The document discusses leading causes of death across the lifespan, including congenital abnormalities and SIDS for infants under 1, accidents for children over 1, and heart disease, cancer, and stroke for adults and the elderly. It also discusses gender differences in mortality, with women living longer than men on average due to riskier behaviors and occupations among men. Finally, it covers heart disease, hypertension, and stroke in more detail, outlining symptoms, risk factors, treatment options, and effects.

1. Heart Disease, Hypertension,
and Stroke

2. Psychological Issues in
Advanced and Terminal
Illness
 Average life expectancy in North America is
76 years.
 Leading causes of death in adults are
chronic illness
 What are the leading causes of death
across the life span?

3. Mortality Rates
Leading causes of death
 < 1 year
 congenital abnormalities;
 sudden infant death syndrome (SIDS)
 Children > 1 year old
 Accidents (40% of all deaths)
 Cancer (especially leukemia)
 Adolescence
 Unintentional injury
 Homicide
 AIDS

4. Mortality Rates
Leading causes of death
 Middle age
 Sudden death due to heart attack or stroke
 Cancer
 Elderly
 Heart disease
 Cancer
 Stroke

5. Why do women live longer
than men?

6. Potential Reasons for Gender
Differences in Mortality
 Females are more hardy
 Males engage in riskier behaviours (factor after
birth and infancy)
 Men engage in riskier sports
 Males tend to hold high stress or higher risk jobs
 Men tend to have poorer health habits (e.g., drink
more alcohol)
 Social support may be more protective in women

7. Risk Factors
 Family history
 Marital status (adds 10 yrs in men; 4 yrs in
women)
 Economic status
 Body weight
 Exercise
 Alcohol (add 2 years if drink 1-3 drinks/day)

8. Risk Factors - continued
 Smoking
 Disposition (add 2 yrs if reasoned, practical)
 Education
 Environment (add 4 yrs if rural)
 Sleep (more than 9 hours subtract 5 years)
 Temperature (add 2 yrs if thermostat is <
68)
 Health care – regular check ups add 3 yrs

9. How do people adapt to
chronic illness?

10. Adapting Under Good
Circumstances
 First concern upon hearing diagnosis is
fears about mortality.
 Optimistic but tentative about plans
 May try to normalize activities
 Risk is they may over-extend
 May have feelings of helplessness
 Risk is to become overly dependent

11. Three Themes of Adaptation
 Find meaning: why illness happened or
rethink priorities
 Gain sense of control
 control symptoms and treatment
 Restore self-esteem
 Often by comparison with worse off others

12. Adapting Under Bad
Circumstances
 Relapse seen as a bad sign with poor
prognosis
 Re-focuses one on the illness
 Need to undergo the coping process
again but likely less hopeful than
before.

13. Heart Disease
 Due to narrowing or blocking of the
coronary arteries.
 Angina pectoris
 painful cramp in chest, arm, neck, or back due
to brief blockage of oxygenated blood to the
heart.
 More often during exercise, stress, cold
temperature, digesting large fat meal.
 Little or no permanent damage

14. Heart Disease
 Myocardium
 Muscle tissue around the heart
 Myocardium infarction (heart attack)
 Prolonged blockage of blood to an area of the
heart resulting in muscle tissue damage.
 Symptoms of a heart attack
 Pressure in chest, fullness, squeezing pain.
 Pain spreading to shoulders, neck, or arms
 Lightheadedness, fainting, sweating, nausea

15. Who Is At Risk of Heart
Disease?
 Prevalence increases with age, particularly
after 45 years of age
 Prior to 50s, 60s, men at greater risk than
women but increases in women after
menopause.
 More women than men are likely to die
from a heart attack
 Blacks at higher risk, Asians at lower risk

16. Heart Disease Risk Factors
 High blood pressure
 Family history
 Cigarette smoking
 High LDL and total cholesterol levels
 Physical inactivity
 Diabetes
 Obesity
 Stress

17. Why high blood pressure a
risk factor?
 Heart has to work harder.
 Since heart muscle is working harder, it
can become enlarged.
 Wear and tear on the arterial wall can
increase the likelihood of lipid and calcium
deposits adhering to the arterial wall. This
leads to hardening of the arteries.

18. Type A Behaviours
 Hostile, cynical
 Judgmental (opinionated)
 Competitive
 Time urgent
 Uses gestures while talking
 Nodding of head while others are talking
 Intense

19. Physiological Reactivity
 Physiological and cardiovascular reactivity
to acute stress (“hot reactors”).
 Exaggerated increases in blood pressure,
heart rate, catecholamines, corticosteroids
 High levels of these hormones can
damage heart and blood vessels
 Presence of epinephrine (a
catecholamine) increases the formation of
clots.

20. Effects of Stress On Cardiac
Risk

21. Psychosocial Predictors
of Sudden Cardiac Death (BDI>10)
1.00
0.95
Proportion
Surviving
0.90
Placebo, BDI <10
Placebo, BDI >10
AMIO, BDI <10
AMIO, BDI >10
0.85
0 200 400 600 800
Survival in days

22. When do heart attacks occur?
 Less likely during sleep.
 Among the employed, more often on a
Monday between 6 and 11 am.
 In part due to waking and becoming active
shortly after dreaming which increases BP.
 In part because of circadian rhythm effects,
increases in arousal hormones and blood
pressure.

23. Medical Treatment
 Initial treatment may involve clot-dissolving
medication and close monitoring
 Balloon angioplasty
 Tiny balloon is inserted into blocked vessel and
inflated to open blood vessel
 Bypass surgery
 Use grafted vessel (e.g., piece from leg) to
bypass blockage in artery to the heart

24. Medical Treatment
 Medications (e.g., beta blockers, calcium
channel blockers) to protect heart and
improve function.
 Risk management
 Control of high blood pressure
 Control of lipid abnormalities

25. Rehabilitation
 Promote recovery and reduce risk of
another attack
 Heart disease is chronic condition
requiring ongoing management.

26. Rehabilitation Includes:
 Exercise
 Physiological and psychological benefits
 Weight management
 Smoking cessation
 Lipid and BP management include dietary
changes to control lipids
 Reduce excessive alcohol intake
 Stress management

27. Rehabilitation
 Exercise is the key component but:
 50% drop-out rate within first 6 months
 For those who continue benefits include:
 Improved self concept, perceived health,
sexual activity, involvement in social activities.
 Those who stop are more likely to:
 Smoke, have poorer cardiac function, have
higher body weight, be more sedentary,
experience greater anxiety and depression.

28. Symptoms of a Stroke
 Sudden
 weakness or numbness of the face, arm, or leg
(usually on one side of the body)
 dimness or loss of vision (usually one eye)
 Loss of speech or trouble talking or
understanding speech
 Unexplained, severe headache
 Dizziness, unsteadiness, or sudden fall

29. What is a stroke?
 Tissue damage to area of the brain due to
disruption in blood supply, depriving that
area of the brain of oxygen.

30. Causes of Strokes
1. Infarction – blockage in cerebral artery
that cuts off or reduces blood supply
a) Thrombosis – blood clot
b) Embolus – piece of plaque becomes lodged
in the artery.
2. Hemorrhage – happens suddenly. Less
frequent than infarction but more
damaging and more likely to cause death.

31. Stroke Risk Factors
 Rare up to age 55, than risk increases
sharply with age (doubling with each
decade).
 More common in men but women more
likely to die from them.
 Rates highest among blacks and lowest
among Asians.
 Family history

32. Stroke Risk Factors
 High blood pressure
 Cigarette smoking
 Heart disease, diabetes, and their risk
factors such as obesity and physical
inactivity.
 High red blood cell count (making the
blood thicker and likelier to clot).
 Mini-strokes – transient ischemic attacks
(TIA)

33. Effects of a Stroke
 Some motor, sensory, cognitive, or speech
impairment usually occurs
 Limitations may be permanent but lessen
in severity over time.
 Younger patients recover better
 Impairments caused by hemorrhages
more easily overcome than those caused
by infarctions.

34. Effects of Stroke
 Motor impairments often due to paralysis
on one side of the body (side opposite to
brain damage).
 After about 6 weeks of rehab about 50% of
patients can perform independently (many with
cane or walker).
 Language, learning, memory, and
perception problems depend on location of
the injury.

35. Effects of Stroke
 Left-hemisphere damage more commonly
associated with language problems called
aphasia.
 Receptive aphasia – difficulty understanding
verbal information.
 Expressive aphasia – difficulty producing and
using language.
 Damage to right side of brain often
associated with difficulties in visual
processing and emotions.

36. Psychosocial Aspects of
Stroke
 Denial is common
 Unclear whether psychological or physiological
basis.
 This ambiguity also applies to depression
when it occurs after a stroke.
 Less than ½ of the patients return to work
following a stroke.