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
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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
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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.
UCSD Sulpizio Cardiovascular Center
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7 Source: AHA Heart Disease and Stroke Statistics – 2013 Update.
UCSD Sulpizio Cardiovascular Center
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UCSD Sulpizio Cardiovascular Center
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Progression of Atherosclerosis
UCSD Sulpizio Cardiovascular Center
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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:
UCSD Sulpizio Cardiovascular Center
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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
UCSD Sulpizio Cardiovascular Center
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Smoking Trends for men and women
UCSD Sulpizio Cardiovascular Center
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Heart Attack
Coronary
Artery Disease
UCSD Sulpizio Cardiovascular Center
Death
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Cardiac Evaluation:
Listen to your Heart Chest pain or pressure Shortness of breath or Fatigue Palpitations
UCSD Sulpizio Cardiovascular Center
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
UCSD Sulpizio Cardiovascular Center
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Coronary Angiography: Definitive Evaluation of CAD
UCSD Sulpizio Cardiovascular Center
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UCSD Sulpizio Cardiovascular Center
Coronary Artery Bypass Graft Surgery – Traditional Approach
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Peripheral Arterial Disease:
UCSD Sulpizio Cardiovascular Center
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Peripheral Arterial Disease: Before Revascularization After
UCSD Sulpizio Cardiovascular Center
Images provided by Dr. Mitul Patel and UCSD and Health System
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Carotid Arterial Disease - Revascularization
Before After
UCSD Sulpizio Cardiovascular Center
Images provided by Dr. Mitul Patel and UCSD and Health System
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UCSD Sulpizio Cardiovascular Center
Aortic Stenosis
Normal Severe Aortic Stenosis
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UCSD Sulpizio Cardiovascular Center
Severe Aortic Stenosis – Traditional Approach
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UCSD Sulpizio Cardiovascular Center
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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UCSD Sulpizio Cardiovascular Center
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:
UCSD Sulpizio Cardiovascular Center
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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.
UCSD Sulpizio Cardiovascular Center
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27 Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.
Effect of Exercise on Survival
UCSD Sulpizio Cardiovascular Center
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Cardiac Rehabilitation after MI, CABG,
Valve surgery or CHF
UCSD Sulpizio Cardiovascular Center
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
UCSD Sulpizio Cardiovascular Center
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Any Questions ?
Thank You!
UCSD Sulpizio Cardiovascular Center