The Cardiovascular System Chapter 11

1. The Cardiovascular SystemChapter 11 Overview of Heart Disease and anatomy

3. The Cardiovascular System A closed system of the heart and blood vessels The heart pumps blood Blood vessels allow blood to circulate to all parts of the body The function of the cardiovascular system is to deliver oxygen and nutrients and to remove carbon dioxide and other waste products

4. The Heart Location Thorax between the lungs Pointed apex directed toward left hip About the size of your fist

5. The Heart

6. Living a Heart Healthy Lifestyle • Emphasis on diet, exercise and the choices you make in terms of not smoking and maintaining a healthy weight.

7. Living a Heart Healthy Lifestyle • Diet: • Avoid greasy foods and excess red meat • Have at least five servings of fruits and vegetables daily.

8. You are what you eat! • Eat fish! Omega-3 fish oil has proven to reduce the risk of death from coronary artery disease. • Choose complex carbohydrates like whole wheat products to lower your cholesterol. •  Limit your sodium intake.

9. Exercise • Any kind of physical activity, whether it be running, swimming, dancing or walking, can lead to a healthier heart.

10. Stay active! • You should aim to exercise thirty minutes a day five times a week. • After 150 minutes of rigorous exercise a week results begin to plateau.

11. Choices • Don’t smoke!

12. Maintaining a Healthy Weight • Maintain a healthy body weight • Try to maintain an ideal body weight with a Body Mass Index between 18-25. • BMI Calulator •  Men should aim for a waist circumference that is less than 40 in. • Women should aim for a waist circumference that is less that 35 in.

13. Risk Factors • If you suffer from any of the following conditions you are more prone to developing coronary artery disease. • 1. Do you smoke? • 2. Do you have high LDL cholesterol? • 3. Do you suffer from diabetes? • 4. Do you have a family history of coronary artery disease? • Do you have High Blood Pressure (HBP) Hypertension?

14. Variations in Blood Pressure • Human normal range is variable • Normal • 140–110 mm Hg systolic • 80–75 mm Hg diastolic • Hypotension • Low systolic (below 110 mm HG) • Often associated with illness • Hypertension • High systolic (above 140 mm HG) • Can be dangerous if it is chronic

15. Measuring Arterial Blood Pressure

16. Blood Pressure: Effects of Factors • Temperature • Heat has a vasodilation effect • Cold has a vasoconstricting effect • Chemicals • Various substances can cause increases or decreases • Diet • Video: Blood Pressure

17. Diabeteshttp://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.htmDiabeteshttp://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.htm • A metabolic problem where there is an excess of glucose in the blood stream. • This high glucose in the blood stream can irritate the arteries. • Insulin- a hormone produced by the pancreas that allows glucose to enter cells. • Diagnosed if blood sugar level is 125mg/dL while fasting.

18. Type I Diabetes • Juvenile diabetes • Pancreas don’t make insulin • Genetic onset • Diabetic ketoacidosis-patients become acidotic when sugar is converted to ketones. • Blood has low pH, below 7.4. http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8883.jpg

19. Type I Diabetes • When diagnosing patients: • Breath smells like Juicy Fruit gum • Very lethargic • Most die before the age of 45 from heart disease, atherosclerosis, kidney disease etc.

20. Coping with Type I Diabetes • Most patients suffering from Type 1 Diabetes will have an insulin pump that delivers doses of insulin.

21. Type II Diabetes • Adult onset diabetes • Some patients have a blood sugar level between 800-900 • Obesity is a large driver, waist fat • Develop high blood pressure (140/90), normal is (115/75) • High triglycerides, low HDL cholesterol

22. Coping with Type II Diabetes • Exercise • Cut back on carbohydrates • Make sure to stay on top of your medications

23. Heart Disease and Treatmenthttp://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_WhatIs.html

24. Although we've known for decades that these different body shapes existed, only now are their causes and related health risks becoming clear. The startling discovery is that these two categories of women-apple-shaped and pear-shaped-are as physiologically different from each other as women are from men. The reason is fat. Fat comes in two main varieties: subcutaneous fat, which is located under the skin; and visceral or abdominal fat, which packs itself around the inner organs of the abdomen. Subcutaneous fat, being closer to the surface, is always easy to see. Visceral fat, on the other hand, is not always visible from the outside. It jams up against the intestines, kidneys, pancreas, and liver (and sometimes even inside the liver). We all have some visceral fat because it protects our internal organs, acting both as shock absorber in case of trauma, and as insulator to help us conserve body heat. While some visceral fat is necessary, too much can create serious health problems. Most people think of fat as inert material, much like the rind of fat surrounding a steak. But fat is actually living, breathing, hormone-producing, metabolically active tissue. Fat is critical for survival because it stores food energy, and because it helps regulate body functions through the give-and-take of chemical communications with the central nervous system. Subcutaneous fat may be visible and annoying, but it is relatively harmless. In fact, fat in the pear zone-hips, thighs, and buttocks-helps to protect us from disease. Scientists believe that pear zone fat acts like a fat magnet, trapping certain fats from the foods we eat and keeping them from escaping into the blood stream where they can damage our arteries. Excess visceral fat, on the other hand, can be dangerous. Visceral fat is more metabolically active than subcutaneous fat, and most of what it does is harmful to the body. Visceral fat decreases insulin sensitivity (making diabetes more likely), increases triglycerides, decreases levels of HDL cholesterol (the good one), creates more inflammation, and raises blood pressure-all of which increase the risk of heart disease. Instead of trapping fat, visceral fat releases more of its free fatty acids into the blood stream, further increasing the risk of both diabetes and heart disease. The overall effect of excess visceral fat is that it creates a physical environment that is primed for heart disease and stroke, and greatly increases the risk for certain cancers. This is why apple-shaped women, who carry their weight around their waists, have an increased risk of metabolic and vascular diseases.

26. http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.htmlhttp://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html Coronary Artery Disease • CAD is a condition where plaque builds up in the coronary arteries.

27. http://my.clevelandclinic.org/PublishingImages/heart/coronaryarteriesnew.jpghttp://my.clevelandclinic.org/PublishingImages/heart/coronaryarteriesnew.jpg The Coronary Arteries

28. Atherosclerosis • A common arterial disorder and type of arteriosclerosis characterized by deposites of fatty substances, cholesterol, cellular waste products, calcium and fibrin (a clotting material in the blood) in the inner lining of an artery. This build-up is called plaque. • Atherosclerosis is the build up of plaque in the arteries. • Irritation, Inflammation, Plaque • Caused by an inflammation of endothelium, the thin lining of the arteries.

29. http://en.wikipedia.org/wiki/Image:Anatomy_artery.png

30. Atherosclerosis • Irritation of thin lining caused by things like nicotine, LDL cholesterol or high blood sugar. • This inflammation can rupture which causes clotting which further blocks the artery.

31. Arteriosclerosis • A common arterial disorder characterized by thickening, loss of elasticity, and calcification of arterial walls, resulting in decreases blood supply, especially to the cerebrum and lower extremities.

32. Regression Possible Potentionally Vulnerable Plaque Development

33. Symptoms • Poor blood flow to the heart can lead to angina and heart attack. • Angina- discomfort felt in the chest due to poor blood flow to the heart. • Ischemia- poor blood flow • Comes on with exertion goes away with rest.

34. Angina Pectoris • Angina pectoris is the medical term for chest pain due to coronary heart disease. This is a condition in which the heart muscle does not recieive enough blood, resulting in pain in the chest. Attacks are often related to exertion, emotional stress, and exposure to intense cold. Pain relief can be achieved through rest and vasodilation of the coronary arteries by medication such as nitroglycerin. • What is heart disease?

35. Heart Attack • Myocardial Infarction • Infarction- tissue death • Complete cessation of blood flow to the heart • Infarcting tissue is electrically unstable which leads to sudden cardiac death. • Video of a HEART ATTACK

36. Statistics • People who survive the acute stage of a heart attack have a chance of illness and death that is 2-9 times higher than that of the general population. • Because women have heart attacks at older ages, they are more likely to die from them.

37. Are You having a Heart Attack? • Some heart attack symptoms include: • Chest discomfort like a squeezing or a heavy pressure on the chest • Discomfort in the arms, jaws or neck • Shortness of breath • Nausea • Heavy sweating

38. Ways to Test for Blockages • Heart CT Scan- You can see the calcium buildup in the arteries. • Coronary Angiography- catheter injection of dye into the coronary arteries • Intravascular Ultrasound (IVUS) • Ultrasound imaging technology where a catheter with a probe is inserted to see insides the blood vessels.

39. Plaque and Calcium Calcification Lipid Core

40. Ways to Remove Blockages • Angioplasty-”The remodeling of the arteries” • A small balloon is inserted to the blockage area using a thin catheter. The inflated balloon pushes the plaque up against the walls of the arteries. Then a stent is inserted to hold it in place.

42. Angioplasty • Numb area of injection • Insert needle into femoral artery • Add a sheath to the injection site • Thread J wire up into the aorta • Send catheter up to aorta • Remove the J wire and send a catheter with a balloon on it to the blockage area • Inflating the balloon will push the plaque to the walls of the arteries. • Video of Angioplasty

43. The Courage Trial • Are people with stable coronary artery disease better off with or without stenting in the long run in regards to preventing cardiovascular problems in the future?

44. The Courage Trial • Adding a stent did not reduce the risk of death or other major cardiovascular events when combined with optimal medical therapy. • Stents are great for short term relief of sypmtoms but they have minimal long term effects. • The medicines are making the difference.

45. http://www.mayoclinic.org/images/hcm-heart-bdy.jpg Hypertrophic Cardiomyopathy • A heart muscle condition caused by an enlarged septum, the wall of muscle between the left and right ventricle. • A large contributor to the number of sudden cardiac deaths in young athletes.

46. How it Kills… • The enlarged septum can cause rhythm problems so with a surge of a adrenaline, like in a sports game, the victim could suffer a fatal arrhythmia and die. • Time is of the essence when resuscitating the patient.

47. http://my.clevelandclinic.org/PublishingImages/heart/icdparts.JPGhttp://my.clevelandclinic.org/PublishingImages/heart/icdparts.JPG Ways to Deal with HCM • Implantable defibrillator • It constantly monitors the rhythm in your heart and delivers a shock whenever there is an abnormal rhythm • A small incision is made under the collar bone • Lead inserted into the right atrium through the subclavian vein • Medications

48. Championship Hearts • The Championship Hearts Foundation is a philanthropic organization founded by a group of cardiologists from the Austin Heart Hospital.

49. What is the difference between Atrial Fibrillation and Ventricular Fibrillation • Atrial fibrillation is a cardiac disrhythmia characterized by disorganized electrical activity in the atria accompanied by a rapid irregular ventricular response. Therefore, the ventricles are beating too fast to fill completely and inadequate amounts of blood are being pumped out. • Video on Atrial Fibrillation • Ventricular fibrillation is an uncoordinated series of very rapid ineffective contractions throughout the ventricles caused by multiple chaotic electrical impulses. In ventricular fibrillation no blood is being pumped from the heart. Blood pressure falls to zero and death can occur in 4 minutes without defibrillation and ventilation.

50. EKG • http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=68&TopicID=600 • Video of an EKG