Knowing by liwenting

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									Knowing              Your
                     Heart


     Knowing Your Heart an educational
   series designed to eliminate heart
  disease, diabetes and the metabolic
  syndrome as the leading causes of
death and disability in the United States.
    Knowing Your Heart stresses the
   importance of screening and risk
assessment, medical management and
          lifestyle modification.
                             Obese
          Overweight
No risk



                       Metabolic                  Diabetes
                       syndrome                     and
                                                   heart
             No risk                              disease
             factors

                                   Heart attack


                     No
                  symptoms
                                                             Death
                    Imagine the opportunity!

Key statistics
   First sign of heart disease is
   death 50% and 68% of heart
   attacks occur in a vessel that
   is < 50% blocked
    Evidence based guidelines
    are followed 60% of the time
    Compliance to statins at 24
    months is < 20%
Is it possible to eliminate
heart disease, diabetes and
obesity?
  • Sending a man to the moon and
    returning him safely to earth – JFK
  • Building the atomic bomb
  • Discovery of penicillin – Jonas Salk

  All required the vision that it was
   possible without the proof that it
   could be done
Attacking the foundation of Chronic
Disease
Checking

Healing

Living
6
The physical heart
Determination: ―He has heart‖
Kindness: ―He has a good heart‖
Love: ―He has a broken heart‖



A pumping station
An electric company
A power supply
                                  7
The Pumping Station
Blood vessels
•Coronary arteries
Chambers
Valves
Blood pressure
•Systolic blood pressure
•Diastolic blood pressure
Hypertension
Heart failure               8
The network:
Arteries and veins


The purpose of the heart is
to supply the body with a
  continuous supply of
blood and other nutrients
   that are stored in the
           blood.
Coronary arteries
Because the heart is a muscle, it also
needs a fresh supply of oxygen. The
 coronary arteries supply the heart.
 Main artery       Aorta
 Main vein         Vena cava
 Coronary arteries
      •Left main
      •Left anterior descending (LAD)
      •Left circumflex (LCX)
      •Right coronary artery (RCA)
                                         10
Coronary artery
disease

     Coronary artery disease occurs
   when the coronary arteries become
    blocked. A partial blockage can
   cause chest pain (angina pectoris),
   and a complete blockage can cause
       a heart attack (myocardial
      infarction or cardiac arrest).

                                         11
Atherosclerosis

• In the heart     coronary artery disease
• In the brain     corotid artery disease
• In the kidneys   renal artery disease
• In the legs      peripheral artery disease




                                           12
Myocardium

• Muscular lining of the walls of the
  heart
• An electrical signal is sent causing
  these muscles to contract – heart beat.
• When a heart attack occurs, these
  muscles die – myocardial infarction.


                                            13
Heart chambers

• 2 upper chambers – Atria
• 2 lower chambers – Ventricles

• Right side sends blood to the lungs
• Left side sends blood to the body



                                        14
Valves
Heart valves
• The tricuspid valve is between the right atrium and
  right ventricle.
• The pulmonary or pulmonic valve is between the
  right ventricle and the pulmonary artery.
• The mitral valve is between the left atrium and left
  ventricle.
• The aortic valve is between the left ventricle and
  the aorta.



                                                         15
Blood pressure

 Systolic blood pressure: pressure in
   arteries when heart beats
 Diastolic blood pressure: pressure in
   arteries when heart is relaxed

 Pressure is affected by volume of blood
   and resistance in the vessels.

                                           16
Hypertension

Blood pressure of greater than 140/90
  on three different occations.

Can cause heart disease, stroke, kidney
 failure and heart failure.




                                          17
18
What is a heart attack
• A heart attack occurs when blood
  flow to a section of heart muscle
  becomes blocked. If the flow of
  blood isn’t restored quickly, the
  section of heart muscle becomes
  damaged from lack of oxygen and
  begins to die.
Heart attack is a leading killer of both
 men and women in the United
 States. But fortunately, today there
 are excellent treatments for heart
 attack that can save lives and
 prevent disabilities. If you think you
 or someone you’re with is having a
 heart attack, call 9–1–1 right away.



                                           20
• During a heart attack, if the
  blockage in the coronary artery
  isn’t treated quickly, the heart
  muscle will begin to die and be
  replaced by scar tissue. This heart
  damage may not be obvious, or it
  may cause severe or long-lasting
  problems.
• Severe problems linked to heart
  attack can include heart failure
  and life-threatening arrythmias
  (irregular heartbeats). Heart failure
  is a condition in which the heart
  can’t pump enough blood
  throughout the body. Ventricular
  fibrillation is a serious arrhythmia
  that can cause death if not treated
  quickly.
                                          22
Get Help Quickly
 Acting fast at the first sign of heart
  attack symptoms can save your life
  and limit damage to your heart.
  Treatment is most effective when
  started within 1 hour of the
  beginning of symptoms.
Outlook
• Each year, about 1.1 million
  people in the United States have
  heart attacks, and almost half of
  them die.
• Many more people could recover
  from heart attacks if they got help
  faster. Of the people who die from
  heart attacks, about half die within
  an hour of the first symptoms and
  before they reach the hospital.



                                         25
Other names

• Myocardial infarction or MI
• Acute myocardial infarction or AMI
• Acute coronary syndrome
• Coronary thrombosis
• Coronary occlusion
Signs and Symptoms of a
heart attack
 • Not all heart attacks begin with a
   sudden, crushing pain that is
   often shown on TV or in the
   movies. The warning signs and
   symptoms of a heart attack aren’t
   the same for everyone. Many
   heart attacks start slowly as mild
   pain or discomfort. Some people
   don’t have symptoms at all .
The most common heart
attack signs and symptoms
 • Chest discomfort or pain—
   uncomfortable pressure,
   squeezing, fullness, or pain in the
   center of the chest that can be
   mild or strong.
 • Upper body discomfort in one or
   both arms, the back, neck, jaw, or
   stomach.
 • Shortness of breath may occur
   with or before chest discomfort.
                                         28
Chest Pain
 The most common symptom of heart
  attack is chest pain or discomfort.
  Most heart attacks involve
  discomfort in the center of the chest
  that lasts for more than a few
  minutes or goes away and comes
  back. The discomfort can feel like
  uncomfortable pressure, squeezing,
  fullness, or pain. It can be mild or
  severe. Heart attack pain can
  sometimes feel like indigestion or
  heartburn.
• Angina pain usually lasts for only
  a few minutes and goes away
  with rest. Angina that doesn’t go
  away or that changes from its
  usual pattern can be a sign of the
  beginning of a heart attack and
  should be checked by a doctor
  right away.
                                       30
31
Stroke
• A stroke, or cerebral vascular
  accident, is an interruption of
  blood blow to the brain.
• Ischemic strokes are caused by a
  blockage in a blood vessel, much
  like a blockage in the heart. This
  can be caused by a fatty build-up,
  a blood clot or an embolism.
• Hemorrhagic strokes are caused
  by a burst or leaking blood vessel.
  TIAs, or transient ischemic attacks
  are temporary reductions in blood
  flow and can be a warning sign of
  an impending stroke.


                                        33
Peripheral artery disease

 • Peripheral artery disease is a form of
   atherosclerosis that occurs in the legs.
   It is also referred to as intermittent
   claudication, which is a pain in the
   calves when you walk. PAD may
   result in the loss of a limb and also
   could indicate the presence of
   coronary artery disease.
35
Knowing   Your
          Heart
          Failure
Knowing Your Heart Failure
 • Heart failure is a condition in
   which the heart pump is not
   working efficiently.
 • Heart failure develops over time
   as the pumping of the heart
   grows weaker.
 • Currently, there’s no cure for
   heart failure.
Stages of HF
 • Stage A: At risk for HF but without
   structural heart disease or symptoms
   of HF
 • Stage B: Structural heart disease but
   without symptoms of HF
 • Stage C: Structural heart disease
   with prior or current symptoms of HF
 • Stage D: Structural heart disease
 38and symptoms of HF
Heart Failure
Types of Heart Failure
• Volume/pressure: Too much
  water/salt
• Pump: Muscles are too weak




                AHA. 2005 Heart and Stroke Statistical Update.
• Right-side heart failure occurs
  when the heart can’t pump blood
  to the lungs, where it picks up
  oxygen. Left-side heart failure
  occurs when the heart can’t pump
  enough oxygen-rich blood to the
  rest of the body.
• Right-side heart failure may cause
  fluid to build up in the feet, ankles,
  legs, liver, abdomen, and, rarely, the
  veins in the neck. Right-side and left-
  side heart failure also cause shortness
  of breath and fatigue (tiredness).



                                            41
What causes heart failure
 • Conditions that damage the heart
   muscle or make it work too hard
   can cause heart failure. Over time,
   the heart weakens. It isn't able to
   fill with and/or pump blood as
   well as it should.
• As the heart weakens, certain proteins
  and other substances may be released
  into the blood. They have a toxic
  effect on the heart and blood flow,
  and they cause heart failure to
  worsen.



                                           43
Major causes
The most common causes of heart
 failure are coronary artery
 disease(CAD),high blood
 pressure, and diabetes.
Treating these problems can
 prevent or improve heart failure.
Other factors also can injure the
  heart muscle and lead to heart
  failure. These include:
• Treatments for cancer, such as
  radiation and chemotherapy
• Thyroid disorders (having either
  too much or too little thyroid
  hormone in the body)
• Alcohol abuse
• HIV/AIDS
• Cocaine and other illegal drug use
• Too much vitamin E                   45
Sleep apnea
Heart damage from obstructive
 sleep apnea may cause heart
 failure to worsen. In obstructive
 sleep apnea, your breathing stops
 or gets very shallow while you’re
 sleeping. This can deprive the
 heart of oxygen and increase its
 workload. Treating this sleep
 problem may improve heart
 failure.

                                     46
Who is at risk for heart failure
 • About 5 million people in the United
   States have heart failure, and it
   results in about 300,000 deaths each
   year. The number of people who
   have heart failure is growing. Each
   year, another 550,000 people are
   diagnosed for the first time.
 • Aging can weaken the heart muscle.
   Older people also may have had a
   disease for many years that causes
   heart failure. Heart failure is the #1
   reason for hospital visits in this age
   group.
• African Americans are more likely
  than people of other races to have
  heart failure and to suffer from more
  severe forms of it. They’re also more
  likely than other groups to have
  symptoms at a younger age, get
  worse faster, have more hospital visits
  due to heart failure, and die from heart
  failure.
• People who are overweight. Excess
  weight puts a greater strain on the
  heart. It also can lead to type diabetes,
  which adds to the risk of heart failure.
                                              48
49
The Electric Company




                       50
What is an arrythmia?
 • An arrhythmia is a problem with
   the speed or rhythm of the
   heartbeat. During an arrhythmia,
   the heart can beat too fast, too
   slow, or with an irregular rhythm.
   A heartbeat that is too fast is
   called tachycardia. A heartbeat
   that is too slow is called
   bradycardia.
• Most arrhythmias are harmless,
  but some can be serious or even
  life threatening. When the heart
  rate is too slow, too fast, or
  irregular, the heart may not be
  able to pump enough blood to the
  body. Lack of blood flow can
  damage the brain, heart, and
  other organs.
                                     52
Premature beat, a.k.a
skipped beat
Atrial Fibrillation (AF)
Ventricular
Tachycardia




              Large, sustained reduction
              of arterial pressure
What causes an arrythmia?
 • An arrhythmia can occur when the
   electrical signals that control the
   heartbeat are delayed or blocked. This
   can happen when the special nerve cells
   that produce the electrical signal don't
   work properly or when the electrical
   signal doesn't travel normally through
   the heart. An arrhythmia also can occur
   when another part of the heart starts to
   produce electrical signals, adding to the
   signals from the special nerve cells and
   disrupting the normal heartbeat.
• Stress, smoking, heavy alcohol use,
  heavy exercise, use of certain drugs
  (such as cocaine or amphetamines),
  use of certain prescription or over-the-
  counter medicines, and too much
  caffeine or nicotine can lead to
  arrhythmia in some people.



                                             57
Populations affected
 • Millions of Americans have
   arrhythmias. They are very common
   in older adults. About 2.2 million
   Americans have atrial fibrillation (a
   common type of arrhythmia that can
   cause problems).
• Most serious arrhythmias happen in
  adults older than 60. This is because
  older adults are more likely to have
  heart disease and other health problems
  that can lead to arrhythmias. Older
  adults also tend to be more sensitive to
  the side effects of medicines, some of
  which can cause arrhythmias. Some
  medicines used to treat arrhythmias can
  cause arrhythmias as a side effect.
                                             59
• Some types of arrhythmia happen
  more often in children and young
  adults. Paroxysmal supraventricular
  tachycardias (a fast heart rate that
  begins and ends suddenly), including
  Wolff-Parkinson-White syndrome, are
  more common in young people.


                                         60
61
The Power Supply
Oxygen
Electrolytes
Fat and cholesterol
Proteins
Glucose
Vitamins and minerals



                        62
Oxygen

Oxygen deprivation   Result
Heart                Heart attack
Heart – brief        Chest pain
Brain                Stroke
Limb                 Amputation



                                    63
Electrolytes

 • Calcium     Vitamins and
 • Potassium   minerals
 • Sodium
               • Iron
               • Vitamins A, B, C, D




                                       64
Sources of energy

 • The sources of energy that our body
   uses are proteins, fats and
   carbohydrates (glucose).




                                         65
Fats

 • Blood fats, primarily cholesterol and
   triglycerides are transported in the
   blood is vessels called lipoproteins
 • Two of these lipoproteins are HDL and
   LDL
   – LDL
   – HDL
   – Triglycerides

                                           66
  Traffic patterns in the blood
                          Inflammation
                                           VLDL
         Endothelial function
          Glucose          IDL
          Hb A1C                                 Chylomicron
                                                  Remnants       Proteins
                   LDL                                           Homocysteine
        LDL
        Receptor                       Triglycerides             Hs-CRP
                                                                 Apo-A
          HDL2                                                   Apo-B
                           Lp(a)
        HDL3                                                   Endothelial cells
Liver
                             Calcium


                                            Macrophage
                                                               Lp-pla2

                         Intimal thickening
Knowing   Your
          Diabetes
Knowing Your Diabetes
• If the problem is with sugar rather than
  fat the result is diabetes. Diabetes is a
  disease in which the body does not
  produce or properly use insulin.
• Insulin is a hormone that is needed to
  convert sugar, starches and other food
  into energy needed for daily life.
• The cause of diabetes continues to be a
  mystery, although both genetics and
  environmental factors such as obesity
  and lack of exercise appear to play roles.
• When you eat, your body breaks
  down food into sugar. Sugar is used
  as a source of energy by your body.
  Sugar travels through your
  bloodstream to all the cells in your
  body. Sensing what you have eaten,
  your body releases insulin, which is
  made by your pancreas. Insulin takes
  the sugar from the blood into your
  body’s cells to be used for energy.
  This energy supports all of the body’s
  functions needed to stay alive.
• When you have diabetes, your
  body does not make any or
  enough insulin. Without insulin,
  your body cannot use food
  properly. That is, sugar cannot
  enter your cells and be used for
  energy. As a result, sugar builds
  up in the blood.
Type 1 Diabetes
 • Type 1, or juvenile onset diabetes
   results from the body's failure to
   produce insulin, the hormone that
   "unlocks" the cells of the body,
   allowing glucose to enter and fuel
   them. It is estimated that 5-10% of
   Americans who are diagnosed
   with diabetes have type 1
   diabetes.
Insulin Resistance

 Often, the pancreas makes some
    insulin, but your body cannot use
    it well. This is called insulin
    resistance.
 If your body cannot use insulin,
    sugar cannot enter your cells and
    be used for energy.
Sugar builds up in your blood. To
 help the sugar enter the cells, the
 pancreas tries to make more insulin.
 For some reason, as if the pancreas
 gets tired, insulin production
 eventually slows down.
Most people with type 2 diabetes
 have insulin resistance and
 defective insulin secretion. This is
 your body cannot properly use the
 insulin it makes, and your body
 does not make enough insulin.      74
Type 2 diabetes
 • Type 2, or adult onset diabetes
   results from insulin resistance (a
   condition in which the body fails
   to properly use insulin), combined
   with relative insulin deficiency.
   Most Americans who are
   diagnosed with diabetes have
   type 2 diabetes.
Gestational Diabetes

 • Gestational diabetes affects about
   4% of all pregnant women - about
   135,000 cases in the United States
   each year.
Pre-diabetes
 • Pre-diabetes is a condition that
   occurs when a person's blood
   glucose levels are higher than
   normal but not high enough for a
   diagnosis of type 2 diabetes.
   There are 54 million Americans
   who have pre-diabetes, in
   addition to the 20.8 million with
   diabetes.
Diabetes and Heart Disease
• Heart disease is responsible for 80%
  of deaths in diabetic patients
  compared with 50% in the general
  population
• 75% of all hospitalizations in diabetic
  patients are caused by atherosclerotic
  complications
• 50% of patients newly diagnosed
  with diabetes already have heart
  disease
Metabolic Syndrome
 ―The State of Excess Energy in the
  Body leading to impaired glucose
   metabolism, eventually resulting
    in diabetes and heart disease‖
     Need 3 of the 5
     1. Increased abdominal girth
     2. Hypertension
     3. Low HDL
     4. Elevated Triglycerides
     5. Elevated Fasting Glucose
80
Heal                     HER
Healthy, Energized and Revitalized




    Knowing                Her
                           Heart
Women and Heart Disease
   Higher HDL
   Less belly fat
    Estrogen has protective quality
    Symptoms present differently

     Diagnostics are less accurate
        More family focused
The goal of Heal Her Heart
• increase awareness of heart disease as the leading cause
  of death in women to 75%(Knowing Her Heart),
• detect metabolic syndrome and heart disease in women
  prior to the onset of clinical events, such as myocardial
  infarction or stroke (Checking Her Heart),
• prevent cardiovascular events and improve compliance
  and risk factors, including lipids, blood pressure, obesity
  and impaired glucose metabolism in high risk women by
  increasing the number of women at evidence based
  treatment goals and by reducing the Framingham risk by
  50% (Healing Her Heart),
• improve lifestyle habits, such as smoking, overeating
  and sedentary lifestyle in women (Living with Her
  Heart), by 50%.
 Attacking the foundation of
 Heart Disease


Increasing awareness
Knowing Her Heart
Assessing risk factors
Checking Her Heart
Lifestyle modification
Living with Her Heart
                               84
       Heart disease Trends in the
        United States: 1979-2001

                             While the rates of heart
                             disease are declining in
                                     men…
                             They are increasing in
                                    women



More women die of heart
   disease than men




         Source: CDC/NCHS.
 Heart Disease: The Leading Cause
 of Death for American Women
   1 in 30
 women will
  die from
   breast
  cancer…
 Percentage
  of women
  who know                                       1 in 2.5
heart disease                                  women will
is the leading                                 die of heart
   cause of                                      disease
    death in
    women
            46%   American Heart Association
Why The Gender Gap?
•Women present to emergency
 rooms or chest pain centers 1- 2
 hours later than men.

•Do the multiple roles a woman takes
 on delay care because of her
 responsibilities to others?

•Do women delay care because they
 perceive that heart disease is
 something that happens to one’s
 father, brother, or spouse?
  Gap May Extend to Healthcare
  Professionals
• only 38% of women have discussed heart
  health with their healthcare provider.
• One year death rate for men following a
  heart attack is 25%, for women 38%*
   – only part of this gap can be explained
     by age
• Recommended treatments for heart
  disease are less likely to be used in
  women.
   – Aspirin
   – Referrals to cardiac rehab programs
   – Cholesterol-lowering medicines
     What can you do…..


•Seek medical advice for
 warning signs
•Act promptly with acute
 symptoms
•Seek information related to
 your own risk level
•Make appropriate
 modifications in lifestyle to
 reduce your risk

								
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