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KIN235 - Heart Disease

Terms in this set (70)

Cardiovascular disease
Any disease causing damage to heart or major arteries leading from the heart
Heart disease includes:
Coronary artery disease, peripheral artery disease, angina pectoris, myocardial infarction and heart failure
How many Americans on average die a year from heart disease
610,000 Americans (1 in 4 deaths)
- Over 1/2 in 2009 were men
- Costs estimated $270 billion/year in US
Arteries
Take blood away from heart to body and veins; take blood away from the body to the heart
- Blood vessels deliver oxygenated blood to the body's systems and tissues
- Any series of blood vessels that carry blood AWAY from the heart to other parts of the body
Myocardial infarction (MI)
A heart attack
- Heart muscle death due to lack of blood supply
Peripheral artery disease
it's not the arteries in your heart that are the problem, but it is the external (away from your core); having problems in arteries outside of heart
Angina pectoris
Angina means pain and chest pain; most commonly happens because there is some sort of blockage in an artery
- Pain in heart or other pain associated with symptoms from Cardiovascular disease (CVD)
Coronary artery disease
Blockage of the arteries in the heart
Congestive heart failure (CHF)
Conditions where the heart cannot pump enough blood to meet the demands of the body
- A lot of geriatric patients eventually pass away from this
Atherosclerosis
Progressive process/disease where fatty deposits (plaques) form/build up in arteries and block the flow of blood
- Fatty deposits can be fat, cholesterol or calcium
- This becomes a problem since the coronary arteries if blocked, deprive cells of oxygenated blood and die, this causes chest pain = angina pectoris
- 1 million people a year admitted chest pain
People with gigantism
Heart problems because heart has to work harder
Ischemia
When the blood flow to heart is stopped via a blockage (plugged artery)
- Reversible if small, if prolonged becomes heart attack - a large infarction is a heart attack

- Every 42 seconds in US someone has a heart attack
- If coronary arteries are blocked or diseased, it may cause a heart attack
Heart disease
The leading cause of death for people of most racial/ethnic groups in the US, including African Americans, Hispanics and whites. For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer
Heart disease risk factors (memorize this all)
- High blood pressure
- High LDL Cholesterol (bad)
- Smoking
- Diabetes
- Overweight/obese
- Poor diet
- Inactive/sedentary
- Excessive alcohol use
What are the 3 leading risk factors, 49% of Americans have one of these three factors
1. High blood pressure
2. High LDL cholesterol (bad)
3. Smoking
Stroke
Insufficient supply of blood to the brain resulting in loss of muscle function, loss of speech, or other symptoms
- Clot on right side of brain = left side problems; problems can be motor or they might have aphasia
Veins
Blood vessels return blood from tissue TO THE HEART (compare with arteries)
Myocardium
Muscular wall of heart that contracts and relaxes
Heart contains what?
4 chambers (each has a door because once the blood goes through it the door shuts and it can't go back and this door is called a valve and it is like a garbage disposal -- only meant to go one way), 2 upper atriums and 2 lower ventricles (right and left of each - they are the person's right and left)
Patterns of blood flow
Deoxygenated blood returns to right atrium then flows to right ventricle blood goes out to be oxygenated by lungs after it is returned by pulmonary veins to left atrium to left ventricle where it exits the aorta to body tissues
- When blood first leaves heart it has oxygen and when it returns it doesn't so needs to filter through again to get oxygen
(LOOK AT CHART)
Pattern of blood flow first stop
Comes down into the right atrium goes through the valve to get to right ventricle; blood with no oxygen
Pattern of blood flow second stop
Leaves right atrium and goes to right ventricle
Pattern of blood flow third stop
Leaves right ventricle through a valve out of a pipeline goes to the lungs to pick up oxygen
Pattern of blood flow fourth stop
When it comes out of the lungs, it will come out and dump into the left atrium (it now has oxygen in it because it is leaving the lungs)
Pattern of blood flow fifth stop
Comes out of left atrium through another door/valve into the left ventricle; it still has oxygen in it because it is coming from the lungs
Pattern of blood flow sixth stop
Now we have to get out of the heart and there is a very large vessel coming out of the left ventricle - aorta, which is an artery exiting the heart in your body; leave left ventricle and going to the rest of the body
Heart contracts how many times per minute?
60-100 xs/min
Sinoatrial node (SA node)
- Heart is controlled by this
- Region of the heart that produces an electrical signal that causes the heart to contract (right atrium)

- Hangs out between the right atrium and the right ventricle - fuse box that controls the electricity of your heart; how does the blood flow is through contracting and that contracting pushes the blood form one chamber to another
Arrhythmia
Loss of rhythm/abnormal rhythm
Atrial fibrillation
Rapid, erratic, contraction of the upper chambers of the heart
V fib
Flat line and die; ventricles not contracting the way they need to
Pacemaker
Implanted device to regulate heart beats
- If i'm shocking someone, thats external, but this is an internal device
Defibrillators
An electrical device that can restart a heart that has stopped beating by delivering electrical shocks, initiate immediately, hence AEDs in public
- Portable version of shocking paddles
- If wait for paramedics, studies show only 6% survive
- Heart transplant last resort (40% rejected from recipients in the first year)
Gum disease in relation to heart disease
There may be link between oral (gum) disease and heart disease (same bacteria found in plaque)
Cardiac catherization
Use a catheter (to visualize) & monitor blood flow in coronary arteries a dye is injected
- Looking at if the flow, flows the way it should; if you don't have a normal blood flow, there is a problem (often done before a major procedure)
- This is an investigation
Coronary artery bypass surgery (CABG)
Surgery to improve blood supply to the heart muscle by replacing damaged portion with a graft
- the g stands for graft
- Might cut out vessel and replace it with a vein, usually from your medial thigh
CABG x1, x2, x3, x4
The higher the number, the worse it is; 4 means that 4 different vessel segments had to be replaced and they have a lot of plaque buildup/arteriosclerosis; higher up the number gets, the more you want to think of the patient as a high-risk patient
Why would someone have a repeated CABG?
If they don't change their diet and are eating high fat foods, leading to high cholesterol or smoke giving you high blood pressure; if not willing to change their diet/habits, they will end up back
Open heart surgery
Surgery performed open heart while blood supply diverted to heart lung machine (CABG is type of this, 1-6% stroke, 2.2% die)
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Procedure to open blocked arteries
- Use balloon once near plaque to push it, break it up, usually reoccurrence but half cost CABG and less invasive
- If not use a stent, thread up to blockage insert stent (pitch a tent)

- Think of it like Draino
Stent
Thin wire mesh; use a stent with a PTCA if someone is higher risk; metal mesh expands and is like a scaffolding system to keep it open for longer
- Don't always put a stent with a PTCA = it will eventually cause abrasions and rubbing so scar tissue can sometimes lead to a lot of problems
Top hat question: Myocardial infarction is not a heart attack; true or false
False
Top hat question: Which one of these is NOT the top three risk factors for a heart attack? High blood pressure, diabetes, smoking, high cholesterol
Diabetes
Top hat question: Arteries return blood toward the heart from the tissues; true or false?
False because it takes blood away
5th leading cause of death in US
Strokes
- 130,000 deaths/year
How many total strokes in US a year
795,000 total
- 619,000 of these are first time

- Every 40 seconds someone has a stroke, every 4 minutes someone dies from it
Leading cause of long term disability in those over 65 years old half suffer reduced mobility after
Stroke
- In 2009 34% of people hospitalized for stroke were less than 65 years old
Left ventricle
Empty out the body; ejection fraction is 55-60%
Ejection fraction
The blood leaving the left ventricle going to rest of body (abbreviated EF)
55-60% KNOW THIS
People with heart disease: their EF might drop anywhere below
45%
Between 20-45%
- Problem because so little blood getting to the rest of the body so heart will fail
Greatest factor for stroke
High blood pressure (70%)
Stroke definition
A cardiovascular disease where there isn't enough blood getting to the brain
(You are getting neurological symptoms, but it is categorized as cardiovascular)
Warning signs of stroke
- Facial dropping
- Sudden weakness or numbness of face, arm, leg or one side of the body
- Sudden dimness or loss of vision especially in one eye
- Loss speech (difficulty understanding or trouble talking)
- Sudden severe headaches with no known cause
- Unexplained unsteadiness, dizziness or sudden falls especially with one of the other symptoms
Why hard to tell if it's a stroke?
A lot of these warning signs in older people are typical symptoms that might expect with aging/might already be dealing with, so might not think it is a stroke
Stroke signs and symptoms
- Sudden numbness or weakness of the face, arms or legs
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no known cause
Stroke: Best prevention is reduce risk factors
1. High blood pressure
2. High cholesterol
3. Smoking

- 2/3 of Americans have one of these
Stroke risk factors you cannot change
Increasing age (being over 65 puts you at risk), being male, race, diabetes mellitus, prior stroke, and hereditary
Stroke risk factors you can change
Healthy diet, move more, limit alcohol, no smoking, healthy weight
2 types of cholesterol
HDL and LDL
High density lipoprotein (HDL)
Carry cholesterol from tissue to liver for removal from circulation, "good"
Low density lipoprotein (LDL)
Carrier of "bad" cholesterol in the blood
Cholesterol mainly responsible for what
Blocked arteries
Low level of cholesterol is less than what
200 mg/dl
(240 or higher gives you 2 times risk for heart disease)
Top hat question: Which is the "bad" cholesterol that is responsible for blocking vessels?
LDL
Hypertension
High blood pressure
Hypertension facts
- 30% American 18+
- Of those who have been diagnosed with a stroke: 10% people in 30s compared to 50% people over 50 years
Primary/essential hypertension
Cause unknown
Secondary hypertension
High blood pressure caused by a recognizable disease
- Kidney, congenital defect of aorta, and adrenal tumor
Metabolic syndrome
One who has at least 3/5 risk factors at risk for cardiovascular disease, diabetes, and premature death
- Rare
- Perfect storm of 3 things coming together (patient only needs 3/5 to be diagnosed)
Metabolic syndrome risk factors (3+)
1. Waist circumference (40+ in men, 35+ in women)
2. Triglycerides over 150
3. Low HDL (40- for men, 50- for women)
4. Fasting blood glucose 100+
5. High blood pressure 135/85
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