KIN235 - Heart Disease

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 gigantismHeart problems because heart has to work harderIschemiaWhen 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 attackHeart diseaseThe 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 cancerHeart disease risk factors (memorize this all)- High blood pressure - High LDL Cholesterol (bad) - Smoking - Diabetes - Overweight/obese - Poor diet - Inactive/sedentary - Excessive alcohol useWhat are the 3 leading risk factors, 49% of Americans have one of these three factors1. High blood pressure 2. High LDL cholesterol (bad) 3. SmokingStrokeInsufficient supply of blood to the brain resulting in loss of muscle function, loss of speech, or other symptoms - Clot on right side of bran = left side problems; problems can be motor or they might have aphasiaVeinsBlood vessels return blood form tissue TO THE HEART (compare with arteries)MyocardiumMuscular wall of heart that contracts and relaxesHeart 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 flowDeoxygenated 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 stopComes down into the right atrium goes through the valve to get to right ventricle; blood with no oxygenPattern of blood flow second stopLeaves right atrium and goes to right ventriclePattern of blood flow third stopLeaves right ventricle through a valve out of a pipeline goes to the lungs to pick up oxygenPattern of blood flow fourth stopWhen 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 stopComes out of left atrium through another door/valve into the left ventricle; it still has oxygen in it because it is coming from the lungsPattern of blood flow sixth stopNow 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 bodyHeart contracts how many times per minute?60-100 xs/minSinoatrial 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 anotherArrhythmiaLoss of rhythm/abnormal rhythmAtrial fibrillationRapid, erratic, contraction of the upper chambers of the heartV fibFlat line and die; ventricles not contracting the way they need toPacemakerImplanted device to regulate heart beats - If i'm shocking someone, thats external, but this is an internal deviceDefibrillatorsAn 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 diseaseThere may be link between oral (gum) disease and heart disease (same bacteria found in plaque)Cardiac catherizationUse 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 investigationCoronary 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 thighCABG x1, x2, x3, x4The 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 patientWhy 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 backOpen heart surgerySurgery 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 DrainoStentThin 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 problemsTop hat question: Myocardial infarction is not a heart attack; true or falseFalseTop hat question: Which one of these is NOT the top three risk factors for a heart attack? High blood pressure, diabetes, smoking, high cholesterolDiabetesTop hat question: Arteries return blood toward the heart from the tissues; true or false?False because it takes blood away5th leading cause of death in USStrokes - 130,000 deaths/yearHow many total strokes in US a year795,000 total - 619,000 of these are first time - Every 40 seconds someone has a stroke, every 4 minutes someone dies from itLeading cause of long term disability in those over 65 years old half suffer reduced mobility afterStroke - In 2009 34% of people hospitalized for stroke were less than 65 years oldLeft ventricleEmpty out the body; ejection fraction is 55-60%Ejection fractionThe blood leaving the left ventricle going to rest of body (abbreviated EF) 55-60% KNOW THISPeople with heart disease: their EF might drop anywhere below45% Between 20-45% - Problem because so little blood getting to the rest of the body so heart will failGreatest factor for strokeHigh blood pressure (70%)Stroke definitionA 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 symptomsWhy 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 strokeStroke 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 causeStroke: Best prevention is reduce risk factors1. High blood pressure 2. High cholesterol 3. Smoking - 2/3 of Americans have one of theseStroke risk factors you cannot changeIncreasing age (being over 65 puts you at risk), being male, race, diabetes mellitus, prior stroke, and hereditaryStroke risk factors you can changeHealthy diet, move more, limit alcohol, no smoking, healthy weight2 types of cholesterolHDL and LDLHigh density lipoprotein (HDL)Carry cholesterol from tissue to liver for removal from circulation, "good"Low density lipoprotein (LDL)Carrier of "bad" cholesterol in th ebloodCholesterol mainly responsible for whatBlocked arteriesLow level of cholesterol is less than what200 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?LDLHypertensionHigh blood pressureHypertension facts- 30% American 18+ - Of those who have been diagnosed with a stroke: 10% people in 30s compared to 50% people over 50 yearsPrimary/essential hypertensionCause unknownSecondary hypertensionHigh blood pressure caused by a recognizable disease - Kidney, congenital defect of aorta, and adrenal tumorMetabolic syndromeOne 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

KIN235 - Heart Disease

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