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The Healthy Heart
The Healthy Heart
Chambers of the Heart
Right AtriumReceives blood
through the superior and
inferior vena cava.
Left VentriclePumps blood rich in
oxygen through the aorta to the arteries to nourish
the body systems.
Left AtriumReceives oxygenated blood from the lungs.
Right VentriclePumps blood in need of
oxygen to the lungs.
The Path Of Blood Flow
Oxygenation of blood in
alveoli capillaries
Death Rates for Cardiovascular Disease in the United States, 1940 & 2000
Women & Heart Disease• Coronary Vascular Disease:
– Coronary heart disease + Stroke• Misconception: Coronary vascular disease is not a
major problem for women– CVD = 493,000 female deaths– Breast cancer = 41,514 female deaths
• Lifetime risk of developing CVD after age 40:– Men: 49%– Women: 32%
• First among all disease categories in hospital discharges for women
• 40% of all female deaths in USA from CVD
Women & Heart Disease• Greater incidence in minority women• 38% of women compared to 25% of men will
die within one year post heart attack• Average age of first heart attack:
– Men: 65.8 y/o– Women: 70.4 y/o
• Incidence of hypertension is greater in men until age 55; after 55, incidence is higher in women
Development of Atherosclerosis
Fatty Streaks Develop on the Arterial Walls at Injury Spots
Growth and Hardening of Fatty Streaks
Plaque Formation (well developed by age 30)
Narrowing and Loss of Elasticity of the Arteries
Restriction of Blood Flow to the Heart or BrainLimited Oxygen Delivery to the Heart or Brain
Blood Pressure Elevation Blood Clot Formation and Thrombosis
Angina, Heart Attack and/or Stroke
The Atherosclerotic
Process
Atherosclerotic Plaque:Artery cross-section
Atherosclerotic plaque occluding an artery
Normal ArteryArterial Plaque
Unclogging The Arteries• Cholesterol-lowering drugs• Low-fat diet• Dean Ornish Diet (without medications)
– Very low-fat diet (8% of total daily calories)– Moderate exercise for 1 hour three times per week.– Stress counseling.– One hour of yoga, meditation, breathing, and
progressive relaxation per day.
Risk Factors for Cardiovascular Disease
Factors You Can Control• Physical Inactivity• Tobacco• Obesity• Hypertension• Hypercholesterolemia• Diabetes Mellitus• Stress• Homocysteine levels• Artery inflammation
Factors You Can’t Control• Heredity• Race and Ethnicity• Age• Gender• Bacterial Infection
Heart Healthy Benefits of Regular Physical Activity
• Reduction in body weight.• Reduction in blood pressure.• Reduction of LDL and total
cholesterol levels.• Increase in HDL cholesterol.• Increased insulin sensitivity.
Regular Physical ExerciseAmerican Heart Association,
AmericanCollege of Sports Medicine and the
CDC30 minutes or more of moderate-intensity physical activity on most,
if not all, days of the week.
Institute of Medicine60 minutes of daily physical activity to
counter the obesity epidemic.
Which of the following is NOT a heart benefit of regular exercise?
A. Reduction in blood pressure
B. Reduction of HDL and total cholesterol levels
C. Increased insulin sensitivity
D. Improved coronary artery circulation
Heart Healthy Nutrition
• Plenty of fruits and vegetables.• Cholesterol Lowering Foods:
– Oats, barley, soy protein, and nuts.• Fish 2 times a week (AHA).• Insufficient Evidence to Recommend For or
Against the Use of:– Supplements of vitamin A, C, or E.– Multivitamins with folic acid.– Antioxidant combinations.
Tobacco and Heart DiseaseHow Smoking Damages The Heart:• Nicotine overstimulates the heart.• Carbon monoxide reduce the oxygen supply to the
heart.• Tars and other smoke residues increase the risk of
cholesterol build-up in the arteries.• Smoking increases blood clotting.• Smoking causes irreversible damage to the arteries.• Second-hand smoke
Blood Pressure
Systolic Blood Pressure Pressure exerted by blood
against walls of the arteriesduring forceful contraction
of the heart.
Diastolic Blood PressurePressure exerted by blood
against the walls of the arteries during
relaxation of the heart.
Definition: A measure of the force exerted against the walls of the vessels by the blood flowing through them.
Sphygmomanometer &Stethoscope
Measuring Blood Pressure
Measurement of Blood Pressure
What Is a Healthy Blood Pressure?
120-139/80-90 mm Hg
140-159/90-99 mm HgHYPERTENSION
PREHYPERTENSION
115/75 mm HgHEALTHY READING
160+/100+ mm Hg
What are common symptoms of patients with
hypertension?
? ?
What is the most common symptom of someone who
has hypertension?
NONE• Hypertension is often called the
“Silent Killer”
Consequences of High Blood Pressure
Cross-section of an artery
Normal artery Hypertension
Preventing Hypertension• Lifestyle Changes
– Losing weight– Regular exercise– Dietary Approaches To Stop Hypertension (DASH
Diet)– Restriction of daily sodium intake
• Factors That Have Not Proven Effective– Dietary supplements such as calcium, magnesium,
potassium, and fish oil
Complications of hypertension involve all of the following organ systems except:
A. HeartB. KidneyC. EyeD. Peripheral arteriesE. BrainF. None of the above
Understanding Blood Lipids
Low Density Lipoprotein
(LDL)
Low Density Lipoprotein
(LDL)
Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol. Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol.
High Density Lipoprotein
(HDL)
High Density Lipoprotein
(HDL)
Very Low Density Lipoprotein
(VLDL)
Very Low Density Lipoprotein
(VLDL)
Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol. Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol.
The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream. The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream.
TriglyceridesTriglycerides Fats that flow through the blood after meals and have been linked to increased risk of coronary artery disease. Fats that flow through the blood after meals and have been linked to increased risk of coronary artery disease.
Serum Cholesterol GuidelinesAmount Rating
Total Cholesterol
<200 mg/dl200-239 mg/dl>240 mg/dl
DesirableBorderline HighHigh Risk
LDL Cholesterol Less than 100 mg/dl100-129 mg/dl130-159 mg/dl160-189 mg/dl190+ mg/dl
OptimalNear OptimalBorderline HighHighVery High
HDL cholesterol >45 mg/dl36-44 mg/dl<35 mg/dl
DesirableBorderline HighHigh Risk
Lowering Cholesterol
Therapeutic Life Changes:• Dietary changes• Weight loss• Physical activityMedications:
– Statins– Niacin
Acute Myocardial InfarctionHeart Attack
Definition: A condition that occurs when blood supply to the heart muscle is cut off and the tissue dies.
Crushing or heavy discomfort or pain
in the chest
Heartburn symptoms accompanied by
nausea and vomiting
Chest pain that spreads to the shoulders, neck,
jaw or arms
Lightheadedness,dizziness or
faintingSweating
Myocardial Infarction
Myocardial Infarction
Healthy heart Myocardial InfarctionWhere is it located?
A temporary decrease in oxygen supply to the myocardium is
A. Myocardial InfarctionB. AtherosclerosisC. AnginaD. HypercholesterolemiaE. Stroke
ArrhythmiasIrregular Heart Beat
• Bradycardia: – Heart rate of fewer than 60 beats per minute
• Tachycardia: – Heart rate of more than 100 beats per minute
• Potential Causes: – Atherosclerosis, hypertension, mineral imbalance, alcohol,
tobacco, cocaine, or other drugs• Symptoms:
– Fatigue, lightheadedness, loss of consciousness, death, and organ damage
• Diagnosis: – Electrocardiogram
• Treatment: – Medications and/or pacemakers
Diagnostic TestsElectrocardiogram (ECG, EKG)
Diagnostic Tests
• Stress Test • Thallium
scintigraphy
Treatments• Aspirin therapy • Medications
– diuretics– beta-blockers– calcium channel blockers– angiotensin-converting enzyme inhibitors (ACE)
• Surgical Procedures– Coronary bypass
• Use of saphenous vein to bypass occlusion• Placement of a titanium stent to bypass artery occlusion
– Percutaneous transluminal coronary angioplasty– Pacemaker
Using a stent to bypass occluded arteries
Titanium stent Expanded stent
Percutaneous transluminal coronary angioplasty
• Pacemaker
Cerebrovascular Accident (Stroke)• Definition
– Blockage of the blood supply to a portion of the brain• Statistics
– the 3rd leading cause of death in the U.S.– Worldwide: the second leading cause of death
• Types– Ischemic stroke
• Thrombotic• Embolic
– Hemorrhagic stroke• Acute / chronic bleed• Rupture of aneurysm
– Transient ischemic attacks (TIA)
Warning Signs of a Stroke
Sudden numbness or weakness of the face, arm, or leg – particularly on one side of the body.
Sudden confusion, difficulty in speech or understanding.
Sudden trouble seeing out of one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
A sudden severe headache of unknown cause.
Risk Factors for StrokesGender
Race
Age
Hypertension
High Red Blood Cell Count
Heart Disease
Blood Fats
Diabetes Mellitus
Prevention and Treatment for StrokesA baby aspirin a day keeps strokes away.Surgery• Carotid endartectomy• Brain angioplastyMedications• Thrombolytic drugs
Which of the following concerning stroke is INCORRECT?
A. Hemorrhagic type results from blood clot
B. Right brain involvement can result in weakness of left leg
C. Major risk factor is hypertensionD. Can be prevented by taking a
baby aspirin a day.
Heart-Smart Strategies For LifeDon’t smoke
Watch your weightCut down on saturated fat and cholesterol
Get movingLower your stress levels
Know your family historyGet your blood pressure checked regularly
Tame your temperGet a lipoprotein profile
Take appropriate medications