Cardiovascular System Diseases and Disorders

Facts and stats

• Heart disease is the leading cause of death in the United States (2^nd in NC).

• One person dies every 36 seconds in the United States from cardiovascular disease (1 in 5 is silent, meaning no symptoms)

• About 655,000 Americans die from heart disease each year—that’s 1 in every 4 deaths.

• Smoking and high systolic BP remained the first and second leading years of life lost risk factors in the United States in both 1990 and 2019.

• By 2035 more than 130 million adults (45.1% of the US population) are projected to have some form of Cardiovascular disease.

• Cardiovascular diseases in the US are the leading cause of death for all age groups.

High systolic blood pressure, High fasting glucose levels, and tobacco use are ______.

the major causes for cardiovascular diseases

Coronary artery disease is the ________.

most common cardiovascular disease

• 1 in 20 adults (20 & older) have CAD

States with the highest Heart disease death rates

• Michigan

• West Virginia

• Kentucky

• Tennessee

• Mississippi

• Alabama

• Arkansas

• Louisiana

• Oklahoma

Anatomy and Physiology

• Cardiovascular system

  • Heart, arteries, and veins with blood

• Heart

  • Size of man’s fist

  • Located slightly left of the middle of the chest

  • Composed of cardiac muscle, 4 chambers, 4 valves

• Heart = Wall of heart has three layers

• Epicardium

• Myocardium

• Endocardium

Common signs and symptoms of Cardiovascular Related disease

• chest pain

• shortness of breath

• tachycardia

• cardiac palpitations 

Most women report feeling symptoms of ______.

indigestion for cardiovascular related diseases.

• why most women do not go to the hospital for heart issues until later

Auscultation

stethoscope on heart/arteries to listen to blood flow

• non-invasive procedure

Doppler

magnifies sound of blood flow

• non-invasive procedure

Sphygmomanometer (Bp cuff)

measures arterial blood pressure 

• non-invasive procedure

Electrocardiogram

measures electrical info

• non-invasive procedure

Echocardiography

sound waves to view pics of heart/arteries

• non-invasive procedure

Cardiac Catheterization

Invasive procedure to determine oxygen content and blood pressure

• A small tube is inserted in an artery and goes to the heart muscle

• can also push plaque against artery walls 

X-rays

Can determine normal function of heart and vessels

• common ones = angiocardiography, arteriography, and venogram

Angiocardiography

Introduce chemical substance into heart to see if it can flow properly

Arteriography

Introduce chemical substances into arteries to see if they are functioning properly

Venogram

Introduce chemical substances into veins to see if they are functioning properly

Diagnostic blood tests

• Enzymes testing for MI

• Creatine phosphokinase (C P K) = elevated levels may indicate damage in heart

• Lactate dehydrogenase (L D H) = elevated levels may indicate damage in heart

HBP Facts and Stats

• In 2018, nearly half a million deaths in the United States included hypertension (high blood pressure/HBP) as a primary or contributing cause.

• Nearly half of adults in the United States (108 million, or 45%) have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension.

• Only about 1 in 4 adults (24%) with hypertension have their condition under control.

• A greater percent of men (47%) have high blood pressure than women (43%).

• High blood pressure is more common in non-Hispanic black adults (54%) than in non-Hispanic white adults (46%), non-Hispanic Asian adults (39%), or Hispanic adults (36%).

Research has show that Gen z and millennials are starting to have ______.

hypertension earlier than previous generations, especially in pregnant women.

Hypertension is considered a _______.

Silent killer

• most people don’t know they have it or don’t think it’s serious until it’s too late

Hypertension is more ______.

prevalent in the south

Hypertension

• Indicator of development of cerebrovascular, cardiovascular, and kidney disease

• Chronic disease

• Leading cause of stroke and heart failure

• Idiopathic with a gradual onset- also known as essential hypertension

Systolic blood pressure

measures highest pressure in the arteries when the ventricles contract

• top number in BP measurements

Diastolic blood pressure

measures pressure in the arteries when the ventricles relax

• bottom number in BP measurements

Normal BP levels

• systolic (upper number) = less than 120

• diastolic (bottom number) = less than 80

Elevated BP levels (Pre-hypertension)

• systolic (upper number) = 120 - 129

• diastolic (bottom number) = less than 80

HBP Stage 1

• systolic (upper number) = 130 - 139

• diastolic (bottom number) = 80 - 89

HBP stage 2

• systolic (upper number) = 140 or higher

• diastolic (bottom number) = 90 or higher

Hypertensive crisis

• systolic (upper number) = higher than 180

• diastolic (bottom number) = higher than 120

• go to ER immediately

Steps for correct BP measurements

• avoid caffeine or smoking before

• rest for 5 minutes before

• feet on floor

• arm on table

• calibrate everything before

• take at elbow, wrist, or thigh

Risk factors for hypertension

• diet = foods high in salt content and energy drinks

• hereditary

• age

• obesity

• smoking = nicotine is a stimulant and increases Bp

• stress

Treatment for Hypertension

• Pharmaceutical Measures = Antihypertensive medications and Diuretics

• Exercise

• diet = DASH diet (eating more fruits, vegetables, healthy protein, less salt)

• manage weight

• don’t smoke

• sleep the recommended hours every night (7-8)

DASH Diet

made by NIH and helps lower Bp

• 6-8 servings of whole grains per day

• 4-5 serving per day of vegetables

• 4-5 servings per day of fruit

• 2-3 servings per day of fat food or low fat dairy

• 4-5 servings per week of nuts, legumes, and seeds

• less than 6 servings per day of fish, pultry, and lean meat

• less than 5 servings of sweets per week

• 2-3 servings per day of fats and oils

Cholesterol is a _______.

waxy substance found in your blood. 

• needed to build healthy cells

• high levels can increase the risk of heart disease

• carried through blood attached to proteins

2/3 of Americans with High cholesterol/hyperlipidemia do ______.

not have it under control, 2x risk for heart attacks

As we get older, plaque grows and _______.

in severe cases can limit blood flow

Lipoprotein

Combination of proteins and cholesterol

• ex: LDL and HDL

Low-density lipoprotein (LDL)

• “Bad”

• carries plaque throughout the body

• function like dump trucks

High-density lipoprotein (HDL)

• “Good”

• grabs plaque and transports to liver for disposal

• function like a taxi cub or uber

Triglycerides

another form of fat in the body

• from burgers, sweets, alcohol, sweetened beverages, poultry, milk, ice cream, etc.

Desirable total cholesterol levels

less than 200 mg/dL

Borderline high total cholesterol levels

200-239 mg/dL

High total cholesterol levels

240 mg/dL and above

Optimal LDL (bad) cholesterol levels

less than 100 mg/dL

Near optimal LDL (bad) cholesterol levels

100-129 mg/dL

Borderline high LDL (bad) cholesterol levels

130-159 mg/dL

High LDL (bad) cholesterol levels

160-189 mg/dL

Very high LDL (bad) cholesterol levels

190 mg/dL and above

HDL (good) cholesterol level that is a risk factor for heart disease

less than 40 mg/dL

HDL (good) cholesterol levels that are good

• 40-59 mg/dL = the higher the better

• healthy levels typically = men > 40 and women > 50

• 60 mg/dL and higher = considered protective against heart disease

Triglycerides levels

• normal = less than 150 mg/dL

• borderline high = 150-199 mg/dL

• High = 200-499 mg/dL

• Very high = 500 mg/dL or higher

Risk factors for high cholesterol 

• unhealthy diet 

• lack of exercise 

• smoking or exposure to tobacco smoke

• being overweight or obese

• family history

• age

• diabetes

HDL cholesterol is affected by ______.

smoking and exercise

Ways to lower bad cholesterol

1. limit foods high in saturated fat

2. choose foods low in saturated fat, trans fat, sodium, and added sugars

3. eat foods naturally high in fiber or unsaturated fats

4. maintain a healthy weight

5. get regular physical activity

6. Take cholesterol medication as prescribed (statins can often make peoples joints and bones hurt so they stop taking them)

Estrogen helps keep women ______.

heart healthy until menopause where women are at the same risk as men

Key take aways

• The purpose of the CV system is to move blood throughout the body to supply nutrients and remove wastes.

• Diseases of the CVS is the number #1 cause of death in the US.

• For most individuals engaging in healthier lifestyle behaviors can reduce the risks of developing CVD or at least delay onset.

Arteriosclerosis/Atherosclerosis

• Loss of elasticity and thickening of artery wall

• Also known as hardening of arteries

• Plaque in the wall of arteries

• Major areas affected:

  • Cerebral arteries = in brain area

  • Aorta

  • Coronary arteries

  • Peripheral arteries = outside brain & heart

Plaque

Deposits of fatty or lipid material in wall of artery

Risk factors for Arteriosclerosis/atherosclerosis

• Non-controllable: age, sex, family history, hereditary, Type 1 diabetes

• Controllable: diet, sedentary lifestyle, cigarette smoking, stress, hypertension, and type 2 diabetes

Diagnosis for arteriosclerosis/atherosclerosis

blood pressure, arteriograms, X-rays, and Doppler

• Symptomatic treatment: bypass or stent placement surgery of occluded arteries and plaque removal

Diseases related to atherosclerosis/ateriosclerosis

• Peripheral Artery Disease

• Carotid Artery Disease

• Ischemic Heart Disease

- Coronary heart disease

- Coronary microvascular disease

Peripheal vascular disease

• Caused by atherosclerotic plaque in arteries supplying blood to legs

• Main risk factor is smoking

• Intermittent claudication- muscle cramps relieved with rest and increased with activity

• Treatment- lifestyle management., anti-clotting meds, bypass or angioplasty 

• If necrosis occurs, amputation of lower extremities

Aneurysm

• Weakening in wall of artery leading to bulge or rupture

• Usually asymptomatic and discovered accidentally

• Abdominal Aorta- most common location (seen in car accidents)

• Treatment- repairing aneurysm before rupture through resection and grafting

• can happen at any age; happens more in men

• In most cases, the cause is unknown

• can happen in veins but occurs more in arteries

Fusiform aneurysm

bulge on both sides of arteries

Saccular aneurysm

bulge on the side of an artery; slows blood flow

Dissection aneurysm

artery has a tear; blood goes through tear and starts filling in artery wall

Coronary artery disease

Narrowing of arteries that supply blood to myocardium

• Single leading cause of death in United States

• Commonly due to atherosclerosis

• Progressive narrowing of vessels may lead to ischemia of heart muscle and symptoms

• Scar tissue may replace muscle, increasing workload of remaining heart muscle

• Occlusion may progress slowly or suddenly as result of thrombus or embolus (free floater clot)

• Myocardial infarction- death of heart muscle

• Diagnosis by history, electrocardiogram (ECG), and angiograms

Treatment of Coronary artery disease

aimed at increasing blood flow or decreasing oxygen needs

• Angina treated with vasodilators

• Angioplasty

• Coronary artery bypass graft (C A B G) = take an artery from somewhere else

• Reduction of atherosclerotic risk factors

             - Diet

             - Exercise

             - Smoking

Angina pectoris

Chest pain caused by a lack of oxygen to myocardium

• Symptom of impending myocardial infarction

• Pain that may radiate into left arm, neck, and jaw

• Treatment: Decrease workload of heart and Use nitroglycerin (vasodilator)

Myocardial Infarction

Heart attack leading to cardiac arrest; Occurs when heart does not get enough oxygen

• Symptoms:

- Severe chest pain with diaphoresis, lightheaded, and nausea

- Referred pain to neck, arm, and jaw with discomfort similar to bad or unrelieved indigestion

Treatments for myocardial infarction

• Give immediate attention to prevent shock

• Relieve respiratory distress

• Decrease workload

• If cardiac arrest, cardiopulmonary resuscitation (C P R) must be performed

• Oxygen and pain medication

• Medications to treat arrhythmias

• Clot-busting medications

• Education on prevention by lifestyle changes:

              - Smoking cessation

              - Diet

              - Exercise

Hypertensive heart disease

Result of long-term hypertension

• Causes: Disease or disorder causing chronic elevation in blood pressure

• Treatment: Treat cause of hypertension

• No cure, just controlled/managed

Rheumatic heart disease

• Autoimmune disorder caused by untreated streptococcal throat infection

• All layers of heart and valves can be affected

• Treatment:

- Prevention/treatment of streptococcal infections (complete strep throat medicine)

- Rest during acute stage

- Valve replacement to correct deformity if necessary

Congestive heart failure

• Heart fails to pump adequate blood supply

• Develops slowly and increases workload of heart

• unmanaged hypertension

• heart is weaker than normal

Symptoms of Congestive heart failure

• Gradual increase in shortness of breath

• Tachycardia

• Neck vein distention

• Edema in ankles and lower legs

• Right-sided leads to congestion of liver and spleen

• Left-sided leads to congestion of lungs

Diagnosis of Congestive heart failure

Diagnosis by history and physical, chest X-ray, and E C G

• Treatment:

           - Decrease workload

           - Diuretics

           - Salt and fluid restrictions

           - Medications to strengthen and slow heart

                - E.g., digitalis

Cardiomyopathy

Disease of heart muscle

• Characterized by dilated, enlarged, thin, flabby heart muscle

• Occurs as a result of increased pre-load for a long duration of time

• No cure

• Leads to CHF, myocardial infarction, and death

• Primary = idiopathic; damage is from other diseases in the heart muscle (ex: hypertension, valvular disorders, and CAD)

• Secondary = a result of damage in other areas of the body (ex: kidney disease, autoimmune disorders, infections, diabetes, heart inflammation)

Carditis

• Inflammation of heart (E.g., pericarditis, myocarditis, endocarditis)

• Often secondary to respiratory, urinary tract, or skin infection

• Treatment:

- Rest

- Antibiotics

- Analgesics

- Antipyretics

Valvular heart disease

• Malfunction of heart valves

• Murmurs or abnormal heart sound

• causes backflow of blood; heart has to work harder to push blood through

• Causes:

           - Congenital abnormalities or malformations

           - Rheumatic fever

           - Endocarditis

Arrhythmias

Abnormal heart rhythm

• Sinus rhythm is normal heart rhythm; normal = 60 to 100 beats per minute (lower for runners and swimmers)

Type of arrhythmias

• Flutter = Unusually fast heart rate

• Fibrillation = Wild and uncoordinated

- Atrial fibrillation – not normally serious in nature

- Ventricle fibrillation (V fib) – Serious – requires defib by electrical shock

• heart block = Interruption in conduction system

• Premature or early contractions (P V C s) may affect atria or ventricles

• Treatment: Unnecessary if asymptomatic

Phlebitis

Inflammation of superficial veins

• Symptoms:

            - Pain

            - Swelling

            - Red, cord-like hardening along vein toward heart

• Treatment: Analgesics, Warm compresses, Elevation of area above heart level, Elastic stockings, Exercise

Phlebitis happens due to ______.

injuries, poor circulation, infections, diabetes, prolonged bed rest

Thrombophelitis

• Clotting in vessels of legs, thighs, and pelvis

• Asymptomatic until embolization occurs

• death occurs by pulmonary embolism

• Risk factors:

  • Immobility = reported for Iraq war was in squat position for too long and developed this and died; why you are recommended to move around on long plane flights

  • Dehydration

  • Varicose veins

  • Leg/pelvic surgery, obesity, pregnancy

• Treatment:

  • Reduce clot

  • Prevent embolization

  • Use anticoagulants

Varicose veins

Dilated, tortuous, and elongated veins in legs

• causes: Prolonged sitting or standing, Pregnancy, Obesity, and Heredity

• Symptoms: Leg fatigue and cramps, Thickening veins, Edema, and Fluid

• treatment: Elevate legs (why preg. women elevate their legs in the 3rd trimester, Walk, Use support or elastic hose, and Strip vein

Hemorrhage

abnormal loss of blood

• acute (very sudden) or chronic (from disease processes; prolonged bleeding that can last for wks)

• Exsanguination- loss of circulating blood (seen in forensics)

• Internal bleeding can lead to anemia or shock due to blood loss

Hemorrhage in low pressure vessels lead to ____.

petechiae or ecchymosis

Hemorrhage in high pressure vessels lead to ______.

squirting of bright red blood

Shock

Extremely low blood pressure that leads to decreased tissue perfusion

• symptoms: Facial pallor, Cool and clammy skin, Cyanosis, Tachycardia, Tachypnea, Altered mental status, Syncope (fainting), Unconsciousness, and Oliguria or anuria

• treatment: Rest in supine position, Move to warm, quiet environment, Elevate feet and legs above heart

Types of shock

• Cardiogenic – inability of the heart to pump blood adequately

• Septic – overwhelming septicemia 

• Hypovolemic – low blood fluid levels

• Neurogenic – generalized vasodilatation due to extreme emotional situations 

• Anaphylactic – allergic reactions

Effects of aging

• Decreased contractility of heart muscle

• Decreased elasticity of vessels

• Thickening of valves = Becoming sclerotic