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Understanding the Cardiovascular System
Understanding the Cardiovascular System
Sub-Components of the Cardio-respiratory System
HeartBloodBlood VesselsLungs
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 fistLocated in the mediastium of the chest cavity
Basics Of Heart Anatomy
It is a four chambered structureTwo upper chambers: atria or atriumTwo 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:
PulmonarySystemic
The Circulatory System
Exchange of Gasses
Oxygen rich air is delivered to alveoli with inspirationOxygen diffuses into the bloodThe 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
120/80120 is the systolic reading80 is the diastolic readingNEVER 80/120
Systolic Blood Pressure 120/80
The highest pressure or valueOccurs during heart contraction phase (ventricular contraction)
Diastolic Blood Pressure 120/80
The lowest pressure or valueOccurs 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 year275 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 secondsClaims 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 pectorisPeripheral vascular disease
Forms of CVD #2
Valve diseaseRheumatic heart diseaseCongenital heart diseaseCongestive heart failure
Coronary Artery Disease (CAD)
Primary form of heart diseaseA disease involving waxy plaque build-up in the arteriesAtherosclerosis
Cardiovascular Disease
Has anyone in your family had bypass surgery?Blocked arteries?
Plaque build-upRelated to high cholesterol levels sustained over timeOccurs, primarily, in vessels closest to the heart
Surgical Procedures
Plaque ruptureBypass (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 exampleRun 3 miles dailyLift weightsStretching exercisesSmokes, stress, excessive alcohol, fatty foods, drugs, etc.
Jim Fixx
36 years old, 215 pounds2 pack a day smokerNo regular exerciseFamily history of heart disease
father had a heart attack at 35, died at 43Began to exercise at age 36Ran 60-80 miles per weekWas 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)
SmokingHypertension (high blood pressure)High serum cholesterolPhysical inactivityDiabetes mellitusObesityFamily History?
Secondary Risk Factors
StressAgeGender (male vs. female)
Arkansas Stats from the Center for Disease Control/Mortality Rates
Males #2 in deaths from CADMales #2 in deaths from lung cancerMales 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 activity36% do not engage in any physical activityArkansans 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 billionCancer, 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, potPersonal economics of smoking
Secondary 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 Tobacco
Chewing tobacco
Actions of Cigarette Smoke on the Body
Injures the inner lining of the arteriesIncreases the risk of blood clottingIncreases the risk of myocardial infarctionLowers HDL cholesterol
Hypertension (High Blood Pressure)
A silent killer140/90 : considered mild stage of hypertensionWhich is more problematic? 140/80 or 130/95Potentially leads to stroke
Hypertension #2
Related to stroke/aneurysmsHypertension may be the result of another health problem
Factors Affecting Blood Pressure
Hypertensive medicationsTime of dayFull bladder contentBody postureRecent intake of caffeineNicotineAlcoholRecent strenuous activity
Impact of Hypertension
25% or 50 million Americans are hypertensive67% are not treated1/2 are unaware of the complication
Factors Contributing To Hypertension
AgeRaceSodium sensitivityChronic alcohol abuseOral contraceptivesSedentary living
Lifestyle Interventions to Maintain or Lower Blood Pressure
Body weight reduction or maintenance Smoking cessation
How To Lower Blood Pressure
Aerobic exerciseReduce stressReduce cholesterol, sodium, high fat diet (saturated)Medications
Hyperlipidema/High Serum Cholesterol
Definition of CholesterolA type of lipid (fat) found in animal tissuesThis fat (Lipid) is insoluble in bloodIt 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-productsA few plants contain saturated fat but no cholesterol
Tropical oils (palm, coconut)
What Are Some Foods That Contain Tropical Oils?
Commercially baked productsPopcorn at the movie
What Happens When I Eat Saturated Fat and Cholesterol Containing (Dietary Cholesterol) Foods?
The body takes in the cholesterolThe 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 ageMay be geneticMedications??
Cholesterol: 3 basic facts
Provides for basic functions of the metabolic processIs manufactured in the liver – non-essentialThe body makes additional cholesterol (LDL) from saturated fats
Lipoprotein Types or Cholesterol Types
LDLHDLVLDL
LDL
Low density lipoproteins (BAD)enhances plaque build up in the arteriesincreases 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 CADMay remove plaque from the arteriesAerobic activity will raise HDL levelCan 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 200Borderline high200-239Risk for CVD 240or >
High Serum Cholesterol #2
If your cholesterol is 250, your risk of heart attack is twice that of 200If 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’sFormula: TC/HDLExample: Male, TC = 190, HDL = 34 (5.4)
190 divided by 34 = 5.4Values equal to or greater than 5.0 for men and 4.5 for women are associated with risk.6.0 = increased risk4.0 = low riskUsually, if HDL is < 35, heart attack risk is indicated
Cholesterol Value Examples
MaleTC: 210 HDL: 32Divide 210 by 32 = 6.566.56 : 1 ratioRatio is >5.0Increased risk of CAD
MaleTC: 220 HDL: 49Divide 220 by 49 = 4.494.49 : 1 ratioRatio is <5.0 Low risk of CAD
Cholesterol Value Examples
FemaleTC: 195 HDL: 36Divide 195 by 36 = 5.425.42 : 1 ratioRatio is >4.5Increased risk of CAD
FemaleTC: 195 HDL: 40Divide 195 by 40 = 4.94.9 : 1 ratioRatio is > 4.5Increased risk of CAD
Cholesterol Value Actual Example
FemaleTC 207 HDL 74207 divided by 74= 2.82.8 : 1 ratio< 4.5Very low risk CAD
How To Control Or Lower Cholesterol
Avoid saturated fats
fats from animal sourcesred meatsanimal fatsanimal by-products
Controlling Cholesterol #2
Avoid dietary cholesterolExerciseConsume a low fat diet (20% or less)Watch egg consumptionLimit 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 weekBake, broil, steamRemove excess fat (soup, chili)
Is ground turkey better?
Controlling Cholesterol #4
Avoid fatty sauces (fettuccini alfredo)Substitute in recipes
Egg whites for eggsApplesauce for oil in cakesSalsa instead of butter for baked potatoesAre 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 heartHelps 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 ratesHelps 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 diabetesNew trends:
Increased cases of Type 2 diabetes childrenIncrease in adults in the 30’s.
Diabetes Mellitus
A condition in which glucose is unable to enter the cellsA disease associated with problems in controlling blood glucose or blood sugarThe disease results when the pancreas has problems producing insulin or the body can no longer use insulin properlyInsulin is the “taxi” that carries sugar from the blood to the cells
Blood Sugar Levels
Normal blood sugar levels: 65-110Hyperglycemia
High levels of blood sugarWhen sugar levels remain high, over time, it damages the walls of the vesselsLeads to impairment of the circulatory systemAffects functioning of most organsProblems healing (small cuts, amputations)Blindness
Hypoglycemia
Low levels of blood sugarIt is appropriate to give sugar to the diabetic in a hypoglycemic emergencySome may experience hypoglycemia but are not diabetic
protein is often recommended
Types of Diabetes
Type I: insulin dependent or juvenile onsetType II: maturity or adult onset, usually non-insulin dependentGestational onset
Diabetes Mellitus: Adult Onset
The pancreas does not produce enough insulin or has just forgotten howDirectly related to obesity90% of all cases are Type II
Adult Onset #2
An 20% increase in body weight doubles the chances of developing diabetesExample:
Appropriate weight = 16020% weight gain = 192
How To Avoid Adult Onset Diabetes
Control cholesterolControl weightControl blood pressureExercise regularly (aerobic)
Diabetics must plan for meals, insulin injections, and exercise
Obesity
61% Americans are overweight25% are obese
Obesity: Fat Distribution
“Apples” Android ObesityFat distributed in upper bodyHigher risk of CAD, strokes, diabetes
“Pears” Gynoid ObesityFat is distributed in the hips and legs
Obesity Is Related To:
High cholesterolHypertension / strokeElevated LDL levelsLower HDL levelsPhysical InactivityDiabetesObesity is also related to joint problems
Other Diseases Associated With Obesity
Renal diseaseGallbladder diseasePulmonary diseaseDegenerative arthritisPsychological problemsSome cancers
Post menopausal obese women 5 times more likely to develop uterine cancer
Problems administering anesthesia
What Constitutes Obesity?
BMI > 25> 20 lbs overweightBody fat percentages
Men > 20% (25)Women > 25% (30)
Secondary Risk Factors
StressAgeGender???Family History???
Stress:
Unmanaged stress is related to CAD.Type A personality is related to CAD.
Age:
Men : 45 and overWomen: 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 55Mother or another female family member has a MI or sudden death prior to 65Family history of diabetes, hypertension
Gender
Men have a greater history of CAD earlier in life.CAD is a disease of “equal opportunity”
