Cardiovascular Health Objectives: Describe the incidence, prevalence and outcomes of Cardiovascular disease. Describe the basic anatomy and physiology of the heart. Describe coronary artery disease and its risk factors. Describe how to prevent and reverse heart disease.

An Epidemiological Overview of Cardiovascular Disease, CVD: CVD, accounts for 50 % of all diseases and deaths in the U.S. More than 2,600 people die each day from CVD, 945,000 deaths per year. Almost 150,000 die before the age of 65 yrs The death rate per 100,000: white men:397 African-Am: 510; white women:286; Af- Am women: 397

An Epidemiological Overview of Cardiovascular Disease, CVD: Nearly 61 million Americans live with some kind of CVD. Nearly 13 million have a history of heart attack, chest pain, or both. CVD will permanently disable 19% of the U.S. labor force. The best line of defense is PREVENTION!

Anatomy and Physiology of the heart: The heart is a pump for the blood. It beats beats per minute, average: There are four chambers: right atrium, left atrium, right ventricle, left ventricle. There are four valves: tricuspid, mitral, pulmonic and aortic.

Heart structures:

A and P cont’d: The heart is self regulating. The coronary arteries supply blood to the heart. The vena cavae bring deoxygenated blood to the heart. The pulmonary artery takes deoxygenated blood from the right ventricle to the lungs for oxygen.

A and P cont’d: The pulmonary veins bring oxygenated blood from the lungs to the left atrium. The aorta takes oxygenated blood to the body from the left ventricle.

Coronary Heart Disease: Also known as Coronary Artery Disease The diagnosis is made when there is 60% occlusion of the coronary arteries. This may lead to a heart attack or myocardial infarction (MI). Heart Attacks or MIs produce irreversible injury and myocardial tissue damage.

Coronary Heart Disease con’d: The area of dead tissue can no longer function as an effective pump. Although most heart attacks occur after the age of 65 years, the dysfunction leading to them begins well before adolescence, sometimes as early as childhood

Risk Factors include: Lifestyle: inactivity, tobacco Environmental influences that increase one’s susceptibility to disease. High blood pressure High blood fats Age, hereditary, and race Obesity Male gender

Major risk factors that can be controlled: Cholesterol, smoking, and physical inactivity What is cholesterol? A steroid, wax type substance that is used for the building of nerve tissue Also used for the construction of cell walls It helps with the manufacturing of hormones and bile (for digestion and absorption of fats).

Some more facts on cholesterol Consumption should be limited to 200mg/day. Is manufactured by the liver, intestines and arterial walls As cholesterol levels rise, atherosclerotic plaque forms When an injury occurs on the arterial walls (by tobacco smoke, high blood pressure, elevated LDLs, diabetes, viral or bacterial infections) the lumen becomes smaller.

Another controllable risk factor Physical Inactivity Behaviors established in childhood and teenage years carry into adulthood Only 50% pf year olds participate in regular physical activity. The percentage of overweight children has doubled since % of overweight 5-10 year olds have one or more risk factors for cardiovascular disease, 27% have 2 or more

Risk factor: physical inactivity cont’d: Endurance exercises can reduce systolic and diastolic pressures by 10 points with people with mild hypertension (above 120/80) Resistive or strength training does not seem to lower blood pressure unless it is accompanied by aerobic exercises.

Why does exercise lower blood pressure? Contributes to weight loss Aerobic exercise reduces resistance to blood flow in arteries, thus lowering the force required to circulate blood.

: Risk factors cont’d: Hypertension: Weight management Alcohol (no more than 2oz/day) Salt restriction Exercise meditation Yoga biofeedback

Another risk factor: Nicotine: Increase LDLs and lowers HDLs Causes platelets to aggregate, increases arterial spasms Increases the oxygen requirement of cardiac muscle Constricts blood vessels Produces irregular heart rate

Nicotine cont’d: Is the causative agent in 30% of heart disease deaths Increases blood viscosity Decreases oxygen carrying capacity of red blood vessels. Increases the oxygen requirement of the heart muscle.

Other possible risk factors: (cutting edge kind of info): Iron rich blood Homocystine-an amino acid, that is a building block for protein, yet if it is not broken down it can lead to a higher risk for heart disease. Lipoprotein- a “bad” cholesterol High sensitivity C-reactive protein, a test that indicates inflammation Fibrinogen-increases thickness of blood.

Preventing and reversing heart disease: Besides everything we have discussed… Dr. Dean Ornish showed that a program consisting of yoga, low fat diet, smoking cessation and support groups decrease atherosclerosis.

Treating coronary artery occlusion,balloon angioplasty: Balloon angioplasty Coronary stent-metallic tube Coronary bypass surgery

Coronary Artery Bypass:

Coronary Stent-metallic tube:

Summary on Heart Attacks: 1/3 are silent, with no signs or symptoms Symptoms when present include: chest pain radiating to the left side of the jaw, nausea Warning sign: angina pectoris Diagnosis: EKG, enzymes, clinical presentation

Other types of C VD: Angina (pectoris) Arrhythmias Congenital rheumatic heart disease * Stroke * congestive heart failure

Summary on how to manage risk factors for CVD : Avoid tobacco Cut down on cholesterol Maintain healthy weight Manage stress Exercise regularly Eat low fat, low salt diet Control blood pressure