Cardiovascular Disease: an Overview

1. Cardiovascular Disease: an Overview Jon W. Wahrenberger, MD March 10, 2007

2. The Good News We are living longer than ever!

3. 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 • Cardiovascular disease continues to strike young and middle-aged individuals • We are losing ground on several important risk factors

4. Obesity in the USA

5. Prevalence of Diabetes 1980-2004 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey.

6. Smoking in Youth 2005 Youth Risk Behavior Survey (YRBS)

8. Potential for Falling Longevity? Life Extending Technology Public Health Measures Health adverse behavior

9. Evolution of Cardiovascular Disease Chain ofSurvival TechnologyInfluences MassMarketing of Junk Food Tobacco SurgicalProcedures Suffering, Loss of QOL Normal Child Overweight Inactive Child Sick Adult Overweight Inactive Adult Drugs Premature Death Devices Food Overabundance CulturalChanges KnowledgeDeficits We must tackle heart disease at all points!

10. Women are not immune to heart disease!

11. What is Cardiovascular Disease? “Cardiovascular disease” refers to diseases involving the heart and blood vessels Peripheral Vasculature Heart Brain AnginaHeart Attack ClaudicationUlcerationAmputation StrokeTIA

12. Cerebral Disease Coronary Disease 25% 7% 30% 3% 4% 12% 19% Peripheral VascularDisease The heart, brain and extremities share a disease process

13. Circulatory system (arteries, veins, etc.) Susceptibility to atherosclerosis The Common Thread?

14. Atherosclerosis AKA “Arteriosclerosis”, “hardening of the arteries” • Complex, self-sustaining inflammatory process • Thickens arterial wall • Occurs slowly over decades

15. Ischemic Heart Disease Cerebrovascular Disease Peripheral Vascular Disease No Symptoms Mild Symptoms Severe Symptoms Atherosclerosis Progression Time (years to decades)

16. What causes atherosclerosis? • Smoking • High Blood Pressure • High Cholesterol • Diabetes • Hereditary Factors • Sedentary Lifestyle • Obesity • Other Factors

17. Normal Coronary Arteries Right Coronary Artery Left Coronary Artery

18. Diseased Coronary Artery

19. Peripheral Vascular Disease

20. Stroke – “Brain Attack”

21. Symptoms of Cardiovascular Disease

22. Suspected Stroke or Heart Attack? Call 911 Time = saved heart muscle Time = saved brain function

23. Other Causes of Heart Disease • Heart failure • Heart rhythm disturbances (arrhythmias) • Congenital heart disease • Heart Valve Disease • Heart infections

24. Heart Failure

25. Heart Failure Definition • state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues

26. Heart Failure Virus Toxins Hypertension Post Partum Ischemia Valve Disease Heart Muscle Injury Heart Failure

27. Heart Failure: Symptoms • Shortness of breath • Fatigue • Edema (swelling)

28. Arrhythmias

29. Heart Electrical System A wave of electrical discharge proceeds mechanical contraction of the heart.

30. Types of Arrhythmias • Premature atrial contractions (PAC) • Atrial fibrillation • Atrial flutter • SVT • Wolf Parkinson White • Heart block • Premature ventricular contractions (PVC) • Ventricular tachycardia • Ventricular fibrillation

31. 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

32. Diagnosis of Arrhythmias • Electrocardiogram • Holter Monitor • Event Monitor • Loop record • Implantable loop record

33. Treatment of Arrhythmia • Removal of precipitants • Caffeine • Electrolyte Imbalances • Thyroid abnormalities • Medications Traditional • Ablation • Implantable defibrillator

34. Ablation of Arrhythmias • Particularly useful with: • SVT • Atrial fibrillation • Atrial flutter • WPW • Some types of Ventricular Tachycardia

35. Implantable Cardioverter/Defibrillator Ventricular Fibrillation View Defibrillator

36. Heart Valve Disease

37. Valve Disease Valves are intended to allow blood flow in only one direction from one heart chamber to another • Normal Function: • Allow blood to flow freely one direction and none backwards • Dysfunction: • Become narrow and impede forward flow (stenosis) • Become incompetent and allow backward flow (regurgitation) Pulmonic Valve Aortic Valve Tricuspid Valve Mitral Valve

38. Shortness of breath Fatigue Chest Pain Susceptibility to infection Death Valve Disease Congenital Abnormality Infection Valve Dysfunction Age Related Degeneration Rheumatic Fever

39. Treatment of Valve Disease • Medications • Surgery • Percutaneous repair

40. Open Heart Surgery

41. Percutaneous Valvuloplasty Mitral Valvuloplasty Aortic Valvuloplasty

42. Percutaneous Aortic Valve Replacement

43. Percutaneous Aortic Valve Replacement

44. What can you do to stay healthy?

45. Know your Enemies! • Inactivity • Obesity • Smoking • Elevated cholesterol • Diabetes • Hypertension

46. Calculate Your Risk Framingham Risk Calculator Men Women

47. 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 • Stay away from restaurants that allow smoking

48. Learn about Trans Fatty Acids • Low level presence in meat and milk of ruminant animals • High levels in “partially hydrogenated vegetable oils” • Lot of bad consequences: • Raise LDL & lower HDL • Increase risk of heart disease by 30%

49. Saturated fats < 7% of total caloric intake Trans fats to < 1% of total caloric intake Cholesterol to < 300 mg per day Total fat to 25-35% of total caloric intake Trans Fatty Acids AHA Recommendations: FDA mandated trans fat food labeling after January 1, 2006

50. Some Unlikely Friends?