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Understanding the Cardiovascular

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					  Understanding the
Cardiovascular System
Sub-Components of the Cardio-
respiratory System
   Heart
   Blood
   Blood Vessels
   Lungs
Function of Cardio-Respiratory
Systems
   Primarily to:
     Transport and exchange gases(O2 and
     CO2)
     Deliver nutrients to cells
Anatomical Considerations of
the Heart
   Size of a closed fist
   Located in the mediastium of the
   chest cavity
Basics Of Heart Anatomy

   It is a four chambered structure
     Two upper chambers: atria or atrium
     Two lower chambers: ventricles
   It is divided into right and left sides
   by muscular tissue known as the
   septum
Basics Of Heart Anatomy #2

   By being divided into right and left
   sides, the heart is able to serve two
   systems:
     Pulmonary
     Systemic
Blood Flow in the Heart




       www.medicine.osu.edu/exam
The Circulatory System
Exchange of Gasses

                 Oxygen rich air is
                 delivered to alveoli
                 with inspiration
                 Oxygen diffuses
                 into the blood
                 The body does not
                 use all of the
                 inhaled oxygen
Hypertension/High Blood
Pressure
   Blood Pressure:
      The driving force that moves blood
     throughout the body.
     The pressure exerted by the blood on
     the walls of the arteries.
Normal Blood Pressure

   120/80
   120 is the systolic reading
   80 is the diastolic reading
   NEVER 80/120
Systolic Blood Pressure
120/80
   The highest pressure or value
   Occurs during heart contraction
   phase (ventricular contraction)
Diastolic Blood Pressure 120/80

    The lowest pressure or value
   Occurs during heart relaxation phase
   (resting or refilling stage of the
   contraction)
Cardiovascular Disease

   60-70 million Americans have one or
   more forms of CVD
Cardiovascular Disease

   1 million deaths each year
   275 billion dollars
Cardiovascular Disease

   Cardiovascular disease (CVD) is the
   number one cause of death in the
   United States.
Cardiovascular Disease

   2600 Americans die each day from
   CVD
     1 death every 33 seconds
   Claims more lives each year than the
   next 7 causes of death combined
   (AHA ’99)
Forms of Cardiovascular Disease

   Coronary artery disease (CAD or
   CVD)
   Hypertension (high blood pressure)
   Cerebral vascular accidents (strokes)
   Angina pectoris
   Peripheral vascular disease
Forms of CVD #2

  Valve disease
  Rheumatic heart disease
  Congenital heart disease
  Congestive heart failure
Coronary Artery Disease (CAD)

   Primary form of heart disease
     A disease involving waxy plaque build-up
     in the arteries
     Atherosclerosis
Cardiovascular Disease

   Has anyone in your family had bypass
   surgery?
   Blocked arteries?
     Plaque build-up
     Related to high cholesterol levels
     sustained over time
     Occurs, primarily, in vessels closest to
     the heart
Surgical Procedures

Plaque rupture
Bypass (7 yr.average)
Angioplasty
Roto Blade
CAD Post-Op Patient

   What behavioral and dietary changes
   were suggested for the patient?
Can One Be FIT But Not
Healthy?
   Personal profile example
   Run 3 miles daily
   Lift weights
   Stretching exercises
   Smokes, stress, excessive alcohol,
   fatty foods, drugs, etc.
Jim Fixx

   36 years old, 215 pounds
   2 pack a day smoker
   No regular exercise
   Family history of heart disease
     father had a heart attack at 35, died at 43
   Began to exercise at age 36
   Ran 60-80 miles per week
   Was FIT but not HEALTHY
Coronary Risk Factors

   Primary Risk Factors: Factors that
   have been definitively associated with
   or directly cause coronary artery
   disease.
   Secondary Risk Factors: Factors
   believed to contribute to or advance
   the severity of atheroschlerosis and
   CAD.
Primary Risk Factors (Alterable)

   Smoking
   Hypertension (high blood pressure)
   High serum cholesterol
   Physical inactivity
   Diabetes mellitus
   Obesity
   Family History?
Secondary Risk Factors

   Stress
   Age
   Gender (male vs. female)
Arkansas Stats from the Center
for Disease Control/Mortality
Rates
   Males #2 in deaths from CAD
   Males #2 in deaths from lung cancer
   Males and Females # 1 in deaths from
   stroke
Additional Ark. Stats

   1/3 of deaths in AR related to CVD
   (l998)
   90% of adults report no vigorous
   activity
   36% do not engage in any physical
   activity
   Arkansans are gaining weight 3 times
   faster than the rest of the nation
    Examining CAD Risk
         Factors
(Primary   followed by Secondary)
Smoking #1

  The single most important,
  preventable cause of illness and early
  death
Smoking #2

  400,000 related deaths per year
   >$50 billion
  Cancer, heart disease, respiratory
  diseases (emphysema)
  Cigarette smoking and passive smoke
  inhalation are highly related to CAD.
Smoking #3

  Smokers have a 70% greater level of
  coronary risk than nonsmokers.
  Magnitude of risk is related to
  number of cigarettes smoked.
  Pipe, cigar, pot
  Personal economics of smoking
Secondary Smoke

  53,000 annual deaths
  For each pack of cigarettes smoked,
  the non smoker, sharing the same air,
  will inhale the equivalent of 3 to 5
  cigarettes.
Smokeless Tobacco

   Chewing tobacco
Actions of Cigarette Smoke on
the Body
   Injures the inner lining of the
   arteries
   Increases the risk of blood clotting
   Increases the risk of myocardial
   infarction
   Lowers HDL cholesterol
Hypertension (High Blood
Pressure)
   A silent killer
   140/90 : considered mild stage of
   hypertension
   Which is more problematic? 140/80
   or 130/95
   Potentially leads to stroke
Hypertension #2

   Related to stroke/aneurysms
   Hypertension may be the result of
   another health problem
Factors Affecting Blood
Pressure
   Hypertensive medications
   Time of day
   Full bladder content
   Body posture
   Recent intake of caffeine
   Nicotine
   Alcohol
   Recent strenuous activity
Impact of Hypertension

   25% or 50 million Americans are
   hypertensive
   67% are not treated
   1/2 are unaware of the complication
Factors Contributing To
Hypertension
   Age
   Race
   Sodium sensitivity
   Chronic alcohol abuse
   Oral contraceptives
   Sedentary living
Lifestyle Interventions to
Maintain or Lower Blood
Pressure
   Body weight reduction or
   maintenance
   Smoking cessation
How To Lower Blood Pressure

   Aerobic exercise
   Reduce stress
   Reduce cholesterol, sodium, high fat
   diet (saturated)
   Medications
Hyperlipidema/High Serum
Cholesterol
   Definition of Cholesterol
     A type of lipid (fat) found in animal
     tissues
     This fat (Lipid) is insoluble in blood
     It binds to proteins (lipoproteins) in
     order to be transported in the body
   Plant sources have no cholesterol
What Foods Do I Eat That
Contain Cholesterol and
Saturated Fat?
   Primarily, animal products and by-
   products
   A few plants contain saturated fat
   but no cholesterol
     Tropical oils (palm, coconut)
What Are Some Foods That
Contain Tropical Oils?
   Commercially baked products
   Popcorn at the movie
What Happens When I Eat Saturated
Fat and Cholesterol Containing (Dietary
Cholesterol) Foods?


    The body takes in the cholesterol
    The body takes in the saturated fat
    and makes increased amounts of “bad”
    cholesterol (LDL)
    Raises the body’s serum cholesterol
    level
What Is So Bad About Having
High Cholesterol Levels??
   High levels lead to a waxy, plaque
   build-up in the arteries, especially
   those near the heart.
   The result is Coronary Artery
   Disease (CAD)
Tell Me More About Plaque

    Affects all of us
    May begin as early as 10 years of age
    May be genetic
    Medications??
Cholesterol: 3 basic facts

     Provides for basic functions of the
     metabolic process
     Is manufactured in the liver – non-
     essential
     The body makes additional cholesterol
     (LDL) from saturated fats
Lipoprotein Types or Cholesterol
Types
   LDL
   HDL
   VLDL
LDL

  Low density lipoproteins (BAD)
      enhances plaque build up in the arteries
      increases with a diet high in saturated
      and trans-fatty acids (hydrogenated
      products)
      Undesirable, increases risk of CAD
HDL

  High density lipoproteins (GOOD)
      Offers protection from CAD
      May remove plaque from the arteries
      Aerobic activity will raise HDL level
      Can be raised by consuming small
      amounts of alcohol daily
VLDL

  Very low density lipoproteins (VLDL)
    undesirable and are associated with
    increase risk of CAD
Serum Cholesterol Levels

    Desirable         below 200
    Borderline high   200-239
    Risk for CVD           240or >
High Serum Cholesterol #2

   If your cholesterol is 250, your risk
   of heart attack is twice that of 200
   If your cholesterol is 300, your risk
   of heart attack is four times that of
   200
Understanding Total Serum
Cholesterol Values
   Knowing an individual’s total
   cholesterol is not adequate when
   determining coronary risk
Understanding Cholesterol
Ratios
   Determine the ratio of total cholesterol to
   HDL’s
   Formula: TC/HDL
   Example: Male, TC = 190, HDL = 34 (5.4)
     190 divided by 34 = 5.4
   Values equal to or greater than 5.0 for
   men and 4.5 for women are associated
   with risk.
   6.0 = increased risk
   4.0 = low risk
   Usually, if HDL is < 35, heart attack risk is
Cholesterol Value Examples

   Male                 Male
   TC: 210       HDL:   TC: 220       HDL:
   32                   49
   Divide 210 by 32 =   Divide 220 by 49 =
   6.56
                        4.49
   6.56 : 1 ratio
                        4.49 : 1 ratio
   Ratio is >5.0
   Increased risk of    Ratio is <5.0
   CAD                  Low risk of CAD
Cholesterol Value Examples

   Female               Female
   TC: 195 HDL: 36      TC: 195 HDL: 40
   Divide 195 by 36 =   Divide 195 by 40 =
   5.42                 4.9
   5.42 : 1 ratio       4.9 : 1 ratio
   Ratio is >4.5        Ratio is > 4.5
   Increased risk of    Increased risk of
   CAD                  CAD
Cholesterol Value
Actual Example
   Female
   TC 207 HDL 74
   207 divided by 74= 2.8
   2.8 : 1 ratio
   < 4.5
   Very low risk CAD
How To Control Or Lower
Cholesterol
                 Avoid saturated
                 fats
                   fats from animal
                   sources
                   red meats
                   animal fats
                   animal by-products
Controlling Cholesterol #2

   Avoid dietary cholesterol
   Exercise
   Consume a low fat diet (20% or less)
   Watch egg consumption
   Limit red meats (fewer than 3 times per
   week)
   Avoid commercially baked goods (tropical
   oils and trans-fatty acids/hydrogenation)
   Use skim milk
Controlling Cholesterol #3

   Eat fish 2-3 times
   per week
   Bake, broil, steam
   Remove excess fat
   (soup, chili)
     Is ground turkey
     better?
Controlling Cholesterol #4

   Avoid fatty sauces (fettuccini alfredo)
   Substitute in recipes
     Egg whites for eggs
     Applesauce for oil in cakes
     Salsa instead of butter for baked potatoes
     Are there substitutions you make?
   Maintain proper body weight
Physical Inactivity

   Physical activity
   levels and CAD are
   strongly inversely
   related.
Physical Inactivity #2

   Sedentary individuals have:
      2-3 times greater risk of CAD than
     active individuals.
     Twice the risk of fatal heart attacks
Physical Activity

                    Physical activity is
                    argumentably be
                    the single best
                    method of
                    controlling or
                    reducing CAD.
                    Collateralization
Physical Activity #2

   Increases strength of the heart
   Helps to establish and maintain
   normal blood pressure.
   Helps to control obesity due to
   increase in caloric expenditure
Physical Activity #2

   Raises HDL levels, while lowering LDL,
   triglyceride and total cholesterol
   levels.
   Decreases resting heart rates
   Helps to manage stress levels
Physical Activity #3

   Increases resting and exercising
   stroke volumes
     Amount of blood pumped by the heart in
     a single beat
   Reduces the risk of diabetes
Diabetes Mellitus

   Arkansas ranks 11th in the prevalence
   of diabetes
   New trends:
     Increased cases of Type 2 diabetes
     children
     Increase in adults in the 30’s.
Diabetes Mellitus

   A condition in which glucose is unable to
   enter the cells
   A disease associated with problems in
   controlling blood glucose or blood sugar
   The disease results when the pancreas has
   problems producing insulin or the body can
   no longer use insulin properly
   Insulin is the “taxi” that carries sugar
   from the blood to the cells
Blood Sugar Levels

   Normal blood sugar levels: 65-110
   Hyperglycemia
     High levels of blood sugar
     When sugar levels remain high, over time, it
     damages the walls of the vessels
     Leads to impairment of the circulatory system
     Affects functioning of most organs
     Problems healing (small cuts, amputations)
     Blindness
Hypoglycemia

   Low levels of blood sugar
   It is appropriate to give sugar to the
   diabetic in a hypoglycemic emergency
   Some may experience hypoglycemia
   but are not diabetic
     protein is often recommended
Types of Diabetes

   Type I: insulin dependent or juvenile
   onset
   Type II: maturity or adult onset,
   usually non-insulin dependent
   Gestational onset
Diabetes Mellitus: Adult Onset

   The pancreas does
   not produce enough
   insulin or has just
   forgotten how
   Directly related to
   obesity
   90% of all cases
   are Type II
Adult Onset #2

   An 20% increase in body weight
   doubles the chances of developing
   diabetes
   Example:
     Appropriate weight = 160
     20% weight gain = 192
How To Avoid Adult Onset
Diabetes
   Control cholesterol
   Control weight
   Control blood pressure
   Exercise regularly (aerobic)
     Diabetics must plan for meals, insulin
     injections, and exercise
Obesity

          61% Americans are
          overweight
          25% are obese
Obesity: Fat Distribution

   “Apples” Android Obesity
     Fat distributed in upper body
     Higher risk of CAD, strokes, diabetes
   “Pears” Gynoid Obesity
     Fat is distributed in the hips and legs
Obesity Is Related To:

   High cholesterol
   Hypertension / stroke
   Elevated LDL levels
   Lower HDL levels
   Physical Inactivity
   Diabetes
   Obesity is also related to joint problems
Other Diseases Associated With
Obesity
   Renal disease
   Gallbladder disease
   Pulmonary disease
   Degenerative arthritis
   Psychological problems
   Some cancers
     Post menopausal obese women 5 times more
     likely to develop uterine cancer
   Problems administering anesthesia
What Constitutes Obesity?

   BMI > 25
   > 20 lbs overweight
   Body fat percentages
    Men > 20% (25)
    Women > 25% (30)
Secondary Risk Factors

   Stress
   Age
   Gender
   ???Family History???
Stress:

   Unmanaged stress
   is related to CAD.
   Type A personality
   is related to CAD.
Age:

   Men : 45 and over
   Women: 55 and over
       menopausal women who do not take
       estrogen replacement therapy (2000
       research contradicts this statement)
Family History: Primary or
Secondary?
   The risk is greater when:
     Father or other first degree relative
     has a MI or sudden death prior to 55
     Mother or another female family
     member has a MI or sudden death prior
     to 65
     Family history of diabetes, hypertension
Gender

         Men have a greater
         history of CAD
         earlier in life.
         CAD is a disease of
         “equal opportunity”

				
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