Understanding the Cardiovascular System Chapter 4 Refers to Heart – Lung Functioning

1
Understanding the Cardiovascular SystemChapter
4Refers to Heart Lung Functioning
2
Sub-Components of the Cardio-respiratory System

• Heart
• Blood
• Blood Vessels
• Lungs

3
Function of Cardio-Respiratory Systems

• Primarily to
• Transport and exchange gases(O2 and CO2)
• Deliver nutrients to cells
• Deliver hormones and nutrients
• Removes waste
• Balance fluids
• Temperature regulation

4
Anatomical Considerations of the Heart

• Size of a closed fist
• Located in the mediastium of the chest cavity

5
Basics 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

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Basics Of Heart Anatomy 2

• By being divided into right and left sides, the
  heart is able to serve two systems
• Pulmonary
• Systemic
• Explanation of basic blood flow

7
Cardiovascular Disease

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

8
Cardiovascular Disease

• 1 million deaths each year
• 330 billion dollars

9
Cardiovascular Disease

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

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Cardiovascular 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)

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Forms of Cardiovascular Disease(Often
preventable and lifestyle 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

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Coronary Artery Disease (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

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Clear Coronary Arteries
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Cardiovascular 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

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Cardiovascular Procedures

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

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CAD Post-Op Patient

• What behavioral and dietary changes are
  suggested for the patient?

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Can One Be FIT But Not Healthy?

• Personal profile example
• Run 3 miles daily
• Lift weights
• Stretching exercises
• Smokes, stress, excessive alcohol, fatty foods,
  drugs, etc.

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Jim 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

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Coronary 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.

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Primary Risk Factors (Alterable)

• Smoking
• Hypertension (high blood pressure)
• High serum cholesterol (hyperlipidemia)
• Physical inactivity
• Diabetes mellitus
• Obesity
• (drug use)

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Secondary Risk Factors

• Stress
• Age
• Gender (male vs. female)
• Family history

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Are Arkansans at Risk for these Health Problems?

• ?

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Arkansas Stats from the Center for Disease
Control/Mortality Rates

• Males 2 in deaths from CAD
• Males 2 in deaths from lung cancer
• Males and Females 1 in deaths from stroke

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Additional 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

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Examining CAD Risk Factors (Primary followed by
Secondary)
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Smoking 1

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

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Smoking 2

• 400,000 related deaths per year
• gt50 billion
• Cancer, heart disease, respiratory diseases
  (emphysema)
• Cigarette smoking and passive smoke inhalation
  are highly related to CAD.

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Smoking 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

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Secondary Smoke

• 53,000 annual deaths
• For each pack of cigarettes smoked, the non
  smoker, sharing the same air, will inhale the
  equivalent of 3 to 5 cigarettes.

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Smokeless Tobacco

• Chewing tobacco
• Overheads

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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

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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

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Hypertension / High Blood Pressure

• Blood Pressure
• The driving force that moves blood throughout
  the body.
• The pressure exerted by the blood on the walls of
  the arteries.

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Blood 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

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Systolic Blood Pressure 120/80

• The highest pressure or value
• Occurs during heart contraction phase
  (ventricular contraction)

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Diastolic Blood Pressure 120/80

• The lowest pressure or value
• Occurs during heart relaxation phase (resting or
  refilling stage of the contraction)

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Hypertension (High Blood 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

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Hypertension 2

• Related to stroke / aneurysms
• Hypertension may be the result of another health
  problem

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Factors Affecting Blood Pressure

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

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Impact of Hypertension

• 25 or 50 million Americans are hypertensive
• 67 are not treated
• 1/2 are unaware of the complication

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Factors Contributing To Hypertension

• Age
• Race
• Sodium sensitivity
• Chronic alcohol abuse
• Oral contraceptives
• Sedentary living

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Lifestyle Interventions to Maintain or Lower
Blood Pressure

• Body weight reduction or maintenance
• Smoking cessation

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How To Lower Blood Pressure

• Aerobic exercise
• Reduce stress
• Reduce cholesterol, sodium, high fat diet
  (saturated)
• Medications

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Hyperlipidema / High Serum Cholesterol

• 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

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Cholesterol 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

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What Is So Bad About Having High Cholesterol
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)

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More About Plaque

• Affects all of us
• May begin as early as 10 years of age
• May be genetic
• Medications??

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Types of Lipoproteins / Types of Cholesterol

• LDL
• HDL
• VLDL

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LDL

• 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

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HDL

• 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

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VLDL

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

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Cholesterol Information

• Dietary Cholesterol
• Refers to foods high in cholesterol
• Example
• Shrimp
• High in cholesterol
• Low in fat

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Cholesterol Information

• Saturated fats
• Can significantly raise LDL levels (bad
  cholesterol) and total serum cholesterol levels
• Found in animal sources and by products

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Cholesterol Information

• 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

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Serum Cholesterol Levels

• Desirable below 200
• Borderline high 200-239
• Risk for CVD 240 or gt
• Some guidelines call for desirable to be 170

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High Serum Cholesterol 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

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Understanding Total Serum Cholesterol Values

• Knowing an individuals total cholesterol is not
  always adequate when determining coronary risk

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Understanding Cholesterol Ratios

• Determine the ratio of total cholesterol to HDLs
• 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

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Cholesterol Value Examples

• Male
• TC 210 HDL 32
• Divide 210 by 32 6.56
• 6.56 1 ratio
• Ratio is gt5.0
• Increased risk of CAD

• Male
• TC 220 HDL 49
• Divide 220 by 49 4.49
• 4.49 1 ratio
• Ratio is lt5.0
• Low risk of CAD

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Cholesterol Value Examples

• Female
• TC 195 HDL 36
• Divide 195 by 36 5.42
• 5.42 1 ratio
• Ratio is gt4.5
• Increased risk of CAD

• Female
• TC 195 HDL 40
• Divide 195 by 40 4.9
• 4.9 1 ratio
• Ratio is gt 4.5
• Increased risk of CAD

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Cholesterol Value Actual Example

• Female
• TC 207 HDL 74
• 207 divided by 74 2.8
• 2.8 1 ratio
• lt 4.5
• Very low risk CAD

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How To Control Or Lower Cholesterol

• Avoid saturated fats
• fats from animal sources
• red meats
• animal fats
• animal by-products

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Controlling 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

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Controlling Cholesterol 3

• Eat fish 2-3 times per week
• Bake, broil, steam
• Remove excess fat (soup, chili)
• Is ground turkey better?

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Controlling 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

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Take Care Of Your Kitchen Disposal
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Physical Inactivity

• Physical activity levels and CAD are strongly
  inversely related.

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Physical Inactivity 2

• Sedentary individuals have
• 2-3 times greater risk of CAD than active
  individuals.
• Twice the risk of fatal heart attacks

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Physical Activity

• Physical activity is argumentably be the single
  best method of controlling or reducing CAD.
• Collateralization

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Physical Activity 2

• Increases strength of the heart
• Helps to establish and maintain normal blood
  pressure.
• Helps to control obesity due to increase in
  caloric expenditure

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Physical Activity 2

• Raises HDL levels, while lowering LDL,
  triglyceride and total cholesterol levels.
• Decreases resting heart rates
• Helps to manage stress levels

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Physical Activity 3

• Increases resting and exercising stroke volumes
• Amount of blood pumped by the heart in a single
  beat
• Reduces the risk of diabetes

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Diabetes Mellitus

• Arkansas ranks 11th in the prevalence of diabetes
• New trends
• Increased cases of Type 2 diabetes children
• Increase in adults in the 30s.

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Diabetes 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

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Blood 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

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Hypoglycemia

• 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

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Types of Diabetes

• Type I insulin dependent or juvenile onset
• Type II maturity or adult onset, usually
  non-insulin dependent
• Gestational onset

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Diabetes Mellitus Adult Onset

• The pancreas does not produce enough insulin or
  has just forgotten how
• Directly related to obesity
• 90 of all cases are Type II

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Adult Onset 2

• An 20 increase in body weight doubles the
  chances of developing diabetes
• Example
• Appropriate weight 160
• 20 weight gain 192

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How To Avoid Adult Onset Diabetes

• Control cholesterol
• Control weight
• Control blood pressure
• Exercise regularly (aerobic)
• Diabetics must plan for meals, insulin
  injections, and exercise

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Obesity

• 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

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Obesity 2

• 38 Arkansas school children overweight
• Young adult obesity can shorten life span by 5 to
  20 years

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Obesity Is Related To

• High cholesterol
• Hypertension / stroke
• Elevated LDL levels
• Lower HDL levels
• Physical Inactivity
• Diabetes
• Obesity is also related to joint problems

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Obesity 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

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Other Diseases Associated With 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

86
What Constitutes Obesity?

• BMI gt 25
• gt 20 lbs overweight
• Body fat percentages
• Men gt 20 (25)
• Women gt 25 (30)

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Secondary Risk Factors (Not alterable)

• Stress (secondary but is alterable to some
  degree)
• Age
• Gender
• Family History

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Stress

• Unmanaged stress is related to CAD.
• Type A personality is related to CAD.

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Age

• Men 45 and over
• Women 55 and over

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Family History Primary or 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

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Gender

• Men have a greater history of CAD earlier in
  life.
• CAD is a disease of equal opportunity

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New Information Homocysteine 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

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New Information

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

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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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Discuss Prescription

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