Heart Disease, Hypertension, and Stroke

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)

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

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

Heart Disease Myocardium Myocardium infarction (heart attack) 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

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

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

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.

Effects of Stress On Cardiac Risk

Psychosocial Predictors of Sudden Cardiac Death (BDI>10) 1.00 0.95 0.90 0.85 Proportion Surviving High scores on the Beck Depression Inventory in the placebo group was associated with a 2-times greater risk of mortality over 2 –years follow-up. Irvine J, Basinski A, Baker B, Jandciu S, Paquette M, Cairns J, Connolly S, Gent M, Roberts R, Dorian P. Depression and risk of sudden cardiac death after acute myocardial infarction: Testing for the confounding effects of fatigue. Psychosomatic Medicine, 1999; 61: 729 -737 Placebo, BDI <10 Placebo, BDI >10 AMIO, BDI <10 AMIO, BDI >10 0 200 400 600 800 Survival in days

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.

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

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

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

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

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.

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

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.

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

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

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) TIAs may occur one or more times before a stroke.

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.

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.

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. The difficulty with emotions can be either managing their own emotions or understanding those of others.

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.