Health Psychology

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Health Psychology

• Chronic illness part 2 Coronary Heart Disease
• PY 470 Hudiburg

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Information about CVD and CHD

• Disorders of the heart and blood vessel system is
  called cardiovascular disease (CVD) about 61
  million American suffer from some type. It is a
  leading killer in the U.S. about 950,000 deaths
  (CDC, 2004), which amounts to one death every 33
  seconds. Alabama is in the highest mortality
  group. The good news is that mortality rates have
  been decreasing since 1960 (525 to 375 per
  100,000)
• Coronary heart disease is a chronic illness in
  which the arteries become narrowed or clogged.
• Coronary heart disease is a leading cause of
  premature, permanent disability among working
  adults.
• Stroke alone accounts for the disability of more
  than 1 million Americans.
• Almost 6 million hospitalizations each year are
  due to cardiovascular disease.
• More prevalent in men ages 25-40 yet more deadly
  in women. This is apparent after age 50, when
  mortality rate from CVD accelerates compared to
  breast cancer (10 times at 65, 15 times at 75, 25
  times at 80)
• African American have greater risk for
  hypertension, coronary artery disease, CHD, and
  highest rate of CVD death
• Hispanic and Native American women have higher
  prevalence of diabetes due to obesity which is a
  controllable risk factor that leads to CVD
• Because a womans heart and blood vessels are
  typically smaller, less plaque is needed for
  blockage

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Death rates for leading causes of death for all
ages United States, 1950-2002 - CDC
All causes
Heart Disease
Cancer
Stroke
Unintentional injuries
CLRD
Year
1950
1960
1970
1980
1985
1990
1995
2002
NOTES Rates are age adjusted. Causes of death
shown are the five leading causes of death for
all ages in 2002. CLRD is chronic lower
respiratory diseases. Starting in 1999, data were
coded according to ICD-10. See Data Table for
data points graphed and additional notes.
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Vital Statistics System.
Centers for Disease Control and Prevention,
National Center for Health Statistics. Health,
United States, 2004
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Heart Disease Death Rates, 19962000 (latest from
CDC)Adults Ages 35 Years and Older, by County
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Anatomy Of The Heart

• The heart is made up of 4 chambers
• Right and Left Atriums
• Right and Left Ventricles
• Tricuspid, Bicuspid, Aortic Valves
• The septum divides the heart into right and left
  sides
• It is a muscular organ about the size of a mans
  fist
• The heart beats 100,000X/day at_at_ 72 BPM

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Vascular System

• The vascular system is comprised of 60,000 miles
  of blood vessels
• Aorta
• Arteries
• Arterioles
• Vena Cava
• Veins
• Venules
• Capillaries

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Coronary Arteries
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Some Disorders of the Cardiovascular System (CVS)

• Atherosclerosis
• Angina Pectoris
• Myocardial Infarction (MI)
• Stroke
• Congestive Heart Failure
• Peripheral artery disease
• Hypertension

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Hyperlipidemia

• High saturated fat in the blood
• Cholesterol is a fat produced in the liver or
  small intestine and should remain below 200
  (milligrams/deciliter) in the blood count
• It is necessary in the manufacture of hormones
  and nerve cell lining
• Triglycerides are components of lipoproteins
• Low density lipoproteins (LDL)
• Very low density lipoproteins (VLDL)

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Atherosclerosis

• Chronic inflammatory disorder of intima of large
  blood vessels characterized by formation of fibro
  fatty plaques called atheroma.
• Artery break down due to clogging
• Clogging is due to excess plaque
• Saturated fats penetrate arterial wall
• Muscle elasticity of the lumen degenerates
• Cholesterol and triglycerides are also
  responsible for the destruction of the artery
• Arteriosclerosis is the hardening of the artery
  due to atherosclerosis and the damage is
  irreversible

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Risk Factors Atherosclerosis

• Non modifiable
• Age middle to late.
• Sex Males, complications
• Genetic - Hypercholesterolemia
• Family history.

• Potentially Modifiable
• Hyperlipidemia HDL/LDL ratio
• Hypertension
• Smoking
• Diabetes
• Life style, diet, exercise

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Risk Factors Cholesterol

• Blood Lipid Fraction Desirable Borderline
  High
• LDL Cholesterol (mg/dl) lt130 130-159
  gt160
• Total Cholesterol (mg/dl) lt200 200-239
  gt240
• Triglycerides (Fasting mg/dl) lt200 200-400
  gt400
• VLDL (estimated Trig/5) lt40 40-80
  gt80
• LDLHDL ratio gt 5.0 indicates risk for men
• gt 4.5 indicates risk for women

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Good vs. BAD cholesterol

• LDL is known as bad cholesterol. It has a
  tendency to increase risk of CHD.
• LDLs are a major component of the
  atherosclerotic plaque that clogs arteries.
• Levels should be lt130, but
• Begin treatment LDL Cholesterol (mg/dl)
• With CHD gt100
• Without CHD one risk factor gt160
• Without CHD gt 2 risk factors gt130

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Good vs. BAD cholesterol

• HDL is known as the good cholesterol.
• It helps carry some of the bad cholesterol out of
  the body.
• It does not have the tendency to clog arteries.
• Levels should be gt35.
• High levels of HDL gt60 can actually negate one
  other risk factor.
• VLDL used to transport triglycerides bad gt80

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Pathogenesis Atherosclerosis

• Unknown etiology Hyperlipidemia, life style,
  hypertension, smoking, genetic, etc.
• Starts with Initial intimal injury,
  inflammation, necrosis, Lipid accumulation,
  Fibrosis - Atheroma.
• Leads to Obstruction or destruction of vessel
• Organ damage due to ischemia
• Complications - Thrombosis, embolism, aneurism,
  dissection and rupture

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Common Sites Atherosclerosis

• Aorta, Carotid and Iliac (large vessels)
• Major Vessels - Heart, Brain Kidney
• Coronary
• Renal
• Abdominal
• Limbs

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Morphology Atherosclerosis

• Fatty Dots
• Fatty Streaks
• Atheromatous Soft Plaque
• Fibrofatty Hard Plaque
• Complications
• Ulceration, Rupture, Hemorrhage, Thrombosis
• Atheroemboli or cholesterol emboli.

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Atherosclerosis
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Stages of Atheroma - Aorta
Stage VI III II
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Atheroma Coronary Artery
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Atherosclerosis - complications
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Angina pectoris

• Angina is Greek for to strangle or mild
  clamping ache to crushing pain in chest
• It is a cluster of symptoms associated with O2
  depravation
• This is also an ischemia which is lack of O2 rich
  blood to the heart muscle
• It is not an Heart Attack but could be a warning
  of CVD
• Pain subsides once O2 is replenished to muscle
• May be mistaken for heartburn, gastric disorders,
  asthma, allergies and bronchitis
• Nitroglycerin is the medication given because it
  is a vasodilator

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Myocardial Infarction (MI)

• An embolism lodged in the coronary artery
• Causes an occlusion and O2 cannot reach the heart
  muscle
• Pain in the chest is severe and crushing and
  cannot be helped by drugs
• Section of heart muscle dies due to lack of O2 or
  ischemia
• Heart Attack or cardiac arrest is the result
• An MI is more lethal to women than men

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Myocardial Infarction
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2 weeks - Myocardial Infarction
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Myocardial Infarction - Rupture
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Stroke

• Cerebrovascular accident or stroke
• Blood vessel damage caused by aneurysm, thrombus,
  or embolus which is a traveling blood clot
• Hypertension or a congenital defect can also
  cause damage
• Depending on what part of the brain that is
  blocked will determine whether speech, memory,
  thought, or movement are affected or lost
• TIAs transient ischemic attacks are minute
  strokes that are a warning sign that a stroke is
  eminent
• Prevalent in white women over 45 Afro.Am. Women
  over 35 and 60 of all stroke deaths are women
• Stroke mortality rates have decreased from 623.8
  to 404.1 deaths per 100,000 from 1981 to 2001 in
  the U.S.

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Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
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Congestive Heart Failure (CHF)

• Heart too weak to pump and circulate blood
• CHF represents a heart whose muscles are weak and
  flabby
• Poor circulation causes fluids to accumulate in
  veins
• Breathing problems result from too much fluid in
  the lungs
• Kidneys are impacted causing swelling in the
  extremities
• CHF is common in older women who suffer from HBP,
  Atherosclerosis, arteriosclerosis, or Congenital
  HD
• Heart damage from Rheumatic Fever and bacterial
  diseases, HA(damage scar tissue)
• Symptoms include shortness of breath, dyspnea,
  edema

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Peripheral Artery Disease

• Disease of the extremities mostly of the legs
• Diminished supply of blood to extremities due to
  atherosclerosis, arteriosclerosis, diabetes,
  smoking, or HBP
• Clogging results in waste products not being
  properly eliminated from the body
• Nutrients are not delivered to the cells
• Cramping, numbness, and necrosis of the tissues
  could result in amputation

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Silent Ischemia

• Cerebrovascular Disease (CVD) has not
  historically been considered a womans disease
  only a mans disease
• Medical research has never focused on women and
  CVD
• Mainly because older women suffer from other
  complicated medical problems
• Silent heart attacks can occur to women without
  any of the regular symptoms
• Women are at greater risk from silent heart
  attacks
• Women may have unspecified pain and a physician
  usually never suspects a heart attack

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Hypertension High Blood Pressure

• Blood Pressure measured as systolic/diastolic
• systolic the pressure while the heart contracts
  to pump blood to the body
• diastolic the pressure when the heart relaxes
  between beats
• measured in millimeters of mercury
• Below 120/80 is optimal, 120-139/80-89 is
  pre-hypertension
• 140/90 is essential hypertension
• Among Americans age 20 and older, the following
  have HBP
• For whites only, 30.6 percent of men and 31.0
  percent of women.
• For blacks 41.8 percent of men and 45.4 percent
  of women.
• For Mexican Americans, 27.8 percent of men and
  28.7 percent of women.
• From 1994 to 2004 the death rate from HBP
  increased 25.2 percent, 54,186 people died from
  hypertension in 2004.
• The 2004 overall death rate from HBP was
  17.1/100,000. Death rates were
• 15.6 for white males. (14.4 in 2002)
• 14.3 for white females. (13.7 in 2002)
• 49.9 for black males. (49.6 in 2002)
• 40.6 for black females. (40.5 in 2002)

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What factors contribute to coronary heart disease?

• Risk factors gender, ethnicity, SES factors
• How do psychological factors contribute to
  coronary heart disease?
• Stress excessive wear and tear on the CVS,
  possible stress from racial discrimination
  (Kreiger Sidney, 1996)
• Behavioral choices smoking and alcohol use,
  smoking decreases the production of HDL
  cholesterol. Other behaviors contribute to
  hypertension. Ones level of LDL cholesterol at
  age 22 is a good predictor of likelihood of
  experience CHD or stroke and age of death (Klag
  et al., 1993)
• Personality Type A? hostility level is a
  strong predictor of CHD based on several studies.
  Other traits associated with CHD anxiety,
  depression, pessimism, and neuroticism has
  reported in several studies.
• How can psychological interventions help reduce
  the risk of reoccurring heart attacks?
• Change health-related behaviors eating high fat
  foods, lack of exercise, coping with stress,
  changing Type A behaviors
• Sustained reduction of total cholesterol of 1 is
  associated with a 2-3 reduction in the incidence
  of coronary heart disease.