Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Electrocardiography wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Baker Heart and Diabetes Institute wikipedia , lookup
Heart failure wikipedia , lookup
Artificial heart valve wikipedia , lookup
Mitral insufficiency wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Rheumatic fever wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Antihypertensive drug wikipedia , lookup
Heart arrhythmia wikipedia , lookup
Cardiovascular Disease: an Overview Jon W. Wahrenberger, MD February 7, 2009 The Good News We are living longer! Heart & stroke death rates are falling! So Why Worry about Cardiovascular Disease? • Cardiovascular disease is the number one killer • About 42% of all deaths • Nationwide: 921,819 annually • NH: 3468 • VT: 1751 Septicemia, 1.34 Kidney, 1.63 Alzheimers, 2.22 Influenza, 2.57 Diabetes, 2.95 Injuries, 4.2 Respiratory, 5.09 • Cardiovascular disease continues to strike young and middle-aged individuals • We are losing ground on several important risk factors Cancer, 22.91 Cardiovascular, 35.74 Changing demographics Obesity in the USA Obesity in Children Prevalence of Diabetes 1980-2004 Source: Wonder.cdc.gov Adult Smoking Smoking in Youth 27.6 Smoking in Last 30 Day (%) 30 24.3 25 19.7 21.4 20 15 10 5 0 9th 10th 11th 12th Grade Level 2005 Youth Risk Behavior Survey (YRBS) Women are not immune to heart disease! Death Rate Per 100,000 Population 400 350 300 Men Women 250 200 150 100 50 0 CVD Resp. Cancer Colon Cancer Breast Cancer Potential for Falling Longevity? Life Extending Technology Public Health Measures Health adverse behavior Evolution of Cardiovascular Disease Technology Influences Normal Child Mass Marketing of Junk Food Overweight Inactive Child Chain of Survival Tobacco Surgical Procedures Overweight Inactive Adult Suffering, Loss of QOL Sick Adult Drugs Food Overabundance Cultural Changes Knowledge Deficits Devices We must tackle heart disease at all points! Premature Death What is Cardiovascular Disease? “Cardiovascular disease” refers to diseases involving the heart and blood vessels Peripheral Heart Brain Vasculature Angina Heart Attack Heart Failure Arrhythmias Stroke TIA Claudication Ulceration Amputation The heart, brain and extremities share a disease process Cerebral Disease Coronary Disease 25% 7% 30% 3% 4% 12% 19% Peripheral Vascular Disease The Common Thread? • Circulatory system (arteries, veins, etc.) • Susceptibility to atherosclerosis Atherosclerosis AKA “Arteriosclerosis”, “hardening of the arteries” • Complex, selfsustaining inflammatory process • Thickens arterial wall • Occurs slowly over decades Atherosclerosis Progression Ischemic Heart Disease Cerebrovascular Disease Peripheral Vascular Disease No Symptoms Mild Symptoms Severe Symptoms Time (years to decades) What causes atherosclerosis? • • • • • • • • Smoking High Blood Pressure High Cholesterol Diabetes Hereditary Factors Sedentary Lifestyle Obesity Other Factors The Big 5 Diseased Coronary Artery Peripheral Vascular Disease Stroke – “Brain Attack” Symptoms of Cardiovascular Disease Heart Disease •Chest Discomfort •Shortness of breath •Fatigue •Palpitations Stroke or TIA •Sudden numbness or weakness. •Sudden confusion, trouble speaking or understanding •Sudden visual loss •Sudden trouble walking, instability •Sudden severe headache with no known cause Peripheral Vascular •Pain in calves, thighs or buttocks •Non-healing ulcers Suspected Stroke or Heart Attack? Call 911 Time = saved heart muscle Time = saved brain function Other Causes of Heart Disease •Heart failure •Heart rhythm disturbances (arrhythmias) •Congenital heart disease •Heart Valve Disease •Heart infections Heart Failure Heart Failure Virus Toxins Hypertension Post Partum Ischemia Valve Disease Heart Muscle Injury Heart Failure Heart Failure: Symptoms • Shortness of breath • Fatigue • Edema (swelling) Heart Failure: Treatment • Salt and fluid restriction • Medications • • • • ACE Inhibitors Beta blockers Angiotensin receptor blockers Digoxin • Devices (Resynchronization therapy) Arrhythmias Heart Electrical System A wave of electrical discharge proceeds mechanical contraction of the heart. Arrhythmia Consequences and treatment Examples Consequences Treatment Rapid heart beating •Supraventricular tachycardia (SVT) •Ventricular tachycardia •Atrial fibrillation •Awareness •Drugs to (Palpitations) slow heart; •Reduced blood •ablation delivery (lightheadedness; loss of consciousness) •Possible stroke risk (AF) Slow heart beating •Sinus bradycardia •Heart block Reduced blood delivery (fatigue; lightheadedness; loss of consciousness) Removal of offending drugs; possible pacemaker Arrhythmia Symptoms • Palpitations (a feeling of thumping, fluttering, skipping or racing of the heart) • Lightheadedness/loss of consciousness • Chest pain or tightness • Shortness of breath • Fatigue • Anxiety Heart Valve Disease Valve Disease Valves are intended to allow blood flow in only one direction from one heart chamber to another Pulmonic Valve Aortic Valve • Normal Function: • Allow blood to flow freely one direction and none backwards • Dysfunction: Mitral Valve Tricuspid Valve • Become narrow and impede forward flow (stenosis) • Become incompetent and allow backward flow (regurgitation) Valve Disease Congenital Abnormality Infection Age Related Degeneration Rheumatic Fever Valve Dysfunction • Shortness of breath • Fatigue • Chest Pain • Susceptibility to infection • Death Treatment of Valve Disease • Medications • Surgery • Percutaneous repair Open Heart Surgery Percutaneous Valvuloplasty Mitral Valvuloplasty Aortic Valvuloplasty Percutaneous Aortic Valve Replacement Percutaneous Aortic Valve Replacement What can you do to stay healthy? Know your Enemies! • • • • • • Inactivity Obesity Smoking Elevated cholesterol Diabetes Hypertension Exercise Recommendation Age 18-65 Age > 65 • Moderate aerobic activity for 30 min 5 x per week, or • Vigorous aerobic activity 20 minutes 3x per week • Can reach moderate activity goal with multiple 10 min periods • Same aerobic recommendations • Intensity based on fitness level • Additional: • Muscle strengthening • Flexibility exercises • Balance exercise Source: ACSM/AHA Recommendations, 2007 Body Mass Index (BMI) BMI = Weight (Kg) Height2 (M2) Below 18.5 = Underweight 18.5-24.9 = Normal 25-29.9 = Overweight 30 and above = Obese (Full table provided with registration materials) Calculate Your Risk Framingham Risk Calculator Men Women Make the right choices • • • • • • • Use the stairs; take a daily walk! Stay away from all fast food restaurants! Eat smaller portions Read food labels Choose foods made from whole grains Minimize saturated fats and trans fats Stay away from restaurants that allow smoking Some Unlikely Friends? Dark Chocolate • Raises HDL • Improves insulin sensitivity • Lowers blood pressure • Improves blood vessel reactivity Rx: Recommended Dose – 100 gm per day Dark Chocolate ≠ Milk Chocolate Alcohol • Elevation of HDL • Antithrombotic effects • Promote formation of nitric oxide (NO) • Reduced coronary heart disease Rx: Recommended Dose – 1-2 drinks per day Olive Oil • Increase in HDL • Reductions • Total Cholesterol • Total to HDL Ratio • Triglycerides • Reduction in oxidative stress markers Green Tea • Decrease in total and cardiovascular mortality • Decrease in myocardial infarction • Decrease in stroke • Reduced mortality after MI • Increases coronary flow reserve • Improved endothelial function Nuts • Nutritionally dense • Associated with reduction in: • Heart disease • Certain cancers • Inflammation • Allergic issues? What’s New? • A new category of drugs - CETP inhibitors (anacetrapib) - has been shown to dramatically increase the levels of protective HDL cholesterol • FDA advisory panel just voted unanimously in favor of approving prasugrel, a new platelet inhibiting drug • The JUPITOR Trial has shown a mortality benefit from Crestor in healthy people with normal lipids but elevated CRP Where are we heading?