Living with Cardiovascular Disease

1. Living with Cardiovascular Disease Cardiac Rehabilitation Education Program St. Mary’s General Hospital

2. A Quote • “Health is not valued until sickness comes” • Dr. Thomas Fuller(1654-1734) a • British physician

3. Statistics • Which disease is the number one disease in Canada? • - Hypertension • - Cancer • - Arthritis, • - Diabetes • - Coronary Artery Disease

4. Statistics • Although cardiovascular disease remains the leading cause of death in Canada,mortality rates have dropped significantly since the early 1950’s. • Cardiac Rehabilitation programs emphasize prevention strategies targeted at reducing the major risk factors associated with heart disease, lowering the risk of death by 20-25%.

5. Learning Session Objectives • Understand how the heart works • What is Coronary Artery Disease • Recognize the Signs and Symptoms • Know the difference between Angina and Heart Attack • Understand the Risk Factors • Manage the Risk Factors

6. Questions • What is the function of the heart? • What are the coronaries? • What is Coronary Artery Disease? • What is Angina? • What is a Heart Attack? • What is the difference between a Heart Attack and Angina?

7. Hollow Muscular Organ • Size of a clenched fist • Located in the center of the chest cavity behind the breast bone. • A pump with a big job to do! The Heart and How It Works

8. The Heart and How It Works • The heart pumps blood into the lungs to pick up oxygen • The blood returns to the heart and is then pumped into arteries and capillaries that carry blood rich in oxygen and nutrients to every cell of the body

9. The Heart as a muscle requires oxygen and nutrients and has its own network of 3 coronary arteries to feed the heart muscle • These arteries curl around the surface of the heart and plunge into the muscle bed where they divide like branches of a tree to reach every fiber in the heart Coronary Arteries

10. A condition in which the arteries that supply the heart muscle with blood containing oxygen and nutrients become narrowed or blocked • Fatty streaks line the inner blood vessel and build up into “plaques” small clumps of irregular shapes and sizes that project out from the wall of the artery causing the narrowing Coronary Artery Disease

11. What are some Signs of Symptoms of Angina or a Heart Attack? • - • - • - • - • -

12. Signs And Symptoms… • When arteries are narrowed the blood cannot flow freely through them which reduces the supply of oxygen to the heart muscle The heart sends out a signal or warning sign called angina *angina pectoris or “chest pain” • A tightness, a pressure, or a squeezing sensation in the middle of the chest • It may radiate into the neck, jaw, throat, elbows. • It can present as shortness of breath or heartburn.

13. Angina • Angina is the signal of an imbalance in the demand of the heart muscle for oxygen • It is typically brought on with exertion and relieved with rest. • It is temporary and causes no muscle damage • Nitroglycerin sublingually relaxes the tone in the walls of the arteries and improves the supply of oxygen rich blood to relieve the discomfort

14. Factors that may cause Angina 5 “E’s” and Smoking: • Exercise • Exertion • Emotion • Eating • Exposure • Smoking

15. Heart Attack • Blood flow through the coronary artery is completely blocked, no blood and oxygen can get beyond the blocked artery and results in permanent damage to heart muscle • Onset not associated with activity • Symptoms include: • Pressure, burning, tightness, heaviness or squeezing that persists for > 15 min and is not relieved with rest and nitroglycerin • Nausea, indigestion and/or vomiting • Sweaty, clammy skin. • Sense that something is very wrong

16. After a Heart Attack: The Healing Process • It takes 6-8 weeks for the damaged muscle to form a scar • This strengthens the area of damage. • New, smaller blood vessels can form to supply the area around the damage with blood (collateral circulation).

17. Angina No heart muscle damage Pain lasts < 15 min. Relieved with rest and nitroglycerin Heart Attack Part of the heart muscle dies Pain lasts > 15 min Is not relieved with nitro and rest Time to treatment crucial. Angina vs. Heart Attack

18. Treatment of Heart Disease • Medication • Coronary Angioplasty • Coronary Artery Bypass Graft Surgery (CABG) • Cardiac Rehabilitation Program

19. Cardiac Investigations • Cardiac Catheterization: A catheter is passed from femoral or brachial artery (groin or wrist) and dye injected into each coronary artery to determine narrowing or blockages and confirm diagnosis

20. Balloon Angioplasty

21. Angioplasty with Stent

22. Angioplasty (PTCA) After Before

23. Angioplasty (PTCA) 5-years later Before

24. Coronary Artery Bypass Graft

25. Valve Surgery • Valve surgery but have clean arteries • Exercise to help in re-conditioning the heart and strengthen the heart • You may have been very short of breath before surgery • Exercise with help build up your strength again

26. Risk Factors • Name some risk factors for heart disease? • Name some risk factors that we cannot change?

27. Modifiable: Smoking High Blood Pressure High Cholesterol Diabetes Obesity Physical Inactivity Stress Non-Modifiable: Age Race Gender Family History Risk Factors for Heart Disease

28. SmokingMost preventable cause of Coronary Artery Disease • Smoking increases the risk of developing coronary artery disease and also the risk of dying from it • Smoking increases the risk of in-stent blockage • Smoking negatively affect bypass grafts • Nicotine contributes to build-up of fatty plaques in your arteries, and increases the workload of the heart by increasing the heart rate and blood pressure • Carbon monoxide in smoke decreases the amount of oxygenbeing supplied to the heart.

29. Managing Smoking • It is never too late to quit smoking • Health Benefits begin as soon as 20 minutes from the time of the last cigarette • Blood pressure and heart rate return to normal • Blood carbon monoxide levels to normal within 8-12 hrs, improving oxygen levels Cardiac Rehab Program can Assist you in this process with group support sessions for “Preparing to Quit Smoking”

30. High Blood Pressure • The target blood pressure we are aiming for is a blood pressure less than 140/90 • Blood vessels are under more stress damaging the walls of the coronary arteries and making them more susceptible to plaque formation

31. Managing Blood Pressure • Blood pressure will be monitored weekly prior to exercise sessions • If elevated over time 24 hour monitoring may be recommended to contribute to improved management Group Education and individualized counseling – Heart Healthy Diet - Medication - Exercise

32. High Cholesterol • An abnormal blood lipid profile has been a major risk factor for cardiovascular disease • Managing the levels to recommended target range has been shown to decrease cardiac events by slowing disease progression stabilizing the plaque and improving the function of the lining of the arteries

33. Managing Cholesterol • Review of lipid profile • Understand the numbers • Set goals to lower your risk Group education and individualized counseling • Heart Healthy Diet • Medication • Exercise

34. Diabetes • In Type 2 diabetes the body either does not use the insulin it makes or it doesn’t make enough insulin causing high levels of glucose or “sugar” in the bloodstream. • Poorly controlled blood sugars accelerates the process of plaque build up causing damage to blood vessels and nerve endings

35. Managing Diabetes • Reduce diabetes complications by keeping your blood sugar in your recommended target range and blood pressure<130/80 • Monitor and record your blood glucose levels daily • Bring your glucometer to exercise sessions. <14 & >4 for safe exercise • Diabetes Education as required

36. Managing Diabetes cont’d • Foot Care Rules: • Never go barefoot, even indoors • Wear shoes that fit properly. They should be supportive, and should not rub or pinch • Wash and dry your feet (Especially between your toes) thoroughly • Wear fresh clean socks everyday • Inspect your feet carefully every day • Clean cuts or scratches with mild soap and water

37. Excess Body Weight • Excess body weight – adds strain on the heart - increases the workload of the heart • Excess body weight also increases blood pressure and blood cholesterol

38. Managing Ideal Body Weight • Studies have demonstrated significant heart health benefit associated with a 10% decrease in weight Cardiac rehab offers counseling and support to assist you to achieve your target weight range • Body Composition Analysis • Heart Healthy nutrition education in group setting • Individualized nutrition counseling

39. Managing Physical Inactivity • Physical inactivity is a major risk factor for many cardiovascular diseases including coronary artery disease • Physical Activity Guideline, From Health Canada recommends a target of 30-60 minutes of moderate intensity physical activity 4-5 days of the week Cardiac rehab offers education sessions about the heart health benefits of daily exercise and active living Supervised exercise program and support in determining goals for independent exercise

40. Stress,Depression,Anxiety • Established as predictors of coronary artery disease and can lead to a heart attack • Depression found to complicate recovery from cardiovascular events as well as an increase in 1 year mortality after heart attack • Increase susceptibility to other risk factors i.e. smoking, inactivity.

41. Managing Stress,Depression and Anxiety • Acknowledge and discuss emotions and reactions that accompany a change in health. Many are normal and a necessary part of recovery • Learning and support may occur through shared experiences and emotions related to coping with heart disease as well as group education to assist in recognizing signs of poor coping Individual counseling with Social Work

42. Sexual Intimacy • You can be sexual intimate when you can climb a flight of stairs without getting any chest pain.

43. “An ounce of prevention is worth a pound of cure.” • An Ancient Proverb

44. Welcome to Cardiac Rehab Looking forward to a great 4 months getting to know you better. Your nursing team: Linda Tammaro R.N. Marilyn Wilk R.N.CCN(C)BScN