The Cardiovascular System

1. The Cardiovascular System

2. CVD is the name for a group of heart and blood disorders that include: • Hypertension (high blood pressure) • Coronary heart disease (heart attack) • Cerebrovascular diseases (Stroke) • Peripheral vascular disease • Heart failure • Rheumatic heart disease • Congenital heart disease • cardiomyopathy

3. RISK FACTORS FOR CVD • Major modifiable risk factors are: • Smoking • Diabetes • Hypertension • Dyslipidaemia • Physical inactivity • Overweight and obesity • Particularly central fat distribution

4. Major non-modifiable risk factors • Aging • Male gender • Ethnicity • Family history of premature death from CHD and dyslipidaemia • Minor risk factors • Excessive alcohol consumption • stress

5. HYPERTENSION

6. What is Blood Pressure?Nicholas Burgess, 2000 • Blood pressure is the pressure exerted by the blood against the walls of the vessels. It is equivalent to the pressure to which the blood is subjected by the force of the heart and the elasticity of the vessels (cardiac output times peripheral resistance) and so is also dependent on the thickness and hardness of the vessel wall. • The blood pressure is highest as the heart contracts for each beat (systolic) and lowest when the heart relaxes between each beat (diastolic).

7. Hypertension is characterised by a diastolic reading above 90-95 mm/hg., and a systolic reading above 140-160mm/hg., or both. • Normal Blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic. • Blood pressure tends to increase with advancing age (because the arteries get thicker and harder) but this is not always the case. • The blood pressure can be elevated temporarily by exposure to cold, a cup of coffee, a cigarette or stress.

8. Hypertension is itself usually a symptom of a more generalised problem. • Hypertension is an important risk factor in predicting future risk of vascular disease and the risk is reduced by lowering the blood pressure.

9. EFFECTS OF HYPERTENSION • The Brain • High blood pressure is the most important risk factor for stroke. • Can cause a break in a weakened blood vessel which then bleeds in the brain. • The Heart • High Blood Pressure is a major risk factor for heart attack. • Is the number one risk factor for Congestive Heart Failure.

10. The Kidneys • High blood pressure can narrow and thicken the blood vessels. • Waste builds up in the blood, can result in kidney damage. • The Eyes • Can eventually cause blood vessels to break and bleed in the eye. • Can result in blurred vision or even blindness.

11. The Arteries • Causes arteries to harden. • This in turn causes the kidneys and heart to work harder. • Contributes to a number of problems.

13. Risk factors • Refer to page 190 Sarris and Wardle and make your list of risk factors for hypertension.

14. Prevention Adopt a healthy lifestyle by: • Following a healthy eating pattern and maintain a healthy weight. Even a 10% weight loss can reduce blood pressure. • Sarris & Wardle page 192 – 194, 198 • Adopt stress reduction techniques • Sarris & Wardle page 192, 196

15. Being Physically Active. • Helps lower blood pressure and lose/ maintain weight. • 30 minutes of moderate level activity on most days of week. Can even break it up into 10 minute sessions. • Page 198 • Limiting Alcohol. • Alcohol raises blood pressure and can harm liver, brain, and heart

16. Exercise: • Five-six hours per week regular physical activity with the large muscle groups, amounting more than 2000 Cal per week, utilizing 50-70 percent of the aerobic capacity or 60-85 percent of the heart rate reserve, increases the HDL-cholesterol level, decreases the triglyceride. • Trainings through months and years decreases the LDL-cholesterol and total cholesterol levels also. Magnitude of the changes are the same (HDL) or comparable to the effects of the lipid-decreasing medicaments.

17. Beyond the beneficial effects on the plasma lipids, the adequate physical activity has a unique influence on the cardiac and cardiovascular functions, on the carbohydrate metabolism, on the blood pressure, on the mood and psychological status. (Apor,P. 2003, `Effectiveness of exercise programs in lipid metabolism disorders’, OrvosiHetilop, vol.144, no.11, pp.507-13)

18. Quitting Smoking. • Injures blood vessel walls • Speeds up process of hardening of the arteries. • In a study of 100 patients who had survived their first episode of MI before the age of 36 years it was found that • Higher levels of total cholesterol, low density lipoprotein cholesterol, triglycerides and lower levels of high density lipoprotein cholesterol were reported.

19. 96% of the patients with premature MI reported current smoking habits. • Current smoking increased 6-fold the odds of having a MI. • It was concluded that cigarette smoking seems to play the most important role for having a MI in individuals under the age of 36 years. (Panagiotakos,DB., Rallidis,LS., Pitsavos,C., Stefanadis,C., Kremastinos,D. 2007, `Cigarette smoking and myocardial infarction in young men and women: a case-control study’, International Journal of Cardiology, vol,116, no.3, pp.371-5)

20. How does homocysteine fit into this picture? Page 194

21. DASH diet • Dietary Approaches to Stop Hypertension. • Was an 11 week trial. • Differences from the food pyramid: • an increase of 1 daily serving of veggies. • an increase of 1-2 servings of fruit. • inclusion of 4-5 servings of nuts, seeds, and beans.

22. A 12-month follow-up study was conducted on participants in the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial to determine the impact of the DASH diet and 150, 100, or 50 mmol/day of sodium after discontinuation of the feeding intervention. • The DASH participants significantly increased their intakes of fruits or juices and vegetables at 12 months. Control participants had no change in DASH food group intake.

23. Both groups increased sodium intake. Among control participants, systolic and diastolic BP increased 5.33 and 3.20 mm Hg respectively. Among DASH participants, systolic and diastolic BP increased 3.12 and 0.79 mm Hg respectively. • CONCLUSIONS: DASH diet participants ate more fruits/vegetables and had sustained reductions in BP despite increased sodium intake. The DASH diet also recommends increasing the intake of calcium, magnesium and potassium which have been found to reduce blood pressure. (Ard,JD., Coffman,CJ., Lin,PH., Svetkey,LP, 2004, `One-year follow-up study of blood pressure and dietary patterns in dietary approaches to stop hypertension (DASH)-sodium participants’, American Journal of hypertension, vol.17, no.12 pt 1, pp. 1156-62)

24. In this report on non-pharmacologic therapy it was reported that: • Nondrug therapy of hypertension really does work but requires strong motivation by both patient and physician. • In addition to global health benefits, prescription of weight loss, exercise, moderation of salt and alcohol intake, Dietary Approach to Stop Hypertension (DASH) eating plan, and tobacco avoidance can decrease the risk for normotensive and prehypertensive patients of developing fixed hypertension.

25. Initiating and maintaining a healthy lifestyle may be sufficient to avoid pharmacologic therapy for some patients and is a valuable adjunct to drug therapy for most. • Blood pressure lowering can be achieved by weight reduction (5-20 mm Hg/10 kg), DASH eating plan (8-14 mm Hg), dietary sodium reduction (2-8 mm Hg), increased physical activity (4-9 mm Hg), and moderation of alcohol consumption (2-4 mm Hg). • Cessation of tobacco abuse not only has global health benefits, but may reduce blood pressure. (Teiada,T., Fornoni,A., Lenz,O., Materson,BJ. 2006, `Nonpharmacologic therapy for hypertension: does it really work?’, Current Cardiology Reports, vol.8, no.6, pp.418-24)

26. TREATMENT PROTOCOL • Peripheral vasodilators • Crataegus spp (Page193) • Crataegus reinforces the positive action of cardiac glycosides without an increase in glycoside activity. Early research exist which demonstrates that a combination of Cratageus with digoxin improves glycoside effectiveness and tolerance in heart failure. However more recent research has found that there is no interaction.

27. Similarities in therapeutic indications between hawthorn and cardioactive drugs have led to conclusions about the toxicity of hawthorn resulting from its cardioactive glycosides being similar to digoxins. However, hawthorn contains no cardioactive glycosides. The principle active components are flavonoids. No drug–herb interaction has been reported in animal and human trials. (Walker,A., Marakis, G, Simpson, E et al, 2006, Hypotensive effects of Hawthorn for patients with diabetes taking prescription drugs, British Journal of General Practice, 56(527): 437–443)

28. Tilia spp • peripheral vasodilator and nervous relaxant • tonic to the vessel walls • Alliumsativa • only mild hypotensive but lowers other cardiovascular risk factors significantly • This systematic review and meta-analysis suggests that garlic preparations are superior to placebo in reducing blood pressure in individuals with hypertension.

29. Most studies included in this review used garlic powder dosages of 600–900 mg per day, providing potentially 3.6–5.4 mg of allicin, the active compound in garlic. In comparison, fresh garlic cloves (~2 g) each yield 5–9 mg allicin • However, different garlic preparations have variable effectiveness on blood pressure, e.g. Minimal allicin compounds are found in aged garlic extract or heat treated garlic, which may limit its hypotensive properties. (Ried, K, Frank, O, Stocks, N. 2008, Effect of garlic on blood pressure: A systematic review and meta-analysis, BMC Cardiovascular Disorders, vol. 8, no. 13)

30. S-Allyl-L-cysteine (SAC), an active organosulfur compound derived from garlic, was found to reduce mortality with lesser incidence of stroke and also to lower the overall stroke-related behavioural score in stroke-prone spontaneously hypertensive (SHRSP) rats by dietary administration. Consequently, the anti-stroke effect of dietary SAC was demonstrated in SHRSP rats. (Kim,JM., Chang,N., Kim,WK., Chun,HS. 2006, `Dietary S-allyl-L-cysteine reduces mortality with decreased incidence of stroke and behavioral changes in stroke-prone spontaneously hypertensive rats’, Bioscience, biotechnology and biochemistry, vol,70. no,8, pp.1979-81)

31. Cardiotonics / cardioprotectives • Leonuriscardiaca: • relaxant, tonic, especially useful in palpitations and for any cardiovascular disease related to nervous tension • when they feel the emotions in the heart

32. Cratageus spp. • Clinical trials of hawthorn in patients with congestive heart failure (CHF) have often reported secondary outcomes involving cardiac rhythm. In one large open trial (n = 3664), hawthorn was found to be particularly useful in patients who had CHF with tachycardiac arrhythmias. (Schmidt U, Albrecht M, Podzuweit H, et al. High dosage therapy with Crataegus extract in patients suffering from heart failure NYHA class I and II [in German]. Z Phytother1998;19:22–30.

33. Salvia Miltiorriza • Improves coronary blood flow, activating collateral coronary circulation • Caffeic acid derivatives occur as major water-soluble components of Salvia miltiorrhiza and has biological activities that include antioxidant, anti-ischemia, anti-thrombosis, anti-hypertension, anti-fibrosis, antivirus and antitumor. (Jiang,RW., Lau,KM., Hon,PM., MAk,TC., Woo,KS., Fung,KP. 2005, `Chemistry and biological activities of caffeic acid derivatives from Salvia miltiorrhiza’, Current Medicinal Chemistry, vol.12, no.2, pp.237-46)

34. Blood vessel relaxants / vasodilators • Oleaeuropa • Contains bitter principles and Oleuropein which is responsible for hypotensive action which is due to peripheral vasodilation. • It is antispasmodic to coronary arteries

35. Valerianaofficinalis • Page 192

36. Viburnum opulus • Relaxes arteriolar smooth muscle and thereby has a vasodilator effect • Helps to stop the transfer of nervous tension to the viscera

37. Reduce cardiovascular risk factors • Lowering platelets to reduce the risk of stroke • Lipid modifications like lowering LDL and VLDL and raising HDLs • Curcuma longa • Curcuma has hypotensive and protective effects on the endothelium in hypertensive rats. (Goto,H., Sasaki,Y., Fushimi,H., Shibahara,N., Shimada,Y., Komatsu,K. 2005, `Effect of curcuma herbs on vasomotion and hemorheology in spontaneously hypertensive rat’, American Journal of Chinese Medicine, vol.33, no.3, pp. 449-57)

38. Curcuminshowed an obvious hypocholesterolemic effect that could be due to an effect on cholesterol absorption, degradation or elimination, but not due to an anti-oxidant mechanism. (Arafa,HM. 2005, `Curcumin attenuates diet-induced hypercholesterolemia in rats’, Medical Science Monitor, vol.11, no.7, pp.BR228-234)

39. Adaptogens to deal with the biological reaction to stress • Bupleurumfalcatum • Rehmanniaglutinosa • Withaniasomnifera: • Eleutherococcussenticosus • Liver herbs and cholagogues • Bupleurumfalcatum: • Cynarascolymus • Salvia miltiorrhiza • Taraxacum officinalis radix

40. Recovery after stroke • Page 195

41. HYPOTENSION

42. SIGNS AND SYMPTOMS • Some people with low blood pressure are in peak physical condition with strong cardiovascular systems and a reduced risk of heart attack and stroke. For these people, low blood pressure, rather than being a cause for concern, is a positive.

43. But low blood pressure can also signal an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as: • Dizziness or light-headedness • Fainting (syncope) • Lack of concentration • Blurred vision • Nausea • Cold, clammy, pale skin • Rapid, shallow breathing • Fatigue • Depression • Thirst

44. CAUSES • Pregnancy • As a result of the expansion of the circulatory system • During the first 24 weeks, systolic blood pressure commonly drops by 5 to 10 points and diastolic pressure by as much as 10 to 15 points • Heart problems • A low heart rate (bradycardia) • Heart valve problems • Heart attack • Heart failure

45. Medications • Diuretics and some drugs that are used for hypertension can cause hypotension • Tricyclic antidepressants • Narcotics • Alcohol • Some over-the-counter products used in combination with high blood pressure drugs can lead to hypotension

46. Endocrine problems • Hypothyroid or hyperthyroid • Adrenal insufficiency (Addison’s Disease) • Low blood sugar • Blood loss • A significant blood loss from major trauma or severe internal bleeding reduces blood volume leading to a severe drop in blood pressure

47. Dehydration • Fever, vomiting, severe diarrhoea, overuse of diuretics, and strenuous exercise • Even mild dehydration, a loss of as little as 1 – 2% of body weight can cause weakness, dizziness and fatigue • Severe infection • Can occur when bacteria leave the original site of infection and enter the bloodstream • The bacteria then produce toxins that enter the blood vessels, leading to a major drop in blood pressure

48. Postural (orthostatic) hypotension • A sudden decrease in systolic pressure, usually at least 20mmHg, when you stand up from a sitting or prone position • Allergic reaction (anaphylaxis) • Can occur when a person has severe reaction to drugs such s penicillin, to certain foods such as peanuts, or to bee or wasp stings

49. TREATMENT PROTOCOL • Circulatory stimulants • Cayenne • Zanthoxylum clava-herculis • Cinnamomumzeylanicum • Ginkgo biloba • Rosmarinusofficinalis • Oxygenation and nourishment of brain tissue • Ginkgo biloba • Urticadioica folia

50. Circulatory tonics • Panax ginseng • Herbs to increase blood pressure • Glycyrrhizaglabra • Adrenal trophorestoratives • Rehmanniaglutinosa • Glycyrrhizaglabra