cardiovascular dse

8/3/2019 Cardiovascular Dse.

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A general term that covers a number ofdiseases which affect the heart,

including coronary artery disease, heart-failure and angina.

Heart Disease is the number one killer inthe United States.



Atherosclerosis-fatty deposits ofcholesterol

Hypertension- we will discuss in detaillater.



Figure 15.1a



Figure 15.1b



Cardiovascular disease (CVD) is theleading cause of death in the U.S.

In 2005 CVD accounted for

approximately 38 percent of all deaths CVD has been the number one killer in

the U.S. since 1900 except for 1918(influenza)

More that 2,500 Americans die from CVDeach day

Among women, 1 in 2.6 deaths from CVD


http://slidepdf.com/reader/full/cardiovascular-dse 8/60Figure 15.2


http://slidepdf.com/reader/full/cardiovascular-dse 9/60Figure 15.3



Cardiovascular system includes: the

heart, arteries, arterioles, capillaries,

venoules, and veins

The heart

› Muscular, four chambered pump

› Contracts 100,000 times per day

› Two upper chambers: atria› Two lower chambers: ventricles

› Tricuspid, pulmonary, mitral, and aortic valves



Deoxygenated blood enters the rightatrium

From the right atrium blood moves to theright ventricle, pumped through thepulmonary artery to the lungs

Oxygen blood enters the left atrium

Blood from the left atrium is forced intothe left ventricle

The left ventricle pumps blood throughthe aorta to various parts of the body



Figure 15.4



Atherosclerosis

Coronary heart disease (CHD)

Chest pain (angina pectoris) Irregular heartbeat (arrhythmia)

Congestive heart failure (CHF)

Congenital and rheumatic heart disease

Stroke



Figure 15.5



Characterized by deposits of fattysubstances, cholesterol, cellular waste

products, calcium, and fibrin in the inner lining of the artery

Hyperlipidemia – abnormally high bloodlipid level

Plaque – the buildup of deposits in thearteries



Myocardial infarction (MI) or heart attack –

blood supplying the heart is disrupted

Coronary thrombosis – blood clot in theartery

Embolus – when the blood clot is dislodged

and moves through the circulatory system

Collateral circulation - if blockage to theheart is minor, an alternative blood flow is

selected



Occurs when the coronary arteries thatsupply the heart muscle become

blocked.

Partially blocked it causes angina.

Fully blocked it causes a myocardialinfarction or a heart attack!



Symptoms: uncomfortable pressure,

fullness, squeezing pain, pain spreading to

the shoulders, neck and arms.

Chest discomfort and light headedness

Anxiety/nervousness Paleness or pallor

Increased irregular heart rate

Feeling of impending doom



Ischemia – reduction of the heart’s bloodand oxygen supply

The more serious the oxygen deprivationthe more severe the pain

Nitroglycerin – drug used to relax (dilate)

the veins Beta blockers control potential

overactivity of the heart muscle



An irregularity in heart rhythm

Tachycardia – racing heart in the

absence of exercise or anxiety Bradycardia – abnormally slow

heartbeat

Fibrillation – heart beat is sporadic,quivering pattern



Damaged or overworked heartmuscle

Lack of proper circulation may allow

blood to accumulate in the vessels ofthe legs, ankles, or lungs

Diuretics relieve fluid accumulation



The right side of the heart collects the blood

returning from the body and sends it to the

lungs.

If it is failing, the blood backs up into the

veins, and there are signs of edema.

The left side of the heart receives the blood

from the lungs and pumps it out into thebody. If it is failing the blood is not pumped

effectively.



May be due to hereditary factors,maternal diseases, or chemical intake

(alcohol) during fetal development Rheumatic heart disease results from

rheumatic fever which affectsconnective tissue



Occurs when the blood supply to thebrain is interrupted

Thrombus – blood clot Embolus – free flowing clot

Aneurysm – bulging or burst blood vessel

Transient ischemic attack (TIA) – briefinterruptions that cause temporaryimpairment



Figure 15.6



Risks you can control

› Avoid tobacco

› Cut back on saturated fat and cholesterol

› Maintain a healthy weight› Modify dietary habits

› Exercise regularly

› Control diabetes

›

Control blood pressure Systolic – upper number

Diastolic – lower number

› Manage stress



Risks you cannot control

› Heredity

›

Age› Gender

› Race



Sudden numbness or weakness of theface, arm or leg, especially on one sideof the body.

Sudden confusion, trouble speaking, or understanding.

Sudden trouble seeing in one or both

eyes. Sudden trouble walking, dizziness, loss of

balance or coordination.



Sudden severe headache with noknown cause.

If you have any of these symptoms youneed immediate medical attention!



Age- the older you get, the greater thechance.

Sex- males have a greater rate evenafter women pass menopause.

Race- minorities have a greater chance.

Family history- if family members havehad CHD, there is a greater chance.



Personal Medical History- other diseasessuch as Diabetes Mellitus can increase

chances.



Hypertension

Serum cholesterol

Obesity Diabetes Mellitus

Physical Inactivity

Cigarette Smoking Alcohol Intake



Everybody needs cholesterol, it serves avital function in the body.

It is a component of the nerve tissue ofthe brain and spinal cord as well as other major organs.

Frequently measured to promote healthand prevent disease.

A major component of the plaque thatclogs arteries.



Lipoproteins- 4 main classes

Chylomicrons

Very low density lipoproteins (VLDL)

Low Density Lipoprotein (LDL)

High Density Lipoprotein (HDL)



Table 15.1



LDL is known as bad cholesterol. It has atendency to increase risk of CHD.

LDL’s are a major component of theatherosclerotic plaque that clogsarteries.

Levels should be <130



HDL is known as the good cholesterol.

It helps carry some of the bad

cholesterol out of the body. It does not have the tendency to clog

arteries.

Levels should be >35. High levels of HDL >60 can actually

negate one other risk factor.



Certain fats are essential for goodnutrition and health.

Fats provide essential fatty acids whichthe body can’t manufacture.

Act as insulators to maintain bodytemperature.

Improve the palatability of food andpromote digestion.



Provide the greatest energy output per gram of any food source. ( 9 cals)

Carry fat soluble vitamins- A,D,E, and K.



Saturated fats- basically means the fat issaturated with hydrogen, they are solid

at room temperature. Examples are lardand butter.

Why are they bad for you?

They increase levels of LDL , decreaseHDL and increase total cholesterol.



What are polyunsaturated fats?

They are unsaturated fats which are

liquid at room temperature and in therefrigerator.

Why are they good for us?

They help the body get rid of newlyformed cholesterol.



What are monounsaturated fats?

They are liquid at room temperature but

start to solidify in the refrigerator. Decrease total cholesterol and lower LDL

levels.



What are trans fatty acids?

They are unsaturated fats but they tend

to raise total and bad cholesterol.Where do you find them?

In fast-food restaurants

Commercial baked goods. Examples:doughnuts, potato chips, cupcakes.



Type of polyunsaturated fat.

Consistently lowers serum triglycerides

and may also have an effect onlowering blood pressure.

Found in oily fish such as salmon, tuna,and herring.

Is available as a supplement.



Causes an increase in blood pressure

Usually have lower levels of HDL

Within 1 year of quitting, CHD risk decreases, within 2 years it reaches thelevel of a nonsmoker.



In small amounts it acts as a vasodilator-Good! 1-2 drinks

In large amounts it acts as avasoconstrictor-BAD! 3-4 drinks

This is a very fine line!



Cardiac Catherization - insertion of aplastic tube into an artery or vein andinjects a dye, this can help to determinewhere the blockages are. Also a goodmethod to determine the amount ofblood and oxygen the heart is receiving.



Coronary Artery Bypass Surgery (CABG)

The most frequently performed major

surgery . Surgery reroutes or bypassesblood around clogged arteries.



Angioplasty (PCTA)

It involves creating a space in a blocker

artery by inserting a small balloon andthen inflating it. Now includes theplacement of a mesh stent to improveeffectiveness.



Diet and Nutrition, there are severalguidelines listed by the American HeartAssociation:

Eat a variety of fruits and vegetablesevery day. ( 5 servings - they arenaturally low in fat and high in vitamins

and minerals)

Eat a variety of grain products ( 6 a day)



Choose nonfat or low-fat products.

Use lean meats- choose chicken, fish,

turkey and lean cuts of beef and pork. Switch to fat-free milk- gradually reduce

the fat content of the milk you drink.



Choose fats with 2 gms or less ofsaturated fats per serving such as liquidand tub margarines, canola oil and olive

oil. Balance the # of calories you eat with

the number of calories you use eachday.

Maintain a level of physical activity thatkeeps you fit and matches the # ofcalories you eat.



Limit your intake of foods high in caloriesand low in nutrition, including foods likesoft drinks and candy.

Limit foods high in saturated fat, trans fatand cholesterol

Eat less than 6 gms of salt a day

Have no more than one alcoholic drink aday.



Serves several functions in preventingand treating those at high risk.

Reduces incidence of obesity.

Increases HDL

Lowers LDL and total cholesterol

Helps control diabetes and hypertension

Those at high risk should take part in aspecially supervised program.



Estrogen› Once estrogen production stops, risk for CVD

death increases

Diagnostic and therapeutic differences:› Complexity in interpreting chest pain in

women› Less aggressive treatment of female heart

attack victims› Smaller coronary arteries in women

Gender bias in CVD research – typicallyCVD research has been conducted onmale subjects



Techniques for diagnosing heart disease:› Electrocardiogram (ECG/ EKG)› Angiography

› Positron emission tomography (PET)› Single positron emission color tomography

(SPECT)› Radionuclide imaging›

Magnetic resonance imaging (MRI)› Ultrafast CT› Digital cardiac angiography (DSA)



Research shows that 80 milligrams ofaspirin every other day is beneficial toheart patients due to its blood thinningproperties

Some side effects of aspirin:gastrointestinal intolerance and a

tendency for difficulty with blood clotting

Should only be taken under the adviceof your physician



If victim reaches an emergency roomand is diagnosed quickly, thrombolysiscan be performed

Thrombolysis involves injecting an agentsuch as tissue plasminogen activator (TPA) to dissolve the clot and restore

some blood flow



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 youbecome sick Ask about alternative procedures Remain with your loved one as a personal

advocate Monitor the actions of health care providers Be considerate of your care provider Be patient with the patient



Cardiovascular disease is the number one killer.

It is highly preventable and controllablewith diet and exercise.

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