2ObjectivesDiscuss 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.
3Activity 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?
5An 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.
7ABC News Video: Heart Disease in America Discussion QuestionsWhat 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?
8Understanding the Cardiovascular System Cardiovascular system includes the heart, arteries, arterioles, capillaries, venules, and veins.The heartMuscular, four-chambered pumpContracts 100,000 times per dayTwo upper chambers: atriaTwo lower chambers: ventriclesTricuspid, pulmonary, mitral, and aortic valvesThe 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.
10Heart Function Right Atrium (pulmonary side) Right ventricle Deoxygenated blood enters the right atrium.Blood moves into the right ventricle.Right ventriclePumps blood through the pulmonary artery to the lungsAtria 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
11Heart Function (cont.) Left Atrium (systemic side) Left ventricle Oxygenated blood enters the left atrium from lungs.Blood is forced into the left ventricle.Left ventriclePumps blood through the aorta to all body parts
12Types of Cardiovascular Disease AtherosclerosisCoronary heart disease (CHD)Chest pain (angina pectoris)Irregular heartbeat (arrhythmia)Congestive heart failure (CHF)Congenital and rheumatic heart diseaseStrokeNote 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
14AtherosclerosisCharacterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the arteryHyperlipidemiaAbnormally high blood lipid levelPlaqueBuildup of deposits in the arteriesAtherosclerosis 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.
16Coronary Heart Disease Myocardial infarction (MI), or heart attackBlood supplied to the heart is disrupted.Coronary thrombosisBlood clot in the coronary arteryEmbolusThe blood clot is dislodged and moves through the circulatory system.Collateral circulationIf 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.
17Angina Pectoris Ischemia Reduction of the heart’s blood and oxygen supplyThe more serious the oxygen deprivation, the more severe the pain.NitroglycerinDrug used to relax (dilate) the veinsBeta blockers control potential overactivity of the heart muscle.
18Arrythmias 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.
19Congestive Heart Failure Damaged or overworked heart muscle is unable to keep blood circulating normally.Affects over 5 million AmericansDamage 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.
20Congenital 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 developmentRheumatic heart disease results from rheumatic fever, which affects connective tissue.
21Stroke 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.
23Activity 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.
24Reducing Your Risk for Cardiovascular Diseases Risks you cannot controlHeredityAgeGenderRace
25Reducing Your Risk for Cardiovascular Diseases (cont.) Risks you can controlAvoid 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.
27Cholesterol and Triglycerides Two major types of cholesterolLDL, 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.
29Modify Dietary HabitsOverweight 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.
31Control Your Blood Pressure Hypertension is sustained high blood pressure.Called the “silent killer” because it has no symptomsGreater risk for CVDFormula for blood pressure: systolic over diastolicSystolic 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.
33Combined 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 fatLow levels of HDLElevated blood pressureElevated fasting glucose greater than 100 mg/dLHigh levels of C-reactive proteins (inflammation)
34Risks 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
36Women and Cardiovascular Disease In 2004, CVD killed:405,780 men450,250 womenEstrogenOnce 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.
37Women and Cardiovascular Disease (cont.) Diagnostic and therapeutic differencesDelay in diagnosing possible heart attackComplexity in interpreting chest pain in womenLess aggressive treatment of female heart attack victimsSmaller coronary arteries in womenGender bias in CVD research—most CVD research has been conducted on male subjects.37
39New Weapons against Heart Disease Techniques for diagnosing heart diseaseElectrocardiogram (ECG)AngiographyPositron emission tomography (PET)Single-photon emission computed tomography (SPECT)Radionuclide imagingMagnetic 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.
40Angioplasty 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.
41Aspirin 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.
42ThrombolysisIf 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.
43Cardiac Rehabilitation Every year, 1 million people survive heart attacks.Cardiac rehabilitation exercise training increases stamina and strength, and promotes recovery.
44Personal 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.