Cardiovascular disease is the leading cause of death in the United States, killing over 370,000 people per year. The heart works to pump blood through the body and provide oxygen, but can be damaged by conditions like coronary artery disease, heart attacks, and heart failure. A heart attack occurs when an artery becomes blocked, preventing blood and oxygen from reaching heart tissue. Treatment depends on the severity but may include medications, angioplasty, or bypass surgery. Heart failure develops when the heart muscle weakens and cannot pump blood effectively, due to prior damage from issues such as heart attacks or hypertension. Management focuses on reducing strain on the heart.

1. Cardiovascular Disorders
(Heart)
Michael C. Joseph, MD
09 November 2016
(Peer Learning)

2. Outline
Cardiovascular Disease
The Heart
Coronary Artery Disease (CAD)
Heart Attack (Myocardial Infarct) (MI)
Heart Failure (HF)
RESOURCES
CREDITS

3. Cardiovascular Disease 2013
 About 85.6 Americans were living with some form of CVD.
 Cardiovascular disease (CVD) (heart disease, stroke, and blood vessel
disorders) was the leading cause of death, in both sexes.
 CVD claimed more lives than all forms of cancer combined.
 About 801,000 people died of CVD:
1 in every 3 deaths;
2,200 deaths every day;
one death every 40 seconds.
Cardiac Arrest:
About 356,000 people experienced out-of-hospital cardiac arrests.
Of those treated by EMS, 12 % survived. Of those witnessed by
bystanders, 38% survived. Each year, about 209,000 people have
a cardiac arrest while hospitalized.

4. CVD – U.S. Geography

5. U.S. CVD Trends (2003 to 2013)
The population increased by 10%, but:
 The death rate from Heart Disease fell by about
38%;
 The death rate from Stroke dropped by about
34%;
 The number of Stroke deaths decreased by about
18%.
Cardiovascular operations and procedures
increased by about 28% from 2000 to 2010 -
totaling about 7.6 million in 2010.

6. “Life’s (Health’s?) Simple 7”
 Blood Pressure
 Physical Activity
 Cholesterol level
 Diet
 Weight
 Smoking Status
 Blood Glucose level

7. Prevalence of Meeting at least 5
Criteria for CV Health

8. Heart Disease
Epidemiology
 Heart disease strikes someone in the U.S.
every 42 seconds.
 Heart disease is the number one cause of
death in the U.S., killing over 370,000
people a year.
 Heart disease is the No. 1 killer of women,
causing more deaths than all forms of
cancer combined.

9. Heart Functions
 Pump
−Circulation of the Blood
−2,575,440,000 heartbeats (70 bpm x 70 yrs)
 Oxygenation
−Venous blood inflow (High CO2)
−Pulmonary exchange (CO2 <-> O2)
−Arterial blood outflow (High O2)

10. Organ System Changes
Cardiopulmonary System
 Heart
−Heart muscle thickens;
−maximum pumping rate decreases;
−oxygen extraction from blood decreases.
 Arteries
−stiffening;
−fatty deposits;
−peripheral insufficiency.
 Lungs
−loss of elasticity;
−decrease in maximum breathing capacity.

11. Anatomy of the Heart

12. The Electrocardiogram
(ECG)
The Electrocardiogram (EKG)

13. Coronary Arteries - Dysfunction
 4 main arteries surround the heart
 Supply oxygen to the heart muscle
 May be obstructed by:
−Blood clot (thrombosis)
−Cholesterol plaque (atherosclerosis)
Acute obstruction destroys heart muscle (infarct)
Chronic obstruction causes pain on exertion (angina
pectoris)

14. Coronary Arteries - Anatomy

15. Myocardial Ischemia

16. Heart Attack – Causes
 Heart attacks most often occur as a result of
coronary heart disease (CHD), also called
coronary artery disease (CAD).
 An area of plaque (atherosclerosis) or a clot
(thrombosis) can occlude an artery. If the
blockage isn't treated quickly, the portion of
heart muscle fed by the artery begins to die, and
healthy heart tissue is replaced with scar tissue.
 A less common cause of heart attack is a severe
spasm of a coronary artery. Spasms can occur
in coronary arteries that are not affected by
atherosclerosis.

17. Heart Attack – Incidence (U.S.)
 About 750,000 persons have heart attacks
each year. Of those, about 116,000 die.
 About 550,000 persons have a first-time
attack each year.
 About 200,000 persons have recurrent
heart attacks.

18. Heart Attack - Signs & Symptoms
 In Men
−Severe substernal chest pain
−May radiate to the left shoulder and arm
 In Women
−Variable pain location
−May radiate to the jaw and neck
 Anxiety
 Nausea, indigestion, heartburn or abdominal pain
 Shortness of breath
 Cold sweat
 Lightheadedness or sudden dizziness
 Fatigue (lasting up to several days in women)

19. Heart Attack (Risk Factors)
Modifiable:
“The Healthy 7”
−Smoking
−High blood pressure
−Diabetes
−Elevated cholesterol
−Obesity
−Diet
−Lack of exercise
−Stress (?)
Non-modifiable:
− Family History
− Age
− Race
− Sex

20. Heart Attack
Risk Factor Assessment
 Cholesterol Management
−Optional Statin treatment
−https://statindecisionaid.mayoclinic.org/index.php/statin/in
dex?PHPSESSID=pq5tmgakob13alef8jrrf2vvc1
 Body Fat Estimation
−Basic Metabolic Index (BMI)
−http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/b
micalc.htm
−BMI may overestimate body fat in athletes and others
who have a muscular build.
−BMI may underestimate body fat in older persons and
others who have lost muscle.

21. Heart Attack
Diagnostic Tests
EKG:
An EKG can show signs of heart damage due
to coronary heart disease (CHD) and signs of
a current or previous attack.
Blood Tests:
During a heart attack, heart muscle cells die and
release proteins into the bloodstream. Serial blood
tests can measure the amount of these proteins in the
bloodstream. Higher than normal levels of these
proteins suggest a heart attack.
Coronary Angiography:
A catheter is threaded into the coronary arteries to
identify blocked blood vessels.

22. Heart Attack Treatment (I)
Immediate
Aspirin to prevent further blood clotting.
‘Clot busters”, such as streptokinase.
Nitroglycerin to reduce your heart’s workload,
and improve blood flow through the coronary
arteries.
Oxygen therapy, as needed.
Treatment for chest pain, e.g. morphine.
Maintenance of Blood Pressure

23. Heart Attack Treatment (II)
Immediate (“Cath Lab”)
Percutaneous Coronary Intervention (PCI) is a nonsurgical procedure
that opens blocked or narrowed coronary arteries.
− A thin, flexible tube (catheter) with a balloon or other device on the end is
threaded through a blood vessel, usually in the groin (upper thigh), to the
narrowed or blocked coronary artery.
− Once in place, the balloon located at the tip of the catheter is inflated to
compress the plaque and related clot against the wall of the artery.
− During the procedure, the doctor may put a small mesh tube called a stent
in the artery. The stent helps to keep the blood vessel open to prevent
blockages in the artery in the months or years after the procedure.
Urgent (Surgery)
Coronary Artery Bypass Graft (CABG)
A surgeon removes a healthy artery or vein from your body. The artery or
vein is then connected, or grafted, to bypass the blocked section of the
coronary artery.

24. Heart Failure - Definition
 Inability of the ventricular heart muscle to
contract effectively
 May be “right-” or “left-”sided
 Progressive changes:
−Hypertrophy (enlargement of the muscle)
−Muscle outstrips its blood supply
−Dilation of the ventricle (poor muscle tone)
−Slow ventricular filling
−Decreased ejection fraction

25. Heart Failure – U.S. Epidemiology
 About 5.7 million people have heart
failure.
 One in 9 deaths in 2009 included heart
failure as a contributing cause.
 About half of the people who develop
heart failure die within 5 years of
diagnosis.

26. Heart Failure (Right vs. Left)

27. Heart Failure – Risk Factors
 People who are age 65 or older.
−Aging can weaken the heart muscle.
−Older people also may have chronic diseases that led to heart
failure.
 Ethnicity
−Blacks are more likely to have heart failure than people of other
races. They’re also more likely to have symptoms at a younger
age, have more hospital visits due to heart failure, and die from
heart failure.
 Obesity
−Excess weight puts strain on the heart. Being overweight also
increases your risk of heart disease and type 2 diabetes, and these
diseases can lead to heart failure.
 Prior Heart Attack
−Damage to the heart muscle from a heart attack can weaken the
heart muscle.

28. Heart Failure (Causes)
 Diabetes and Nutritional Deficiencies
 Medications (e.g. chemotherapy)
 High blood pressure
 Endurance exercise (“the athlete’s heart”)
 Coronary artery disease
 Abnormal rhythm (arrhythmia)
 Heart muscle disorders (cardiomyopathy)
 Obstructed ventricular outflow
−Pulmonary disease
−Arterial stenosis (aorta, pulmonary artery)
−Valve stenosis (aortic, pulmonic)

29. Heart Failure (Treatment)
 Decrease fluid load on the heart
−Salt and fluid restriction
−Increase salt and fluid excretion
 Improve cardiac function
−Increase ventricular contractility
−Relieve output obstruction
−Decrease blood pressure

30. RESOURCES
 American Heart Association
−(https://www.heart.org)
 National Institutes of Health
(http://www.nhlbi.nih.gov)
 CDC
− (http://www.cdc.gov)

31. CREDITS
 American Heart Association
− https://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/documents/downloadable/ucm_462014.pdf
− http://www.heart.org/idc/groups/ahamah-
public/@wcm/@sop/@smd/documents/downloadable/ucm_480110.pdf
− http://www.heart.org/idc/groups/ahamah-
public/@wcm/@sop/@smd/documents/downloadable/ucm_480086.pdf
 National Institute of Health
− http://www.nhlbi.nih.gov/health/health-topics/topics/hd
− http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/
− http://www.nhlbi.nih.gov/health/health-topics/topics/hf
 CDC
− http://www.cdc.gov/heartdisease/facts.htm