Cardiovascular diseases

• Leading cause of death in US

accounting for nearly half of all
deaths
• The collective term for various forms
of diseases of the heart and blood
vessels
 Risk factors for cardiovascular
disease
MAJOR RISK FACTORS THAT CAN BE CHANGED
1. Tobacco Use
– about 1 in 5 deaths
– People who smoke a pack of cigarettes a day
have twice the risk of heart attack; smoking 2 or
more packs a day triples the risk
– Women who smoke heavily and use oral
contraceptives are up to 32 times more likely to
have a heart attack and 20 times to have a stroke
2. High blood pressure
3. High Levels of cholesterol
– LDL – blood fat that transports
cholesterol from the liver to organs and
tissues; excess is deposited on artery
walls, where it can eventually block the
flow of blood to the heart and brain
– HDL – blood fat that helps transport
cholesterol out of the arteries and thus
protects against heart diseases
4. Physical Inactivity
– The more physical activity you engage in,
the more cardiovascular benefit you
derive.
5. Obesity
- The risk of death from CVD is 2-3X higher
in obese people (BMI ≥30) than it is in lean
people (BMI 18.5-24.9) and for every 5
unit increment of BMI, a person’s risk of
death from Coronary heart disease
increases by 30%
- abdominal obesity
6. Diabetes
–Having diabetes doubles the risk
of CVD for men and triples the risk
for women
–People with prediabetes also face a
significant increased risk of CVD
 Contributing Risk factors that can
be changed
1. High Triglycerides Levels
2. Psychological and Social Factors
– A. stress
– B. Chronic hostility and anger
– C. Supressing Psychological distress
– D. Depression and anxiety
– E. Social Isolation
– F. low economic status
3. Alcohol and drugs
 Major risk factors that can’t be
changed
1. Heredity
2. Aging
3. Being Male
4. Ethnicity
Cardiovascular disease includes a number of
conditions affecting the structures or function of
the heart. They can include:
• Coronary artery disease (narrowing of the arteries)
• Heart attack
• Abnormal heart rhythms or arrythmias
• Heart failure
• Heart valve disease
• Congenital heart disease
• Heart muscle disease (cardiomyopathy)
• Pericardial disease
• Aorta disease and Marfan syndrome
• Vascular disease (blood vessel disease)
Coronary Artery Disease
• Coronary artery disease (CAD) is
atherosclerosis, or hardening, of the
arteries that provide vital oxygen
and nutrients to the heart. . It causes
angina (chest pain) and heart
attacks. The good news is that you
can do something about heart
disease.
• Atherosclerosis, occurs when the
normal lining of the arteries
deteriorates, the walls of arteries
thicken, and deposits of fat and
plaque build up, causing narrowing
(or even blockage) of the arteries.
• Atherosclerosis is a type of arteriosclerosis
(thickening and hardening of the arteries). As
we age, some hardening of the arteries can
occur naturally. When a person has
atherosclerosis, the inner walls of the arteries
become narrower due to a buildup of plaque.
Plaque results from deposits of
fat, cholesterol, and other substances. Blood
clots form, thus blocking the blood flow. This
can lead to heart attacks and strokes. Risk
factors for atherosclerosis include:
–High blood cholesterol
–Smoking
–High blood pressure
–Diabetes
–Obesity
–Not physically active
Angina
• Angina is a pain or discomfort in the
chest that happens when some part of
the heart does not receive enough
blood. It often feels like a pressing or
squeezing pain, generally in the chest
under the breastbone, but sometimes
in the shoulders, arms, neck, jaw, or
back. The most common trigger for
angina is physical exertion. Other
triggers include:
–Emotional stress
–Extreme cold or heat
–Alcohol
–Smoking

Angina seldom causes permanent

damage to the heart, unlike a heart
attack. A heart attack happens when the
blood flow to a part of the heart is
suddenly and permanently cut off.
Stroke
• Lack of blood flow to the brain from a blood
clot, or bleeding in the brain from a broken
blood vessel, causes a stroke. Without a good
blood supply, brain cells cannot get enough
oxygen and begin to die. You can also have
what is sometimes called a "mini-stroke,"
or transient ischemic attack (TIA), where no
damage is done to the brain. Even though
they do no damage, TIAs are serious and can
put you at greater risk of having a full stroke.
Risk factors for stroke include:
• Uncontrolled high blood pressure
• Smoking
• Diabetes
High Blood Pressure
• There are ways to measure blood
pressure and several medications to lower it if
it is too high. A blood pressure reading
measures the force of blood pumped from the
heart against the walls of your blood vessels.
It is recorded as two numbers: a top number
of systolic pressure (the pressure of blood in
the vessels as the heart beats), and a bottom
number of diastolic pressure (the pressure of
the blood between heartbeats, when the
heart rests).
Heart Attack
• Most heart attacks are the result of
coronary heart disease, a condition that
clogs coronary arteries with fatty,
calcified plaques. In the early 1980s,
researchers confirmed that the immediate
cause of nearly all heart attacks is not the
obstructive plaque itself. Instead, it's the
sudden formation of a blood clot on top
of plaque that cuts off blood flow in an
already narrowed blood vessel.
• The step-by-step process that leads to heart
attack is not fully understood. Major risk
factors, though, are well-known, and some
can be controlled. Of these, the main ones
are high blood pressure, high
cholesterol, obesity, smoking, diabetes and a
sedentary lifestyle. Stress may also raise the
risk, and exertion and excitement can act as
triggers for an attack. Another important risk
factor is family history. A family history of
heart disease can increase the risk in both
men and women at earlier ages.
• Men over the age of 50 with a family
history of heart disease are predisposed
to heart attack. High levels
of estrogen are thought to protect
premenopausal women fairly well, but
the risk of heart attack increases
significantly after menopause.
Heart Attack Treatment
• A heart attack is a medical emergency. It
must be quickly addressed by
conventional medicine. At this
point, alternative medicine cannot
compete with standard drug therapy and
surgical treatments. Alternative medicine
may at other times, though, make
valuable contributions to heart attack
prevention and recovery.
Conventional Response to a Heart Attack
• Heart attack victims are usually
hospitalized in special coronary care units
(CCU) for at least 36 hours. Standard drug
therapy includes:
• A painkiller such as morphine
• Vasodilators such as nitroglycerine to
expand blood vessels
• Beta-adrenergic blocker drugs to calm
the heart
• Aspirin to reduce clotting activity
Heart Attack Diagnosis
• A cardiologist, or heart specialist, relies on
various tests to diagnose a heart attack. These
tests can also identify sites of blockage as well as
tissue damage.
• Monitoring the heart's electrical activity
together with blood tests provides data for an
initial assessment of the patient's condition.
Images of the heart and coronary arteries done
with angiograms and radioisotope scans locate
specific areas of damage and blockage.
Ultrasound tests called echocardiograms
evaluate the heart's function. With such data, the
doctor can decide on proper treatment as well as
anticipate potential complications.
Abnormal Heart Rhythms
• The heart is an amazing organ. It beats in a
steady, even rhythm, about 60 to 100 times
each minute (that's about 100,000 times each
day!). But, sometimes your heart gets out of
rhythm. An irregular or abnormal heartbeat is
called an arrhythmia. An arrhythmia (also
called a dysrhythmia) can involve a change in
the rhythm, producing an uneven heartbeat,
or a change in the rate, causing a very slow or
very fast heartbeat.
Heart Failure
• The term "heart failure" can be frightening. It
means the heart does not pump as well as it
should. This then leads to salt and water
retention, causing swelling and shortness of
breath. The swelling and shortness of breath
are the primary symptoms of heart failure.
• Heart failure is a major health problem in the
U.S., affecting nearly 5 million Americans.
About 550,000 people are diagnosed with
heart failure each year. It is the leading cause
of hospitalization in people older than 65.
• Congestive heart failure is a term often
used to describe heart failure.
Congestion, or the buildup of fluid, is
only one symptom of heart failure and
does not occur in all people who have
heart failure. There are two main
categories of heart failure: systolic and
diastolic. Within each category of heart
failure, the symptoms vary from person
to person.
HEART VALVE PROBLEMS
• Your heart valves lie at the exit of each of
your four heart chambers and maintain
one-way blood-flow through your heart.
• Examples of heart valve problems include
mitral valve prolapse, aortic stenosis,
and mitral valve insufficiency.
 Mitral valve prolapse
• One or both valve leaflets protrude into
the left atrium. MVP syndrome is the
term used when the anatomic prolapse is
accompanied by signs and symptoms
unrelated to the valvular abnormality
 Aortic insufficiency
• Blood flows back into the left ventricle
during diastole, causing fluid overload in
the ventricle , which dilates and
hypertrophies. The excess volume causes
fluid overload in the left atrium and
finally , the pulmonary system. Left
ventricular failure and pulmonary
edema eventually results.
 Mitral stenosis
• Narrowing of the valve by valvular
abnormalities, fibrosis or calcification
obstructs blood flow from the left
atrium to the left ventricle.
Consequently , left atrial volume and
pressure rise and the chambers dilate
• Results from rheumatic fever
• Most common in females
 Aortic stenosis
• Increased left ventricular pressure tries
to overcome the resistance of the
narrowed valvular opening . The added
workload increases the demand for
oxygen, and diminished cardiac output
causes poor coronary artery perfusion,
ischemia of the left ventricle and the left
ventricular failure.
 Pulmonary insufficiency
• Blood ejected into the pulmonary artery
during systole flows back into the right
ventricle during diastole, causing fluid
overload in the ventricle, ventricular
hypertrophy and finally ventricular
failure
 Pulmonic stenosis
• Obstructed right ventricular outflow
causes right ventricular hypertrophy,
eventually resulting in right ventricular
failure
 Tricuspid Insufficiency
• Blood flows back into the right atrium
during systole, decreasing blood flow to
the lungs and left side of the heart.
• Cardiac output also lessens
• Fluid overload in the right side of the
heart eventually lead to right ventricular
failure
 Tricuspid stenosis
• Obstructed blood flow from the right
atrium to the right ventricle causes the
right atrium to dilate and hypertrophy
• This leads to right ventricular failure and
increases pressure in the vena cava
 Cardiomyopathy, Dilated
• Resulting from extensive damage myocardial
muscle fibers, it interferes with myocardial
metabolism and grossly dilates all chambers of
the heart
• This gives the heart a globular appearance
• Leads to intractable heart failure,
arrhythmias and emboli
• Can be due to viruses, endocrine and
electrolyte disorders and nutritional
deficiencies
 Cardiomyopathy, hypertrophic
• Characterized by disproportionate,
assymmetric thickening of the
interventricular septum in relation to the free
wall of the left ventricle.
• Cardiac output may be low, normal or high
depending on whether stenosis is obstructive
or nonobstructive
• May be inherited or idiopathic
 Cardiomyopathy, restrictive
• Characterized by restrictive ventricular
filling and endocardial fibrosis and
thickening.
• If severe, it’s irreversible
• Unknown cause
 Pericarditis
• Inflammation of the pericardium, the
fibroserous sac that envelops, supports
and protects the heart.
• Can be acute or chronic
• Common causes are:
–Bacterial, fungal, viral or parasitic
infection
–Neoplasms
–High dose radiation to the chest
–Uremia
–Hypersensitivity or autoimmune
disease such as rheumatic fever, LE
and rheumatoid arthritis
–Postcardiac injury such as MI, trauma
or surgery
–Drugs such as hydralazine or
procainamide
–Idiopathic factors
 Marfan syndrome
• Rare inherited, degenerative
generalized disease of the
connective tissue that causes
ocular, skeletal and cardiovascular
anomalies
 Vasculitis
• A broad spectrum of disorders, vasculitis is
characterized by inflammation and necrosis
of blood vessels
• The clinical effects depend on the vessels
involved and reflect tissue ischemia caused by
blood flow obstruction
• Can occur at any age
• Maybe a primary disorder or secondary to
other disorders such as LE and rheumatoid
arthritis
 Congenital heart disease
• Hypertrophic cardiomyopathy (HCM)
–Inherited condition that causes the
heart muscle to become hypertrophic,
primarily in the septum, which is the
area between the two ventricles
–With high risk of sudden death
–Should not be engaged in competitive
sports
 Other forms of heart disease
• Rheumatic Heart Disease
–Rheumatic fever due to untreated
streptococcal throat infection,
damaging the heart muscles and heart
valves ( rheumatic heart disease )
 You can do a lot to lower your odds of
getting heart disease. Taking action will
improve your health -- and, possibly, save
your life. Get going on these 8 ways to get
on track.
• 1. Quit smoking. If you smoke, you are more
than twice as likely to have a heart attack as
nonsmokers, and you’re much more likely to
die if you do have a heart attack.
• 2. Improve cholesterol levels. You're more
likely to get heart disease if you have:
–Total cholesterol level over 200
–HDL ("good") cholesterol level under
40
–LDL ("bad") cholesterol level over 160
–Cholesterol isn't the only thing that
matters. Your doctor will consider the
big picture, including all your potential
risks. To help lower cholesterol levels,
eat a diet low in cholesterol and
saturated fat.
• 3. Control high blood pressure. More than 50
million people in the U.S. have hypertension,
or high blood pressure, making it the most
common heart disease risk factor. Exercise
and healthy eating help. Some people may
need medicine to control their blood pressure,
too.
• 4. Get active. People who don't exercise are
more likely to get heart disease, and die from
it, than people who are active. Check with
your doctor before starting a
new exercise program, especially if you aren't
active now. She can tell you what you can do.
• 5. Follow a heart-healthy diet. Eat foods that
are low in fat and cholesterol. Just about
everyone should eat more fruits, vegetables,
whole grains, beans, nuts, legumes, and other
plant-based foods. The fiber is good for
your cholesterol, and you'll get vitamins the
natural way, from foods.
• You can still eat fish (especially salmon or
tuna, which are high in good-for-you omega-3
fatty acids), poultry, and meat, but make it
lean and keep the portions modest. Also limit
salt and sugar. Most people get too much of
both.
• 6. Get to a healthy weight. Losing
extra weight is good for your heart. It can
also help you lower high blood pressure
and manage diabetes.
• 7. Control diabetes. Diabetes makes
heart disease more likely. Many people
who have diabetes don't know it. Get
tested and get treated.
• 8. Manage stress and anger. Everyone
has stress, and it's normal to get angry
now and then. When stress and anger
flare up, especially if it happens a lot,
that's a problem. Managing your stress
and handling your anger in healthy ways
puts you back in charge.
• Although the average blood pressure
reading for adults is 120/80, a slightly
higher or lower reading (for either
number) may not be a problem. High
blood pressure is diagnosed when the
reading consistently exceeds 140/90.
High blood pressure is often called a
"silent" killer because it usually has no
signs or symptoms. High blood pressure
can cause heart failure and can also lead
to:
–Stroke
–Kidney failure
–Other health problems

Talk to your healthcare provider and get

your blood pressure monitored regularly.
If you have high blood pressure, diet,
exercise, and medicine can help you in
lowering it.
• Systolic heart failure happens when the heart's
ability to pump blood decreases. The heart
cannot push enough blood into the circulatory
system, which causes the blood coming into the
heart from the lungs to back up and leak fluid
into the lungs (called pulmonary congestion).
Diastolic heart failure occurs when the heart has
trouble relaxing or resting. The heart muscle
becomes stiff and cannot fill with blood, causing
lung congestion and other areas of fluid buildup
(most often in the feet, ankles, and legs). Talk
with your healthcare provider right away if you
have any of the signs of heart failure. There are
drugs that can treat heart failure. Having a
healthy diet and getting regular exercise can
lower your risk for heart failure.