acquired heart disease: prevention and treatment
TRANSCRIPT
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Acquired Heart Disease: Acquired Heart Disease: Prevention and TreatmentPrevention and TreatmentSharon L. Roble, MDAssistant ProfessorAdult Congenital Heart ProgramThe Ohio State University/Nationwide Children’s HospitalColumbus, Ohio
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Congenital Versus AcquiredCongenital Versus Acquired
Congenital—any condition that a person is born with Acquired—any condition that develops after birth
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Congenital Heart DiseaseCongenital Heart Disease
Bicuspid Aortic ValveTetralogy of FallotTransposition of the Great ArteriesVentricular Septal Defects (VSD)Atrial Septal Defects (ASD)Truncus ArteriosusAnomalous Pulmonary Venous Return
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Acquired Heart DiseaseAcquired Heart Disease
Coronary Artery DiseaseValvular Heart DiseaseHigh Blood PressureRheumatic Heart DiseaseKawaski’s Disease
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CORONARY ARTERY CORONARY ARTERY DISEASEDISEASE
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Coronary Artery DiseaseCoronary Artery DiseaseAtherosclerosis◦ An active process by which blockages develop in
heart arteries due to the build up of plaques (cholesterol, platelets, inflammatory cells)
Clinical presentation varies◦ Asymptomatic◦ Chest pain◦ Shortness of breathGoal of treatment is to slow the development of significant blockages
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Clinical PresentationClinical Presentation
AsymptomaticAngina = chest pain◦ Stable-occurs with exertion◦ Unstable-occurs at rest
“Heart Attack”= Myocardial Infarction◦ Heart muscle cells die due to lack of oxygen◦ Different types
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Risk FactorsRisk Factors
AgeGenderHigh Blood Pressure◦ Systolic (Top number)
Treated versus untreated
SmokingCholesterol◦ Total cholesterol◦ HDL (good) cholesterol
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WhatWhat’’s your risk?s your risk?
Framingham Data Risk Calculator10 year risk of “hard cardiac event”◦ Myocardial Infarction (i.e., heart attack)◦ Death due to coronary disease
Patients without known coronary diseaseCoronary artery disease equivalents◦ Diabetes◦ Peripheral Vascular Disease
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How is risk calculated?How is risk calculated?
Framingham dataPoints assigned for each risk factor and points summedTotal number of points then correlates to a percentage◦ Percentage is risk of cardiovascular event
over 10 years
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Example: SmokingExample: Smoking
20-39 40-49 50-59 60-69 70-79
Nonsmoker 0 0 0 0 0
Smoker 8 5 3 1 1
20-39 40-49 50-59 60-69 70-79
Nonsmoker 0 0 0 0 0
Smoker 9 7 4 2 1
MEN
WOMEN
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PreventionPreventionDiet◦ Low-fat◦ High fiberExerciseWeight LossSmoking CessationTreatment of high blood pressureTreatment of cholesterol◦ Aggressiveness of treatment depends on risk
factors
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DietDiet1500-2000 calories/day30% of calories from fat◦ 8-10% saturated fat◦ 1% trans fat—”partially hydrogenated”◦ Unsaturated fats, in moderation
Limit sodium to 2400 mg/dayLimit cholesterol to 300 mg/day◦ 200 mg/day if high LDL
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““Good FatsGood Fats”” versus versus ““Bad FatBad Fat””Unsaturated FatsOlive OilCanola OilTrans-fat free margarineCholesterol lowering margarine
Saturated or Trans FatButterLardBacon FatGravy Cream SaucesHydrogenated margarine/shorteningCoconut/palm/cottonseed/palm-kernel oils
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ExerciseExercise30 minutes of moderate exercise 4-6 days per weekLight Exercise◦ Desk work◦ Golf◦ Light housework
Moderate Exercise◦ Walking (exercise)◦ Gardening/yard work/farming◦ Cycling◦ Tennis◦ Running◦ Dancing
Heavy Exercise◦ Walking uphill◦ Construction work/physical labor◦ Basketball◦ Football
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TreatmentTreatment
Medicine◦ Aspirin/Plavix◦ Cholesterol lowering agents◦ Blood pressure lowering medications
Stents◦ Cardiac catheterization
Surgery—”Bypass Surgery”◦ Arteries◦ Veins
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Treatment for CholesterolTreatment for Cholesterol
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Coronary Artery StentingCoronary Artery Stenting
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VALVULAR HEART VALVULAR HEART DISEASEDISEASE
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Calcific (Degenerative) Aortic Valve Calcific (Degenerative) Aortic Valve DiseaseDisease
As valves age, the process of atherosclerosis can affect aortic valve resulting in calcium deposition May result in stenosis or regurgitationSymptoms present in 70-80’sAccelerated in patients with abnormal valves (i.e., bicuspid valves)
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HIGH BLOOD HIGH BLOOD PRESSUREPRESSURE
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High Blood Pressure High Blood Pressure
“The Silent Killer”Long-standing, untreated high blood pressure damages arteries and veinsLong-term consequences◦ Heart failure◦ Heart attacks◦ Stroke◦ Kidney Failure◦ Blindness
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Diagnosis of High Blood PressureDiagnosis of High Blood Pressure
2 or more elevated blood pressures on 2 separate occasions
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Metabolic SyndromeMetabolic SyndromeGroup of risk factors which greatly increase risk of developing cardiovascular disease including stroke.Risk Factors◦ Abdominal obesity (abdominal waist
circumference)Men >40 inchesWomen >35 inches
◦ High fasting glucose (>100)◦ High triglycerides (>150)◦ Low HDL (Men<40, Women<50)◦ High blood pressure (>130/85)
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RHEUMATIC HEART RHEUMATIC HEART DISEASEDISEASE
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Rheumatic Heart DiseaseRheumatic Heart Disease
Begins with “strep throat”Inflammatory process in response to initial infection results in antibodies that attack the connective tissues of the body Approximately 2-4 weeks after initial strep infection, patients present with clinical features of rheumatic fever
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Clinical Features of Rheumatic Clinical Features of Rheumatic FeverFever
Pain and swelling in large jointsFeverWeaknessMuscle achesShortness of breathChest painNausea and vomitingHacking coughCircular rashLumps under the skinAbnormal, sudden movements of arms and legsDamage to heart valves may present later and is permanent
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Rheumatic Heart DiseaseRheumatic Heart DiseaseEarly recognition and treatment of strep throat has led to a significant decrease in the incidence of rheumatic heart disease in the US and other developed countriesRemains a significant cause of heart disease in developing countriesSymptoms of heart disease may not present until several years after initial Strep infection
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TreatmentTreatment
Penicillin to avoid recurrent strep infectionsIf severe valvular disease, require valve replacement
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KAWASKIKAWASKI’’S DISEASES DISEASE
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KawaskiKawaski’’s Diseases DiseaseInflammation of the small and medium-sized vessels in the body◦ Includes coronary arteriesPresents in early childhood ◦ Ages 2-8Clinical presentation◦ Fever > 5 days◦ Rash◦ Peeling of skin on hands and feet◦ “Pink eye”◦ “Strawberry tongue
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TreatmentTreatment
Treatment is designed to stop inflammatory process and prevent long-term sequelae of coronary artery aneurysms.Long-term consequence of Kawaski’s is coronary artery aneuryms which may initially be asymptomatic; however aneurysms may lead to heart attacks later in life.
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KawaskiKawaski’’s Diseases Disease
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Useful WebsitesUseful Websiteswww.americanheart.orghttp://hp2010.nhlbihin.net/atpiii/calculator.aspwww.mayoclinic.com/health/heart-healthy-diet/www.nhlbi.nih.gov/guidelines/cholesterolwww.kdfoundation.org