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Cardiovascular Disease

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... associated with increased risk of coronary artery disease and heart attack. ... As chiropractors we are NOT 'authorized' to treat heart disease. Pain Relief ... – PowerPoint PPT presentation

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Title: Cardiovascular Disease


1
Cardiovascular Disease
2
Hyperlipidemia
  • Elevated Cholesterol
  • Poor Cardiac Risk Ratio
  • Elevated Triglyceride

3
Elevated Cholesterol
  • Elevated Low Density Lipoprotein
  • Low Density Lipoprotein carries cholesterol from
    the liver to the periphery. This lipoprotein is
    most closely associated with increased risk of
    coronary artery disease and heart attack.

4
LDL
  • It is now thought prudent to maintain LDL levels
    of 130 mg/dl or lower.
  • HDL levels of 35 mg/dl or greater are desirable.
  • Total cholesterol to HDL ratio should be 41 or
    less, i.e.(Total Cholesterol 200, HDL 50).

5
High Density Lipoprotein
  • HDL carries cholesterol from periphery back to
    liver to be excreted or recycled.
  • High levels are favorable.
  • With sufficiently high HDL, a person can have a
    higher total cholesterol and still be protected
    against coronary artery disease.

6
High Triglycerides
  • The combination of high LDL and high
    trigylcerides is the most lethal
  • High triglycerides is related to sugar intake

7
Risk Factors for CAD
  • Age (male 45 female 55)
  • Family History
  • Cigarette Smoking
  • Hypertension 140/90
  • Low HDL
  • Diabetes Mellitus

8
Coronary Artery Disease
  • Following significant atherosclerotic
    accumulation in coronary arteries, symptoms will
    develop.
  • Angina pectoris is the chest pain associated with
    coronary artery disease

9
Angina
  • Chest pain of
  • Pain is brought on by exertion and relieved by
    rest
  • Can be described as sharp and stabbing or
    pressure-like and squeezing
  • Not all persons with CAD have this symptom

10
Angina (continued)
  • If blockage exists in the absence of angina it is
    termed silent ischemia.
  • The pain of angina is due to lactic acid build up
    in ventricles as a result of poor oxygenation due
    to blocked vascular supply of nutrients to heart
    muscle.

11
Stable Angina
  • The previously described angina is called stable
    or simple angina.

12
Pre-infarction Angina
  • There is another form called unstable angina or
    pre-infarction angina.
  • It can occur at any time (even at rest or during
    the night)
  • Denotes worsening of narrowed arteries
  • I.E. Pre-Infarction

13
Prinzmetal Variant
  • A third type is due to vasospasm, called
    prinzmetal variant.
  • This is related closely to stress
  • There may be little or no coronary artery
    occlusion
  • There may be superimposed CAD

14
Angina
  • May be improved with Vitamin E supplementation
  • Do NOT tell the patient this!
  • Just recommend the E and see what happens
  • As chiropractors we are NOT authorized to treat
    heart disease.

15
Pain Relief
  • Mechanism of pain relief offered by Vitamin E
    supplementation is that Vitamin E acts as an
    anti-platelet aggregation factor
  • Platelets that aggregate form small clots,
    blocking arterioles, causing ischemia

16
B-6
  • Supplemental Vitamin B-6 lowers levels of
    homocystine. Homocystine is a major cause of
    atherosclerotic plaque formation

17
Coenzyme Q-10
  • Beneficial nutrient for heart muscle
  • Administration following heart attack improves
    recovery and is related to reduced repeat attacks
  • Maintenance with Co-Q-10 thought to be preventive
  • Widely used in Europe

18
Copper
  • Trace amounts of copper needed for all elastic
    tissue.
  • Relevant to aortic disease

19
Vitamin C
  • The antioxidant role of C is beneficial in
    preventing atherosclerosis and in preventing
    already existing disease from progressing.
  • Collagen component keeps vessels healthy

20
Multiple Minerals
  • A good balance of minerals play a role in
    electrolyte balance and benefits heart
    performance.

21
Other Recommendations
  • Exercise on a regular basis
  • Weight Loss
  • Prevent glucose intolerance
  • Stress Reduction
  • PMA

22
Nutritional Help
  • Dont attempt or claim to help CAD with
    nutritional intervention
  • However
  • With proper counseling, however, pain relief may
    be a realistic goal.

23
Myocardial Infarction
  • Without intervention eventually the ischemia will
    become necrosis
  • This is an M.I.
  • There are varying degrees of intensity of M.I.s,
    from silent to immediate death.

24
Signs Symptoms
  • A list of signs and symptoms is useful, but
    remember not every patient has any or all of
    these SSs.
  • Retrosternal chest pain (squeezing pressure
    or intense pain)
  • MAY radiate to arm (often left), shoulder (often
    left) neck or jaw

25
SS (Continued)
  • Levines Sign (fist over heart)
  • Dyspnea
  • Anxiety
  • Nausea Vomiting
  • Diaphoresis
  • Orthopnea

26
SS (continued)
  • May have been preceded by angina.
  • Females often have only extreme fatigue as
    precursor

27
Exam Findings M.I.
  • Elevated jugular pulse
  • Increased heart rate
  • May have faint heart sounds
  • S3 and/or S4
  • Increased breath sounds
  • Blood pressure MAY lower
  • Fever (after 24 hours)

28
M.I.
  • If M.I. Diagnosed or Suspected
  • Transfer patient to hospital via ambulance.
  • Immediately call ambulance
  • Keep patient quite and comfortable
  • If family member present suggest an aspirin
  • Do NOT adjust (unless requested or close friend
    or family)

29
Lab Values
  • CPK Myocardial Band (earliest sign)
  • LDH
  • SGOT
  • ESR (latest and longest lasting)
  • WBC elevation

30
CPK
  • Used to monitor progress or number of attacks
  • Raises within 4-6 hours and returns to normal
    within 3 days (failure denotes repeated attacks)

31
ECG
  • Not appreciably predictive
  • Not necessarily correlated with clinical
  • Characteristics
  • Elevated S-T segment
  • Abnormal Q wave
  • T-wave inversion

32
Differentials
  • Acute pericarditis
  • Fever precedes pain
  • Pleuritic pain
  • Pain relieved positionally
  • Friction rub
  • No ECG changes
  • SGOT LDH normal

33
Differentials
  • Pulmonary Embolism
  • Dyspnea more severe
  • Recent surgical procedure or bedridden
  • No history of angina
  • Cardiac findings may be similar however, PE
    must be transferred via ambulance as well.

34
Aortic Dissection
  • Younger patient
  • May have collagen disease or Marfans
  • History of hypertension
  • Stroke-like symptoms may accompany
  • Must be transferred via ambulance anyway

35
Recommendations
  • Coronary Artery Disease improves with
  • Weight Loss
  • Regular Exercise
  • Stress Reduction
  • Positive Mental Attitude
  • Anecdotal evidence of help through adjustments

36
Other Cardiovascular Conditions
  • Aortic Dissection

37
Aortic Dissection
  • A false channel is forged in aorta and blood
    travels down this false channel. Can be a lengthy
    dissection into abdomen or a rather small
    dissection exits lumen and re-enters in a
    relatively small area.

38
Aortic Dissection
  • A rare and often fatal condition
  • Approximately 2000 cases in U.S. per year
    (although with better diagnosis this number is
    rising)
  • Associated with hypertension
  • Associated with aortic valve disease

39
Signs Symptoms
  • Sudden, severe retrosternal chest pain
  • May faint or have paresis
  • If arterial branches cut off, may suffer organ
    failure
  • If brain loses blood supply, stroke symptoms
  • May extend into abdomen with symptoms

40
Treatment
  • Emergency medical treatment necessary
  • Transfer via ambulance
  • Need immediate lowering of blood pressure
  • Surgery sometimes required, but poor prognosis
  • Generally a younger person than in M.I.
  • Smokers are more prone

41
Non-dissecting Aneurysms
  • Abdominal aorta is most common
  • Other vessels may have, especially popliteal
  • In brain, often called berry aneurysm

42
Abdominal Aneurysm
  • Very common condition
  • In men over 65 years old
  • Especially in smokers
  • Especially in obese
  • Often diagnosed as an incidental finding on
    abdominal radiograph
  • Lateral film most likely to demonstrate

43
Signs Symptoms
  • Often is asymptomatic
  • May see as pulsating mass
  • May have abdominal bruit upon auscultation
  • Aortic pulsations may palpate as wider than normal

44
Chiropractic Treatment
  • Should plan to alter techniques used to prevent
    damages
  • Refer for diagnostic ultrasound (for evaluation)
  • Often surgery is performed, unless a poor risk
    then may watchit
  • DC better watch it too!

45
Techniques
  • No abdominal suspension
  • No lumbar rolls
  • Padding for prone lying
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