An Invitation to HealthAn Invitation to HealthChapter 14Chapter 14

Keeping Your Heart HealthyKeeping Your Heart Healthy

Dr. Lana Zinger

©2004 Wadsworth Publishing Co.

The Healthy HeartThe Healthy Heart

The Healthy HeartThe Healthy Heart

Chambers of the HeartChambers of the Heart

Right AtriumRight AtriumReceives blood

through the superior and

inferior vena cava.

Left VentricleLeft VentriclePumps blood rich in

oxygen through the aorta to the arteries to nourish

the body systems.

Left AtriumLeft AtriumReceives oxygenated blood from the lungs.

Right VentricleRight VentriclePumps blood in need of

oxygen to the lungs.

The Path Of Blood FlowThe Path Of Blood Flow

Death Rates for Cardiovascular Death Rates for Cardiovascular Disease in the United States, 1940 Disease in the United States, 1940

& 2000& 2000

Heart Healthy Benefits of Regular Heart Healthy Benefits of Regular Physical ActivityPhysical Activity

Reduction in body weight.Reduction in body weight.Reduction in blood pressure.Reduction in blood pressure.

Reduction of LDL and total cholesterol.Reduction of LDL and total cholesterol.Increase in HDL cholesterol.Increase in HDL cholesterol.Increased insulin sensitivity.Increased insulin sensitivity.

American Heart Association, AmericanAmerican Heart Association, AmericanCollege of Sports Medicine and the CDCCollege of Sports Medicine and the CDC

30 minutes or more of moderate-30 minutes or more of moderate-intensity physical activity on most, if intensity physical activity on most, if

not all, days of the week.not all, days of the week.Institute of MedicineInstitute of Medicine

60 minutes of daily physical activity to 60 minutes of daily physical activity to counter the obesity epidemic.counter the obesity epidemic.

Heart Healthy NutritionHeart Healthy Nutrition

Plenty of fruits and vegetables.Plenty of fruits and vegetables. Cholesterol Lowering FoodsCholesterol Lowering Foods::

Oats, barley, soy protein, and nuts.Oats, barley, soy protein, and nuts. Fish 2 times a week (AHA).Fish 2 times a week (AHA). Insufficient Evidence to Insufficient Evidence to

Recommend For or Against the Use Recommend For or Against the Use ofof:: Supplements of vitamin A, C, or E.Supplements of vitamin A, C, or E. Multivitamins with folic acid.Multivitamins with folic acid. Antioxidant combinations.Antioxidant combinations.

The Lifestyle SyndromeThe Lifestyle Syndrome DefinitionDefinition: A cluster of conditions and : A cluster of conditions and

diseases that result from:diseases that result from: Consuming too many calories.Consuming too many calories. Ingesting too much saturated fat, sodium, Ingesting too much saturated fat, sodium,

and alcohol.and alcohol. Not burning up enough calories.Not burning up enough calories. Smoking or being exposed to tobacco smoke.Smoking or being exposed to tobacco smoke.

ConsequencesConsequences:: Hypertension, metabolic syndrome, obesity, Hypertension, metabolic syndrome, obesity,

high cholesterol, cardiovascular disease, high cholesterol, cardiovascular disease, cancer, osteoarthritis, depression, sexual cancer, osteoarthritis, depression, sexual dysfunction, and diabetes mellitus.dysfunction, and diabetes mellitus.

Risk Factors for Risk Factors for Cardiovascular DiseaseCardiovascular Disease

Factors You Can Factors You Can ControlControl

Physical InactivityPhysical Inactivity TobaccoTobacco ObesityObesity Blood FatsBlood Fats Metabolic Metabolic

SyndromeSyndrome Diabetes MellitusDiabetes Mellitus

Factors You Can’t Factors You Can’t ControlControl

HeredityHeredity Race and Race and

EthnicityEthnicity AgeAge GenderGender Bacterial Bacterial

InfectionInfection

Tobacco and Heart Tobacco and Heart DiseaseDisease

Smoking is the single most significant risk Smoking is the single most significant risk factor for CV disease and peripheral vascular factor for CV disease and peripheral vascular disease.disease.

Each year smoking causes 250,000+ deaths Each year smoking causes 250,000+ deaths from cardiovascular disease.from cardiovascular disease.

Active vs. passive smoking.Active vs. passive smoking. How Smoking Damages The HeartHow Smoking Damages The Heart::

Nicotine overstimulates the heart.Nicotine overstimulates the heart. Carbon monoxide reduce the oxygen supply to the Carbon monoxide reduce the oxygen supply to the

heart.heart. Tars and other smoke residues increase the risk of Tars and other smoke residues increase the risk of

cholesterol build-up in the arteries.cholesterol build-up in the arteries. Smoking increases blood clotting.Smoking increases blood clotting. Smoking causes irreversible damage to the Smoking causes irreversible damage to the

arteries.arteries.

Measurement of Blood Measurement of Blood PressurePressure

Blood PressureBlood Pressure

Systolic BloodSystolic Blood Pressure Pressure

Pressure exerted by bloodPressure exerted by bloodagainst walls of the arteriesagainst walls of the arteriesduring forceful contraction during forceful contraction

of the heart.of the heart.

Diastolic Blood PressureDiastolic Blood PressurePressure exerted by blood Pressure exerted by blood

against the walls of the against the walls of the arteries duringarteries during

relaxation of the heart.relaxation of the heart.

DefinitionDefinition:: A measure of the force exerted against the walls of

the vessels by the blood flowing through them.

Sphygmomanometer &Stethoscope

What Is a Healthy Blood What Is a Healthy Blood Pressure?Pressure?

120-139/80-90 mm Hg120-139/80-90 mm Hg

140-159/90-99 mm Hg140-159/90-99 mm HgHYPERTENSION

PREHYPERTENSIONPREHYPERTENSION

115/75 mm Hg115/75 mm HgHEALTHY READINGHEALTHY READING

160+/100+ mm Hg160+/100+ mm Hg

Consequences of High Blood Consequences of High Blood PressurePressure

Understanding Blood Understanding Blood LipidsLipids

Low Density Low Density LipoproteinLipoprotein

(LDL)(LDL)

Low Density Low Density LipoproteinLipoprotein

(LDL)(LDL)

Fatty substances produced by the liver that carry Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol.cholesterol to arterial walls; “bad” cholesterol. Fatty substances produced by the liver that carry Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol.cholesterol to arterial walls; “bad” cholesterol.

High Density High Density Lipoprotein Lipoprotein

(HDL)(HDL)

High Density High Density Lipoprotein Lipoprotein

(HDL)(HDL)

Very Low Density Very Low Density LipoproteinLipoprotein

(VLDL)(VLDL)

Very Low Density Very Low Density LipoproteinLipoprotein

(VLDL)(VLDL)

Fatty substance that picks up cholesterol in the blood-Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol.stream and returns it to the liver; “good” cholesterol. Fatty substance that picks up cholesterol in the blood-Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol.stream and returns it to the liver; “good” cholesterol.

The largest of the lipoproteins which allow The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream.cholesterol to circulate in the bloodstream. The largest of the lipoproteins which allow The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream.cholesterol to circulate in the bloodstream.

TriglyceridesTriglyceridesTriglyceridesTriglycerides Fats that flow through the blood after meals and Fats that flow through the blood after meals and have been linked to increased risk of coronary have been linked to increased risk of coronary artery disease.artery disease.

Fats that flow through the blood after meals and Fats that flow through the blood after meals and have been linked to increased risk of coronary have been linked to increased risk of coronary artery disease.artery disease.

Metabolic SyndromeMetabolic SyndromeSyndrome X or Insulin-Resistant Syndrome X or Insulin-Resistant

SyndromeSyndrome DefinitionDefinition: A cluster of medical : A cluster of medical

abnormalities that increases the risk of heart abnormalities that increases the risk of heart disease and diabetes.disease and diabetes.

Probable CausesProbable Causes: Genetics, lack of exercise, : Genetics, lack of exercise, and overeating.and overeating.

Diagnostic CriteriaDiagnostic Criteria:: Waist CircumferenceWaist Circumference: Men : Men >> 40 inches; Women 40 inches; Women

>>35 inches.35 inches. TriglyceridesTriglycerides: : >>150 mg/dL.150 mg/dL. High-Density LipoproteinsHigh-Density Lipoproteins: Men <40 mg/dl; : Men <40 mg/dl;

Women <50 mg/dl.Women <50 mg/dl. Blood PressureBlood Pressure:130 mm Hg (systole)/85 mm Hg :130 mm Hg (systole)/85 mm Hg

(diastole).(diastole). Fasting Blood SugarFasting Blood Sugar: : >>110 mg/dl.110 mg/dl.

Preventing HypertensionPreventing Hypertension Lifestyle ChangesLifestyle Changes

Losing weight.Losing weight. Regular exercise.Regular exercise. Dietary Approaches To Stop Dietary Approaches To Stop

Hypertension (DASH Diet).Hypertension (DASH Diet). Restriction of daily sodium intake.Restriction of daily sodium intake.

Serum Cholesterol Serum Cholesterol GuidelinesGuidelines

AmountAmount RatingRating

Total Total CholesterolCholesterol

<200 mg/dl<200 mg/dl

200-239 mg/dl200-239 mg/dl

>>240 mg/dl240 mg/dl

DesirableDesirable

Borderline HighBorderline High

High RiskHigh Risk

LDL LDL CholesterolCholesterol

Less than 100 Less than 100 mg/dlmg/dl

100-129 mg/dl100-129 mg/dl

130-159 mg/dl130-159 mg/dl

160-189 mg/dl160-189 mg/dl

190+ mg/dl190+ mg/dl

OptimalOptimal

Near OptimalNear Optimal

Borderline HighBorderline High

HighHigh

Very HighVery High

HDL HDL cholesterolcholesterol

>>45 mg/dl45 mg/dl

36-44 mg/dl36-44 mg/dl

<<35 mg/dl35 mg/dl

DesirableDesirable

Borderline HighBorderline High

High RiskHigh Risk

Lowering CholesterolLowering Cholesterol

Therapeutic LifeTherapeutic Life

Changes (TLC)Changes (TLC) Dietary changes Weight

management Physical activity

MedicationsMedications

Statins Bile Acid

Sequestrants Nicotinic acid

(niacin) Fibrates

Novel Risk Factors for Heart Novel Risk Factors for Heart DiseaseDisease

C-Reactive Protein (CRP)C-Reactive Protein (CRP)

Lipoprotein (a)Lipoprotein (a)FibrinogenFibrinogen

HomocysteineHomocysteine Lipoprotein ParticleLipoprotein ParticleSize and DensitySize and Density

Development of AtherosclerosisDevelopment of Atherosclerosis

Fatty Streaks Develop on the Arterial Walls at Injury SpotsFatty Streaks Develop on the Arterial Walls at Injury Spots

Growth and Hardening of Fatty StreaksGrowth and Hardening of Fatty Streaks

Plaque Formation (well developed by age 30)Plaque Formation (well developed by age 30)

Narrowing and Loss of Elasticity of the Arteries Narrowing and Loss of Elasticity of the Arteries

Restriction of Blood Flow to the Heart or BrainRestriction of Blood Flow to the Heart or BrainLimited Oxygen Delivery to the Heart or BrainLimited Oxygen Delivery to the Heart or Brain

Blood Pressure Elevation Blood Pressure Elevation Blood Clot Formation and ThrombosisBlood Clot Formation and Thrombosis

Angina, Heart Attack and/or StrokeAngina, Heart Attack and/or Stroke

The The AtherosclerotAtherosclerot

ic ic ProcessProcess

Unclogging The ArteriesUnclogging The Arteries Cholesterol-lowering Cholesterol-lowering

drugsdrugs Low-fat dietLow-fat diet Dean Ornish Diet Dean Ornish Diet

(without medications)(without medications) Very low-fat diet (8% of Very low-fat diet (8% of

total daily calories)total daily calories) Moderate exercise for 1 Moderate exercise for 1

hour three times per hour three times per week.week.

Stress counseling.Stress counseling. One hour of yoga, One hour of yoga,

meditation, breathing, meditation, breathing, and progressive and progressive relaxation per day.relaxation per day.

Factors That Trigger Factors That Trigger Coronary Artery SpasmsCoronary Artery Spasms

Clumping ofClumping ofPlateletsPlatelets

StressStress

SmokingSmokingIncreased Increased Calcium Calcium

FlowFlow

Acute Myocardial Acute Myocardial InfarctionInfarctionHeart AttackHeart Attack

DefinitionDefinition: A condition that occurs when blood supply to the heart muscle is cut off and the tissue dies.

Crushing or heavy discomfort or pain

in the chest

Heartburn symptoms accompanied by

nausea and vomiting

Chest pain that spreads to the shoulders, neck,

jaw or arms

Lightheadedness,dizziness or

faintingSweating

Treatments That Save Treatments That Save HeartsHearts

Clot-dissolving drugsClot-dissolving drugs ThrombolyticThrombolytic Platelet receptor Platelet receptor

blockerblocker Early Early

administrationadministration of of appropriate appropriate medications.medications.

Intravenous Intravenous nitroglycerinnitroglycerin

Beta-blockersBeta-blockers AngioplastyAngioplasty

ArrythmiasArrythmiasIrregular Heart BeatIrregular Heart Beat

BradycardiaBradycardia:: Heart rate of fewer than 60 beats per minute.Heart rate of fewer than 60 beats per minute.

TachycardiaTachycardia: : Heart rate of more than 100 beats per minute.Heart rate of more than 100 beats per minute.

Potential CausesPotential Causes: : Atherosclerosis, hypertension, mineral Atherosclerosis, hypertension, mineral

imbalance, alcohol, tobacco, cocaine, or other imbalance, alcohol, tobacco, cocaine, or other drugs.drugs.

SymptomsSymptoms: : Fatigue, lightheadedness, loss of Fatigue, lightheadedness, loss of

consciousness, death, and organ damage.consciousness, death, and organ damage. DiagnosisDiagnosis: :

Electrocardiogram.Electrocardiogram. TreatmentTreatment: :

Medications and/or pacemakers.Medications and/or pacemakers.

Other Crises Of The HeartOther Crises Of The Heart

Mitral-Valve ProlapseMitral-Valve Prolapse

Congestive Congestive Heart FailureHeart Failure

Congenital Congenital DefectsDefects

Rheumatic FeverRheumatic Fever

Heart SaversHeart Savers Diagnostic TestsDiagnostic Tests

Electrocardiogram (ECG, EKG) Thallium scintigraphy Coronary angiography

TreatmentsTreatments Aspirin therapy Medications

Diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACE).

Surgical Procedures Coronary bypasspercutaneous transluminal coronary

angioplasty, heart transplant, and left-ventricular-assist devices (LVADs).

StrokeStroke DefinitionDefinition

When the blood supply to a portion of the brain is blocked. Also called a cerebrovascular accident.

StatisticsStatistics Strokes are the 3rd leading cause of death in the

U.S. Worldwide stroke are the second leading cause of

death. TypesTypes

Ischemic stroke vs. hemorrhagic stroke vs. transient ischemic attacks.

CausesCauses Cerebral thrombosis, cerebral embolism, head

injury and bursting of an aneurysm.

Warning Signs of a Warning Signs of a StrokeStroke

Sudden numbness or weakness of the Sudden numbness or weakness of the face, arm, or leg – particularly on one face, arm, or leg – particularly on one

side of the body.side of the body.

Sudden confusion, difficulty in speech Sudden confusion, difficulty in speech or understanding.or understanding.

Sudden trouble seeing out of one or Sudden trouble seeing out of one or both eyes.both eyes.

Sudden trouble walking, dizziness, loss Sudden trouble walking, dizziness, loss of balance or coordination.of balance or coordination.

A sudden severe headache of unknown A sudden severe headache of unknown cause.cause.

Risk Factors for StrokesRisk Factors for Strokes

GenderGender

RaceRace

AgeAge

HypertensionHypertension

High Red Blood Cell High Red Blood Cell CountCount

Heart DiseaseHeart Disease

Blood FatsBlood Fats

Diabetes MellitusDiabetes Mellitus

Prevention and Treatment for Prevention and Treatment for StrokesStrokes

A baby aspirin a day keeps A baby aspirin a day keeps strokes away.strokes away.

SurgerySurgery Carotid endartectomyCarotid endartectomy Brain angioplastyBrain angioplasty

MedicationsMedications Thrombolytic drugsThrombolytic drugs

Tissue-type plasminogen activator (tPa)Tissue-type plasminogen activator (tPa) HeparinoidsHeparinoids NimodipineNimodipine

Heart-Smart Strategies Heart-Smart Strategies For LifeFor LifeDon’t smokeDon’t smoke

Watch your weightWatch your weightCut down on saturated fat and cholesterolCut down on saturated fat and cholesterol

Get movingGet movingLower your stress levelsLower your stress levelsKnow your family historyKnow your family history

Get your blood pressure checked Get your blood pressure checked regularlyregularly

Tame your temperTame your temperGet a lipoprotein profileGet a lipoprotein profile

Take appropriate medicationsTake appropriate medications