insel10ebrup ppt ch12

Cardiovascular Disease and Cancer

Chapter 12

Chapter 12 ©2008 McGraw-Hill Companies. All Rights Reserved. 2

The Cardiovascular System

Pulmonary circulation Blood to and from the lungs.

Systemic circulation Left side of the heart pumps blood

through the rest of the body. Total blood volume for a 150 pound

person is about 5 quarts, which circulates once every minute


Cardiovascular System Systole

The hearts contraction Diastole.

The period of relaxation


Cardiovascular System Heart, blood vessels, hormones, enzymes and

wastes. Four chambers (size of a fist).

Upper chambers (Atriums). Right atrium contains the sinus node

Lower chambers (Ventricles). Vena cava. Pulmonary Artery and vein. Aorta. Coronary Arteries and veins. Veins Capillaries


Risk Factors For Cardiovascular Disease

Major Risk factors Contributing Risk Factors Four Major Risk Factors that can be changed.

Tobacco use. High blood pressure. High levels of cholesterol. Physical inactivity. Obesity. Diabetes.


Tobacco Use 1 in 5 deaths from CVD is a smoker Smokers have 2-4 times higher risk of

death from a heart attack, than non-smokers

Reduces HDL’s CO displaces O2 Causes platelets to become sticky and

increases blood thickness


High Blood Pressure Contributing factors Hypertension

Too much pressure against arterial walls Atherosclerosis

Heart has to work harder, weakens, enlarges, arteries narrow, scar and harden

See Table 15-1 for blood pressure classification for healthy adults


High Blood Pressure

Tachycardias. 100 or more beats per minute. Compromises the ability of the heart to

pump effectively. Ventricles can not completely fill.


Low Blood Pressure

Bradychardia 60 or less beats per minute Poor circulation of the blood Lack of 02 throughout to body and brain


Cholesterol LDL’s and HDL’s or good versus bad Clogs the arteries Increased risk of CVD Recommended blood cholesterol levels see

Table 15-2 LDL’s - less than 120 mg/dl HDL’s - greater than 60 mg/dl Total cholesterol should be below 200 mg/dl Levels over 240 mg/dl indicates high risk of CVD Triglycerides – less than 150 mg/dl

Benefits of controlling cholesterol


Physical Inactivity Exercise reduces risk by:

Controlling Blood pressure Lowering LDL’s Increasing HDL’s Maintaining weight Helps prevent or control Diabetes


Obesity

More than 30% above recommended weight. BMI equal to or greater than 30 Increase 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 dilating Inflammatory markers


Diabetes 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


Contributing Risk Factors That Can Be Changed

High Triglyceride Levels Psychological and Social factors

Chronic hostility and anger Suppressing psychological distress Depression Anxiety Social isolation Low socioeconomic status


Major Risk Factors That Can’t Be Changed

HeredityHeredity - CVD has genetic component; high cholesterol levels, blood clotting and obesity

AgeAge - Over the age of 65 SexSex - Men have higher risk earlier in life EthnicityEthnicity - African Americans have higher

risk of hypertension; Hispanics greater risk of HBP and Angina; Asians Lower rates of CVD


Possible Risk Factors Currently Being Studied

Inflammation and C-reactive protein Insulin resistance and metabolic syndrome Homocysteine Infectious agents Lipoprotein(a) LDL Particle size. Fibrinogen Blood Viscosity and Iron Uric Acid Time of day and time of year


Major Forms of Cardiovascular Disease

Atherosclerosis - Atherosclerosis - narrowed by fatty deposits. Starts during childhood fat.

Heart AttackHeart Attack - Coronary thrombosis, coronary occlusion or myocardial infarction. Vessels in the heart become blocked.

Angina Angina – narrowed by disease, but under stress heart can not receive enough oxygen.

Arrhythmias and sudden cardiac deathArrhythmias and sudden cardiac death – Electrical conduction system is disrupted


Helping a Heart Attack Victim

Most die within 2 hours from initial symptoms

Cardiopulmonary resuscitation (CPR) Refer to Box “What to Do in Case of a

Heart Attack, Cardiac Arrest, or Stroke”.


Detecting and Treating Heart Disease

Electrocardiogram (ECG or EKG) Electron-beam computed tomography

(EBCT) Echocardiograph – sound waves Magnetic Resonance Imaging (MRI) Angiogram Balloon Angioplasty Coronary Bypass Surgery


Stroke or Cerebrovascular Accident (CVA)

Ischemic stroke Ischemic stroke – blockage in blood vessels Thrombotic strokeThrombotic stroke clot forms in a cerebral artery;

hypertension Embolic StrokeEmbolic Stroke - wandering blood clot

Hemorrhagic stroke- blood vessel ruptures in the brain Subarachnoid hemorrhage Intracerebral hemorrhage Aneurysm


The Effects of a Stroke 700,000 Americans per year One-third die within a year Those who survive have some lasting

disability. Paralysis Walking disability Speech impairment Memory loss Changes in behavior


Detecting and Treating Stroke Prompt recognition of symptoms

Sudden numbness or weakness of face, arm, leg or one side of the body

Loss of Speech or difficulty speaking Dimming or loss of vision in one eye Unexplained dizziness in relation to other

symptoms Refer to “Stroke Warning Signs”


Detecting and Treating Stroke Transient ischemic attack (TIA)

Temporary stroke like symptoms. Computed tomography (CT) Carotid endarterectomy surgery – plaque is

removed from the artery Rehabilitation

Physical therapy Speech and Language therapy Occupational therapy


Congested Heart Failure Number of conditions Pulmonary edema - Fluid 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


Other Forms of Heart Disease

Congenital heart disease Malformation of the heart or major blood vessel

Hypertrophic Cardiomyopathy (HCM) Most common cause of sudden death in athletes

Rheumatic Heart Disease Streptococcal infections causes damage to the heart

muscle and valves. Strep throat needs to be treated, primary cause if not

treated. Heart Valve Disorders

Mitral valve prolapse


Protecting Yourself Against CVD

Eat heart-healthy Decreased Fat and Cholesterol

Total Fats less than 30% of total calories Low Saturated Fats Increased Dietary Fiber Decreased sodium intake and increased

potassium intake Moderation of Alcohol


Other Dietary Factors Omega-3 fatty acids Plant stanols and sterols Folic acid Vitamins B-6 and B-12 Calcium Soy protein Healthy carbohydrates DASH

Dietary Approaches to Stop Hypertension


Protecting Yourself

Exercise Regularly Avoid Tobacco Know and manage your blood pressure

(monitored once every two years) Know and manage your Cholesterol

levels Effective means of controlling stress and

anger


What is Cancer?

Definition: an abnormal and uncontrollable growth of cells or tissue that can lead to death. Tumor: a mass of tissue that serves no purpose.

Benign versus malignant tumors Benign tumor: mass of cells enclosed in a membrane

that prevents their penetration of other tissues. Malignant tumor: (Neoplasm) cancerous, can invade

surrounding tissues. Every case of cancer begins as a change in a cell that

allows it to grow and divide when it should not.


How Cancer Spreads

Metastasis: Primary tumor Definition: the spreading of cancer cells,

occurs because cancer cells do not stick to each other as strongly as normal cells. Cells break away from primary tumor and

invade surrounding tissues or travel through the blood and lymphatic system.

Secondary tumor or metastases


Types of Cancer

Classified according to the types of cells. Initially retain some of the original properties of the

host cell. Carcinomas - most common - arises from the

epithelial tissue that cover body surfaces. Linings, tubes, cavities and secretion glands.

Sarcomas: arise in connective and fibrous tissues. Bone, muscle, cartilage and membranes covering muscle or fat.

Lymphomas: Cancers of the lymph nodes. Leukemia: cancer of the blood-forming cells in bone

marrow.


The Incidence of Cancer

1.4 million Americans are diagnosed yearly More than half will be cured. About 40% will die as a result of cancer. 1 in 2 men and 1 in 3 women will be develop

cancer during their lifetime. American Cancer Society estimates

90% of skin cancer could have be prevented 87% of lung cancer could have be prevented


Cancer cases and deaths by site and sex


Lung Cancer

Most common cause of cancer death in the U.S. 162,000 deaths per year Risk Factors

Tobacco smoking contributes to 87%. Combined with environmental carcinogens multiply by a

factor of 10. Detection and Treatment (Difficult to detect)

Symptoms are not detected until cancer has reached the invasive stage.

Persistent cough, chest pain, or recurring bronchitis. Diagnosis - chest x-ray or sputum examination - fiber-

optic bronchosectomy.


Lung Cancer

Treatment: Difficult to treat. Caught early treated by surgery

Only 16% are detected prior to spreading Radiation and chemotherapy are used in addition

Detected early 50%of patients are alive 5 years post.

Overall the survival rate is only 15% Phototherapy, gene therapy, and

immunotherapy are being studied.


Colon and Rectal

Second leading cancer causing death. Risk Factors

Directly linked to diet and genetic predisposition. 90% occurs after 50 yr. of age. Heredity Lifestyle Up to 1/3 of the population is genetically prone.

Detection and Treatment Diet low in fat and High in fiber Screening Sigmoidoscopy or colonoscopy


Breast Cancer

Second most common cancer in women Causes almost as many deaths in women as lung

cancer 1:7 American women will develop it during her lifetime

(213,000). 1:30 Will die from the disease (41,000 deaths).

Risk Factors Most common in women over 50 5 year survival rate is 79% “Disease of Civilization” Common causes: Genetic predisposition, High fat, High

calorie diet and Sedentary lifestyle, Alcohol use, early onset of menstruation, First child after 30 and obesity

Estrogen -cancer in estrogen-responsive sites


Breast Cancer

Detection and Treatment Early detection.

Monthly breast self-exam for all women over 20. Clinical breast exam by a physician every 3 yr. Mammography- Every 1-2 years 40-50 yr. old.

Over 50 every year. Treatment

Ultrasonography Biopsied

Survival rate 98% if the cells did not metastasized 88% for all stages at 5 years 80% at 10 years

New strategies for treatment and prevention


Prostate Cancer

Most common cancer in men. 235,000 new cases per year More than 27,000 deaths per year

Risk Factors Age Diet Lifestyle Genetic predisposition

Early detection is key. PSA Blood test Treatment - surgical removal of the prostate and radiation Survival

All stages near 100% after 5 years


Cancers of the Female Reproductive Tract

Cervical cancer - sexually transmitted. Most cases stem from infection by the papillomavirus - transmitted

by unprotected sex. Smoking Infection by genital herpes

Cervical cancer most common in women in their 20’s and 30’s. Factors: sexual intercourse before 18, multiple sex partners,

cigarette smoking and low socioeconomic status. Screening:

PAP Test Cervical dysplasia All sexually active women ages 18-65 should be tested

Treatment Surgery


Cancers of the Female Reproductive Tract

Uterine, or Endometrial: Occurs after 55 Risk factors similar to breast cancer Determined by Pelvic Exam Treatment is surgery

Ovarian Cancer: Difficult to detect and diagnosis, No warning signs Family history or genetic factors Determined

Pelvic Exam Blood test – tumor marker called CA-125

Treatment is surgery & radiation DES (diethylstilbestrol):

Help prevent miscarriage DES daughters have an increased risk of vaginal or cervical cancer.


Skin Cancer

Most common form 1 million cases per year 62,000 are melanoma Easily detected and highly curable Exposure to ultraviolet rays during childhood Common cause - sunburns and suntans Types:

Basal and Squamous Melanoma - more dangerous form

Prevention Avoid long term overexposure to sunlight

Blistering and peeling sunburns Detection and Treatment

ABCD screen test


Other Cancers

Oral Cancer Testicular Cancer …


Causes of Cancer

The Role of DNA Each cells has 23 pairs of chromosomes

Each controls the way a cell will work A gene

DNA Mutations and Cancer Changes the way the cells function Mutagens – radiation, certain viruses and chemical

substances Oncogenes – a gene involved in the transformation of a

normal cell into cancer Tumor suppressor genes – type of oncogene that

restrains cellular growth


Cancer promoters

Do not directly produce mutations, they accelerate the growth of cells without damaging of permanently altering the DNA.

Estrogen Cigarette smoking is a complete

carcinogen because it is a cancer initiator and promoter.


Dietary Factors

Dietary Fat and Meat High in fat and meat has a direct impact of rates

of cancers. Alcohol Fried Foods Dietary Fiber Fruits and Vegetables

Anticarcinogens Carotenoids Antioxidants versus Free radicals Phytochemicals


Carcinogens in the Environment

Ingested Chemicals Environmental and Industrial pollution Radiation - UV rays or man made


Detecting, Diagnosing, and Treating Cancer

Detecting: Self-monitoring CAUTION acronym

Diagnosing: Biopsy Magnetic resonance imaging (MRI) Computed tomography (CT) Ultrasonography

Treatment: Surgery Chemotherapy Radiation Therapy

New and Experimental: Gene therapy Bone marrow and Stem Cell transplants Biological therapies Proteasome inhibitors Enzyme activators/blockers


Prevention

Lifestyle choices Avoid tobacco Controlling diet and weight Regular exercise Protecting skin from the sun Avoiding environmental and occupational

carcinogensRecommended screening tests

Be aware of the early signs and symptoms

Cardiovascular Disease and Cancer

Chapter 12

insel10ebrup ppt ch12

Health & Medicine