Transcript Coronary Heart Disease (CHD)

Arteriosclerosis and
Coronary Heart
Disease (CHD)
Arteriosclerosis
Disease of the arteries characterized by
thickening, loss of elasticity and calcification
of arterial walls
Resulting in decreased blood supply
particularly to the cerebrum and lower
extremities
Often develops with:
• aging
• hypertension
• diabetes
Progression of Arteriosclerosis
Coronary Heart Disease (CHD)
• Seven million Americans effected
• Caused by narrowing of the coronary arteries
• No. 1 killer of men and women in U.S.
>500,000 each year
• > 60 million Americans have some form of
coronary vascular disease (CVD) including high
BP, CAD, CHD, congestive heart failure,
myocardial infarction and others
• >2,600 Americans die each day of CVD, i.e.,
1 death/33 sec
• ~ $299 billion cost to the U.S.
Risk factors
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High blood pressure (hypertension)
High blood cholesterol
Smoking
Obesity
Physical inactivity
Controllable
Diabetes
Stress (?)
Risk Factors
(cont’d)
• Gender
• Heredity
• Age
Uncontrollable
Major Risk Factors:
The Big Three
• Hypertension
• High cholesterol
• Cigarette smoking
AND…. we should add
All three increase risk
factor eight times
LACK OF EXERCISE
Hypertension
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Commonly called high blood pressure
Systolic and diastolic measurements
Normal systolic - 110-130 mmHg
Normal diastolic - 70-90 mm Hg
Symptoms of CHD
• Chest pain (angina)
• Shortness of breath
• Heaviness, tightness, pain, burning,
pressure or squeezing
behind the breastbone or in the arms,
neck, or jaws
• Pain may vary
• Perhaps no pain
Cause & Consequencess of CHD
• Lack of oxygen due to ischemia (lack
of blood supply)
• Narrowing of coronary arteries
• Heart responds with angina
• Finally, heart attack (myocardial
infarction
local ischemia usually due to thrombus
(clot) or embolus (clot that has moved
from another site and lodged in a
smaller vessel)
• Possible permanent damage
Diagnosis of CHD
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Electrocardiogram (EKG)
Stress test
Nuclear scanning
Coronary angiography
Treatment for CHD
• Lifestyle changes
• Medication
• Surgery
Lifestyle Changes
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Change of habits
Low fat diet
Lower weight
Increase exercise
Stop smoking
Medications to Treat CHD
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Beta blockers
Nitroglycerine and other nitrates
Calcium-channel blockers
Aspirin
Cholesterol-lowering drugs
lovastatin, colestipol, cholestyramine,
etc
• Digitalis
• ACE inhibitors
• Diuretics
Surgery to Treat CHD
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Balloon angioplasty
Atherectomy
Laser angioplasty
Stent insertion
Coronary artery bypass operation
(CABG)
Gender Disparity
• Coronary Artery Disease (CAD) more
common in men
• Women have higher mortality rates
Older and sicker when first heart attack occurs
Less aggressively treated than men
Failure to recognize symptoms in timely fashion
• MI in young, healthy women is rare
Occurrence greater in those who use OC
Age 30-39: 2.7X; 40-44: 5.7X; (complilcated by
cigarette use)
Effects of Smoking
• For adult males, smoking has
declined from 53 % to 38%
• For women, remains at 30%
• Has increased for younger and
teenaged women
• Heavy smoker = 20- 30 cigs/day
Effects of Smoking (cont’d)
• Cigs contain about 2000 compounds
• Main harmful are tar, nicotine and CO
Tar contains hydrocarbons and other carcinogenic
substances
Nicotine causes release of epinephrine and
norepinephrine resulting in increased HR, BP,
cardiac output, stroke volume, contractility, oxygen
consumption, and coronary blood flow
CO reduces oxygen carrying capacity of the blood;
can precipitate angina
Effects of Smoking (cont’d)
• Contributes to development of
atherosclerosis
• Lowers levels of HDL
causes deterioration of elasticity of
vessels
Responsible for 20% of all deaths from
heart disease
• Female smokers have a higher risk
than male smokers
STRESS
• Sociocultural
Mobility
• Socioeconomic
Status
• Status Incongruity
• Education Level
• Anxiety and
Neuroses
• Life Dissatisfaction
• Life Change
• Behavior Pattern
Signs of Preclinical CVD
• Left ventricular hypertrophy (LVH)
associated with increased CAD risk
(Framingham Study)
• Definite LVH-EKG increased CAD risk
threefold
Blood and Tissue
Characteristics
• Type O = lower cholesterol
• Higher cholesterol contributes to
higher rate of CAD
• HDL:LDL (high density lipoproteins:
low density lipoproteins) ratio may
be more important than cholesterol
level
HDL
• High density lipoproteins seem to have
protective effect against development of
atherosclerosis (a form or arteriosclerosis in which
deposits of yellowish plaque containing cholesterol, lipoid
substances and lipophages are formed within large and
medium-sized arteries)
• Women have higher concentrations than men
• Most important of all lipid risk factors
• Below 35 mg/dl----- 8X incidence of CAD
compared to those with 65 mg/dl
• Moderate alcohol intake may have + effect
• Exercise has + effect
• Greater weight has a negative effect
DIET
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Reduce saturated fats
Increase polyunsaturated fats
Higher protein to fat ratio
Count calories
Effects of Exercise
Additional Information