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Cardiovascular Disease: an Overview

Cardiovascular Disease: an Overview. Jon W. Wahrenberger, MD March 10, 2007. The Good News. We are living longer than ever!. So Why Worry about Cardiovascular Disease?. Cardiovascular disease is the number one killer About 42% of all deaths Nationwide: 921,819 annually NH: 3468

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Cardiovascular Disease: an Overview

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  1. Cardiovascular Disease: an Overview Jon W. Wahrenberger, MD March 10, 2007

  2. The Good News We are living longer than ever!

  3. So Why Worry about Cardiovascular Disease? • Cardiovascular disease is the number one killer • About 42% of all deaths • Nationwide: 921,819 annually • NH: 3468 • VT: 1751 • Cardiovascular disease continues to strike young and middle-aged individuals • We are losing ground on several important risk factors

  4. Obesity in the USA

  5. Prevalence of Diabetes 1980-2004 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey.

  6. Smoking in Youth 2005 Youth Risk Behavior Survey (YRBS)

  7. Potential for Falling Longevity? Life Extending Technology Public Health Measures Health adverse behavior

  8. Evolution of Cardiovascular Disease Chain ofSurvival TechnologyInfluences MassMarketing of Junk Food Tobacco SurgicalProcedures Suffering, Loss of QOL Normal Child Overweight Inactive Child Sick Adult Overweight Inactive Adult Drugs Premature Death Devices Food Overabundance CulturalChanges KnowledgeDeficits We must tackle heart disease at all points!

  9. Women are not immune to heart disease!

  10. What is Cardiovascular Disease? “Cardiovascular disease” refers to diseases involving the heart and blood vessels Peripheral Vasculature Heart Brain AnginaHeart Attack ClaudicationUlcerationAmputation StrokeTIA

  11. Cerebral Disease Coronary Disease 25% 7% 30% 3% 4% 12% 19% Peripheral VascularDisease The heart, brain and extremities share a disease process

  12. Circulatory system (arteries, veins, etc.) Susceptibility to atherosclerosis The Common Thread?

  13. Atherosclerosis AKA “Arteriosclerosis”, “hardening of the arteries” • Complex, self-sustaining inflammatory process • Thickens arterial wall • Occurs slowly over decades

  14. Ischemic Heart Disease Cerebrovascular Disease Peripheral Vascular Disease No Symptoms Mild Symptoms Severe Symptoms Atherosclerosis Progression Time (years to decades)

  15. What causes atherosclerosis? • Smoking • High Blood Pressure • High Cholesterol • Diabetes • Hereditary Factors • Sedentary Lifestyle • Obesity • Other Factors

  16. Normal Coronary Arteries Right Coronary Artery Left Coronary Artery

  17. Diseased Coronary Artery

  18. Peripheral Vascular Disease

  19. Stroke – “Brain Attack”

  20. Symptoms of Cardiovascular Disease

  21. Suspected Stroke or Heart Attack? Call 911 Time = saved heart muscle Time = saved brain function

  22. Other Causes of Heart Disease • Heart failure • Heart rhythm disturbances (arrhythmias) • Congenital heart disease • Heart Valve Disease • Heart infections

  23. Heart Failure

  24. Heart Failure Definition • state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues

  25. Heart Failure Virus Toxins Hypertension Post Partum Ischemia Valve Disease Heart Muscle Injury Heart Failure

  26. Heart Failure: Symptoms • Shortness of breath • Fatigue • Edema (swelling)

  27. Arrhythmias

  28. Heart Electrical System A wave of electrical discharge proceeds mechanical contraction of the heart.

  29. Types of Arrhythmias • Premature atrial contractions (PAC) • Atrial fibrillation • Atrial flutter • SVT • Wolf Parkinson White • Heart block • Premature ventricular contractions (PVC) • Ventricular tachycardia • Ventricular fibrillation

  30. Arrhythmia Symptoms • Palpitations (a feeling of thumping, fluttering, skipping or racing of the heart) • Lightheadedness/loss of consciousness • Chest pain or tightness • Shortness of breath • Fatigue • Anxiety

  31. Diagnosis of Arrhythmias • Electrocardiogram • Holter Monitor • Event Monitor • Loop record • Implantable loop record

  32. Treatment of Arrhythmia • Removal of precipitants • Caffeine • Electrolyte Imbalances • Thyroid abnormalities • Medications Traditional • Ablation • Implantable defibrillator

  33. Ablation of Arrhythmias • Particularly useful with: • SVT • Atrial fibrillation • Atrial flutter • WPW • Some types of Ventricular Tachycardia

  34. Implantable Cardioverter/Defibrillator Ventricular Fibrillation View Defibrillator

  35. Heart Valve Disease

  36. Valve Disease Valves are intended to allow blood flow in only one direction from one heart chamber to another • Normal Function: • Allow blood to flow freely one direction and none backwards • Dysfunction: • Become narrow and impede forward flow (stenosis) • Become incompetent and allow backward flow (regurgitation) Pulmonic Valve Aortic Valve Tricuspid Valve Mitral Valve

  37. Shortness of breath Fatigue Chest Pain Susceptibility to infection Death Valve Disease Congenital Abnormality Infection Valve Dysfunction Age Related Degeneration Rheumatic Fever

  38. Treatment of Valve Disease • Medications • Surgery • Percutaneous repair

  39. Open Heart Surgery

  40. Percutaneous Valvuloplasty Mitral Valvuloplasty Aortic Valvuloplasty

  41. Percutaneous Aortic Valve Replacement

  42. Percutaneous Aortic Valve Replacement

  43. What can you do to stay healthy?

  44. Know your Enemies! • Inactivity • Obesity • Smoking • Elevated cholesterol • Diabetes • Hypertension

  45. Calculate Your Risk Framingham Risk Calculator Men Women

  46. Make the right choices • Use the stairs; take a daily walk! • Stay away from all fast food restaurants! • Eat smaller portions • Read food labels • Choose foods made from whole grains • Stay away from restaurants that allow smoking

  47. Learn about Trans Fatty Acids • Low level presence in meat and milk of ruminant animals • High levels in “partially hydrogenated vegetable oils” • Lot of bad consequences: • Raise LDL & lower HDL • Increase risk of heart disease by 30%

  48. Saturated fats < 7% of total caloric intake Trans fats to < 1% of total caloric intake Cholesterol to < 300 mg per day Total fat to 25-35% of total caloric intake Trans Fatty Acids AHA Recommendations: FDA mandated trans fat food labeling after January 1, 2006

  49. Some Unlikely Friends?

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