helena taskinen occupational health and the heart
TRANSCRIPT
Slide 1Helena Taskinen
Introduction
Heart disease and stroke cause the majority of deaths in the world
Major risk factor:
BOX OCCUPATIONAL
Helena Taskinen
Introduction
The united states estimate that 1% to 3% of deaths from cardiovascular disease are work related
Note:
Preventable
Chemical
Toxic cardiovascular disease is usually the result of chronic low level exposures
BOX OCCUPATIONAL
Helena Taskinen
Agents can be grouped by main or major effects on the C.V.S
Coronary artery disease
*
Five physiological-pathological manifestations of the effects of occupational agents on the heart; this provides a good framework to classify agents. Many are now of historic interest, as controls have reduced hazards, though they still may be encountered. Each will be considered in turn.
Helena Taskinen
Cigarette smoking
Carbon monoxide is the most commonly encountered occupational and environmental agent with cardiotoxic effects. Photograph shows indoor foundry work, where combustion occurring in limited oxygen supply may lead to CO formation.
Helena Taskinen
Patogenesis
Binds to hemoglobin more avidly than O2 (CO has 200x oxygen’s affinity) (carboxy hemoglobin)
Increases platelet stickiness
Decreases arrhythmia threshold
*
Explosive manufacturing, construction work involving blasting, pharmaceutical manufacturing of nitrate
CAD risk increased 2-3x after 20 years exposure: persists after removal
Three-fold increase in acute deaths in younger men from ischemic CHD
Helena Taskinen
Nitrate directly dilate blood vessels (coronary)
Possible HTN after cessation of exposure Nitrate directly dilate blood vessels (coronary)
Withdrawal: HTN, angina, MI
*
Effects of exposures to aliphatic nitrates (nitroglycerin and ethylene glycol dinitrate) in explosives workers were soon seen after manufacturing rapidly increased in the 19th century. Many developed headaches, tachycardia, syncope (also familiar side effects of the medical use of nitrates); tolerance or tachyphylaxis usually developed over a week or so on the job.
Picture shows original DuPont manufacturing houses on Delaware River: note thick walls with buttresses and thin ceilings to channel any explosions upward and back toward woods rather than outward to other areas of plant.
Helena Taskinen
ATHEROGENESIS
RR of 2 to 5x for death from CAD
Epidemiologic evidence suggests a direct role in atherogenesis in blood vessels
Disturbances of lipid metabolism and thyroid function (LDL , hypothyrodism) (risk factor atherosclerosis)
Early sign:abnormal ocular microcirculation , micro aneurysms, hemorrhages such diabetic retinopathy
Helena Taskinen
Other solvents: Trichloroethylene, toluene
Dysrhythmias and sudden death first noted in solvent abusers and glue sniffers. Ambulatory EKG monitoring showed abnormalities in pathology residents exposed to chlorofluorocarbons such as Freon; these improved with improvements in ventilation. Occasional deaths have been reported from excess physical activity near leaking refrigerants. Autopsy results in cases of sudden death from solvent exposures show no evidence for atherogenesis.
Helena Taskinen
Low level of exposure:
Sensitize, arrhythmia (VT,VF), death
Symptom:
Cardiomyopathy reported in beer drinkers several months afterward
*
CARDIOMYOPATHY
May also increase vascular tone and resistance
Cadmium:
Possibly associated with HTN; noted to occur at levels below nephrotoxic dose
Chelation may reduce blood pressure in cases of acute lead intoxication; in chronic cases in which interstitial nephritis is present it is unlikely to be of value.
Helena Taskinen
Occupational Stress
1.5 million MI each year
Nearly 200,000 CABG per year
*
CARDIOVASCULAR DISEASE AND THE WORKPLACE
3
3
3
Ergonomics comes from the combination of two Latin words, “ergos,” meaning work, and “nomos” meaning natural laws or systems. Hence, in its broadest sense, ergonomics is the science of work. Practically applied, ergonomics seeks to optimize the functioning of systems by ensuring that they are compatible with human capabilities and needs.
When applied to job design, ergonomics seeks to
- improve productivity
- reduce the number of problem tasks that make it difficult to staff them
- increase the number of jobs within the capabilities of women and older workers
2.unknown
*
Physicians should be careful not to exclude workers on the basis of positive testing without clear demonstration that physical capacity is limited: this would conflict with statutes protecting the disabled such as the ADA.
Helena Taskinen
*
Physicians should be careful not to exclude workers on the basis of positive testing without clear demonstration that physical capacity is limited: this would conflict with statutes protecting the disabled such as the ADA.
Helena Taskinen
Introduction
Heart disease and stroke cause the majority of deaths in the world
Major risk factor:
BOX OCCUPATIONAL
Helena Taskinen
Introduction
The united states estimate that 1% to 3% of deaths from cardiovascular disease are work related
Note:
Preventable
Chemical
Toxic cardiovascular disease is usually the result of chronic low level exposures
BOX OCCUPATIONAL
Helena Taskinen
Agents can be grouped by main or major effects on the C.V.S
Coronary artery disease
*
Five physiological-pathological manifestations of the effects of occupational agents on the heart; this provides a good framework to classify agents. Many are now of historic interest, as controls have reduced hazards, though they still may be encountered. Each will be considered in turn.
Helena Taskinen
Cigarette smoking
Carbon monoxide is the most commonly encountered occupational and environmental agent with cardiotoxic effects. Photograph shows indoor foundry work, where combustion occurring in limited oxygen supply may lead to CO formation.
Helena Taskinen
Patogenesis
Binds to hemoglobin more avidly than O2 (CO has 200x oxygen’s affinity) (carboxy hemoglobin)
Increases platelet stickiness
Decreases arrhythmia threshold
*
Explosive manufacturing, construction work involving blasting, pharmaceutical manufacturing of nitrate
CAD risk increased 2-3x after 20 years exposure: persists after removal
Three-fold increase in acute deaths in younger men from ischemic CHD
Helena Taskinen
Nitrate directly dilate blood vessels (coronary)
Possible HTN after cessation of exposure Nitrate directly dilate blood vessels (coronary)
Withdrawal: HTN, angina, MI
*
Effects of exposures to aliphatic nitrates (nitroglycerin and ethylene glycol dinitrate) in explosives workers were soon seen after manufacturing rapidly increased in the 19th century. Many developed headaches, tachycardia, syncope (also familiar side effects of the medical use of nitrates); tolerance or tachyphylaxis usually developed over a week or so on the job.
Picture shows original DuPont manufacturing houses on Delaware River: note thick walls with buttresses and thin ceilings to channel any explosions upward and back toward woods rather than outward to other areas of plant.
Helena Taskinen
ATHEROGENESIS
RR of 2 to 5x for death from CAD
Epidemiologic evidence suggests a direct role in atherogenesis in blood vessels
Disturbances of lipid metabolism and thyroid function (LDL , hypothyrodism) (risk factor atherosclerosis)
Early sign:abnormal ocular microcirculation , micro aneurysms, hemorrhages such diabetic retinopathy
Helena Taskinen
Other solvents: Trichloroethylene, toluene
Dysrhythmias and sudden death first noted in solvent abusers and glue sniffers. Ambulatory EKG monitoring showed abnormalities in pathology residents exposed to chlorofluorocarbons such as Freon; these improved with improvements in ventilation. Occasional deaths have been reported from excess physical activity near leaking refrigerants. Autopsy results in cases of sudden death from solvent exposures show no evidence for atherogenesis.
Helena Taskinen
Low level of exposure:
Sensitize, arrhythmia (VT,VF), death
Symptom:
Cardiomyopathy reported in beer drinkers several months afterward
*
CARDIOMYOPATHY
May also increase vascular tone and resistance
Cadmium:
Possibly associated with HTN; noted to occur at levels below nephrotoxic dose
Chelation may reduce blood pressure in cases of acute lead intoxication; in chronic cases in which interstitial nephritis is present it is unlikely to be of value.
Helena Taskinen
Occupational Stress
1.5 million MI each year
Nearly 200,000 CABG per year
*
CARDIOVASCULAR DISEASE AND THE WORKPLACE
3
3
3
Ergonomics comes from the combination of two Latin words, “ergos,” meaning work, and “nomos” meaning natural laws or systems. Hence, in its broadest sense, ergonomics is the science of work. Practically applied, ergonomics seeks to optimize the functioning of systems by ensuring that they are compatible with human capabilities and needs.
When applied to job design, ergonomics seeks to
- improve productivity
- reduce the number of problem tasks that make it difficult to staff them
- increase the number of jobs within the capabilities of women and older workers
2.unknown
*
Physicians should be careful not to exclude workers on the basis of positive testing without clear demonstration that physical capacity is limited: this would conflict with statutes protecting the disabled such as the ADA.
Helena Taskinen
*
Physicians should be careful not to exclude workers on the basis of positive testing without clear demonstration that physical capacity is limited: this would conflict with statutes protecting the disabled such as the ADA.
Helena Taskinen