CARDIOVASCULAR HEALTH

Causes of Death

Top three causes of death

• Heart disease– Someone suffers a coronary event every 29 seconds

in the US– Someone dies from a coronary event every minute

• Cancer

• Infectious disease

Cost to Society

• 274 billion per year on cardiovascular disease

• 99 billion per year on alcohol related disease• 72 billion on smoking related diseases• 67 billion spend on drug abuse

Physiology of the Heart

• Four chambered pump• Size of a fist• Weighs about 1 pound• Creates pressure to circulate blood

throughout the body• Located between the lungs, left of center in

the thorax

Blood flow through the heart

• Deoxygenated blood from the inferior and superior vena cava empties into the right atrium

• Continues past the tricuspid valve into the right ventricle

• Leaves the right ventricle and heads toward the lungs to pick up oxygen and returns to the heart as oxygenated blood

Blood flow through the heart

• Oxygenated blood returns to the left side of the heart entering the left atrium

• Flows past the mitral valve into the left ventricle

• Leaves the left ventricle through the aorta out to the rest of the body

Important features of the heart

• Valves ensure that the blood flows in one direction

• Left ventricle is more muscular then the other chambers

• Septum divides the heart in half

Electrical Stimulation of the Heart

• Signal sends impulses from the brain to the heart

• SA node (pacemaker of the heart) creates an electrical impulse that contracts the atria

• AV node picks up the signal and sends it on to the ventricles

• EKG picks up the electrical signals from the heart and is able to detect abnormalities in the conduction

Function of the blood

• Transportation of nutrients, oxygen, waste products and hormones

• Regulation of water content for cells• Regulation of body temperature• Buffers to maintain pH level• Clotting capabilities• Protection against pathogens by circulating

antibodies• Average person has 6 quarts of blood

The Vascular System

• Refers to the blood vessels• Arteries carry blood away from the heart• Veins carry blood back into the heart• Coronary arteries carry blood to the heart• Carotid arteries carry blood to the brain• Iliac and femoral arteries carry blood to the

abdomen and legs

Permanent Risk Factors for Heart Disease

• Age – as you age, the greater the risk• Gender – men are more at risk then

premenopausal women• Ethnicity –African Americans more at risk

due to the increased rates of high blood pressure

• Heredity – if you have a family history of CVD your risk is greater

Cardiovascular Risk Factors That Can Be Changed

• High cholesterol• High blood pressure• Inflammation• Physical inactivity• Smoking• Diabetes• Obesity• Diet• Periodontal disease

Cholesterol

• Cholesterol manufactured in the liver and small intestines

• Needed for the production of sex hormones, cell membranes, bile salts and nerve fibers

• Cholesterol attaches itself to lipoproteins

Cholesterol

• Two types of lipoproteins– LDL-low density lipids

• Bad cholesterol• Average levels

– Less the 100 is optimal– 100-129 is near optimal– 130 or higher is dangerous– New study indicates even lower levels of LDL may be

necessary ie; 60-70

• Carries cholesterol to coronary arteries• Agitate arterial walls and form lesions that

allow plaque buildup

Cholesterol

– HDL-high density lipids• Good cholesterol• Average level

– Men – 40-50– Women – 50-60

• Carries cholesterol away from arteries to the liver

• Offer protection against heart disease• Pick up LDL and bring them to the liver for

removal

Cholesterol

• Total cholesterol above 200 is high– Combines HDL and LDL

• HDL above 60 is healthy, below 40 is dangerous

• LDL below 130 is healthy , above 190 is dangerous

Cholesterol Reduction

• Exercise– Single most effective way to increase HDLs

• Weight reduction• Diet

– Limit saturated fats– Increase your intake of fatty fish– High fiber diet

• Smoking • Moderate alcohol intake

– Phenols in red wine • Genetic predisposition

Blood Pressure

• Pressure exerted on the walls of the arteries• Systolic

– Highest pressure– Pressure exerted when left ventricle is contracting

• Diastolic– Lowest pressure– Left ventricle is filling with blood

• Normal range– 120/80– 120/80 to 139/89 now is called pre-hypertension

Hypertension (High Blood Pressure)

• Decreased elasticity of blood vessels makes is more difficult for the heart to pump the blood and increases the blood pressure

• Higher incidence in non-whites• 65 million Americans have hypertension

– Approx 35% of the population

Hypertension

• Signs and symptoms– No signs initially, until the pressure

becomes very high– Headache– Irritability– Dizziness – Blurred vision

Hypertension

• Medical problems associated with high blood pressure– Stroke– Coronary artery disease– Kidney failure– Blindness– Dementia– Heart failure

Hypertension

• Known as the “silent killer”• Symptoms only appear when the blood

pressure is dangerously high• You must take you medications even if you

feel fine

Hypertension

• Medications – Diuretics - to remove fluid– Vasodilators – to enlarge the size of the

blood vessels

• Side effects– Impotence– Fatigue– Muscle weakness

Hypertension

• Blood pressure reduction– Weight reduction– Exercise– Reduce salt intake– Diet high in fruits and vegetables

Inflammation of Blood Vessels

• Inflammation in the vessels causes the plaque to break free

• May contribute to heart attacks• Measured by C reactive proteins (CRP)• Average reading of CRP is 1.5• High levels come from chronic infections

(gum disease), sedentary lifestyle, HTN• Normally produced by the body to fight

infections and promote healing

Physical Inactivity

• Exercise is the single most effective way to increase your HDL levels

• Exercise decreases your blood pressure• Exercise contributes to weight reduction• Exercise strengthens your heart muscle and

increases the efficiency • Exercise can increase your longevity

– Walked 30 min/day for five days/week live 1.3-1.5 years longer

– Running 30 min/day (or equivalent) live 3.5-3.7 years longer

Smoking

• The most dangerous risk factor for heart disease

• Increases your heart rate and constricts your blood vessels

• Doubles the risk of heart attack for a person who smokes one pack per day

Diabetes

• More then 80% of people with diabetes die from cardiovascular disease

• If not well controlled can contribute to high cholesterol levels

• Can be managed through diet, exercise and medications

Obesity

• Increases the strain on the heart• Increases blood pressure• May trigger diabetes• Weight loss increases your HDL and lowers

your LDL• Weight gain of 11-18 lbs in adult life had 25%

increase in risk of MI, increase over 25 lbs increased risk of MI by 200-300%

Diet

• Limit saturated fats– Beef, ham, pork– Dairy products– Palm and coconut oils

• Use more polyunsaturated fats– Corn oil– Safflower oil

Diet

• Increase fatty fish such as salmon, mackerel– High in omega 3 fatty acids

• High fiber diet– Men who ate 29 gms of fiber/day (one cup bran

cereal) 36% decreased risk of MI

• Keep fat to 30% of diet– Americans eat 46% fat in diet

Periodontal Disease

• Chronic infections from gum disease increase the CRP levels

• Toxins and bacteria enter your bloodstream causing inflammation of the vessels

Types Of Heart Disease

• CAD – coronary artery disease• Hypertension• Stroke• Congenital heart disease• Congestive heart disease• Rheumatic heart disease

Coronary Artery Disease

• Atherosclerosis – hardening of the arteries

• Fatty deposits build up inside the vessels that slow the flow of blood or completely occlude it

Coronary Artery Disease

• Angina– Chest pain– Decreased blood supply to coronary

arteries– Nitroglycerin

Myocardial InfarctionHeart Attack

• MIs are getting smaller secondary to better medications and active lifestyles

• Men are 20% more likely to have MI on birthday

• Higher incidence in winter versus summer• More likely on Monday• more likely to be fatal at night• Four times more likely if you are depressed• Weekend warriors at greater risk

Myocardial Infarction

• Women and heart attacks

– First MI 10-20 years later then men, but 70% more likely to die

– Women take one hour longer to get to the ED

– Women do not exhibit classic symptoms of MI, tends to be a spasm, not a blockage of the coronary arteries

– 30% less likely to get the proper medications

Myocardial Infarction

– Premenopausal women usually protected but 9000 women younger then 45 die each yr

– More women die from heart attacks and strokes then breast cancer, 500,000 women vs 40,000/yr

– Women on HRT have an increased chance of MI/stroke/blood clots

– Doubles risk of MI during first year

Myocardial InfarctionHeart Attack

• Heart Attack or Myocardial Infarction (MI)– Death of the cardiac muscle secondary to

a lack of oxygen– Cause is a blockage of the coronary

arteries by a floating piece of plaque or eventual closure due to cholesterol

– Extent of damage depends on the size of the artery affected

Coronary Artery Disease

• Heart Attack Signs and Symptoms– Crushing substernal chest pain– Sweating, short of breath– Pain radiating to the jaw or left arm– Indigestion

• Get the person to the hospital, time is muscle• Ask if they use NTG• CPR• Ventricular fibrillation

Heart Attack

Heart Attack

Ventricular Fibrillation

Ventricular Fibrillation

Coronary Artery Disease

• Hospital Care– Anticoagulants (blood thinner)

• aspirin

– TPA – tissue plasminogen activator– Angioplasty– Bypass surgery

Angioplasty

Stent Placement

Bypass Surgery

New Areas of Research

• Synthetic form of HDL– Found to reverse plaque build up in the arteries

• Genetic link– Identified gene that may cause coronary artery disease– Identified gene variant that reduces inflammation thereby

reducing heart disease

• Medication– New drug to increase the HDL level

• Risk factors– Men who were hostile and contemptuous of other people

were 30% more likely to develop irregular heart beats– Explore anger management modifications

StrokeCerebral Vascular Accident (CVA)

• Decreased blood supply to the brain• Types of CVAs

– Cerebral hemorrhage– Cerebral occlusion– Cerebral aneurysm

Stroke

• Cerebral hemorrhage– Blood vessel burst

inside the brain

Stroke

• Cerebral occlusion– Floating clot or

cerebral emboli• Cerebral thrombosis

– Gradual narrowing

Stroke

• Cerebral aneurysm– Weakness in the

vessel

Stroke

• Signs and Symptoms– May have no warning, sudden collapse– TIAs – transient ischemic attacks– Numbness or weakness in limbs– Slurred speech– Dizzy

• Diagnosis• Treatment

– Clot buster drugs– Surgery

Stroke

• Prevention– Detection and control of diabetes– Stop smoking– Control hypertension– Low cholesterol diet– Diet high in fruits and vegetables– Antioxidant vitamins C,E, beta carotene, folic acid– Report TIAs to MD– Daily ASA

Congenital Heart Disease

• Abnormalities present at birth• May be due to environmental factors or

illness contracted during pregnancy• 8 out of 1000 infants have CHD• Blue baby

Congenital Heart Defects

Congenital Heart Defects

Congestive Heart Failure

• Enlarged heart due to lack of strength• Causes include MI, HTN, defective valves• Blood backs up into the body and the lungs• Treatment includes medications such as

diuretics and vasodilators as well as reduction of salt in diet

Congestive Heart Failure

Congestive Heart Failure

Rheumatic Heart Disease

• Damage due to rheumatic fever via strep throat

• Caused by streptococcal bacteria• Damages the valves of the heart• Surgery may be required to correct the

defect

Rheumatic Heart Disease

Cardiovascular Health Rules

• Follow these rules and reduce your chance for heart disease by 82%– Don’t smoke– Avoid obesity– Get at least 30 min of moderate to vigorous

exercise every day– Drink moderately– Eat healthy foods

• Avoid saturated fats• Eat fish oil, folate, fiber, vegetable oils, whole grain

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