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List the non-modifiable primary risk factors for developing CVD. 1) Advancing Age 2) Gender 3) Family History Describe how is advancing age a primary risk factor for CVD. - atherolsclerosis accumulation associated w/ aging - 50% of myocardial infarctions occur in ppl over 65 - 45% of MI occur in ppl 45 - 65 - 5% of MI occur in ppl under 45 Describe how gender is a primary risk factor for CVD. - 1/3 all adult men and women have some form of CVD - risk of CVD is higher in men before age 75 - postmenopausal women 2-3x more risk of CHD than pre-menopausal women - After 40, men have 49% risk of developing CVD in their lifetime, women have 32% risk - women have higher mortality rate associated w/ MI, and higher likelihood to suffer from angina pectoris, CHF, sudden death and stroke than men Describe how family history is a primary risk factor for CVD. - Kids and siblings of person w/ CAD are more likely to develop CAD - positive family history of CVD carries excess risk - Risk of CVD increases w/ number of relatives affected and younger ages of onset List the modifiable primary risk factors for developing CVD. 1) Tobacco smoking 2) Dyslipidemia - high blood cholesterol Describe how smoking is a primary risk factor for developing CVD. - smokers are at 2.5x greater risk for CAD than non-smokers - risk of heart disease decreases by 50% w/in 1-year of quitting smoking, and approaches non-smoker risk w/in 15 years of quitting - acute (increased myocardial O₂ demand) and chronic (endothelial damage) effects - negatively impacts other CAD risk factors (lowers HDLs) Describe how dyslipidemia is a primary risk factor for developing CVD. - positive correlation b/t total cholesterol (TC) and LDL levels, amount of fat, saturated fat and cholesterol in diet and CAD mortality and morbidity - TC, LDLs, TGs contribute to atherosclerosis process - risk of developing CAD over next 10 years determines lipid management, specifically LDL management - Recommendations for detection, eval, and treatment provided by National Cholesterol Education Program Adult Treatment Panel III (ATPIII) Describe how hypertension is primary risk factor for developing CVD - as BP increases, risk of CVD also increases regardless of whether person has existing hypertension or not - has both acute (increased myocardial O₂ demand) and chronic (endothelial and renal dysfunction) effects on myocardium - Treatment of hypertension doesn't remove all CVD risks associated w/ high BP Describe how a sedentary life is primary risk factor for developing CVD - carries similar risk factors for CVD as hypertension, dyslipidemia and smoking - influences other CVD factors like increased BP, decreased HDL, obesity, decreased sensitivity to insulin) - following MI, sedentary ppl have higher mortality rate than active ppl Describe how overweight/obesity is primary risk factor for developing CVD - strong positive relationship w/ CAD risk factors like hypertension, dyslipidemia, type 2 diabetes - risk for CVD greater in ppl w/ central obesity (abdominal or upper body) than ppl w/ peripheral obesity (lower body) - Waist-Hip ratio (WHR) provides good index of central obesity - health risk increases w/ increased WHR and waist circumference - BMI good indicator of obesity List ways that body fat can be measured. - skinfold - bioelectrical impedance - hydrostatic weighing - air displacement measurements - dual energy x-ray absortiometry Describe how diabetes mellitus (DM) is primary risk factor for developing CVD - 2-8x more likely to develop CVD than persons w/o DM - asymptomatic (silent) myocardial ischemia is common in ppl w/ DM - renal disease is common complication of DM, increasing CVD risk - person w/ DM is also considered to have CVD when looking at risk assessments - aggressive risk factor modification needed to reduce CVD risk - DM is highly preventable and goes undiagnosed in 1/3 of all cases What is metabolic syndrome? - group of CVD risk factors that are of metabolic orientation and appear to initiate atherosclerotic CVD What are the risk factors for metabolic syndrome? - ab obesity and insulin resistance (most imp) - dyslipidemia - high LDL and TG, low HDL - elevated BP - elevated plasma glucose - prothrombotic state - proinflammatory state - aging, physical inactivity, genetics Describe how metabolic syndrome is primary risk factor for developing CVD - doubles risk of CVD - increases risk of getting DM by 5x How is metabolic syndrome diagnosed and treated? Diagnosed: presences of at least 3 of following 5 factors 1) Elevated waist circumference (>40" in men and 35" in women) 2) Elevated TGs (>=150 mgdL) 3) Reduced HDL (<40 mg/dL in men and 50 mg/dL in women) 4) Elevated BP (>130/85 mmHG) 5) Elevated fasting glucose (>=100 mg/dL) Treatment: - person considered to have CVD, so treated similar to CVD What are emerging risk factors and list some examples - factors associated w/ increased risk of CVD, but whose casual ink has not been proved w/ certainty Examples: - poor oral health - high consumption of dietary trans fats - subclinical atherosclerosis What ECG abnormalities will occur in a person w/ MI? - ST segment abnormalities - ST segment depression shows subendocardial ischemia - ST segment elevations shows acute ischemia - significant Q waves - absence of R wave Define Radionuclide Scintigraphy (perfusion imaging) and how it's used to determine myocardial health - assess extent and location of both transient (ischemia) and fixed (necrosis) myocardial perfusion defects - radioisotope injected intravenously at rest or during exercise - radioisotope taken up by myocardium in proportion to cardiac blood flow, showing areas of inadequate perfusion Define SPECT or PET scanning and how they're used to determine myocardial health - similar to perfusion imaging where radioisotope is injected - healthy heart shows full perfusion in both scan types - ischemic heart shows unequal perfusion on stress-test scan but not resting scan - necrotic heart shows unequal perfusion in areas where scarring has occurred in both rest and stress tests What are the sensitivity and specificity levels of PET, Planar, and SPECT scans? PET: sensitivity=78-100%; specificity=87-97% Planar: sensitivity=83%; specificity=88% SPECT: sensitivity=89%; specificity=76% Define Radionuclide ventriculography (RVG) or multiple gated acquisition scan and describe how it works - used to assess heart wall motion abnormalities, ejection fraction, systolic and diastolic function and CO - bolus of radioisotope injected in central vein during rest or during exercise - real time resting scans are compares w/ exercise scans to determine abnormalities during times of stress due to ischemia or MI Define echocardiography and describe how it works - used to assess heart wall motion abnormalities, structural abnormalities, valvular function, systolic and diastolic function, ejection fraction and CO using ultrasound waves - real time resting scans are compares w/ exercise scans to determine abnormalities during times of stress due to ischemia or MI What is coronary angiography and how does it work - gold standard diagnostic for CHD - often used w/ ventriculography 1) catheter is placed through incision in groin or arm and guided through femoral or brachial artery to coronary artery system 2) dye w/ vasodilator effect ejected, allowing for visualization of blood through coronary tree 3) Areas of narrowing can be identified and quantified for level of stenosis w/in coronary arter What is a coronary calcium assessment? - tests coronary artery calcium levels using 2 methods 1) Electron beam computed technology (EBCT) 2) Spiral tomography (ST) How is coronary calcium assessment done? 1) patient prescanned to determine length of heart 2) Electrodes placed on check allowing image to be gated w/ cardiac cycle 3) subjects holds breath for 30 secs to minimize throacic mvmt 4) 20 - 30 sliced of heart are scanned during diastole 5) Calcium deposits will show up as white areas and can be quantified based on their intensity, w/ higher score being greater amount of calcium When is coronary calcium assessment used and not used? - calcium detected in coronary arteries shows signs of CHD - useful in identifying preclinical CHD - not recommended for CAD screening - cannot detect degree of stenosis in arteris