ANEURYSMS

CORONARY HEART DISEASEHNI 4551Impact of CVD in the US2012 UpdateCardiovascular disease (CVD) caused 811,940 deaths in 2008 (more than one in three) and is the single leading cause of death in America today (more than cancer, trauma and chronic respiratory disease combined).More than 2200 Americans die from CVD each day1 death every 39 secondsCoronary Heart Disease responsible for 405,309 of these deathsCHD=coronary heart disease.American Heart Association. Heart Disease and Stroke Statistics2012 Update. 2Coronary heart disease includes MI, angina, CVA and HFIf CVD eliminated, would gain 7 years in life expectancy. If all forms of cancer eliminated, would only gain 3 yearsImpact of CVD in the US2012 UpdateHypertension (HTN)33.5% of US adults 20 y.o. have HTN (SBP 140)Equal in men and womenAfrican Americans make up 44%Smoking21.2% men, 17.5% women smoke19.5% students in grades 9-12 report smokingCholesterol15% of Americans 20 y.o. have total cholesterol 240 mg/dL

CHD=coronary heart disease.American Heart Association. Heart Disease and Stroke Statistics2012 Update. 3Coronary heart disease includes MI, angina, CVA and HFIf CVD eliminated, would gain 7 years in life expectancy. If all forms of cancer eliminated, would only gain 3 yearsImpact of CVD in the US2012 UpdateObesity33.7% of US Adults are obese (BMI 30 kg/m2)33% adults report no physical activity31.7% children aged 2-19 are overweight or obese29.9% girls and 17% boys in grades 9-12 report not engaging in 60 mins of moderate physical activity once a weekCHD=coronary heart disease.American Heart Association. Heart Disease and Stroke Statistics2012 Update. 4Coronary heart disease includes MI, angina, CVA and HFImpact of CVD in the US2012 UpdateAngina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)9,000,000 Myocardial infarction 610,000 new 325,000 recurrentEvery 34 secondsabout one fourth of these will die in an emergency department or before reaching a hospital.*From 1998 to 2008 the death rate from coronary heart disease decreased 30.6 percent CHD=coronary heart disease.American Heart Association. Heart Disease and Stroke Statistics2012 Update. 5Coronary heart disease includes MI, angina, CVA and HFCardiac OutputThe amount of blood ejected from the heart in one minute. (4-8 L/min)CO=SV X HRStroke volume is the amount of blood pumped with each contraction6Cardiac index is the CO divided by the body surface area and is the preferred value because it reflects the CO related to patient size. (norm 2.8 to 4.2 l/min/m2)Factors Affecting Cardiac OutputPreload volume of blood in the LV at the end of diastole. Starlings Law

Afterload The resistance against which the LV must pump.

Contractility Refers to the intensity with which the cardiac fibers contract.

7Preload is a reflection of the pressure exerted by blood volume in the ventricle at the end of diastole. Preload is often called filling pressure.Afterload is primarily a reflection of vascular tone, but it is also a reflection of the stress or tension generated in the ventricle during systoleContractility refers to an alteration in the force of contraction that occurs at the cellular level and is related to changes in myocardial fiber length and CA levels. Contractility is affected by the sympathetic nervous system stimulation as well as injury, acidosis, electrolyte imbalance and hypoxia..Hemodynamic monitoringSpecial indwelling catheters that provide information about blood volume and perfusion, fluid status and how well the heart is pumping.Central venous pressure (CVP)Pulmonary artery catheters (PA)Intra-arterial pressure (a-line)8Atherosclerotic Progression

93 stages of atherosclerotic plaque developmentFatty streaks earliest lesions age 15. LDL lowering agents may reverse.Fibrous plaque phase endothelial damage cholesterol deposition in intimaComplicated lesion stage continuation of inflammation leads to an unstable plaque lesion. Rupture platelets thrombus!10p. 761 - 762Hemodynamic effects of CADDisturbance in the delicate balance between myocardial oxygen supply and demand

Vessels become stiff and lose ability to dilate

Decreased O2 is supplied to myocardium; resulting in tissue hypoxia or ischemia11Review - Risk factors for CADAge, gender, ethnicityFamily history and genetic*Elevated serum lipids Mayo clinic- most people should aim for an LDL below 130mg/dl*Hypertension Normal is 60 yoaComplain they can feel their heart beating in their abdomen80 % are palpable with bruit over massSurgically repaired