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Preventing Preventing Cardiovascular Cardiovascular

DiseaseDisease

Chapter 2Chapter 2

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Cardiovascular DiseaseCardiovascular Disease

the leading cause of death in the U.S.— the leading cause of death in the U.S.— 37.3% of all deaths37.3% of all deaths

Approximately 25% of Americans have Approximately 25% of Americans have one or more forms of heart or blood one or more forms of heart or blood vessel disease.vessel disease.

Approximately 330,000 Approximately 330,000 people die annually of people die annually of coronary heart disease coronary heart disease (CHD).(CHD).

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The HeartThe Heart

Consists of cardiac muscleConsists of cardiac muscle

Weighs 8 to 10 ouncesWeighs 8 to 10 ounces

Has two halves (pumps) Has two halves (pumps)

divided by the septumdivided by the septum

Halves are divided into upper Halves are divided into upper chambers (atria) and lower chambers chambers (atria) and lower chambers (ventricles)(ventricles)

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Circulation Circulation The primary function of circulation is to provide a constant The primary function of circulation is to provide a constant supply of blood and nutrients to cells while removing their supply of blood and nutrients to cells while removing their

waste productswaste products

The left side of the The left side of the heart (systemic pump) heart (systemic pump) receives the receives the oxygenated blood oxygenated blood from the lungs and from the lungs and pumps it to all the pumps it to all the tissues in the bodytissues in the body

The right side of the The right side of the heart (pulmonary heart (pulmonary pump) receives pump) receives deoxygenated blood deoxygenated blood from the body and from the body and pumps it to the lungspumps it to the lungs

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CirculationCirculation

The heart has its own The heart has its own conduction systemconduction system

The beating rate and The beating rate and rhythm are established rhythm are established by the sinoatrial (SA) by the sinoatrial (SA) node (pacemaker)node (pacemaker)

The electrical The electrical contraction pauses at contraction pauses at the atrioventricular (AV) the atrioventricular (AV) node, allowing the node, allowing the ventricles to fill with ventricles to fill with bloodblood

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CirculationCirculation

The heart is supplied The heart is supplied with blood from with blood from coronary circulation coronary circulation after it has been after it has been ejected from the heartejected from the heart

Blood is so important Blood is so important to the heart that to the heart that every muscle fiber is every muscle fiber is supplied by at least supplied by at least one capillaryone capillary

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Cardiovascular DiseaseCardiovascular Disease

Coronary heart disease (coronary artery Coronary heart disease (coronary artery disease; CAD) is diagnosed when any artery disease; CAD) is diagnosed when any artery is narrowed by 60% or moreis narrowed by 60% or more

A myocardial infarction (heart attack; death A myocardial infarction (heart attack; death of the heart muscle) occurs when blood flow of the heart muscle) occurs when blood flow to the heart muscle is disruptedto the heart muscle is disrupted

Most heart attacks occur after age 65, but Most heart attacks occur after age 65, but the problems leading up to them begin as the problems leading up to them begin as early as adolescenceearly as adolescence

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Myocardial Infarction Myocardial Infarction The medical term for heart attack is myocardial infarction (MI)The medical term for heart attack is myocardial infarction (MI)

Up to one third of all heart attacks Up to one third of all heart attacks are silent—without obvious signs or are silent—without obvious signs or symptomssymptoms

– Silent ischemia, reduced blood flow, can Silent ischemia, reduced blood flow, can initiate heart attacks without warninginitiate heart attacks without warning

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Cardiovascular Disease (2)Cardiovascular Disease (2)

Americans as young as 8 have Americans as young as 8 have obstructions in their coronary obstructions in their coronary arteries caused by arteries caused by atherosclerosisatherosclerosis

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Stroke (Brain Attack)Stroke (Brain Attack)

Strokes are caused by a thrombus or Strokes are caused by a thrombus or an embolus (70% to 80%) or a an embolus (70% to 80%) or a cerebral hemorrhagecerebral hemorrhage

Brain cells die, causing loss of Brain cells die, causing loss of function of some parts of the bodyfunction of some parts of the body

Strokes have similar risk and Strokes have similar risk and prevention factors as heart diseaseprevention factors as heart disease

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Unchangeable Risk Factors for Unchangeable Risk Factors for Heart DiseaseHeart Disease

AgeAge

– 55% of heart attacks occur after age 6555% of heart attacks occur after age 65

Male genderMale gender

– Heart disease is the leading cause of death for Heart disease is the leading cause of death for both males and femalesboth males and females

– Females have a lower rate than malesFemales have a lower rate than males

– Rate is increasing among females, particularly Rate is increasing among females, particularly those who smoke and use oral contraceptivesthose who smoke and use oral contraceptives

Heredity & RaceHeredity & Race

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Major Risk Factors That Can Be Major Risk Factors That Can Be Changed Changed

Cholesterol is a steroid that does not Cholesterol is a steroid that does not dissolve in blood, so it is transported dissolve in blood, so it is transported to cells by protein packagesto cells by protein packages

A certain amount of cholesterol is A certain amount of cholesterol is necessary for good healthnecessary for good health

– The best way to lower serum (blood) The best way to lower serum (blood) cholesterol is to reduce intake of saturated fatcholesterol is to reduce intake of saturated fat

– Saturated fat increases the liver’s production of Saturated fat increases the liver’s production of cholesterolcholesterol

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Major Risk Factors That Can Be Major Risk Factors That Can Be ChangedChanged

Low-density lipoproteins (LDL), the Low-density lipoproteins (LDL), the primary transporters of cholesterol, primary transporters of cholesterol, are the most capable of producing are the most capable of producing atherosclerosisatherosclerosis

People with low blood levels of LDL People with low blood levels of LDL (less than 100 mg/dl) rarely have (less than 100 mg/dl) rarely have heart attacksheart attacks

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More Risk Factors That Can Be More Risk Factors That Can Be Changed:Changed:

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Blood Pressure (1)Blood Pressure (1) Blood pressure is the force exerted Blood pressure is the force exerted

against artery walls as blood travels against artery walls as blood travels through the circulatory systemthrough the circulatory system

– High blood pressure (hypertension) has no signs or High blood pressure (hypertension) has no signs or symptomssymptoms

– An estimated 90% to 95% of hypertension is essential An estimated 90% to 95% of hypertension is essential (of unknown origin)(of unknown origin)

– Prehypertension includes blood pressures ranging Prehypertension includes blood pressures ranging from 120/80 to 139/89from 120/80 to 139/89

– Hypertension= 140/90 mmHgHypertension= 140/90 mmHg

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Blood Pressure (2)Blood Pressure (2)

Long-term uncontrolled Long-term uncontrolled hypertension increases the hypertension increases the work of the heart, causes it work of the heart, causes it to hypertrophy, and leads to to hypertrophy, and leads to congestive heart failurecongestive heart failure

Hypertension is the most Hypertension is the most important risk factor for important risk factor for strokesstrokes

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Cigarette Smoking/Tobacco Cigarette Smoking/Tobacco UseUse

Cigarette smoking is considered to be the Cigarette smoking is considered to be the most harmful of the preventable risk factors most harmful of the preventable risk factors for chronic illness and premature deathfor chronic illness and premature death– These illnesses include chronic bronchitis, emphysema, These illnesses include chronic bronchitis, emphysema,

strokes, and 87% of all lung cancersstrokes, and 87% of all lung cancers

– Loss of life from smoking represents a life expectancy Loss of life from smoking represents a life expectancy drop of ~18%drop of ~18%

Passive smoking, inhaling the smoke of Passive smoking, inhaling the smoke of others, causes the deaths of 38,000 to others, causes the deaths of 38,000 to 43,000 nonsmokers annually43,000 nonsmokers annually

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Physical Inactivity Physical Inactivity

Physical inactivity increases the risk of Physical inactivity increases the risk of coronary heart disease by 1.5 to 2.4 timescoronary heart disease by 1.5 to 2.4 times

The greatest health benefits are gained The greatest health benefits are gained when people expend 1500 to 2000 when people expend 1500 to 2000 calories (walk 15 to 20 miles) per weekcalories (walk 15 to 20 miles) per week

Exercise for health does not have to be as Exercise for health does not have to be as strenuous as exercise for physical fitnessstrenuous as exercise for physical fitness

– But physical fitness is an important factor in But physical fitness is an important factor in cardiovascular healthcardiovascular health

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Physical InactivityPhysical Inactivity

Physical activity is any physical Physical activity is any physical movement that results in energy movement that results in energy expenditure—walking, mowing the expenditure—walking, mowing the lawn, vacuuminglawn, vacuuming

““Every U.S. adult should accumulate Every U.S. adult should accumulate 30 minutes or more of moderate 30 minutes or more of moderate intensity physical activity on most, intensity physical activity on most, preferably all, days of the week.” preferably all, days of the week.” (ACSM/CDC statement)(ACSM/CDC statement)

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ObesityObesity

Obese people who have no other risk factors Obese people who have no other risk factors are still more likely to develop heart disease or are still more likely to develop heart disease or stroke.stroke.

Fat that accumulates in the upper half of the Fat that accumulates in the upper half of the body (central abdominal obesity) is body (central abdominal obesity) is significantly more likely to contribute to heart significantly more likely to contribute to heart diseasedisease

A 5% to 10% weight loss that is maintained A 5% to 10% weight loss that is maintained can significantly reduce the risk of heart can significantly reduce the risk of heart diseasedisease

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Diabetes MellitusDiabetes Mellitus Diabetes is a metabolic disorder in which the Diabetes is a metabolic disorder in which the

body cannot properly use sugar (glucose) as body cannot properly use sugar (glucose) as fuelfuel

Type II (90% of all diabetes) typically occurs Type II (90% of all diabetes) typically occurs in older, overweight, sedentary adultsin older, overweight, sedentary adults

– It is being seen more and more in children, It is being seen more and more in children, adolescents, and young adultsadolescents, and young adults

Diabetes increases the risk of coronary artery Diabetes increases the risk of coronary artery disease 2 to 4 times that of non-diabeticsdisease 2 to 4 times that of non-diabetics

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Changeable Risk FactorsChangeable Risk FactorsStressStress

Stress elevates heart rate, blood pressure, breathing Stress elevates heart rate, blood pressure, breathing rate, and blood sugar levels, activates the immune rate, and blood sugar levels, activates the immune response, and causes other physiological changesresponse, and causes other physiological changes

Chronic (long-term) distress significantly strains the bodyChronic (long-term) distress significantly strains the body

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Preventable / Changeable Risk Preventable / Changeable Risk Factors:Factors:

CholesterolCholesterol Blood PressureBlood Pressure Cigarette Smoking/Tobacco UseCigarette Smoking/Tobacco Use Physical InactivityPhysical Inactivity ObesityObesity Diabetes MellitusDiabetes Mellitus StressStress

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Preventing and Reversing Heart Preventing and Reversing Heart DiseaseDisease

Preventing includes:Preventing includes: Exercising regularlyExercising regularly Maintaining an optimal Maintaining an optimal

body weightbody weight Practicing sound nutritionPracticing sound nutrition Nonuse of tobacco and other drugsNonuse of tobacco and other drugs Nonuse or moderate use of alcoholNonuse or moderate use of alcohol Dealing constructively with stressDealing constructively with stress Periodic medical examinationsPeriodic medical examinations

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Preventing and Reversing Heart Preventing and Reversing Heart DiseaseDisease

Reversing includes:Reversing includes: Following a low-fat dietFollowing a low-fat diet Stopping tobacco useStopping tobacco use Managing stressManaging stress Attending support group Attending support group

meetings regularlymeetings regularly Exercising consistently at a Exercising consistently at a

moderately intense levelmoderately intense level

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Other Risk FactorsOther Risk Factors

Other factors include:Other factors include: Iron-enriched bloodIron-enriched blood HomocysteineHomocysteine LipoproteinLipoprotein High Sensitivity C-ReactiveHigh Sensitivity C-Reactive

ProteinProtein FibrinoginFibrinogin

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Diagnostic TechniquesDiagnostic Techniques Medical examination and patient Medical examination and patient

historyhistory

Exercise stress testsExercise stress tests

Thallium treadmill testThallium treadmill test

EchocardiographyEchocardiography

Cardiac catheterizationCardiac catheterization

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Medical TreatmentMedical Treatment

Low-dose aspirin therapyLow-dose aspirin therapy Coronary artery bypass Coronary artery bypass

surgerysurgery Balloon angioplastyBalloon angioplasty Coronary stentCoronary stent Artificial valvesArtificial valves Left ventricular assist Left ventricular assist

devicesdevices Heart transplantsHeart transplants

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Preventing Cardiovascular DiseasePreventing Cardiovascular Disease

Chapter 2Chapter 2