1. Cardiovascular Disease: Reducing Your Risk
Chapter 15
Cardiovascular Disease: Reducing Your Risk
Lecture Outline
written by Bridget Melton, Georgia Southern University
Copyright © 2010 Pearson Education, Inc.

2. Objectives
Discuss the incidence, prevalence, and outcomes of cardiovascular disease.
Describe the anatomy and physiology of the heart and circulatory system and the importance of healthy heart function.
Review major types of cardiovascular disease, controllable and uncontrollable risk factors, methods of prevention, and current strategies for diagnosis and treatment.

3. Activity Break: Health Family Tree
Create a family tree that includes each person’s cause of death and his or her major health condition, if any.
Take 5 to 10 minutes to begin your family tree.
We will discuss as a group the diseases you recognize.
Continue adding to your health family tree this week by talking to your relatives.
Ask how many students have cardiovascular disease, cancer, and stroke on their tree. How many have obesity, high blood pressure, smoking, and high cholesterol?

4. Total Cardiovascular Disease Death Rates by State, Age Adjusted
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5. An Epidemiological Overview
Cardiovascular disease (CVD) is the leading cause of death in the United States.
In 2005, CVD accounted for approximately 37 percent of all deaths.
CVD has been the number-one killer in the United States since 1900, except during the 1918 influenza pandemic.
More than 2,400 Americans die from CVD each day.
Among women, 1 in 2.6 are deaths from CVD.
In 2008, 80.7 million Americans—one out of every three adults—suffered from one or more types of CVD.

6. Prevalence of Cardiovascular Disease in U. S
Prevalence of Cardiovascular Disease in U.S. Adults Aged 20 and Older by Age and Sex
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7. ABC News Video: Heart Disease in America
Discussion Questions
What preventive measures can be taken to avoid a heart attack?
What effect does a celebrity death from a certain illness have on how members of the public address their own health?

8. Understanding the Cardiovascular System
Cardiovascular system includes the heart, arteries, arterioles, capillaries, venules, and veins.
The heart
Muscular, four-chambered pump
Contracts 100,000 times per day
Two upper chambers: atria
Two lower chambers: ventricles
Tricuspid, pulmonary, mitral, and aortic valves
The normal heart is a strong, muscular pump a little larger than a fist. It pumps blood continuously through the circulatory system. In a 70-year lifetime, the average human heart beats 2.5 billion times.

9. Anatomy of the Heart
Normally, the heart beat starts in the right atrium when a special group of cells sends an electrical signal. As a group, these cells are called the sinoatrial (SA) node or the sinus node. They are the heart’s pacemaker.
The heart normally beats about 70 to 80 times per minute; it is the only self-contracting muscle in the body, acting without an external signal from nerves.
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10. Heart Function Right Atrium (pulmonary side) Right ventricle
Deoxygenated blood enters the right atrium.
Blood moves into the right ventricle.
Right ventricle
Pumps blood through the pulmonary artery to the lungs
Atria are like holding cells: they receive blood and then transfer it to a ventricle.
Note the thickness of the walls of the ventricles (previous slide). The left side is more muscular because it pushes blood to the whole body. The right side pushes blood only into the lungs, or the pulmonary side. 10

11. Heart Function (cont.) Left Atrium (systemic side) Left ventricle
Oxygenated blood enters the left atrium from lungs.
Blood is forced into the left ventricle.
Left ventricle
Pumps blood through the aorta to all body parts

12. Types of Cardiovascular Disease
Atherosclerosis
Coronary heart disease (CHD)
Chest pain (angina pectoris)
Irregular heartbeat (arrhythmia)
Congestive heart failure (CHF)
Congenital and rheumatic heart disease
Stroke
Note that CVD is not one type of heart disease. Many things can damage your CV system. Some are related to lifestyle and some are related to genetics.
What baseball player did your book feature? Hint: he was 33 years old, played for the Cardinals, and died in 2002 from atherosclerosis. Answer: Daryl Kile

13. Percentage Breakdown of Deaths from Cardiovascular Disease in the United States
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14. Atherosclerosis
Characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the artery
Hyperlipidemia
Abnormally high blood lipid level
Plaque
Buildup of deposits in the arteries
Atherosclerosis is the condition resulting from fatty deposits in the inner layer of the arteries and their fibrosis.
Arteriosclerosis, or thickening and hardening of the arteries, is a type of atherosclerosis. It underlies many cardiovascular health problems and is believed to be the biggest contributor to disease burden globally.
Plaque is fatty deposits inside the vessels.
Sclerosis is hardening of the vessels.

15. Atherosclerosis (cont.)
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16. Coronary Heart Disease
Myocardial infarction (MI), or heart attack
Blood supplied to the heart is disrupted.
Coronary thrombosis
Blood clot in the coronary artery
Embolus
The blood clot is dislodged and moves through the circulatory system.
Collateral circulation
If blockage to the heart is minor, blood flow is rerouted.
MI disrupts heart muscle activity, typically as a result of coronary occlusion, or heart attack.
Thrombus is a clot of blood formed within a blood vessel that remains attached to its place of origin.

17. Angina Pectoris Ischemia
Reduction of the heart’s blood and oxygen supply
The more serious the oxygen deprivation, the more severe the pain.
Nitroglycerin
Drug used to relax (dilate) the veins
Beta blockers control potential overactivity of the heart muscle.

18. Arrythmias Irregularities in heart rhythm
Tachycardia is a racing heart in the absence of exercise or anxiety.
Bradycardia is an abnormally slow heart beat.
Fibrillation is a sporadic heart beat with a quivering pattern.

19. Congestive Heart Failure
Damaged or overworked heart muscle is unable to keep blood circulating normally.
Affects over 5 million Americans
Damage to heart muscle may result from rheumatic fever, pneumonia, heart attack, or other cardiovascular problem.
Lack of proper circulation may allow blood to accumulate in the vessels of the legs, ankles, or lungs.
Diuretics relieve fluid accumulation.

20. Congenital and Rheumatic Heart Disease
Congenital heart disease affects 1 out of 125 children.
May be due to hereditary factors, maternal diseases, or chemical intake (alcohol) during fetal development
Rheumatic heart disease results from rheumatic fever, which affects connective tissue.

21. Stroke Occurs when the blood supply to the brain is interrupted
Thrombus is a blood clot.
Embolus is a free-flowing clot.
Aneurysm is a bulging or burst blood vessel.
Transient ischemic attack (TIA) is a brief interruption of blood supply that causes temporary impairment.

22. Blood Vessel Disorders that Can Lead to Stroke
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23. Activity Break: CVD Risk Factors
Get into groups of four to five students.
Assign a note taker and a runner.
When your group has the answer, run it up to me.
List four nonmodifiable risk factors for CVD.
List four modifiable risk factors for CVD.
Have fun with this exercise, and then we’ll discuss what we can do both as individuals and as a community to address lifestyle risk factors.

24. Reducing Your Risk for Cardiovascular Diseases
Risks you cannot control
Heredity
Age
Gender
Race

25. Reducing Your Risk for Cardiovascular Diseases (cont.)
Risks you can control
Avoid tobacco.
Cut back on saturated fat and cholesterol.
Maintain a healthy weight.
Modify dietary habits.
Exercise regularly.
Control diabetes.
Control blood pressure.
Systolic is the first number.
Diastolic is the second number.
Manage stress.

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27. Cholesterol and Triglycerides
Two major types of cholesterol
LDL, or low-density lipoprotein, is “bad” cholesterol that builds up on artery walls.
HDL, or high-density lipoprotein, is “good” cholesterol that helps protect the body by removing cholesterol from artery walls and transporting it to the liver for elimination.
Triglycerides are a common fat produced by your body.
They do not cause arteries to thicken, but may speed the process.
A lipoprotein analysis provides an accurate assessment of your total cholesterol, LDL, HDL, and triglyceride levels.

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29. Modify Dietary Habits
Overweight people are more likely to develop heart disease and stroke.
Heart health can be improved by good dietary habits.
Consume 5 to10 milligrams of fiber per day.
Consume approximately 2 grams of plant sterols per day (found in fruits, vegetables, nuts, seeds, cereals, legumes, and vegetable oils).
Limit your salt intake.

30. The DASH Eating Plan
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31. Control Your Blood Pressure
Hypertension is sustained high blood pressure.
Called the “silent killer” because it has no symptoms
Greater risk for CVD
Formula for blood pressure: systolic over diastolic
Systolic pressure is pressure applied to artery walls as the heart contracts.
Diastolic pressure is pressure applied to the artery walls during relaxation phase.
For the average person, 110/80 is a healthy blood pressure. High blood pressure is diagnosed when systolic pressure (the first number) is 140 or above.

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33. Combined Risks: Metabolic Syndrome
Metabolic syndrome is a group of obesity-related risk factors that increase the risk of heart disease and diabetes.
Indicated by three or more of the following:
Abdominal obesity (40-inch waist in men; 35-inch waist in women)
Elevated blood fat
Low levels of HDL
Elevated blood pressure
Elevated fasting glucose greater than 100 mg/dL
High levels of C-reactive proteins (inflammation)

34. Risks You Cannot Control
Race: African Americans are at a 45 percent greater risk for hypertension and heart disease.
Heredity: Cautionary medical factors seem to have a genetic link.
Age: 75 percent of all heart attacks affect people over age 65.
Gender: Men are at a greater risk for cardiovascular disease until around age 60. After menopause, women are at increase for cardiovascular disease. 34

35. Deaths from Cardiovascular Disease in the United States by Gender and Race
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36. Women and Cardiovascular Disease
In 2004, CVD killed:
405,780 men
450,250 women
Estrogen
Once estrogen production stops, risk for CVD death increases.
In 2004, CVD claimed the lives of more women than men, even though more men had heart attacks.

37. Women and Cardiovascular Disease (cont.)
Diagnostic and therapeutic differences
Delay in diagnosing possible heart attack
Complexity in interpreting chest pain in women
Less aggressive treatment of female heart attack victims
Smaller coronary arteries in women
Gender bias in CVD research—most CVD research has been conducted on male subjects. 37

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39. New Weapons against Heart Disease
Techniques for diagnosing heart disease
Electrocardiogram (ECG)
Angiography
Positron emission tomography (PET)
Single-photon emission computed tomography (SPECT)
Radionuclide imaging
Magnetic resonance imaging (MRI)
Ultrafast computed tomography (CT)
Digital subtraction angiography (DSA)
An ECG is a record of the heart’s electrical activity.
Angiography (also referred to as cardiac catheterization), is more accurate than an ECG. In angiography, a needle-thin tube called a catheter is threaded through heart arteries, a dye is injected, and an X ray is taken to discover blockages.
A PET scan produces three-dimensional images of the heart as blood flows through it. During a PET scan, a patient receives an intravenous injection of a radioactive tracer at rest and during exercise.
SPECT scans are a newer method and provide an even better view than a PET scan.
Radionuclide imaging procedures involve injecting radionuclides into the bloodstream. Computer-generated pictures can then show them in the heart.
An MRI uses powerful magnets to look inside the body. Computer-generated pictures can show the heart muscle and help physicians identify damage from a heart attack, diagnose congenital heart defects, and evaluate disease of larger blood vessels such as the aorta.
Ultrafast CT is an especially fast form of heart X ray designed to evaluate bypass grafts, diagnose ventricular function, and measure calcium deposits.
DSA is a modified form of computer-aided imaging that records pictures of the heart and its blood vessels.

40. Angioplasty versus Bypass Surgery
Angioplasty involves threading a thin catheter through the blocked arteries. The catheter has a balloon on the tip, which is inflated to flatten the fatty deposits against the wall of the artery.
Coronary bypass surgery takes a blood vessel from another site and implants it to bypass blocked arteries and transport blood.

41. Aspirin for Heart Disease?
Research shows that 80 milligrams of aspirin daily or every other day is beneficial to heart patients due to its blood-thinning properties.
Some side effects of aspirin include gastrointestinal intolerance and a tendency for difficulty with blood clotting.
Aspirin should be taken only under the advice of your physician.

42. Thrombolysis
If a heart attack victim reaches an emergency room and is diagnosed quickly, thrombolysis can be performed.
Thrombolysis involves injecting an agent such as tissue plasminogen activator (TPA) to dissolve the clot and restore some blood flow.

43. Cardiac Rehabilitation
Every year, 1 million people survive heart attacks.
Cardiac rehabilitation exercise training increases stamina and strength, and promotes recovery.

44. Personal Advocacy and Heart-Smart Behaviors
Know your rights as a patient.
Find out about informed consent procedures, living wills, durable power of attorney, organ donation, and other legal issues before you become sick.
Ask about alternative procedures.
Remain with your loved one as a personal advocate.
Check the credentials of health care providers.
Be considerate of your care provider.
Be patient with the patient.