Transcript Cardiovascular Disease - McGraw Hill Higher Education

Cardiovascular Disease and
Cancer
Chapter 12
1
Cardiovascular Disease (CVD)
Leading cause of death in the U.S.
 Affects more than 81 million Americans
 Claims one life every 38 seconds, nearly
2300 Americans every day
 The high rate of CVD is primarily caused
by Americans’ lifestyles

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2
The Cardiovascular System

The Heart
› Pulmonary circulation

Right side of the heart pumps blood to and from the lungs

Left side of the heart pumps blood through the rest of the
body
› Systemic circulation
› Path of blood flow:
1.
2.
3.
4.
Venae Cavae
Right Atrium
Right Ventricle
Pulmonary Artery
5.
6.
7.
8.
Pulmonary Veins
Left Atrium
Left Ventricle
Aorta
 To the lungs
• Body’s largest artery
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3
The Cardiovascular System

The Heart
› Systole
 The period of the heart’s contraction
› Diastole
 The period of the heart’s relaxation
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4
The Cardiovascular System
 The
Blood Vessels
› Veins
 Carry blood to the heart
 Thin walls
› Arteries
 Carry blood away from the heart
 Thick elastic walls which expand and relax with the
volume of blood
 Coronary arteries
 One of the system of arteries branching from the aorta
 Two large vessels that supply the heart muscle with
oxygenated blood
› Capillaries
 Tiny vessels only one cell thick
 Deliver oxygen and nutrient-rich blood to the tissues and
pick up oxygen-poor, waste-laden blood which returns
through a system of veins to the heart to repeat the
cycle
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5
Risk Factors for Cardiovascular
Disease


Two categories of increased risk of CVD
1.
2.
Major risk factors
Contributing risk factors
›
American Heart Association identified six major risk
factors for CVD that can be changed
Tobacco use
High blood pressure
High cholesterol
Physical inactivity
Obesity
Diabetes
Major risk factors that can be changed:
1.
2.
3.
4.
5.
6.
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6
Tobacco Use





1 in 5 deaths is attributable to smoking
People who smoke a pack a day have twice the risk of a
heart attack as nonsmokers
Smoking two or more packs a day triples risk
Heart attack victims who smoke are 2 to 3 more times likely to
die from the attack
Smoking…
›
›
›
›
›
›
›
›
Damages the lining of arteries
Reduces HDL (good cholesterol)
Raises triglycerides and LDL (bad cholesterol)
Nicotine increases blood pressure and heart rate
CO displaces O2
Causes platelets to become sticky, leading to clotting
Speeds the development of fatty deposits in the arteries
Doubles risk of stroke
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7
High Blood Pressure

Hypertension
› Too much pressure against arterial walls


Short periods of high blood pressure is normal
but chronic high blood pressure is a health risk
Atherosclerosis
› Causes arteries to become clogged and
narrowed


33% of Americans have high blood pressure,
22% of them aren’t aware of their condition
African Americans have the highest rate of
hypertension – 41%
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8
High Cholesterol

Cholesterol is a fatty, waxlike substance that
circulates through the bloodstream
› Important component of:
 Cell membranes
 Sex hormones
 Vitamin D
 Fluid that coats the lungs
 Protective sheaths around nerves

Excessive cholesterol clogs the arteries

Good versus bad cholesterol
› Increased risk of CVD
› Low –density lipoproteins (LDL)
 “Bad” cholesterol
 Shuttle cholesterol from the liver to the organs and
tissues
› High-density lipoproteins (HDL)
 “Good” cholesterol
 Shuttle unused cholesterol back to the liver for
recycling

Benefits of controlling cholesterol
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9
Physical Inactivity



40-60 million Americans are so sedentary that they
are at high risk for developing CVD
Physical activity is closest thing we have to a magic
bullet against heart disease
Exercise reduces risk by:





Decreasing blood pressure and resting heart rate
Increasing HDL levels
Maintaining weight
Improving the condition of blood vessels
Helping to prevent or control diabetes
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10
Obesity


Risk of death from CVD is two to three times more
likely in obese people (BMI > 30)
Strongly associated with:
›
›
›
›
›
›
›
›

Hypertension
High cholesterol levels
Insulin resistance
Diabetes
Physical inactivity
Increasing age
Ventricular hypertrophy (enlargement of the heart)
Failure of the heart muscle
Even moderate weight reduction and moderate
cardiorespiratory fitness can lower risk
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11
Diabetes



Doubles the risk of CVD for men
Triples the risk of CVD for women
Higher rates for other CVD risk factors:
Hypertension
Obesity
Unhealthy blood lipid levels
Damaged endothelial cells
More vulnerable to atherosclerosis
Increased risk of heart attack and
strokes
› Even pre-diabetes increases risks
›
›
›
›
›
›
© 2012 McGraw-Hill Higher Education. All rights reserved.
12
Contributing Risk Factors That
Can Be Changed

High Triglyceride Levels
› Reliable predictor of heart disease

Psychological and Social Factors
›
›
›
›
›
›
›

Stress
Chronic hostility and anger
Suppressing psychological distress
Depression
Anxiety
Social isolation
Low socioeconomic status
Alcohol and Drugs
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13
Major Risk Factors That Can’t
Be Changed

Heredity
› CVD has genetic component which leads to increases in
cholesterol levels, blood clotting and obesity
› Risk is modifiable by lifestyle factors

Aging
› Over the age of 65

Being male
›

Men have higher risk earlier in life
Ethnicity
› African Americans have higher risk of hypertension, heart
disease, and stroke than other groups; Hispanics have a
greater risk of HBP and angina than non-Hispanic whites;
Asians have lower rates of CVD than whites

Inflammation and C-Reactive Protein
› Caused by damaged arteries
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14
Possible Risk Factors Currently
Being Studied

Insulin resistance and metabolic syndrome
› With weight gain and lack of activity, the body becomes
less sensitive to insulin, causing insulin resistance (prediabetes)
› Metabolic syndrome (or insulin resistance syndrome) is the term
for a cluster of abnormalities
› About 34% of American adults have metabolic syndrome
› To reduce risk of metabolic syndrome, choose a healthy diet and
get plenty of exercise, amount and type of carbohydrate intake
matters

Homocysteine
› Amino acid circulating in the blood
› Appears to damage the lining of blood vessels, resulting in
inflammation and the development of fatty deposits
› Can lead to heart attacks, strokes, memory loss
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15
Major Forms of Cardiovascular
Disease
Atherosclerosis – Arteries become narrowed
by deposits of fat, cholesterol, and other
substances
› Coronary arteries become blocked with
plaque buildup: Coronary heart disease
(CHD) or Coronary artery disease (CAD)
› An artery in a limb becomes narrowed or
blocked: Peripheral arterial disease (PAD)
 Heart Attack – Coronary artery becomes
blocked
› Myocardial infarction (MI)

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16
Heart Attack Symptoms







Chest pain or pressure
Arm, neck, or jaw pain
Difficulty breathing
Excessive sweating
Nausea and vomiting
Loss of consciousness
1/3 of victims don’t feel
chest pain: especially women, ethnic
minorities, older adults, and people with
diabetes
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17
Heart Disease and Heart
Attack

Angina – Arteries are narrowed by disease
but open enough to deliver blood under
normal circumstances
› During times of stress or exertion, heart doesn’t
receive enough oxygen
› Angina pectoris (chest pain)
› Usually felt as an extreme tightness in the chest
and heavy pressure behind the breastbone or in
the shoulder, neck, arm, hand, or back

Arrhythmias and sudden cardiac death –
Electrical conduction system is disrupted
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18
Helping a Heart Attack Victim




Most people who die from a heart attack
expire within 2 hours of the onset of initial
symptoms
Victim should chew and swallow one adult
aspirin
Cardiopulmonary resuscitation (CPR)
Refer to Box “What to Do in Case of a Heart
Attack, Stroke, or Cardiac Arrest”
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19
Detecting and Treating Heart
Disease
Electrocardiogram (ECG or EKG)
 Magnetic resonance imaging (MRI)
 Positron emission tomography (PET)
 Angiogram
 Balloon angioplasty
 Coronary bypass surgery

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20
Stroke


Also called cerebro-vascular accident (CVA)
Ischemic stroke – blockage in a blood vessel
› Thrombotic stroke: clot forms in a cerebral artery that
has been narrowed or damaged by atherosclerosis
› Embolic stroke - wandering blood clot, linked to
atrial fibrillation
 Hemorrhagic stroke – blood vessel ruptures in the
brain
› Intracerebral hemorrhage
› Subarachnoid hemorrhage
› Aneurysm
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21
Figure 12.2 Types of stroke
22
The Effects of a Stroke


Interruption of the blood supply to any area of
the brain prevents the nerve cells there from
functioning – in some cases causing death
Those who survive a stroke usually have some
lasting disability
›
›
›
›
›
Paralysis
Walking disability
Speech impairment
Memory loss
Changes in behavior
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23
Detecting and Treating Stroke

Prompt recognition of symptoms
› Sudden numbness or weakness of face, arm,
leg or one side of the body
› Loss of speech or difficulty speaking
› Dizziness
› Symptoms may be brief and temporary
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24
Detecting and Treating Stroke

Transient ischemic attack (TIA)
› Temporary stroke-like symptoms





Computed tomography (CT)
MRI
Ultrasound
Clot-dissolving drugs
Rehabilitation
› Nerve cells in the brain can make new pathways
› Some functions can be taken over by other parts of the
brain
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25
Congestive Heart Failure




Heart is damaged by high blood pressure or
other disease conditions and cannot maintain
regular pumping rate and force, causing
fluids to back up into body tissue
Edema (swelling) in legs, ankles, other body parts
Pulmonary edema - Fluid accumulates in the lungs
Treatment:
›
›
›
›
Reducing cardiac workload
Modifying salt intake
Drug therapy to help the body eliminate excess fluid
Heart transplant
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26
Other Forms of Heart Disease

Congenital Heart Defects
› Malformation of the heart or major blood vessels
 36,000 children born each year in the U.S. with defects
 About 3,600 deaths a year
› Hypertrophic Cardiomyopathy (HCM)
 1 out of every 500 people
 Most common cause of sudden death in athletes younger
than 35
 Can be identified by a murmur

Rheumatic Heart Disease (RHD)
› Untreated streptococcal throat infections can cause
rheumatic fever which can permanently damage the
heart muscle and valves
› Strep throat needs to be treated, primary cause if not
treated, up to 3% of infections progress into fever

Heart Valve Disorders
› Congenital heart defects and certain types of infections
› Mitral valve prolapse (MVP) – occurs in about 3% of the
population
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27
Protecting Yourself Against
Cardiovascular Disease

Eat heart-healthy diet
› Fat and cholesterol
 Total fats should be less than 30% of total calories
 Low intake of saturated fats
 Limit dietary cholesterol to less than 300 mg per day
› Fiber
 25-38 grams of dietary fiber per day
› Sodium and potassium
 No more than 1500 mg sodium per day
 Increase potassium
› Alcohol
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28
Other Dietary Factors









Omega-3 fatty acids
Plant stanols and sterols
Folic acid
Vitamins B-6 and B-12
Calcium
Soy protein
Healthy carbohydrates
Total calories
DASH diet
› Dietary Approaches to Stop Hypertension
© 2012 McGraw-Hill Higher Education. All rights reserved.
29
Protecting Yourself Against
Cardiovascular Disease
Exercise regularly
 Avoid tobacco
 Know and manage your blood pressure

› Get it monitored at least once every 2 years

Know and manage your cholesterol
levels
› Get it checked at least once every 5 years

Develop effective ways to handle stress
and anger
30
What is Cancer?
 Cancer:
An abnormal and uncontrolled
multiplication of cells , which, if left untreated can
lead to death
 Tumor: A mass of tissue that serves no
physiological purpose
› Benign (non-cancerous) tumor: Mass of normal cells
enclosed in a membrane that prevents their penetration
of other tissues
› Malignant (cancerous) tumor: Can invade surrounding
tissues, can spread via blood and lympatic circulation
› Every case of cancer begins as a change in a cell that
allows the cell to grow and divide when it should not
31
Metastasis
The
spreading of cancer cells
Primary tumor is original location of
cancer
Metastasizing – The traveling and seeding
process of cancerous cells
New tumors are called secondary tumors
or metastases
Can invade nearby tissue or spread to
different parts of the body
32
Types of Cancer
The
behavior of tumors arising in different
body organs is characteristic of the tissue
of origin
Classified according to types of cells that
give rise to them
› Carcinomas
› Sarcomas
› Lymphomas
› Leukemias
33
The Incidence of Cancer
1.5
million Americans are diagnosed
yearly
American Cancer Society
› Estimates that the 5-year survival rate for all
cancers diagnosed between 1995 and 2005 is
68%
› Nearly 1 in 2 men and more than 1 in 3 women
will develop cancer during their lifetime
› 90% of skin cancer could have been prevented
› 87% of lung cancer could have been prevented
› Regular screening and self-examinations could
save an additional 100,000 lives per year
34
Lung Cancer
 Most common cause of cancer death in the U.S.
› 157,000 deaths per year
› Risk factors
 Tobacco contributes to 30% of all cancer deaths and 90%
of lung cancer deaths
› Detection
 Difficult to detect
 Symptoms do not usually appear until cancer has reached
the invasive stage
 Persistent cough, chest pain, or recurring bronchitis
 Diagnosis: CT scan, chest x-ray, or sputum examination
35
Lung Cancer
Treatment
› If caught early, can be treated with surgery
 Only 15% are detected prior to spreading
 Radiation and chemotherapy are used in
addition to surgery
› Detected early, 53% of patients are alive 5
years post-diagnosis
› Overall, the 5-year survival rate is only 15%
36
Colon and Rectal Cancer
 Third most common
› Risk factors
type of cancer
 Directly linked to age, genetic predisposition, lifestyle
habits, diet
 91% of cases occur after 50 years of age
 Excessive alcohol use and smoking may increase risk
 Obesity and diets rich in red and processed meats increases
risk
 Regular physical exercise and diets rich in fruits, vegetables,
and whole grains may lower risk
 Research mixed on high-fiber diets
 Oral contraceptives and hormone replacement may
increase risk in women
› Detection and treatment
 Regular screening
 Surgery is primary treatment
 Radiation and chemotherapy can be used
 Survival 91% if detected early, 65% overall
37
Breast Cancer
 Most common cancer in women
 1 in 8 American women will develop
lifetime
it during her
› About 200,000 American women are diagnosed each year
 1 in 30 women will die from the disease
› About 41,000 women die from it each year
 Risk factors
 Incidents rise quickly with age, about 50% occurring in women
ages 45-65
 Genetic predisposition/family history
 Early onset of menstruation
 Late onset of menopause
 Having first child after 30
 Having no children
 Hormone replacement therapy
 Estrogen connection
 Obesity, diet, and alcohol use
38
Detection and Treatment
› Early detection – cure most likely when cancer
is detected early
 Monthly breast self-exam for all women over 20
 Clinical breast exam by a physician every 3 years
(every year for women over 40)
 Mammography- Every 1 year for women over 40
 MRIs
› Treatment
 Ultrasonography
 Biopsy
 Lump found to be harmless growth in 90% of
cases
 Surgery: lumpectomy, mastectomy
39
Breast Cancer
› Survival rate
 98% if the cells haven’t metastasized
 90% for all stages at 5 years
› New strategies for treatment and
prevention
 SERMs (tamoxifen, raloxifene)
 Monoclonal antibodies (trastuzumab):
Antibodies designed to bind to specific
cancer-related targets
40
Prostate Cancer
 Most common cancer in men
 Second leading cause of cancer death
 Nearly 218,000 new cases per year
 More than 32,000 deaths per year
in men
 Risk factors
› Age
› Genetic predisposition/family history
› Diet
› Lifestyle
› History of STDs
› Type 2 diabetes and insulin resistance
 Detection
› Prostate-specific antigen (PSA) blood test
› Digital rectal examination
› Yearly screening beginning between ages 40-50
 Treatment
› Surgical removal of the prostate and radiation
› Implantation of radioactive seeds
› 5-year survival rate is nearly 100%
41
Cancers of the Female
Reproductive Tract
 Cervical cancer
› Most cases stem from infection by the human
papillomavirus (HPV)- transmitted by unprotected
sex
 Smoking, immunosuppression, and prolonged use of oral
contraceptives may contribute to incidence
› Cervical cancer is most common in women in their
20’s and 30’s
› Prevention
 The PAP test is a highly effective screening test for this
cancer
 All sexually active women ages 18-65 should be tested
regularly
 2 HPV vaccines approved by FDA (Gardasil, Cervarix)
42
Cancers of the Female
Reproductive Tract
 Uterine, or Endometrial, Cancer
› Normally occurs after the age 55
› Risk factors similar to breast cancer






Prolonged exposure to estrogen
Early menstruation
Late menopause
No pregnancies
Obesity
Type 2 diabetes
› Treatment is surgery
 Oftentimes by hysterectomy
 Radiation, hormones, and chemotherapy may be used
› 96% survivability after 5 years if detected early, less
than 68% if cancer has spread
43
Cancers of the Female
Reproductive Tract

Ovarian Cancer
› Causes more deaths than cervical and uterine
cancer combined, though it is rarer than both
› Difficult to detect and diagnose
 Often no warning signs
 Sometimes increased abdominal size and bloating,
urinary urgency, and pelvic pain are early clues
 Often diagnosed too late
› Risk factors similar to breast cancer
 Age, no pregnancy, family history, obesity, genetic
mutations, high number of ovulations during
lifespan
› Treatment is surgical removal of the ovaries, the
fallopian tubes, and the uterus
 Radiation and chemotherapy are sometimes used
44
Skin Cancer

Most common form of cancer
› More than 1 million cases per year
 Most are easily treated
› 68,000 are melanoma
 Most serious type of skin cancer

Risk factors
› Excessive exposure to ultraviolet rays (UVA and UVB)
› Common causes are sunburns and suntans (including those produced by
sunlamps and tanning beds), especially severe sunburns in childhood
› Risk doubles for those who’ve had 5 or more sunburns in their life
› Caucasians are 10X more likely than African Americans to develop
melanoma

Types of skin cancer

Prevention

Detection and treatment
› Basal cell carcinomas
› Squamous cell carcinomas
› Melanoma
› Avoid lifelong overexposure to sunlight
› Use sunscreens and protective clothing
› Examine your skin regularly – ABCD test
› Check moles
› Treatment usually surgical removal under local anesthetic
45
Figure 12.4 The ABCD test for melanoma
46
Other Cancers
 Head and Neck Cancers
› Cancers of the oral cavity, pharynx, larynx, and nasal
cavity
› Primarily caused by tobacco use and excessive alcohol
consumption
› Incidence 2x greater in men than in women
› Chemotherapy, radiation, and surgery
are primary methods of treatment
› Can cause disfigurement, lead to other primary
cancers of the head and neck
› 61% survival rate after 5 years
 Testicular Cancer
› Rare
› Most common in men ages 20-35
› Most common among white men and those with family
history
› Undescended testicles increase risk
› Detection: self-exam
› Treatment: surgical removal of testicle and possible
chemotherapy
47
The Causes of Cancer
 The Role of DNA
› Certain genes may predispose some people to
cancer
› Specific genetic mutations (changes in the normal
makeup of a gene) have been associated with
cancer
 Mutations can be inherited or caused by environmental
agents
 Tobacco Use
› Responsible for 30% of all cancer deaths
› Responsible for nearly 1 in 5 deaths, nearly 444,000
premature deaths each year
 Direct cause of lung, bronchial, larynx, mouth,
pharynx, esophagus, stomach, pancreas, kidney,
bladder, and cervical cancers
48
Dietary Factors
 Food
choices affect your cancer risk by exposing
you to potentially dangerous compounds and
depriving you of protective compounds
 Dietary fat and meat
› Diets high in “bad” fats and meat may contribute to
colon, stomach, and prostate cancers
› Omega-3 fats are healthier for body
 Alcohol
› Risk of oral and breast cancer
 Fried foods
› Some contain Acrylamide, a probable carcinogen
 Fruits and vegetables
› Contain anti-cancer agents such as anticarcinogens,
carotenoids, and phytochemicals
 Inactivity and obesity linked to several cancers
49
Carcinogens in the
Environment
Ingested
chemicals
› Nitrosamines: Nitrates and nitrites found in
processed meats that combine with dietary
substances and become highly potent
carcinogens
› Salt and smoke-cured foods
Environmental
and industrial pollution
Radiation
50
Detecting, Diagnosing, and
Treating Cancer
 Detecting cancer
› Self-monitoring
› Routine checkups and screenings
 Diagnosing and treating cancer
› Biopsy
› MRIs, CT scanning, and ultrasonography
› Surgery
› Chemotherapy
› Radiation
 New
and experimental techniques
51
Cardiovascular Disease and
Cancer
Chapter 12
52