listen to your heart: good cardiovascular health for life · pdf file1 listen to your heart:...

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Listen to your heart: Good Cardiovascular Health for Life

Luis R. Castellanos MD, MPH

Assistant Clinical Professor of Medicine

University of California San Diego School of Medicine

Sulpizio Family Cardiovascular Center, La Jolla, CA

Financial Disclosures: None

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UC San Diego Health System

Sulpizio Cardiovascular Center

San Diego’s First Comprehensive Cardiovascular Center

42nd in America by U.S. News & World Report

Top 10 – Most Beautiful Hospitals in America

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UC San Diego Health System

Objectives & Take Home Points

Epidemiology and Significance of Cardiovascular Diseases

Causes of CV Diseases

Medical Treatments

Invasive Therapies

Preventive Measures

Listen to Your Heart

5 Source: AHA Heart Disease and Stroke Statistics – 2013 Update.

Major Causes of Deaths in the U.S. 2009

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

All Ages <85 85+

Deaths

Alzheimer

CLRD

Cancer

All Other CVD

Stroke

Heart Disease

UCSD Sulpizio Cardiovascular Center

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Approximately 80 million Americans suffer from Cardiovascular

Diseases (CHD, HF, HTN, Stroke, PAD)

Close to 50% of CV deaths occur from Coronary Heart Disease

Source: ACC/AHA Heart and Stroke Statistics, 2012. From MMWR, 2008;57:1221-26.


7 Source: AHA Heart Disease and Stroke Statistics – 2013 Update.


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Progression of Atherosclerosis


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Tobacco Smoking

Family History of Early CAD

Dyslipidemia (High cholesterol)

Diabetes Mellitus

Hypertension (High blood pressure)

Advanced Age (> 65 years)

Metabolic Syndrome

Cardiovascular Risk Factors:


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Source: www.cdc.gov

Diabetes

Obesity (BMI ≥30 kg/m2)

<4% 4%-4.9% 5%-5.9% ≥6%

10%-14% 15%-19% 20%-24% ≥25%

2004 1994


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Smoking Trends for men and women


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Heart Attack

Coronary

Artery Disease


Death

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Cardiac Evaluation:

Listen to your Heart Chest pain or pressure Shortness of breath or Fatigue Palpitations


History and Physical Exam

EKG

Stress Testing Exercise Treadmill Pharmacologic Stress Test

• Dobutamine Echo

• Nuclear Imaging

• Dobutamine MRI

• Cardiac CT Angiogram

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Coronary Artery Disease & Cardiac CT Angiogram


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Coronary Angiography: Definitive Evaluation of CAD


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Coronary Artery Bypass Graft Surgery – Traditional Approach

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Peripheral Arterial Disease:


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Peripheral Arterial Disease: Before Revascularization After


Images provided by Dr. Mitul Patel and UCSD and Health System

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Carotid Arterial Disease - Revascularization

Before After


Images provided by Dr. Mitul Patel and UCSD and Health System

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Aortic Stenosis

Normal Severe Aortic Stenosis

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Severe Aortic Stenosis – Traditional Approach

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Severe Aortic Stenosis – Percutaneous Approach Transcatheter Aortic Valve Replacement - TAVR

Images by Dr. Mahmud and Dr. Patel at UCSD Division of Cardiovascular Medicine, 2013.

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Severe Aortic Stenosis

Before TAVR After TAVR

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Dyslipidemia

Diabetes Mellitus

Advance Age

Hypertension

Metabolic Syndrome

Family History of Early CAD

Prevention of CAD, PAD and Valvular Disease

Tobacco Smoking

Targeting Cardiac Risk Factors:


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Brisk walking for 30 minutes per day

Intermittent periods of activity, 10 min intervals for a total of 30 minutes per day

Exercise routine 5 to 7 times per week

Additional health benefits from more vigorous activity

Improving Cardiovascular Health

Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.


27 Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.

Effect of Exercise on Survival


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Cardiac Rehabilitation after MI, CABG,

Valve surgery or CHF


Mortality Benefits

17% reduction in recurrent Heart Attacks

15% overall mortality reduction

Morbidity Benefits

31% reduction in hospital readmissions

63% reduction in depression

Clark AM, et al. Meta-analysis; secondary prevention programs for patients with coronary artery disease.

Ann Intern Med 2005;143:659-72.

2Milani RV, et al. Impact of cardiac rehabilitation on depression and its associated mortality. The American

Journal of Medicine (2007);120,799-906

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Non-Invasive Strategies

Improvement in Cardiovascular Health via:

Healthy cardiac diet

Smoking cessation

Diabetes and BP control

Lipid lowering strategies

Exercise and weight loss

Invasive Strategies

Percutaneous Interventions – PCI and TAVR

Traditional Coronary Bypass Graft Surgery

Summary


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Any Questions ?

Thank You!


listen to your heart: good cardiovascular health for life · pdf file1 listen to your heart:...

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