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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) 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) 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. Jim Fixx 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 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 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 Smoking Benefits #2 ??? 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 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) 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 Hypertension #2 Related to stroke / aneurysms Hypertension may be the result of another health problem Factors Affecting Blood Pressure Hypertensive medications Time of day Full bladder content Body posture Recent intake of caffeine Nicotine Alcohol Recent strenuous activity 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 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 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 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 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 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 Male TC: 220 HDL: 49 Divide 220 by 49 = 4.49 4.49 : 1 ratio Ratio is <5.0 Low risk of CAD 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 Female TC: 195 HDL: 40 Divide 195 by 40 = 4.9 4.9 : 1 ratio Ratio is > 4.5 Increased risk of CAD 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 How To Control Or Lower Cholesterol Avoid saturated fats – fats from animal sources – red meats – animal fats – animal by-products Controlling Cholesterol #2 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) – Is ground turkey better? Controlling Cholesterol #4 Avoid fatty sauces (fettuccini alfredo) Substitute in recipes – – – – 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. 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 – 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 64% Americans are overweight – 25% obese 60% Arkansans at unhealthy weight – 37% obese Arkansas: 77% increase in obesity from 1991 to 2000 117 billion spent on obesityrelated illnesses Obesity #2 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 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 Renal disease Gallbladder disease Pulmonary disease Degenerative arthritis Psychological problems Some cancers – Post menopausal obese women 5 times more likely to develop uterine cancer 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. 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 – Vegetables, fruits, vitamins E, C, Bcomplex and selenium **New Information 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?? Discuss Prescription Page one