Transcript Understanding the Cardiovascular System - A

Understanding the
Cardiovascular System
Chapter 4
Refers to Heart – Lung
Functioning
Sub-Components of the
Cardio-respiratory System
 Heart
 Blood
 Blood
 Lungs
Vessels
Function of Cardio-Respiratory
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 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
 Explanation
of basic blood flow
Cardiovascular Disease

60-70 million Americans have one or
more forms of CVD
Cardiovascular Disease
1
million deaths each year
 330 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
(Often preventable and lifestyle related)
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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 (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
Arteries
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
Cardiovascular Procedures
Angioplasty
 Roto-Blade
 Stints
 Keyhole Surgery
 Radiation
 Bypass Surgery (7 yr.average)
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CAD Post-Op Patient
What
behavioral and
dietary changes are
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.
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Jim Fixx
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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
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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
(hyperlipidemia)
 Physical inactivity
 Diabetes mellitus
 Obesity

– (drug use)
Secondary Risk Factors
 Stress
 Age
 Gender
(male vs. female)
 Family history
Are Arkansans at Risk
for
these Health
?
Problems?
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
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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 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
 Overheads
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
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Smoking Benefits #2 ???
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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
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Stop smoking
– Heart disease risk drops in a matter of
months
– Cancer risk drops slowly and may take
10 years
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.
Blood 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
 The
120/80
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)
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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
 Causes the heart muscle to overwork
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Hypertension #2
Related to stroke / aneurysms
 Hypertension may be the result of
another health problem
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Factors Affecting Blood Pressure
Hypertensive medications
 Time of day
 Full bladder content
 Body posture
 Recent intake of caffeine
 Nicotine
 Alcohol
 Recent strenuous activity
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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
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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 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 Having
High Cholesterol 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 Plaque
– Affects all of us
– May begin as early as 10 years of
age
– May be genetic
– Medications??
Types of Lipoproteins /
Types of Cholesterol
 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
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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
Cholesterol Information
 Dietary
Cholesterol
– Refers to foods high in
cholesterol
– Example:
»Shrimp
 High
in cholesterol
 Low in fat
Cholesterol Information
 Saturated
fats
– Can significantly raise LDL
levels (“bad” cholesterol) and total
serum cholesterol levels
– Found in animal sources and by
products
Cholesterol Information
 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
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Ingestion of dietary cholesterol
Serum Cholesterol Levels
–Desirable
below 200
–Borderline high 200-239
–Risk for CVD
240 or >
– Some guidelines call for desirable to be 170
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
always adequate when
determining coronary risk
Understanding Cholesterol
Ratios
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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
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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 Examples
Male
 TC: 210
HDL: 32
 Divide 210 by 32 =
6.56
 6.56 : 1 ratio
 Ratio is >5.0
 Increased risk of
CAD
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Male
 TC: 220
HDL: 49
 Divide 220 by 49 =
4.49
 4.49 : 1 ratio
 Ratio is <5.0
 Low risk of CAD
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Cholesterol Value Examples
Female
 TC: 195 HDL: 36
 Divide 195 by 36
= 5.42
 5.42 : 1 ratio
 Ratio is >4.5
 Increased risk of
CAD
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Female
 TC: 195 HDL: 40
 Divide 195 by 40
= 4.9
 4.9 : 1 ratio
 Ratio is > 4.5
 Increased risk of
CAD
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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
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How To Control Or Lower
Cholesterol
 Avoid
saturated fats
– fats from animal sources
– red meats
– animal fats
– animal by-products
Controlling Cholesterol #2
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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)
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– Is ground turkey
better?
Controlling Cholesterol #4
Avoid fatty sauces (fettuccini alfredo)
 Substitute in recipes
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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 Your
Kitchen Disposal
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.
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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
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– 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
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64% Americans are
overweight
– 25% obese
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60% Arkansans at unhealthy
weight
– 37% obese
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Arkansas: 77% increase in
obesity from 1991 to 2000
117 billion spent on obesityrelated illnesses
Obesity #2
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38% Arkansas school children overweight
Young adult obesity can shorten life span by
5 to 20 years
Obesity Is Related To:
High cholesterol
 Hypertension / stroke
 Elevated LDL levels
 Lower HDL levels
 Physical Inactivity
 Diabetes
 Obesity is also related to joint problems
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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
Other Diseases Associated With
Obesity
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Renal disease
Gallbladder disease
Pulmonary disease
Degenerative arthritis
Psychological problems
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Some cancers
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– Post menopausal obese women 5 times more
likely to develop uterine cancer
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Problems administering anesthesia
What Constitutes Obesity?
 BMI
> 25
 > 20 lbs overweight
 Body fat percentages
–Men > 20% (25)
–Women > 25% (30)
Secondary Risk Factors
(Not alterable)
 Stress
(secondary but is
alterable to some degree)
 Age
 Gender
 Family History
Stress:
Unmanaged stress is related to CAD.
 Type A personality is related to CAD.
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Age:
 Men
: 45 and over
 Women: 55 and over
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”
**New Information:
Homocysteine Levels
An amino acid (level becomes too high)
 Causes heart disease (sudden blockage)
 Birth defects
 Testing is involved and expensive
 Consume folic acid
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– Vegetables, fruits, vitamins E, C, Bcomplex and selenium
**New Information
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High triglyceride levels are associated
with increase in CAD (fall 2000)
**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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Discuss Prescription
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