Understanding the Understanding the Cardiovascular SystemCardiovascular System

Chapter 4Chapter 4Refers to Heart – Lung Refers to Heart – Lung

FunctioningFunctioning

Sub-Components of Sub-Components of the Cardio-the Cardio-respiratory Systemrespiratory SystemHeartBloodBlood VesselsLungs

Function of Cardio-Function of Cardio-Respiratory SystemsRespiratory 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 Anatomical Considerations of the Heartof the Heart

Size of a closed fist Located in the mediastium of

the chest cavity

Basics Of Heart AnatomyBasics 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 Basics Of Heart Anatomy #2#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 DiseaseCardiovascular Disease

60-70 million Americans have one or more forms of CVD

Cardiovascular DiseaseCardiovascular Disease

1 million deaths each year330 billion dollars

Cardiovascular DiseaseCardiovascular Disease

Cardiovascular disease (CVD) is the number one cause of death in the United States.

Cardiovascular DiseaseCardiovascular 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 Forms of Cardiovascular DiseaseCardiovascular Disease(Often preventable and lifestyle (Often preventable and lifestyle

related)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 Coronary Artery Disease (CAD)(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 Clear Coronary Arteries Arteries

Cardiovascular DiseaseCardiovascular 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 ProceduresCardiovascular Procedures

Angioplasty Roto-Blade Stints Keyhole Surgery Radiation Bypass Surgery (7 yr.average)

CAD Post-Op CAD Post-Op PatientPatientWhat behavioral and dietary changes are suggested for the patient?

Can One Be FIT But Not Can One Be FIT But Not Healthy?Healthy? Personal profile example Run 3 miles daily Lift weights Stretching exercises Smokes, stress, excessive alcohol,

fatty foods, drugs, etc.

Jim FixxJim 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 FactorsCoronary 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 Primary Risk Factors (Alterable)(Alterable) Smoking

Hypertension (high blood pressure) High serum cholesterol

(hyperlipidemia) Physical inactivity Diabetes mellitus Obesity

– (drug use)

Secondary Risk FactorsSecondary Risk Factors

StressAgeGender (male vs. female)Family history

Are Arkansans at Are Arkansans at Risk for these Risk for these Health Problems?Health Problems??

Arkansas Stats from the Arkansas Stats from the Center for Disease Center for Disease Control/Mortality RatesControl/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. StatsAdditional 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 Examining CAD Risk Factors Factors ((Primary followed by Primary followed by Secondary)Secondary)

Smoking #1Smoking #1

The single most important, preventable cause of illness and early death

Smoking #2Smoking #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 #3Smoking #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 SmokeSecondary Smoke

53,000 annual deathsFor each pack of cigarettes

smoked, the non smoker, sharing the same air, will inhale the equivalent of 3 to 5 cigarettes.

Smokeless TobaccoSmokeless Tobacco

Chewing tobaccoOverheads

Smoking Benefits??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 ???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 Hypertension / High Blood PressureBlood 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 PressureBlood 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 Systolic Blood Pressure

120120/80/80The highest pressure or value

Occurs during heart contraction phase (ventricular contraction)

Diastolic Blood Pressure Diastolic Blood Pressure

120/120/8080 The lowest pressure or value

Occurs during heart relaxation phase (resting or refilling stage of the contraction)

Hypertension (High Blood Hypertension (High Blood Pressure)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 #2Hypertension #2

Related to stroke / aneurysms Hypertension may be the result of

another health problem

Factors Affecting Blood Factors Affecting Blood PressurePressure Hypertensive medications

Time of day Full bladder content Body posture Recent intake of caffeine Nicotine Alcohol Recent strenuous activity

Impact of HypertensionImpact of Hypertension

25% or 50 million Americans are hypertensive

67% are not treated1/2 are unaware of the

complication

Factors Contributing To Factors Contributing To HypertensionHypertension

AgeRaceSodium sensitivityChronic alcohol abuseOral contraceptivesSedentary living

Lifestyle Interventions to Lifestyle Interventions to Maintain or Lower Blood Maintain or Lower Blood PressurePressure

Body weight reduction or maintenance

Smoking cessation

How To Lower Blood How To Lower Blood PressurePressureAerobic exerciseReduce stressReduce cholesterol, sodium,

high fat diet (saturated)Medications

Hyperlipidema / Hyperlipidema / High Serum High Serum CholesterolCholesterol 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 factsCholesterol: 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 What Is So Bad About Having High Cholesterol Having High Cholesterol Levels??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 PlaqueMore About Plaque

–Affects all of us –May begin as early as 10 years of age

–May be genetic–Medications??

Types of Types of Lipoproteins / Lipoproteins / Types of Types of CholesterolCholesterolLDLHDLVLDL

LDLLDL

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

HDLHDL

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

VLDLVLDL

Very low density lipoproteins (VLDL)–undesirable and are associated with increase risk of CAD

Cholesterol Cholesterol InformationInformationDietary Cholesterol

–Refers to foods high in cholesterol

–Example:»Shrimp

High in cholesterol Low in fat

Cholesterol Cholesterol InformationInformationSaturated fats

–Can significantly raise LDL levels (“bad” cholesterol) and total serum cholesterol levels

–Found in animal sources and by products

Cholesterol Cholesterol InformationInformation 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 Serum Cholesterol LevelsLevels

–Desirable below 200

–Borderline high 200-239–Risk for CVD 240 or >

– Some guidelines call for desirable to be 170

High Serum Cholesterol High Serum Cholesterol #2#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 Understanding Total Serum Cholesterol ValuesSerum Cholesterol Values

Knowing an individual’s total cholesterol is not always adequate when determining coronary risk

Understanding Cholesterol Understanding Cholesterol Ratios 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 Cholesterol Value ExamplesExamples 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 Cholesterol Value ExamplesExamples 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 ValueCholesterol Value Actual Example 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 How To Control Or Lower CholesterolCholesterolAvoid saturated fats

–fats from animal sources–red meats–animal fats–animal by-products

Controlling Cholesterol #2Controlling 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 #3Controlling Cholesterol #3

Eat fish 2-3 times per week

Bake, broil, steam

Remove excess fat (soup, chili)– Is ground turkey

better?

Controlling Cholesterol #4Controlling 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 Take Care Of Your Kitchen Your Kitchen DisposalDisposal

Physical InactivityPhysical Inactivity

Physical activity levels and CAD are strongly inversely related.

Physical Inactivity #2Physical Inactivity #2

Sedentary individuals have:– 2-3 times greater risk of CAD than active individuals.

–Twice the risk of fatal heart attacks

Physical ActivityPhysical ActivityPhysical activity is

argumentably be the single best method of controlling or reducing CAD.

Collateralization

Physical Activity #2Physical Activity #2

Increases strength of the heartHelps to establish and maintain

normal blood pressure.Helps to control obesity due to

increase in caloric expenditure

Physical Activity #2Physical Activity #2

Raises HDL levels, while lowering LDL, triglyceride and total cholesterol levels.

Decreases resting heart rates

Helps to manage stress levels

Physical Activity #3Physical 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 MellitusDiabetes 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 MellitusDiabetes 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 LevelsBlood 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

HypoglycemiaHypoglycemia

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 DiabetesTypes of Diabetes

Type I: insulin dependent or juvenile onset

Type II: maturity or adult onset, usually non-insulin dependent

Gestational onset

Diabetes Mellitus: Adult Diabetes Mellitus: Adult OnsetOnset 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 #2Adult 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 How To Avoid Adult Onset DiabetesDiabetes

Control cholesterolControl weightControl blood pressureExercise regularly (aerobic)

–Diabetics must plan for meals, insulin injections, and exercise

ObesityObesity 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 obesity-related illnesses

Obesity #2Obesity #2

38% Arkansas school children overweight

Young adult obesity can shorten life span by 5 to 20 years

Obesity Is Related To: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 DistributionObesity: 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 Other Diseases Associated With ObesityWith 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 What Constitutes Obesity?Obesity?BMI > 25> 20 lbs overweightBody fat percentages

–Men > 20% (25)–Women > 25% (30)

Secondary Risk Secondary Risk Factors (Not Factors (Not

alterable)alterable)Stress (secondary but is alterable to some degree)

AgeGenderFamily History

Stress:Stress:

Unmanaged stress is related to CAD.

Type A personality is related to CAD.

Age:Age:

Men : 45 and overWomen: 55 and over

Family History: Primary or Family History: Primary or Secondary?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

GenderGender

Men have a greater history of CAD earlier in life.

CAD is a disease of “equal opportunity”

**New Information: **New Information: Homocysteine LevelsHomocysteine 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, B- complex and selenium

**New Information**New Information

High triglyceride levels are associated with increase in CAD (fall 2000)

**New Information**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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