Cardiovascular Cardiovascular HealthHealth

Chapter 15Chapter 15

• Cardiovascular Disease (CVD)Cardiovascular Disease (CVD)– Leading cause of death in the U.S.Leading cause of death in the U.S.– Affects nearly 81 million AmericansAffects nearly 81 million Americans– Claims one life every 37 secondsClaims one life every 37 seconds– About 2400 Americans every dayAbout 2400 Americans every day– CVD is due to our way of lifeCVD is due to our way of life

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CARDIOVASCULAR TERMSCARDIOVASCULAR TERMS

ATHEROSCLEROSIS

THROMBUS

EMBOLUS

MYOCARDIAL INFARCTION

ANGINA PECTORIS

ANEURYSM

COLLATERAL CIRCULATION

• Pulmonary circulationPulmonary circulation– Blood to and from the lungs.Blood to and from the lungs.

• Systemic circulationSystemic circulation– Left side of the heart pumps blood through the rest of Left side of the heart pumps blood through the rest of

the body.the body.• Path of blood flow:Path of blood flow:

1.1.Venae CavaeVenae Cavae2.2.Right AtriumRight Atrium

• Sinoatrial node (pacemaker)Sinoatrial node (pacemaker)3.3.Right VentricleRight Ventricle4.4.Pulmonary Artery Pulmonary Artery

• To the lungsTo the lungs5.5.Pulmonary VeinPulmonary Vein6.6.Left AtriumLeft Atrium7.7.Left VentricleLeft Ventricle8.8.AortaAorta

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Characteristics of the Characteristics of the HeartHeart

• 4 chambered pump (atria, ventricles)4 chambered pump (atria, ventricles)• Size of a fistSize of a fist• Weighs about 1 poundWeighs about 1 pound• Function - creates pressure to Function - creates pressure to

circulate blood throughout the bodycirculate blood throughout the body• Blood enters via the Vena Cava into Blood enters via the Vena Cava into

the right atrium (see the right atrium (see Figure 15-2Figure 15-2 on on blood circulation)blood circulation)

Cardiovascular SystemCardiovascular System

• Systole and Diastole.Systole and Diastole.– action of the heart is controlled by an action of the heart is controlled by an

electrical signal which originates in the electrical signal which originates in the right atrium.right atrium.

• Veins carry blood back to the heart.Veins carry blood back to the heart.• Arteries carry blood away from the Arteries carry blood away from the

heart.heart.• CapillariesCapillaries

• Heart, blood vessels, hormones, enzymes and Heart, blood vessels, hormones, enzymes and wastes.wastes.

• The Blood VesselsThe Blood Vessels– VeinsVeins

• Carry blood to the heartCarry blood to the heart• Thin wallsThin walls

– ArteriesArteries• Carry blood away from the heartCarry blood away from the heart• Thick elastic walls which expand and relax with the Thick elastic walls which expand and relax with the

volume of bloodvolume of blood• Coronary artery Coronary artery

– Two large vessels that supply blood to the heartTwo large vessels that supply blood to the heart– CapillariesCapillaries

• One cell thickOne cell thick– VenulesVenules

• Blood empties from the capillaries into the venules Blood empties from the capillaries into the venules which connect to veins that return the blood back to which connect to veins that return the blood back to the heartthe heart

– 150-pound person has about 5 quarts of blood, which 150-pound person has about 5 quarts of blood, which circulates about once each minute.circulates about once each minute.

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• Two categories of increased CVDTwo categories of increased CVD1.1. Major Risk factorsMajor Risk factors2.2. Contributing Risk FactorsContributing Risk Factors

• Controllable aspects of lifestyle that can be Controllable aspects of lifestyle that can be changed.changed.

• Major risk factors that can be changedMajor risk factors that can be changed– American Heart Association identifiedAmerican Heart Association identified Six Six

major risk factors.major risk factors.1.1. Tobacco use.Tobacco use.2.2. High blood pressure.High blood pressure.3.3. High levels of cholesterol.High levels of cholesterol.4.4. Physical inactivity.Physical inactivity.5.5. Obesity.Obesity.6.6. Diabetes.Diabetes.

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• 1 in 5 deaths from CVD is a smoker1 in 5 deaths from CVD is a smoker• Smokers have 2 to 3 times higher risk of Smokers have 2 to 3 times higher risk of

death from a heart attack, than non-smokersdeath from a heart attack, than non-smokers• Damages the lining of arteries Damages the lining of arteries • Reduces HDL’sReduces HDL’s• Raises triglycerides and LDL’sRaises triglycerides and LDL’s• Nicotine increases blood pressureNicotine increases blood pressure• CO displaces OCO displaces O22 • Causes platelets to become sticky and Causes platelets to become sticky and

increases blood thicknessincreases blood thickness• Speeds the development of fatty deposits in Speeds the development of fatty deposits in

the arteriesthe arteries14

• HypertensionHypertension– Too much pressure against arterial wallsToo much pressure against arterial walls

• Short periods of high blood pressure is Short periods of high blood pressure is normal but chronic high blood pressure is a normal but chronic high blood pressure is a health riskhealth risk

• AtherosclerosisAtherosclerosis– Heart has to work harder, weakens, enlarges, Heart has to work harder, weakens, enlarges,

arteries narrow, scar and hardenarteries narrow, scar and harden

• About 33% (73 million) of adults have About 33% (73 million) of adults have hypertensionhypertension

• 37% of adults have prehypertension37% of adults have prehypertension• Test your blood pressure at least once every Test your blood pressure at least once every

two yearstwo years15

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• Tachycardias.Tachycardias.– 100 or more beats per minute.100 or more beats per minute.– Compromises the ability of the heart to Compromises the ability of the heart to

pump effectively.pump effectively.• Ventricles can not completely fill.Ventricles can not completely fill.

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• BradychardiaBradychardia– 60 or less beats per minute60 or less beats per minute– Poor circulation of the blood Poor circulation of the blood – Lack of 0Lack of 02 2 throughout to body and throughout to body and

brainbrain

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• Is a fatty, wax like substance that circulates through the Is a fatty, wax like substance that circulates through the bloodstreambloodstream– Important component of:Important component of:

• Cell membranesCell membranes• Sex hormonesSex hormones• Vitamin DVitamin D• Fluid that coats the lungsFluid that coats the lungs• Protective sheaths around nervesProtective sheaths around nerves

• Excessive cholesterol clogs the arteriesExcessive cholesterol clogs the arteries– Increased risk of CVDIncreased risk of CVD

• Good versus Bad CholesterolGood versus Bad Cholesterol– Low –density lipoproteins (LDL)-BADLow –density lipoproteins (LDL)-BAD

• Shuttle cholesterol from the liver to the organs and Shuttle cholesterol from the liver to the organs and tissuestissues

– High-density lipoproteins (HDL)-GOODHigh-density lipoproteins (HDL)-GOOD• Shuttle unused cholesterol back to the liver for Shuttle unused cholesterol back to the liver for

recyclingrecycling• By removing cholesterol from blood vessels, HDL helps By removing cholesterol from blood vessels, HDL helps

protect against atherosclerosisprotect against atherosclerosis

• Benefits of controlling cholesterolBenefits of controlling cholesterol19

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CHOLESTEROL FACTSCHOLESTEROL FACTS

HIGH – 240 AND ABOVE

BORDERLINE HIGH – 200-239

DESIRABLE – BELOW 200

TOTAL CHOLESTEROL TO HDL RATIO:

4.5 OR LOWER – GOOD FOR MEN

4.0 OR LOWER – GOOD FOR WOMEN

WAYS TO LOWER LDL:

1. LOSING BODY FAT

2. MAINTAINING A LOW FAT AND HIGH FIBER DIET

3. TAKING MEDICATION IF NECESSARY

WAYS TO INCREASE HDL:

1. MAINTAIN REGULAR AEROBIC EXERCISE

2. WEIGHT LOSS

3. QUITTING SMOKING

40-60 million Americans are so sedentary 40-60 million Americans are so sedentary that they are at high risk for developing CVDthat they are at high risk for developing CVD

• Exercise Exercise reducesreduces risk by: risk by:– Closest thing we have to a magic bullet Closest thing we have to a magic bullet

against heart diseaseagainst heart disease– Controlling Blood pressure and resting heart Controlling Blood pressure and resting heart

raterate– Lowering LDL’sLowering LDL’s– Increasing HDL’sIncreasing HDL’s– Maintaining weightMaintaining weight– Improve the condition of blood vesselsImprove the condition of blood vessels– Helps prevent or control DiabetesHelps prevent or control Diabetes

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• Risk of death from CVD is two to three times Risk of death from CVD is two to three times more likely in obese people (BMI more likely in obese people (BMI > 30)> 30)

• Increase strain on the heart.Increase strain on the heart.• Strongly associated with:Strongly associated with:

– HypertensionHypertension– High cholesterolHigh cholesterol– Insulin resistanceInsulin resistance– Diabetes physical inactivityDiabetes physical inactivity– Increasing ageIncreasing age– Endothelial cell dysfunctionEndothelial cell dysfunction

• Coronary arteries constrict instead of dilatingCoronary arteries constrict instead of dilating

– Inflammatory markersInflammatory markers

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• Doubles the risk of CVD for men.Doubles the risk of CVD for men.• Triples the risk of CVD for women.Triples the risk of CVD for women.• Loss of 5-10 years off your lifeLoss of 5-10 years off your life• Higher risk:Higher risk:

– HypertensionHypertension– ObesityObesity– Unhealthy blood lipid levelsUnhealthy blood lipid levels– Elevated blood glucose and insulin can Elevated blood glucose and insulin can

damage the endothelial cells lining the damage the endothelial cells lining the arteriesarteries

– More vulnerable to atherosclerosisMore vulnerable to atherosclerosis

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• High Triglyceride LevelsHigh Triglyceride Levels– Reliable predictor of heart diseaseReliable predictor of heart disease

• Psychological and Social factorsPsychological and Social factors– StressStress– Chronic hostility and angerChronic hostility and anger– Suppressing psychological distressSuppressing psychological distress– Depression Depression – AnxietyAnxiety– Social isolationSocial isolation– Low socioeconomic statusLow socioeconomic status

• Alcohol and Drugs Alcohol and Drugs

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• HeredityHeredity – CVD has genetic component; high CVD has genetic component; high

cholesterol levels, blood clotting and obesitycholesterol levels, blood clotting and obesity• AgingAging

– Over the age of 65Over the age of 65• Being maleBeing male

– Men have higher risk earlier in lifeMen have higher risk earlier in life• EthnicityEthnicity

– African Americans have higher risk of African Americans have higher risk of hypertension; Hispanics greater risk of HBP hypertension; Hispanics greater risk of HBP and Angina; Asians Lower rates of CVDand Angina; Asians Lower rates of CVD

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• Inflammation and C-reactive protein (CRP)Inflammation and C-reactive protein (CRP)• Insulin resistance and metabolic syndromeInsulin resistance and metabolic syndrome• HomocysteineHomocysteine

– Amino acid circulating in the bloodAmino acid circulating in the blood• Infectious agentsInfectious agents

– Chlamydia pneumoniae – flu-like respiratory infectionsChlamydia pneumoniae – flu-like respiratory infections• Lipoprotein(a) – Lp(a)Lipoprotein(a) – Lp(a)

– Strong genetic componentStrong genetic component• LDL Particle sizeLDL Particle size

– Particles differ in shape and sizeParticles differ in shape and size• Blood Viscosity and IronBlood Viscosity and Iron• Uric AcidUric Acid• Time of day and time of yearTime of day and time of year

– More heart attacks and sudden death occur between More heart attacks and sudden death occur between 6:00AM and noon6:00AM and noon

– 50% more occur in winter months than in summer 50% more occur in winter months than in summer monthsmonths

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• Atherosclerosis - Atherosclerosis - narrowed by fatty narrowed by fatty deposits. deposits. – Starts during childhood fat.Starts during childhood fat.– Coronary heart disease (CHD)Coronary heart disease (CHD)– Coronary artery disease (CAD)Coronary artery disease (CAD)– Peripheral arterial disease (PAD)Peripheral arterial disease (PAD)

• Heart AttackHeart Attack – heart tissue is damaged – heart tissue is damaged and part of it may die from lack of bloodand part of it may die from lack of blood– Myocardial infarction (MI)Myocardial infarction (MI)– American Heart AssociationAmerican Heart Association

• 600,000 people have a first heart attack each year600,000 people have a first heart attack each year• 320,000 people have recurrent attack320,000 people have recurrent attack• 190,000 people suffer a symptomless or “silent” heart 190,000 people suffer a symptomless or “silent” heart

attack each yearattack each year30

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• Chest pain or pressureChest pain or pressure• Arm, neck, or jaw painArm, neck, or jaw pain• Difficulty breathingDifficulty breathing• Excessive sweatingExcessive sweating• Nausea and vomitingNausea and vomiting• Loss of consciousnessLoss of consciousness

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• Angina Angina – narrowed by disease, but – narrowed by disease, but under stress heart can not receive under stress heart can not receive enough oxygen.enough oxygen.– Angina pectorisAngina pectoris– Usually felt as an extreme tightness in the Usually felt as an extreme tightness in the

chest and heavy pressure behind the chest and heavy pressure behind the breastbone or in the shoulder, neck, arm, breastbone or in the shoulder, neck, arm, hand, or back.hand, or back.

• Arrhythmias and sudden cardiac deathArrhythmias and sudden cardiac death – Electrical conduction system is – Electrical conduction system is disrupteddisrupted

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• Most die within 2 hours from initial Most die within 2 hours from initial symptomssymptoms

• Cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR)(CPR)

• Refer to Box “What to Do in Case of Refer to Box “What to Do in Case of a Heart Attack, Cardiac Arrest, or a Heart Attack, Cardiac Arrest, or Stroke”.Stroke”.

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• Electrocardiogram (ECG or EKG)Electrocardiogram (ECG or EKG)• Electron-beam computed tomography Electron-beam computed tomography

(EBCT)(EBCT)• Echocardiograph – sound wavesEchocardiograph – sound waves• Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)• Nuclear myocardial perfusion imagingNuclear myocardial perfusion imaging• Positron Emission Tomography (PET)Positron Emission Tomography (PET)• AngiogramAngiogram• Balloon AngioplastyBalloon Angioplasty• Coronary Bypass SurgeryCoronary Bypass Surgery

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• 780,000780,000 Americans suffer strokes each Americans suffer strokes each yearyear

• 2 million brain cells die per minute 2 million brain cells die per minute during a stroke.during a stroke.

• Ischemic stroke Ischemic stroke – – blockage in blood vesselsblockage in blood vessels– Thrombotic strokeThrombotic stroke clot forms in a cerebral clot forms in a cerebral

artery; hypertensionartery; hypertension– Embolic StrokeEmbolic Stroke - wandering blood clot - wandering blood clot

• Hemorrhagic strokeHemorrhagic stroke- - blood vessel ruptures blood vessel ruptures in the brainin the brain– Intracerebral hemorrhageIntracerebral hemorrhage– Subarachnoid hemorrhageSubarachnoid hemorrhage– AneurysmAneurysm

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• Interruption of the blood supply or any Interruption of the blood supply or any area of the brain prevents the nerve cells area of the brain prevents the nerve cells from functioning in some cases causing from functioning in some cases causing death.death.

• Those who survive have some lasting Those who survive have some lasting disability.disability.– ParalysisParalysis– Walking disabilityWalking disability– Speech impairmentSpeech impairment– Memory lossMemory loss– Changes in behaviorChanges in behavior

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• Prompt recognition of symptomsPrompt recognition of symptoms– Sudden numbness or weakness of face, Sudden numbness or weakness of face,

arm, leg or one side of the bodyarm, leg or one side of the body– Loss of Speech or difficulty speakingLoss of Speech or difficulty speaking– Dimming or loss of vision in one eyeDimming or loss of vision in one eye– Unexplained dizziness in relation to Unexplained dizziness in relation to

other symptomsother symptoms– Refer to “Three Simple Ways to Refer to “Three Simple Ways to

Recognize a Stroke”Recognize a Stroke”

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• PAD – atherosclerosis in the leg (or arm) PAD – atherosclerosis in the leg (or arm) arteries, which can limit or block the blood flow.arteries, which can limit or block the blood flow.

• Patient’s typically also have coronary artery Patient’s typically also have coronary artery disease.disease.

• 8-12 million people in the U.S. have PAD8-12 million people in the U.S. have PAD• Risk factors:Risk factors:

– SmokingSmoking– DiabetesDiabetes– HypertensionHypertension– High cholesterolHigh cholesterol

• SymptomsSymptoms– Claudication and rest painClaudication and rest pain

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• Number of conditionsNumber of conditions– High blood pressureHigh blood pressure– Heart attackHeart attack– AtherosclerosisAtherosclerosis– AlcoholismAlcoholism– Viral infectionsViral infections– Rheumatic feverRheumatic fever– Birth defectsBirth defects

• Pulmonary edemaPulmonary edema - - Fluid accumulates in the lungs.Fluid accumulates in the lungs.– Heart can not maintain regular pumping rate; fluid Heart can not maintain regular pumping rate; fluid

backs up.backs up.• Controlled by:Controlled by:

– Reducing cardiac loadReducing cardiac load– Eliminating excess fluidEliminating excess fluid– Restriction of salt Restriction of salt – Drug therapyDrug therapy

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• Congenital heart defectsCongenital heart defects– Malformation of the heart or major blood vesselMalformation of the heart or major blood vessel

• Hypertrophic Cardiomyopathy (HCM)Hypertrophic Cardiomyopathy (HCM)– 1:500 people 1:500 people – Most common cause of sudden death in athletes Most common cause of sudden death in athletes

younger than 35younger than 35– MummurMummur

• Rheumatic Heart Disease Rheumatic Heart Disease – Streptococcal infections causes damage to the Streptococcal infections causes damage to the

heart muscle and valves.heart muscle and valves.– Strep throat needs to be treated, primary cause if Strep throat needs to be treated, primary cause if

not treated.not treated.• Heart Valve DisordersHeart Valve Disorders

– Congenital heart defects and certain types of Congenital heart defects and certain types of infectionsinfections

– Mitral valve prolapseMitral valve prolapse44

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