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Understanding the Understanding the Cardiovascular SystemCardiovascular System
Chapter 4Chapter 4Refers to Heart – Lung Refers to Heart – Lung
FunctioningFunctioning
Sub-Components of Sub-Components of the Cardio-the Cardio-respiratory Systemrespiratory SystemHeartBloodBlood VesselsLungs
Function of Cardio-Function of Cardio-Respiratory SystemsRespiratory Systems
Primarily to:– Transport and exchange
gases(O2 and CO2)– Deliver nutrients to cells– Deliver hormones and nutrients– Removes waste– Balance fluids– Temperature regulation
Anatomical Considerations Anatomical Considerations of the Heartof the Heart
Size of a closed fist Located in the mediastium of
the chest cavity
Basics Of Heart AnatomyBasics 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 Basics Of Heart Anatomy #2#2 By being divided into right and
left sides, the heart is able to serve two systems: – Pulmonary– Systemic
Explanation of basic blood flow
Cardiovascular DiseaseCardiovascular Disease
60-70 million Americans have one or more forms of CVD
Cardiovascular DiseaseCardiovascular Disease
1 million deaths each year330 billion dollars
Cardiovascular DiseaseCardiovascular Disease
Cardiovascular disease (CVD) is the number one cause of death in the United States.
Cardiovascular DiseaseCardiovascular 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 Forms of Cardiovascular DiseaseCardiovascular Disease(Often preventable and lifestyle (Often preventable and lifestyle
related)related) Coronary artery disease (CAD or CVD) Hypertension (high blood pressure) Cerebral vascular accidents (strokes) Angina pectoris Peripheral vascular disease Valve disease Rheumatic heart disease Congenital heart disease Congestive heart failure
Coronary Artery Disease Coronary Artery Disease (CAD)(CAD) Primary form of heart disease May be caused by a variety of
conditions, however most cases are associated with:– Waxy plaque build-up in the
arteries
–Atherosclerosis
Clear Coronary Clear Coronary Arteries Arteries
Cardiovascular DiseaseCardiovascular 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
Cardiovascular ProceduresCardiovascular Procedures
Angioplasty Roto-Blade Stints Keyhole Surgery Radiation Bypass Surgery (7 yr.average)
CAD Post-Op CAD Post-Op PatientPatientWhat behavioral and dietary changes are suggested for the patient?
Can One Be FIT But Not Can One Be FIT But Not Healthy?Healthy? Personal profile example Run 3 miles daily Lift weights Stretching exercises Smokes, stress, excessive alcohol,
fatty foods, drugs, etc.
Jim FixxJim 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 FactorsCoronary 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 Primary Risk Factors (Alterable)(Alterable) Smoking
Hypertension (high blood pressure) High serum cholesterol
(hyperlipidemia) Physical inactivity Diabetes mellitus Obesity
– (drug use)
Secondary Risk FactorsSecondary Risk Factors
StressAgeGender (male vs. female)Family history
Are Arkansans at Are Arkansans at Risk for these Risk for these Health Problems?Health Problems??
Arkansas Stats from the Arkansas Stats from the Center for Disease Center for Disease Control/Mortality RatesControl/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. StatsAdditional 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
40% AR youths carry excessive weight
Examining CAD Risk Examining CAD Risk Factors Factors ((Primary followed by Primary followed by Secondary)Secondary)
Smoking #1Smoking #1
The single most important, preventable cause of illness and early death
Smoking #2Smoking #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 #3Smoking #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 SmokeSecondary Smoke
53,000 annual deathsFor each pack of cigarettes
smoked, the non smoker, sharing the same air, will inhale the equivalent of 3 to 5 cigarettes.
Smokeless TobaccoSmokeless Tobacco
Chewing tobaccoOverheads
Smoking Benefits??Smoking Benefits??
Injures the inner lining of the arteries
Increases the risk of blood clotting Increases the risk of heart attack Increases risk of sudden death Allows for consumption of 63
cancer causing chemicals
Smoking Benefits #2 ???Smoking Benefits #2 ??? 87% of lung cancer caused by smoking Most emphysema and chronic bronchitis caused by
smoking Lowers HDL cholesterol Increases facial wrinkles Increases risk of many other diseases Reduces length of life by as much as 17 years
– Depends on amount smoked and years smoked
Stop smoking– Heart disease risk drops in a matter of
months– Cancer risk drops slowly and may take
10 years
Hypertension / High Hypertension / High Blood PressureBlood Pressure
Blood Pressure: – The driving force that moves blood throughout the body.
–The pressure exerted by the blood on the walls of the arteries.
Blood PressureBlood Pressure
120/80 or less is optimal
120-139/80-89 is Pre-hypertension
140-159/90-99 is stage 1 160/100 or higher is stage 2
Systolic Blood Pressure Systolic Blood Pressure
120120/80/80The highest pressure or value
Occurs during heart contraction phase (ventricular contraction)
Diastolic Blood Pressure Diastolic Blood Pressure
120/120/8080 The lowest pressure or value
Occurs during heart relaxation phase (resting or refilling stage of the contraction)
Hypertension (High Blood Hypertension (High Blood Pressure)Pressure) A silent killer 140/90 : considered mild stage of
hypertension Which is more problematic? 140/80
or 130/95 Potentially leads to stroke Causes the heart muscle to
overwork
Hypertension #2Hypertension #2
Related to stroke / aneurysms Hypertension may be the result of
another health problem
Factors Affecting Blood Factors Affecting Blood PressurePressure Hypertensive medications
Time of day Full bladder content Body posture Recent intake of caffeine Nicotine Alcohol Recent strenuous activity
Impact of HypertensionImpact of Hypertension
25% or 50 million Americans are hypertensive
67% are not treated1/2 are unaware of the
complication
Factors Contributing To Factors Contributing To HypertensionHypertension
AgeRaceSodium sensitivityChronic alcohol abuseOral contraceptivesSedentary living
Lifestyle Interventions to Lifestyle Interventions to Maintain or Lower Blood Maintain or Lower Blood PressurePressure
Body weight reduction or maintenance
Smoking cessation
How To Lower Blood How To Lower Blood PressurePressureAerobic exerciseReduce stressReduce cholesterol, sodium,
high fat diet (saturated)Medications
Hyperlipidema / Hyperlipidema / High Serum High Serum CholesterolCholesterol 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
Cholesterol: 3 basic factsCholesterol: 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
What Is So Bad About What Is So Bad About Having High Cholesterol Having High Cholesterol Levels??Levels??High levels lead to a waxy, plaque build-up in the arteries, especially those near the heart.
The result can be increased risk of Coronary Artery Disease (CAD)
More About PlaqueMore About Plaque
–Affects all of us –May begin as early as 10 years of age
–May be genetic–Medications??
Types of Types of Lipoproteins / Lipoproteins / Types of Types of CholesterolCholesterolLDLHDLVLDL
LDLLDL
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
HDLHDL
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
VLDLVLDL
Very low density lipoproteins (VLDL)–undesirable and are associated with increase risk of CAD
Cholesterol Cholesterol InformationInformationDietary Cholesterol
–Refers to foods high in cholesterol
–Example:»Shrimp
High in cholesterol Low in fat
Cholesterol Cholesterol InformationInformationSaturated fats
–Can significantly raise LDL levels (“bad” cholesterol) and total serum cholesterol levels
–Found in animal sources and by products
Cholesterol Cholesterol InformationInformation Plants are NEVER sources
of cholesterol, but can be sources of saturated fat. – Examples:
»Tropical oils (palm, coconut)»Examples of sources: Movie popcorn,
commercially baked goods
Ingestion of dietary cholesterol
Serum Cholesterol Serum Cholesterol LevelsLevels
–Desirable below 200
–Borderline high 200-239–Risk for CVD 240 or >
– Some guidelines call for desirable to be 170
High Serum Cholesterol High Serum Cholesterol #2#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 Understanding Total Serum Cholesterol ValuesSerum Cholesterol Values
Knowing an individual’s total cholesterol is not always adequate when determining coronary risk
Understanding Cholesterol Understanding Cholesterol Ratios 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 less than 35, heart attack risk
is indicated
Cholesterol Value Cholesterol Value ExamplesExamples Male
TC: 210 HDL: 32
Divide 210 by 32 = 6.56
6.56 : 1 ratio Ratio is >5.0 Increased risk of
CAD
Male TC: 220 HDL:
49 Divide 220 by 49
= 4.49 4.49 : 1 ratio Ratio is <5.0 Low risk of CAD
Cholesterol Value Cholesterol Value ExamplesExamples Female TC: 195 HDL:
36 Divide 195 by 36
= 5.42 5.42 : 1 ratio Ratio is >4.5 Increased risk of
CAD
Female TC: 195 HDL:
40 Divide 195 by 40
= 4.9 4.9 : 1 ratio Ratio is > 4.5 Increased risk of
CAD
Cholesterol ValueCholesterol Value Actual Example 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 How To Control Or Lower CholesterolCholesterolAvoid saturated fats
–fats from animal sources–red meats–animal fats–animal by-products
Controlling Cholesterol #2Controlling 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 #3Controlling Cholesterol #3
Eat fish 2-3 times per week
Bake, broil, steam
Remove excess fat (soup, chili)– Is ground turkey
better?
Controlling Cholesterol #4Controlling 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
Take Care Of Take Care Of Your Kitchen Your Kitchen DisposalDisposal
Physical InactivityPhysical Inactivity
Physical activity levels and CAD are strongly inversely related.
Physical Inactivity #2Physical Inactivity #2
Sedentary individuals have:– 2-3 times greater risk of CAD than active individuals.
–Twice the risk of fatal heart attacks
Physical ActivityPhysical ActivityPhysical activity is
argumentably be the single best method of controlling or reducing CAD.
Collateralization
Physical Activity #2Physical Activity #2
Increases strength of the heartHelps to establish and maintain
normal blood pressure.Helps to control obesity due to
increase in caloric expenditure
Physical Activity #2Physical Activity #2
Raises HDL levels, while lowering LDL, triglyceride and total cholesterol levels.
Decreases resting heart rates
Helps to manage stress levels
Physical Activity #3Physical 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 MellitusDiabetes 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 MellitusDiabetes 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 LevelsBlood 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
HypoglycemiaHypoglycemia
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 DiabetesTypes of Diabetes
Type I: insulin dependent or juvenile onset
Type II: maturity or adult onset, usually non-insulin dependent
Gestational onset
Diabetes Mellitus: Adult Diabetes Mellitus: Adult OnsetOnset 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 #2Adult 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 How To Avoid Adult Onset DiabetesDiabetes
Control cholesterolControl weightControl blood pressureExercise regularly (aerobic)
–Diabetics must plan for meals, insulin injections, and exercise
ObesityObesity 64% Americans are
overweight– 25% obese
60% Arkansans at unhealthy weight– 37% obese
Arkansas: 77% increase in obesity from 1991 to 2000
117 billion spent on obesity-related illnesses
Obesity #2Obesity #2
38% Arkansas school children overweight
Young adult obesity can shorten life span by 5 to 20 years
Obesity Is Related To:Obesity Is Related To:
High cholesterol Hypertension / stroke Elevated LDL levels Lower HDL levels Physical Inactivity Diabetes Obesity is also related to joint
problems
Obesity: Fat DistributionObesity: 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
Other Diseases Associated Other Diseases Associated With ObesityWith 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 What Constitutes Obesity?Obesity?BMI > 25> 20 lbs overweightBody fat percentages
–Men > 20% (25)–Women > 25% (30)
Secondary Risk Secondary Risk Factors (Not Factors (Not
alterable)alterable)Stress (secondary but is alterable to some degree)
AgeGenderFamily History
Stress:Stress:
Unmanaged stress is related to CAD.
Type A personality is related to CAD.
Age:Age:
Men : 45 and overWomen: 55 and over
Family History: Primary or Family History: Primary or Secondary?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
GenderGender
Men have a greater history of CAD earlier in life.
CAD is a disease of “equal opportunity”
**New Information: **New Information: Homocysteine LevelsHomocysteine Levels An amino acid (level becomes too high) Causes heart disease (sudden
blockage) Birth defects Testing is involved and expensive Consume folic acid
– Vegetables, fruits, vitamins E, C, B- complex and selenium
**New Information**New Information
High triglyceride levels are associated with increase in CAD (fall 2000)
**New Information**New Information
Blood tests for C-Reactive Protein Presence of protein indicated
inflamed arteries Inflammation may cause plaque to
break away (plaque rupture) Prescribe an antibiotic??
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