1. © 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 15

2. © 2012 McGraw-Hill Companies. All Rights Reserved.  Cardiovascular disease (CVD) › Leading cause of death in the U.S. › Affects nearly 81 million Americans › Claims one life every 38 seconds › About 2,300 Americans die every day › CVD is largely due to our way of life 2

3. © 2012 McGraw-Hill Companies. All Rights Reserved.  Consists of the heart and blood vessels  With lungs, known as the cardiorespiratory system  The Heart  Four-chambered, fist-sized muscle located just beneath the sternum  Blood travels through two separate circulatory systems:  Pulmonary circulation › Right side of heart pumps blood to lungs.  Systemic circulation › Left side of heart pumps blood through the rest of the body  Path of blood flow: 1. Through venae cavae into atrium (right upper chamber) 2. From atrium to ventricle (right lower chamber) 3. Pulmonary artery to the lungs 4. In lungs, picks up oxygen and discards carbon dioxide 5. Through pulmonary veins into heart’s left atrium 6. Left atrium fills, pumps blood into left ventricle 7. When left ventricle full, pumps blood through aorta for distribution to the rest of the body’s blood vessels 3

4. © 2012 McGraw-Hill Companies. All Rights Reserved.  Systole › The heart’s contraction  Diastole › The period of relaxation  Blood pressure › Force exerted by blood on the walls of the blood vessels, created by pumping action of the heart  Heartbeat › Controlled by nerve impulses 4

5. © 2012 McGraw-Hill Companies. All Rights Reserved.  Blood Vessels (classified by size and function) › Veins  Carry blood to the heart  Thin walls › Arteries  Carry blood away from the heart  Thick elastic walls expand and relax with the volume of blood  Coronary arteries  Two large vessels that supply blood to the heart › Capillaries  Smallest arteries, only one cell thick › Venules  Blood empties from capillaries into venules that connect to veins that return the blood back to the heart › 150-pound person has about 5 quarts of blood that circulates about once each minute 5

6. © 2012 McGraw-Hill Companies. All Rights Reserved.  Two categories of increased risk for CVD 1. Major risk factors 2. Contributing risk factors  Controllable aspects of lifestyle that can be changed  Major risk factors that can be changed › American Heart Association identified six major risk factors. 1. Tobacco use 2. High blood pressure 3. High cholesterol 4. Physical inactivity 5. Obesity 6. Diabetes 6

7. © 2012 McGraw-Hill Companies. All Rights Reserved.  1 in 5 deaths from CVD is a smoker  Smokers have 2 to 3 times higher risk of death from a heart attack than do nonsmokers  Smoking doubles risk of stroke  Damages the lining of arteries  Reduces HDL (“good” cholesterol)  Raises triglycerides and LDL  Nicotine increases blood pressure and heart rate  CO displaces O 2  Causes platelets to become sticky and increases blood thickness  Speeds the development of fatty deposits in the arteries 7

8. © 2012 McGraw-Hill Companies. All Rights Reserved.  Hypertension › Too much pressure against blood vessel walls  Short periods of high blood pressure are normal, but chronic high blood pressure is a health risk  Atherosclerosis › Heart has to work harder, weakens, enlarges, arteries narrow, scar, and harden  About 33% (73 million) of adults have hypertension  37% of adults have prehypertension  Test your blood pressure at least once every two years 8

9. © 2012 McGraw-Hill Companies. All Rights Reserved. 9

10.  Fatty, waxlike substance that circulates through the bloodstream › Important component of:  Cell membranes  Sex hormones  Vitamin D  Fluid that coats the lungs  Protective sheaths around nerves  Excessive cholesterol clogs the arteries › Increased risk of CVD  Good versus bad cholesterol › Low –density lipoproteins (LDL) (“bad” cholesterol)  Shuttle cholesterol from the liver to organs and tissues › High-density lipoproteins (HDL) (“good” cholesterol)  Shuttle unused cholesterol back to the liver for recycling  By removing cholesterol from blood vessels, HDL helps protect against atherosclerosis  Recommended blood cholesterol levels  Benefits of controlling cholesterol 10

11. © 2012 McGraw-Hill Companies. All Rights Reserved. 11

12. © 2012 McGraw-Hill Companies. All Rights Reserved.  40-60 million Americans are so sedentary that they are at high risk for developing CVD  Exercise reduces risk › Closest thing we have to a magic bullet against heart disease › Controls blood pressure and resting heart rate › Lowers LDL › Increases HDL › Maintains weight › Improves the condition of blood vessels › Helps prevent or controls diabetes 12

13. © 2012 McGraw-Hill Companies. All Rights Reserved.  Risk of death from CVD is two to three times more likely in obese people (BMI ≥ 30)  Increased strain on the heart  Strongly associated with: › Hypertension › High cholesterol › Insulin resistance › Diabetes › Physical inactivity › Increasing age › Endothelial cell dysfunction  Coronary arteries constrict instead of dilate › Hypertrophy (ventricular enlargement) 13

14. © 2012 McGraw-Hill Companies. All Rights Reserved.  Doubles the risk of CVD for men  Triples the risk of CVD for women  Loss of 5-10 years off your life  Higher risk › Hypertension › Obesity › Unhealthy blood lipid levels › Elevated blood glucose and insulin can damage the endothelial cells lining the arteries › More vulnerable to atherosclerosis 14

15. © 2012 McGraw-Hill Companies. All Rights Reserved.  High triglyceride levels › Blood fats that are a reliable predictor of heart disease  Psychological and social factors › Stress › Chronic hostility and anger › Suppressing psychological distress › Depression › Anxiety › Social isolation › Low socioeconomic status  Alcohol and drugs 15

16. © 2012 McGraw-Hill Companies. All Rights Reserved.  Heredity › CVD has genetic component; high cholesterol levels, hypertension, diabetes, and obesity  Aging › Over the age of 65  Being male › Men have higher risk earlier in life  Ethnicity › African Americans higher risk of hypertension; Hispanics greater risk of HBP and angina; Asians lower rates of CVD 16

17. © 2012 McGraw-Hill Companies. All Rights Reserved.  Insulin resistance and metabolic syndrome  Homocysteine › Amino acid circulating in the blood  Infectious agents › Chlamydia pneumoniae – flulike respiratory infections  Lipoprotein(a) – Lp(a) › Strong genetic component  LDL particle size › Particles differ in shape and size  Blood viscosity (thickness) and iron  Uric acid  Time of day and time of year › More heart attacks and sudden death occur between 6:00AM and noon › 50% more occur in winter months than in summer months 17

18. © 2012 McGraw-Hill Companies. All Rights Reserved.  Atherosclerosis - narrowed by fatty deposits › Plaques accumulate in artery walls › Coronary heart disease (CHD) › Coronary artery disease (CAD) › Peripheral arterial disease (PAD)  Heart attack – heart tissue is damaged and part of it may die from lack of blood › Myocardial infarction (MI) › American Heart Association  785,000 people have a first heart attack each year  470,000 people have recurrent attack  195,000 people suffer a symptomless or “silent” heart attack each year 18

19. © 2012 McGraw-Hill Companies. All Rights Reserved. 19

20. © 2012 McGraw-Hill Companies. All Rights Reserved.  Chest pain or pressure  Arm, neck, or jaw pain  Difficulty breathing  Excessive sweating  Nausea and vomiting  Loss of consciousness 20

21. © 2012 McGraw-Hill Companies. All Rights Reserved.  Angina – arteries narrowed by disease, but under stress heart cannot receive enough oxygen › Angina pectoris › Usually felt as an extreme tightness in the chest and heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or back  Arrhythmias and sudden cardiac death – electrical conduction system is disrupted › Sudden cardiac death (cardiac arrest) often caused by an arrhythmia called ventricular fibrillation 21

22. © 2012 McGraw-Hill Companies. All Rights Reserved.  Most victims die within 2 hours from initial symptoms  Give one adult aspirin tablet (325 mg)  Cardiopulmonary resuscitation (CPR)  Refer to Take Charge box “What to Do in Case of a Heart Attack, Cardiac Arrest, or Stroke” 22

23. © 2012 McGraw-Hill Companies. All Rights Reserved.  Electrocardiogram (ECG or EKG)  Electron-beam computed tomography (EBCT)  Echocardiography – sound waves  Multi-slice computed tomography (MSCT)  Magnetic resonance imaging (MRI)  Nuclear myocardial perfusion imaging  Positron Emission Tomography (PET)  Angiogram  Balloon angioplasty  Coronary bypass surgery 23

24. © 2012 McGraw-Hill Companies. All Rights Reserved.  2 million brain cells die per minute during a stroke  Ischemic stroke – blockage in a blood vessel › Thrombotic stroke - clot forms in a cerebral artery › Embolic stroke - wandering blood clot  Hemorrhagic stroke - blood vessel ruptures in the brain › Intracerebral hemorrhage › Subarachnoid hemorrhage › Aneurysm 24

25. © 2012 McGraw-Hill Companies. All Rights Reserved. 25

26. © 2012 McGraw-Hill Companies. All Rights Reserved.  Interruption of the blood supply to any area of the brain prevents the nerve cells from functioning, in some cases causing death  Usually suffer some lasting disability › Paralysis › Walking disability › Speech impairment › Memory loss › Changes in behavior 26

27. © 2012 McGraw-Hill Companies. All Rights Reserved.  Prompt recognition of symptoms: › Sudden numbness or weakness of face, arm, leg, or one side of the body › Loss of speech or difficulty speaking › “Three Simple Ways to Recognize a Stroke” 1. Ask the person to smile. If her smile droops on one side, or if she is unable to move or open one side of her mouth, she may be having a stroke. 2. Ask the person to hold his arms out. If the person cannot move one arm or hold one arm still, it may be a sign of a stroke. 3. Ask the person to repeat a simple sentence, such as “Take me out to the ball game.” If she has trouble speaking or cannot speak, a stroke is possible. 27

28. © 2012 McGraw-Hill Companies. All Rights Reserved.  Transient ischemic attack (TIA) › Temporary stroke-like symptoms (ministroke)  Computed tomography (CT)  MRI  Ultrasound  Drugs  Carotid endarterectomy surgery – plaque is removed from the artery  Rehabilitation › Physical therapy › Speech and language therapy › Occupational therapy 28

29. © 2012 McGraw-Hill Companies. All Rights Reserved.  PAD – atherosclerosis in the leg (or arm) arteries, which can limit or block the blood flow  Patients typically also have coronary artery disease  About 8 million people in the U.S. have PAD  Risk factors: › Smoking › Diabetes › Hypertension › High cholesterol  Symptoms › Claudication (aching or fatigue in the affected leg) › Rest pain (limb artery cannot supply enough blood at rest) 29

30. © 2012 McGraw-Hill Companies. All Rights Reserved.  Number of conditions › High blood pressure › Heart attack › Atherosclerosis › Alcoholism › Viral infections › Rheumatic fever › Birth defects  Pulmonary edema - f luid accumulates in the lungs › Heart can not maintain regular pumping rate; fluid backs up  Controlled by: › Reducing cardiac load › Eliminating excess fluid › Restriction of salt › Drug therapy 30

31. © 2012 McGraw-Hill Companies. All Rights Reserved.  Congenital heart defects › Malformation of the heart or major blood vessel  Hypertrophic cardiomyopathy (HCM) › Occurs in 1 out of 500 people › Most common cause of sudden death in athletes younger than 35 › May be identified by a murmur  Rheumatic heart disease › Streptococcal infections cause damage to the heart muscle and valves › Strep throat needs to be treated  Heart valve disorders › Congenital heart defects and certain types of infections › Mitral valve prolapse 31

32. © 2012 McGraw-Hill Companies. All Rights Reserved.  Eat heart-healthy  Decrease fat and cholesterol › Total fats less than 30% of total calories › Low saturated fats  Increase fiber intake  Decrease sodium intake and increase potassium intake  Moderation of alcohol 32

33. © 2012 McGraw-Hill Companies. All Rights Reserved.  Omega-3 fatty acids  Plant stanols and sterols  Folic acid  Vitamins B-6 and B-12  Calcium  Soy protein  Healthy carbohydrates  Total calories  DASH › Dietary Approaches to Stop Hypertension 33

34. © 2012 McGraw-Hill Companies. All Rights Reserved.  Moderate physical activity  Avoid tobacco  Know and manage your blood pressure (monitor once every two years)  Know and manage your cholesterol levels  Develop effective ways to handle stress and anger 34

35. © 2012 McGraw-Hill Companies. All Rights Reserved. 35

36. © 2012 McGraw-Hill Companies. All Rights Reserved.