Understanding the Cardiovascular System

Sub-Components of the Cardio-respiratory System

HeartBloodBlood VesselsLungs

Function of Cardio-Respiratory Systems

Primarily to:Transport and exchange gases(O2 and CO2)Deliver nutrients to cells

Anatomical Considerations of the Heart

Size of a closed fistLocated in the mediastium of the chest cavity

Basics Of Heart Anatomy

It is a four chambered structureTwo upper chambers: atria or atriumTwo lower chambers: ventricles

It is divided into right and left sides by muscular tissue known as the septum

Basics Of Heart Anatomy #2

By being divided into right and left sides, the heart is able to serve two systems:

PulmonarySystemic

Blood Flow in the Heart

www.medicine.osu.edu/exam

The Circulatory System

Exchange of Gasses

Oxygen rich air is delivered to alveoli with inspirationOxygen diffuses into the bloodThe body does not use all of the inhaled oxygen

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.

Normal Blood Pressure

120/80120 is the systolic reading80 is the diastolic readingNEVER 80/120

Systolic Blood Pressure 120/80

The highest pressure or valueOccurs during heart contraction phase (ventricular contraction)

Diastolic Blood Pressure 120/80

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

Cardiovascular Disease

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

Cardiovascular Disease

1 million deaths each year275 billion dollars

Cardiovascular Disease

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

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)

Forms of Cardiovascular Disease

Coronary artery disease (CAD or CVD) Hypertension (high blood pressure)Cerebral vascular accidents (strokes)Angina pectorisPeripheral vascular disease

Forms of CVD #2

Valve diseaseRheumatic heart diseaseCongenital heart diseaseCongestive heart failure

Coronary Artery Disease (CAD)

Primary form of heart diseaseA disease involving waxy plaque build-up in the arteriesAtherosclerosis

Cardiovascular Disease

Has anyone in your family had bypass surgery?Blocked arteries?

Plaque build-upRelated to high cholesterol levels sustained over timeOccurs, primarily, in vessels closest to the heart

Surgical Procedures

Plaque ruptureBypass (7 yr.average)Angioplasty Roto Blade

CAD Post-Op Patient

What behavioral and dietary changes were suggested for the patient?

Can One Be FIT But Not Healthy?

Personal profile exampleRun 3 miles dailyLift weightsStretching exercisesSmokes, stress, excessive alcohol, fatty foods, drugs, etc.

Jim Fixx

36 years old, 215 pounds2 pack a day smokerNo regular exerciseFamily history of heart disease

father had a heart attack at 35, died at 43

Began to exercise at age 36Ran 60-80 miles per weekWas FIT but not HEALTHY

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.

Primary Risk Factors (Alterable)

SmokingHypertension (high blood pressure)High serum cholesterolPhysical inactivityDiabetes mellitusObesityFamily History?

Secondary Risk Factors

StressAgeGender (male vs. female)

Arkansas Stats from the Center for Disease Control/Mortality Rates

Males #2 in deaths from CADMales #2 in deaths from lung cancerMales and Females # 1 in deaths from stroke

Additional Ark. Stats

1/3 of deaths in AR related to CVD (l998)90% of adults report no vigorous activity36% do not engage in any physical activityArkansans are gaining weight 3 times faster than the rest of the nation

Examining CAD Risk Factors

(Primary followed by Secondary)

Smoking #1

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

Smoking #2

400,000 related deaths per year >$50 billionCancer, heart disease, respiratory diseases (emphysema)Cigarette smoking and passive smoke inhalation are highly related to CAD.

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, potPersonal economics of smoking

Secondary Smoke

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

Smokeless Tobacco

Chewing tobacco

Actions of Cigarette Smoke on the Body

Injures the inner lining of the arteriesIncreases the risk of blood clottingIncreases the risk of myocardial infarctionLowers HDL cholesterol

Hypertension (High Blood Pressure)

A silent killer140/90 : considered mild stage of hypertensionWhich is more problematic? 140/80 or 130/95Potentially leads to stroke

Hypertension #2

Related to stroke/aneurysmsHypertension may be the result of another health problem

Factors Affecting Blood Pressure

Hypertensive medicationsTime of dayFull bladder contentBody postureRecent intake of caffeineNicotineAlcoholRecent strenuous activity

Impact of Hypertension

25% or 50 million Americans are hypertensive67% are not treated1/2 are unaware of the complication

Factors Contributing To Hypertension

AgeRaceSodium sensitivityChronic alcohol abuseOral contraceptivesSedentary living

Lifestyle Interventions to Maintain or Lower Blood Pressure

Body weight reduction or maintenance Smoking cessation

How To Lower Blood Pressure

Aerobic exerciseReduce stressReduce cholesterol, sodium, high fat diet (saturated)Medications

Hyperlipidema/High Serum Cholesterol

Definition of CholesterolA type of lipid (fat) found in animal tissuesThis fat (Lipid) is insoluble in bloodIt binds to proteins (lipoproteins) in order to be transported in the body

Plant sources have no cholesterol

What Foods Do I Eat That Contain Cholesterol and Saturated Fat?

Primarily, animal products and by-productsA few plants contain saturated fat but no cholesterol

Tropical oils (palm, coconut)

What Are Some Foods That Contain Tropical Oils?

Commercially baked productsPopcorn at the movie

What Happens When I Eat Saturated Fat and Cholesterol Containing (Dietary Cholesterol) Foods?

The body takes in the cholesterolThe body takes in the saturated fat and makes increased amounts of “bad” cholesterol (LDL)Raises the body’s serum cholesterol level

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 is Coronary Artery Disease (CAD)

Tell Me More About Plaque

Affects all of us May begin as early as 10 years of ageMay be geneticMedications??

Cholesterol: 3 basic facts

Provides for basic functions of the metabolic processIs manufactured in the liver – non-essentialThe body makes additional cholesterol (LDL) from saturated fats

Lipoprotein Types or Cholesterol Types

LDLHDLVLDL

LDL

Low density lipoproteins (BAD)enhances plaque build up in the arteriesincreases with a diet high in saturated and trans-fatty acids (hydrogenated products)Undesirable, increases risk of CAD

HDL

High density lipoproteins (GOOD)Offers protection from CADMay remove plaque from the arteriesAerobic activity will raise HDL levelCan be raised by consuming small amounts of alcohol daily

VLDL

Very low density lipoproteins (VLDL)

undesirable and are associated with increase risk of CAD

Serum Cholesterol Levels

Desirable below 200Borderline high200-239Risk for CVD 240or >

High Serum Cholesterol #2

If your cholesterol is 250, your risk of heart attack is twice that of 200If your cholesterol is 300, your risk of heart attack is four times that of 200

Understanding Total Serum Cholesterol Values

Knowing an individual’s total cholesterol is not adequate when determining coronary risk

Understanding Cholesterol Ratios

Determine the ratio of total cholesterol to HDL’sFormula: TC/HDLExample: 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 risk4.0 = low riskUsually, if HDL is < 35, heart attack risk is indicated

Cholesterol Value Examples

MaleTC: 210 HDL: 32Divide 210 by 32 = 6.566.56 : 1 ratioRatio is >5.0Increased risk of CAD

MaleTC: 220 HDL: 49Divide 220 by 49 = 4.494.49 : 1 ratioRatio is <5.0 Low risk of CAD

Cholesterol Value Examples

FemaleTC: 195 HDL: 36Divide 195 by 36 = 5.425.42 : 1 ratioRatio is >4.5Increased risk of CAD

FemaleTC: 195 HDL: 40Divide 195 by 40 = 4.94.9 : 1 ratioRatio is > 4.5Increased risk of CAD

Cholesterol Value Actual Example

FemaleTC 207 HDL 74207 divided by 74= 2.82.8 : 1 ratio< 4.5Very low risk CAD

How To Control Or Lower Cholesterol

Avoid saturated fats

fats from animal sourcesred meatsanimal fatsanimal by-products

Controlling Cholesterol #2

Avoid dietary cholesterolExerciseConsume a low fat diet (20% or less)Watch egg consumptionLimit red meats (fewer than 3 times per week)Avoid commercially baked goods (tropical oils and trans-fatty acids/hydrogenation)Use skim milk

Controlling Cholesterol #3

Eat fish 2-3 times per weekBake, broil, steamRemove excess fat (soup, chili)

Is ground turkey better?

Controlling Cholesterol #4

Avoid fatty sauces (fettuccini alfredo)Substitute in recipes

Egg whites for eggsApplesauce for oil in cakesSalsa instead of butter for baked potatoesAre there substitutions you make?

Maintain proper body weight

Physical Inactivity

Physical activity levels and CAD are strongly inversely related.

Physical Inactivity #2

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

Physical Activity

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

Physical Activity #2

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

Physical Activity #2

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

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

Diabetes Mellitus

Arkansas ranks 11th in the prevalence of diabetesNew trends:

Increased cases of Type 2 diabetes childrenIncrease in adults in the 30’s.

Diabetes Mellitus

A condition in which glucose is unable to enter the cellsA disease associated with problems in controlling blood glucose or blood sugarThe disease results when the pancreas has problems producing insulin or the body can no longer use insulin properlyInsulin is the “taxi” that carries sugar from the blood to the cells

Blood Sugar Levels

Normal blood sugar levels: 65-110Hyperglycemia

High levels of blood sugarWhen sugar levels remain high, over time, it damages the walls of the vesselsLeads to impairment of the circulatory systemAffects functioning of most organsProblems healing (small cuts, amputations)Blindness

Hypoglycemia

Low levels of blood sugarIt is appropriate to give sugar to the diabetic in a hypoglycemic emergencySome may experience hypoglycemia but are not diabetic

protein is often recommended

Types of Diabetes

Type I: insulin dependent or juvenile onsetType II: maturity or adult onset, usually non-insulin dependentGestational onset

Diabetes Mellitus: Adult Onset

The pancreas does not produce enough insulin or has just forgotten howDirectly related to obesity90% of all cases are Type II

Adult Onset #2

An 20% increase in body weight doubles the chances of developing diabetesExample:

Appropriate weight = 16020% weight gain = 192

How To Avoid Adult Onset Diabetes

Control cholesterolControl weightControl blood pressureExercise regularly (aerobic)

Diabetics must plan for meals, insulin injections, and exercise

Obesity

61% Americans are overweight25% are obese

Obesity: Fat Distribution

“Apples” Android ObesityFat distributed in upper bodyHigher risk of CAD, strokes, diabetes

“Pears” Gynoid ObesityFat is distributed in the hips and legs

Obesity Is Related To:

High cholesterolHypertension / strokeElevated LDL levelsLower HDL levelsPhysical InactivityDiabetesObesity is also related to joint problems

Other Diseases Associated With Obesity

Renal diseaseGallbladder diseasePulmonary diseaseDegenerative arthritisPsychological problemsSome cancers

Post menopausal obese women 5 times more likely to develop uterine cancer

Problems administering anesthesia

What Constitutes Obesity?

BMI > 25> 20 lbs overweightBody fat percentages

Men > 20% (25)Women > 25% (30)

Secondary Risk Factors

StressAgeGender???Family History???

Stress:

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

Age:

Men : 45 and overWomen: 55 and over

menopausal women who do not take estrogen replacement therapy (2000 research contradicts this statement)

Family History: Primary or Secondary?

The risk is greater when: Father or other first degree relative has a MI or sudden death prior to 55Mother or another female family member has a MI or sudden death prior to 65Family history of diabetes, hypertension

Gender

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