul><ul><ul><li>Death of the cardiac muscle secondary to a lack of oxygen </li></ul></ul><ul><ul><li>Cause is a blockage of the coronary arteries by a floating piece of plaque or eventual closure due to cholesterol </li></ul></ul><ul><ul><li>Extent of damage depends on the size of the artery affected </li></ul></ul>
  40. 51. Coronary Artery Disease <ul><li>Heart Attack Signs and Symptoms </li></ul><ul><ul><li>Crushing substernal chest pain </li></ul></ul><ul><ul><li>Sweating, short of breath </li></ul></ul><ul><ul><li>Pain radiating to the jaw or left arm </li></ul></ul><ul><ul><li>Indigestion </li></ul></ul><ul><li>Get the person to the hospital, time is muscle </li></ul><ul><li>Ask if they use NTG </li></ul><ul><li>CPR </li></ul><ul><li>Ventricular fibrillation </li></ul>
  41. 52. Heart Attack
  42. 53. Heart Attack
  43. 54. Ventricular Fibrillation
  44. 55. Ventricular Fibrillation
  45. 56. Coronary Artery Disease <ul><li>Hospital Care </li></ul><ul><ul><li>Anticoagulants (blood thinner) </li></ul></ul><ul><ul><ul><li>aspirin </li></ul></ul></ul><ul><ul><li>TPA – tissue plasminogen activator </li></ul></ul><ul><ul><li>Angioplasty </li></ul></ul><ul><ul><li>Bypass surgery </li></ul></ul>
  46. 57. Angioplasty
  47. 59. Stent Placement
  48. 60. Bypass Surgery
  49. 62. New Areas of Research <ul><li>Synthetic form of HDL </li></ul><ul><ul><li>Found to reverse plaque build up in the arteries </li></ul></ul><ul><li>Genetic link </li></ul><ul><ul><li>Identified gene that may cause coronary artery disease </li></ul></ul><ul><ul><li>Identified gene variant that reduces inflammation thereby reducing heart disease </li></ul></ul><ul><li>Medication </li></ul><ul><ul><li>New drug to increase the HDL level </li></ul></ul><ul><li>Risk factors </li></ul><ul><ul><li>Men who were hostile and contemptuous of other people were 30% more likely to develop irregular heart beats </li></ul></ul><ul><ul><li>Explore anger management modifications </li></ul></ul>
  50. 63. Stroke Cerebral Vascular Accident (CVA) <ul><li>Decreased blood supply to the brain </li></ul><ul><li>Types of CVAs </li></ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul><ul><ul><li>Cerebral occlusion </li></ul></ul><ul><ul><li>Cerebral aneurysm </li></ul></ul>
  51. 65. Stroke <ul><li>Cerebral hemorrhage </li></ul><ul><ul><li>Blood vessel burst inside the brain </li></ul></ul>
  52. 66. Stroke <ul><li>Cerebral occlusion </li></ul><ul><ul><li>Floating clot or cerebral emboli </li></ul></ul><ul><li>Cerebral thrombosis </li></ul><ul><ul><li>Gradual narrowing </li></ul></ul>
  53. 67. Stroke <ul><li>Cerebral aneurysm </li></ul><ul><ul><li>Weakness in the vessel </li></ul></ul>
  54. 68. Stroke <ul><li>Signs and Symptoms </li></ul><ul><ul><li>May have no warning, sudden collapse </li></ul></ul><ul><ul><li>TIAs – transient ischemic attacks </li></ul></ul><ul><ul><li>Numbness or weakness in limbs </li></ul></ul><ul><ul><li>Slurred speech </li></ul></ul><ul><ul><li>Dizzy </li></ul></ul><ul><li>Diagnosis </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Clot buster drugs </li></ul></ul><ul><ul><li>Surgery </li></ul></ul>
  55. 69. Stroke <ul><li>Prevention </li></ul><ul><ul><li>Detection and control of diabetes </li></ul></ul><ul><ul><li>Stop smoking </li></ul></ul><ul><ul><li>Control hypertension </li></ul></ul><ul><ul><li>Low cholesterol diet </li></ul></ul><ul><ul><li>Diet high in fruits and vegetables </li></ul></ul><ul><ul><li>Antioxidant vitamins C,E, beta carotene, folic acid </li></ul></ul><ul><ul><li>Report TIAs to MD </li></ul></ul><ul><ul><li>Daily ASA </li></ul></ul>
  56. 70. Congenital Heart Disease <ul><li>Abnormalities present at birth </li></ul><ul><li>May be due to environmental factors or illness contracted during pregnancy </li></ul><ul><li>8 out of 1000 infants have CHD </li></ul><ul><li>Blue baby </li></ul>
  57. 71. Congenital Heart Defects
  58. 72. Congenital Heart Defects
  59. 73. Congestive Heart Failure <ul><li>Enlarged heart due to lack of strength </li></ul><ul><li>Causes include MI, HTN, defective valves </li></ul><ul><li>Blood backs up into the body and the lungs </li></ul><ul><li>Treatment includes medications such as diuretics and vasodilators as well as reduction of salt in diet </li></ul>
  60. 74. Congestive Heart Failure
  61. 75. Congestive Heart Failure
  62. 76. Rheumatic Heart Disease <ul><li>Damage due to rheumatic fever via strep throat </li></ul><ul><li>Caused by streptococcal bacteria </li></ul><ul><li>Damages the valves of the heart </li></ul><ul><li>Surgery may be required to correct the defect </li></ul>
  63. 77. Rheumatic Heart Disease
  64. 78. Cardiovascular Health Rules <ul><li>Follow these rules and reduce your chance for heart disease by 82% </li></ul><ul><ul><li>Don’t smoke </li></ul></ul><ul><ul><li>Avoid obesity </li></ul></ul><ul><ul><li>Get at least 30 min of moderate to vigorous exercise every day </li></ul></ul><ul><ul><li>Drink moderately </li></ul></ul><ul><ul><li>Eat healthy foods </li></ul></ul><ul><ul><ul><li>Avoid saturated fats </li></ul></ul></ul><ul><ul><ul><li>Eat fish oil, folate, fiber, vegetable oils, whole grain products </li></ul></ul></ul>