. © 2009 McGraw-Hill Higher Education. All rights reserved. 1 Chapter Eighteen Cardiovascular Disease: Risks, Prevention, and Treatment

© 2009 McGraw-Hill Higher Education. All rights reserved. 2 The Cardiovascular System The Cardiovascular System: the heart and blood vessels that circulate blood throughout the body Pulmonary circulation: the pumping of oxygen-poor blood to the lungs and oxygen-rich blood back to the heart by the right side of the heart Systemic Circulation: the pumping of oxygen-rich blood to the body and oxygen-poor blood back to the heart by the left side of the heart

© 2009 McGraw-Hill Higher Education. All rights reserved. 3 The Cardiovascular System (cont.) Aorta: largest artery in the body – leaves the heart and branches into smaller arteries, arterioles, and capillaries carrying oxygen- rich blood to body tissues Vena cava: largest vein in the body – carries oxygen-poor blood from the body back to the heart Coronary arteries: medium sized arteries that supply blood to the heart muscle Sinus node: (sinoatrial—SA—node) group of cells in the right atrium where the electrical signal is generated that establishes the heartbeat

© 2009 McGraw-Hill Higher Education. All rights reserved. 4 Cardiovascular Disease (CVD) Any disease involving the heart and/or blood vessels Currently the leading cause of death in the United States accounting for 36.3% of all deaths Cardiovascular Disease is a general term which includes the following diseases: Heart Attack Stroke Peripheral Artery Disease Congestive Failure Other Conditions The disease process underlying many forms of CVD is atherosclerosis (hardening of the arteries)

© 2009 McGraw-Hill Higher Education. All rights reserved. 5 Atherosclerosis A thickening or hardening of the arteries due to the buildup of lipid (fat) deposits (common form of arteriosclerosis) Starts with damage to the inner lining and the formation of a fatty streak (accumulation of lipoproteins within the walls of an artery) Once an injury exists on the artery, white blood cells, collagen, and other proteins are formed, creating plaque (accumulation of debris in an artery wall), resulting in slow blood flow, reducing the amount of blood to the tissues Plaque can break off and completely block the artery, preventing any blood flow, resulting in heart attacks, strokes, and peripheral vascular disease.

© 2009 McGraw-Hill Higher Education. All rights reserved. 6 Coronary Heart Disease (CHD) Atherosclerosis of the coronary arteries can result in a heart attack. The leading form of all Cardiovascular diseases An estimated 16 million Americans are living with Coronary Heart Disease. Those who survive a heart attack are often left with damaged hearts and significantly altered lives.

© 2009 McGraw-Hill Higher Education. All rights reserved. 7 Heart Attack and Angina Ischemia: insufficient supply of oxygen and nutrients to tissue, caused by narrowed or blocked arteries Myocardial infarction: Lack of blood flow to the heart muscle with resulting death of heart tissue (often called a heart attack) Coronary thrombosis: blockage of a coronary artery by a blood clot forms that may cause sudden death Angina: pain, pressure, heaviness, or tightness in the center of the chest caused by a narrowed coronary artery

© 2009 McGraw-Hill Higher Education. All rights reserved. 8 Arrhythmias and Sudden Cardiac Death Arrhythmia: irregular or disorganized heartbeat Normal adult heart rate is beats/minute Ventricular fibrillation: type of arrhythmia in which the ventricles contract rapidly and erratically, causing the heart to quiver or “tremor” rather than beat Sudden cardiac death: abrupt loss of heart function caused by an irregular or ineffective heartbeat

© 2009 McGraw-Hill Higher Education. All rights reserved. 9 Stroke or Cerebrovascular Accident (CVA) A stroke occurs when blood flow to the brain or part of the brain is blocked 3 rd leading cause of death in the United States and the leading cause of severe, long-term disability Ischemic stroke: caused by blockage in a blood vessel in the brain (accounts for 87% of all strokes) – Thrombus – Embolism Hemorraghic stroke: caused by rupture of a blood vessel in the brain, with bleeding into brain tissue

© 2009 McGraw-Hill Higher Education. All rights reserved. 10 Blood Pressure and Hypertension Blood pressure: force exerted by the blood against artery walls Blood pressure is determined by two forces – Systolic Blood pressure: pressure when the heart contracts (top number) – Diastolic Blood pressure: pressure in the arteries when the heart is relaxed (bottom number) Hypertension: blood pressure that is forceful enough to damage artery walls More than 65 million people in the United States have high blood pressure. – Untreated high blood pressure/hypertension: Can weaken and scar the arteries and make the heart work harder Can cause heart attacks, strokes, kidney disease, peripheral artery disease, and blindness

© 2009 McGraw-Hill Higher Education. All rights reserved. 11 Congestive Heart Failure Condition in which the heart is not pumping the blood as well as it should, allowing blood and fluids to back up in the lungs Can develop after a heart attack or as a result of hypertension, heart valve abnormality, or disease of the heart muscle Person with this condition experiences difficulty breathing, shortness of breath, coughing, fatigue, and confusion Approximately 5 million Americans live with this condition.

© 2009 McGraw-Hill Higher Education. All rights reserved. 12 Other Cardiovascular Diseases Heart Valve Disorders Most common is the mitral valve prolapse Rheumatic Heart Disease Due to Rheumatic Fever (strep throat) Congenital Heart Disease Structural defect at birth Septal defect is common (hole in heart) Peripheral Vascular Disease Atherosclerosis in the arms and legs Cardiomyopathy Disease of the heart muscle

© 2009 McGraw-Hill Higher Education. All rights reserved. 13 Major Controllable Risk Factors with CVD Tobacco Use Hypertension Unhealthy Cholesterol Levels Physical Inactivity Obesity Diabetes © The McGraw-Hill Companies, Inc./Lars A. Niki

© 2009 McGraw-Hill Higher Education. All rights reserved. 14 Contributing Risk Factors in CVD High Triglyceride Levels Levels of these blood fats should be < 150 to achieve desired levels High Alcohol Intake Heavy drinking (> 3 drinks/day) can damage the heart Light drinking (< 2 drinks/day) can increase HDL levels, therefore protecting against heart disease and stroke risk Psychosocial Factors 5 factors can play a role in contributing to the risk of heart disease: – Personality – Chronic stress – Socioeconomic status – Depression – Social support

© 2009 McGraw-Hill Higher Education. All rights reserved. 15 Possible Risk Factors in CVD Lipoprotein (a) Homocysteine Vitamin D Deficiency Metabolic Syndrome Inflammatory Response and C-Reactive Protein Infectious Agents Fetal Origin

© 2009 McGraw-Hill Higher Education. All rights reserved. 16 Non-controllable Risk Factors in CVD Age Gender Ethnicity and Race Family History Postmenopausal Status © Corbis

© 2009 McGraw-Hill Higher Education. All rights reserved. 17 Testing and Treatment (Heart Attack] Diagnostic Testing Electrocardiogram (EKG) Echocardiogram (sound waves) Exercise stress test Coronary angiograms (dye) Medical Management Aspirin or clot busters medications (TPAs) Nitrates (vasodilators) Beta-blockers (slows heart and lowers blood pressure) Surgical Management Angioplasty (balloon catheter) Coronary artery bypass grafting

© 2009 McGraw-Hill Higher Education. All rights reserved. 18 Testing and Treatment [Stroke] Diagnostic Testing CT or MRI scan (images of the brain) Examination of the carotid arteries Management If thrombotic, thrombolytic medications can dissolve clot and restore blood flow to the brain Rehabilitation (physical therapy)

© 2009 McGraw-Hill Higher Education. All rights reserved. 19 Protecting Yourself from CVD Eating for Heart Health Exercising Regularly Avoiding Tobacco Use Controlling Blood Pressure Managing Cholesterol Levels Using Aspirin Therapy Controlling Diabetes Managing Stress and Improving Mental Health © Punchstock/Image Source

. © 2009 McGraw-Hill Higher Education. All rights reserved. 20 Chapter Eighteen Cardiovascular Disease: Risks, Prevention, and Treatment