Heart Disease- CHD

1. Heart Disease- CHD Risks, facts, screenings, questions http://www.heart.org/HEARTORG/Conditions/Conditions_UCM_001087_SubHomePage.jsp

2. Facts: what is CHD • Coronary Heart Disease is a condition which affects the vessels which supply the heart's muscle with blood, oxygen and nutrients. • If vessels become partially blocked- decreased heart functioning- experience chest pain or angina • If vessels completely blocked- some heart muscle can die- cuase heart attacks • Fat, calcium, cholesterol, and other substances can block vessels • Blocked vessels make the aterial walls narrow from plaque or form hard fibrous caps which can erupt and cause blood clots.

3. Facts- Causes/ Incidences • Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. • Coronary Heart Disease (CHD) kills over 400,000 men and women each year. • One out of every five deaths is due to CHD. One-third of people who have a heart attack do not survive it. • In addition, over 12 million Americans are currently living with coronary heart disease pain and/or heart problems. • Stroke is the No. 4 cause of death in the United States.

4. Facts cont. • CHD is a simple term used to describe several problems related to plaque buildup in the walls of the arteries, or atherosclerosis. As the plaque builds up, the arteries narrow, making it more difficult for blood to flow and creating a risk for heart attack or stroke. Other types of heart disease include heart failure, an irregular heartbeat – or arrhythmia – and heart valve problems. • Coronary heart disease is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries. • Fatty material and other substances form a plaque build-up on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart. • This buildup causes the arteries to get narrow. • As a result, blood flow to the heart can slow down or stop.

5. The risk factors for heart disease that you CANNOT change are: • Your age. The risk of heart disease increases with age. • Your gender. Men have a higher risk of getting heart disease than women who are still getting their menstrual period. After menopause, the risk for women is closer to the risk for men. See: Heart disease and women • Your genes. If your parents or other close relatives had heart disease, you are at higher risk. • Your race. African Americans, Mexican Americans, American Indians, Hawaiians, and some Asian Americans also have a higher risk for heart problems.

6. Things That Increase Your Risk • Diabetes is a strong risk factor for heart disease. • High blood pressure increases your risks of heart disease and heart failure. • Extra cholesterol in your blood builds up inside the walls of your heart's arteries (blood vessels). • Smokers have a much higher risk of heart disease. • Chronic kidney disease can increase your risk.

7. Things that increase your risk cont. • People with narrowed arteries in another part of the body (examples are stroke and poor blood flow to the legs) are more likely to have heart disease. • Substance abuse (such as cocaine) • Being overweight • Not getting enough exercise, and feeling depressed or having excess stress are other risk factors. • http://www.youtube.com/watch?v=Z_uTp31Fgx8&feature=related

8. Symptoms • It may feel heavy or like someone is squeezing your heart. You feel it under your breast bone (sternum), but also in your neck, arms, stomach, or upper back. • The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. • Other symptoms include shortness of breath and fatigue with activity (exertion). • Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as: • Fatigue • Shortness of breath • Weakness

9. What is blood pressure? • Blood pressure measures the force pushing outwards on your arterial walls. • The first force occurs as blood pumps out of the heart and into the arteries that are part of the circulatory system. The second force is created as the heart rests between heart beats. • Systollic vs. diastollic • The more forcefully that blood pumps, the more the arteries stretch to allow blood to easily flow. Over time, if the force of the blood flow is often high, the tissue that makes up the walls of arteries gets stretched beyond its healthy limit.

10. Blood pressure • Systollic- • Diastollic- • Healthy blood pressure: • Normal- 120/80 • Prehypertension- 120-139/ 80-89 • High blood pressure(stage 1)- 140-159/ 90-99 • Stage 2- 160 or higher/ 100 or higher • Stage 3 hypertensive crisis)- higher than 180/ higher than 110

11. Low blood pressure • Low blood pressure, or hypotension, occurs when blood pressure during and after each heartbeat is much lower than usual. This means the heart, brain, and other parts of the body do not get enough blood. • Another name for it? • Blood pressure that is borderline low for one person may be normal for another. Most normal blood pressures fall in the range of 90/60 millimeters of mercury (mm Hg) to 130/80 mm Hg. But a significant drop, even as little as 20 mm Hg, can cause problems for some people. • Low bp caused by certain drugs such as:

12. High blood pressure • Can result in: • Vascular weakness • Scarring workload on arteries and circulatory system • Scarring • Plaque build up • Organ damage • Risk of blood clots • Heart failure, heart attack, stroke

13. Prevention-hbp • Eat a better diet, which may include reducing salt • Enjoy regular physical activity • Maintain a healthy weight • Manage stress • Avoid tobacco smoke • Understand hot tub safety • Comply with medication prescriptions • If you drink, limit alcohol http://www.youtube.com/watch?v=pPxnIh_WTb8&feature=endscreen&NR=1

14. Heart Attack • A coronary attack (heart attack) occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. • When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the artery and shut off blood flow to the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the United States has a myocardial infarction (heart attack).

15. Warning Signs of Heart Attack • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. • Shortness of breath with or without chest discomfort. • Other signs may include breaking out in a cold sweat, nausea or lightheadedness. • Angina is a type of chest discomfort due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). • Stable vsunstable angina • Heart Attack - Warning Signs

16. Risks- heart attack • Heart Attack Risk Calculator. • CAD is the leading cause of death and disability in women after menopause. In fact, a 50-year-old woman faces a 46% risk of developing CAD and a 31% risk of dying from coronary artery disease. In contrast, her probability of contracting and dying from breast cancer is 10% and 3%, respectively • What to do in case of heart attack? • http://www.youtube.com/watch?v=H_VsHmoRQKk&feature=related

17. Prevention • ABCs: • Avoid tobacco • Become more active • Choose good nutrition • Reduce blood cholesterol • Lower high blood pressure • Aim for healthy weight • Manage diabetes • Reduce stress • Limit alcohol

18. arrhythmia • The normal heart is a strong, muscular pump a little larger than a fist. It pumps blood continuously through the circulatory system. • Each day the average heart beats (expands and contracts) 100,000 times and pumps about 2,000 gallons of blood. • In a 70-year lifetime, an average human heart beats more than 2.5 billion times. • Arrhythmia is refers to any change from the normal sequence of electrical impulses. The electrical impulses may happen too fast, too slowly, or erratically – causing the heart to beat too fast, too slowly, or erratically. When the heart doesn't beat properly, it can't pump blood effectively. When the heart doesn't pump blood effectively, the lungs, brain and all other organs can't work properly and may shut down or be damaged. • http://medmovie.com/mmdatabase/mediaplayer.aspx?Message=VG9waWNpZD0wO0NsaWVudElEPTY1O1Zlcm5hY3VsYXJJRD0x-P83bCzVaVLA%3d

19. Congestive Heart Failure • Heart failure doesn't mean that the heart has stopped working, but that it just isn't able to pump enough blood to meet the needs of the body. • This may happen when the heart muscle itself is weaker than normal or when there is a defect in the heart that prevents blood from getting out into the circulation • When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. The extra fluid in the circulation builds up in the lungs, the liver, around the eyes, and sometimes in the legs. This is called fluid "congestion" and for this reason doctors call this "congestive heart failure". • Fluid may also build up in the rest of the body, causing swelling of the feet, the legs or around the eyes.

20. Types of CHf • Systolic Heart Failure: In this type, the heart’s ability to contract decreases leading to backing up of blood coming from the lungs causing the fluid to leak into the lungs. This condition is called pulmonary congestion. • Diastolic Heart Failure: In this type, the heart cannot relax properly due to stiffening of the heart’s muscle leading to improper filling of the heart with blood. This condition may lead to fluid accumulation in the feet, ankles, legs and sometimes the lungs. (7) • Right-sided heart failure: The failure of the pumping action of the right side of the heart causes swelling in the legs and abdomen. • Left-sided heart failure: In this type, the left side of the heart fails in its pumping action causing congestion in the lungs. • Forward heart failure: Inability of the heart to pump sufficient blood to meet the oxygen needs of the body during an exercise or rest leads to forward heart failure. • Backward heart failure: It is the inability of the heart to meet the oxygen needs when heart pressures are very high. • High output heart failure: Though the heart pumps out the usual amount of blood, the body’s needs may not be fulfilled (8).

21. CHF Treatment • Medicines called diuretics ("water pills"), e.g., furosemide (Lasix), help get rid of the extra fluid by increasing urination. To help the body rid itself of the extra fluid, a low-salt diet may sometimes be necessary. Blood vessel relaxing medications (captopril, enalapril) may sometimes be used to make it easier for the heart to pump. Another medication, digoxin, may help the heart contract with more force.

22. Procedures • Angioplasty procedure

23. Cardiac arrest • Cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. • Each year about 295,000 emergency medical services-treated out-of-hospital cardiac arrests occur in the United States. • Heart attack vs. Cardiac Arrest • While a heart attack may cause cardiac arrest and sudden death • Cardiac arrest is caused when the heart's electrical system malfunctions. In cardiac arrest death results when the heart suddenly stops working properly. This is caused by abnormal, or irregular, heart rhythms (called arrhythmias). The most common arrhythmia in cardiac arrest is ventricular fibrillation. This is when the heart's lower chambers suddenly start beating chaotically and don't pump blood. Death occurs within minutes after the heart stops. Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed or a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes.

24. Symptoms-cardiac arrest • Sudden loss of responsiveness •  No normal breathing     The victim does not take a normal breath when you tilt the head up  Check for at least five seconds • What to do in case of cardiac arrest? • http://www.youtube.com/watch?v=jcPSqe-oxPM&feature=related • http://www.youtube.com/watch?v=kYg9e5eM9xA&feature=related • http://www.youtube.com/watch?v=LLtzT2bXVGI&feature=related

25. Diabetes • "Diabetes mellitus," more commonly referred to as "diabetes," is a condition that causes blood sugar to rise to dangerous levels: a fasting blood glucose of 126 milligrams per deciliter (mg/dL) or more. • Most of the food you eat is turned into glucose, or sugar, for your body to use for energy. The pancreas, an organ near the stomach, produces a hormone called insulin. This hormone is necessary for the body to be able to use sugar or glucose, the basic fuel for cells in the body. Insulin's role is to take sugar from the blood into the cells. When your body does not produce enough insulin and/or does not efficiently use the insulin it produces, sugar levels rise and build up in the bloodstream. When this happens, it can cause two problems: 1. Right away, the body's cells may be starved for energy. • 2. Over time, high blood glucose levels may damage the eyes, kidneys, nerves or heart. • Show medmovie

26. Diabetes cont. • Type 1 diabetes is a serious condition that occurs when the pancreas makes little or no insulin. Without insulin, the body is unable to take the glucose (blood sugar) it gets from food into cells to fuel the body. So without daily injections of insulin, people with type 1 diabetes won't survive. For that reason, this type of diabetes is also referred to as insulin-dependent diabetes.Type 1 diabetes was previously known as juvenile diabetes because it's usually diagnosed in children and young adults. However, this chronic, lifelong disease can strike at any age, and those with a family history of it are particularly at risk.Health Risks for Type 1 DiabetesDuring the development of type 1 diabetes, the body's immune system attacks certain cells (called beta cells) in the pancreas. Although the reasons this occurs are still unknown, the effects are clear. Once these cells are destroyed, the pancreas produces little or no insulin, so the glucose stays in the blood. When there's too much glucose in the blood, especially for prolonged periods, all the organ systems in the body suffer long-term damage. Learn more about the health consequences of diabetes and how to treat it.

27. Type II • Type 2 diabetes is the most common form of diabetes. Historically, type 2 diabetes has been diagnosed primarily in middle-aged adults. Today, however, adolescents and young adults are developing type 2 diabetes at an alarming rate. This correlates with the increasing incidence of obesity and physical inactivity in this population, both of which are risk factors for type 2 diabetes.This type of diabetes can occur under two different circumstances: •     The pancreas doesn't make enough insulin, or •     The body develops "insulin resistance" and can't make efficient use of the insulin it makes • In a mild form, this type of diabetes can go undiagnosed for many years, which is a cause for great concern since untreated diabetes can lead to many serious medical problems, including cardiovascular disease. Type 2 diabetes may be delayed or controlled with diet and exercise.

28. Precursors to Diabetes • Prediabetes is a condition in which fasting blood glucose (blood sugar) levels are higher than normal but have not quite reached the 126 milligrams/deciliter (mg/dL) threshold considered to be full-blown diabetes.Two prediabetic states include: •  Impaired fasting glucose (IFG): A person is considered to have IFG with a fasting blood glucose ranging from 100 to 125 mg/dL. •  Impaired glucose tolerance (IGT): Individuals with IGT have a fasting glucose less than 126 mg/dL and a glucose level between 140 and 199 mg/dL two hours after taking an oral glucose tolerance test.    • Health Risks for PrediabeticsThe American Heart Association estimates that 59.7 million Americans 20 years and older have prediabetes. People with IFG and IGT are at increased risk for developing type 2 diabetes, heart disease and stroke. Long-term damage to the cardiovascular system may occur while a person has prediabetes, and a recent study indicates that prediabetes more than doubles the risk of death due to heart attack.*

29. Insulin Resistance • Both type 2 diabetes and prediabetes usually result from insulin resistance.Insulin resistance, which is a condition that affects more than 60 million Americans, occurs when the body can't use insulin efficiently. To compensate, the pancreas releases more and more insulin to try to keep blood sugar levels normal. Gradually, the insulin-producing cells in the pancreas become defective and ultimately decrease in total number. As a result, blood sugar levels begin to rise, causing prediabetes and, eventually, type 2 diabetes to develop.When a fasting individual has too much glucose in the blood (hyperglycemia) or too much insulin in the blood (hyperinsulinemia), it indicates a person may have insulin resistance.Health Risks of Insulin ResistancePeople with insulin resistance are at greater risk of developing type 2 diabetes. They also are more likely to have too much LDL ("bad") cholesterol, not enough HDL ("good") cholesterol, and high triglycerides, which cause atherosclerosis.

31. Who should be tested • Overweight and over age 45 • Overweight, under age 45 and have one of more additional risk factors such as: • High blood pressure • High cholesterol • A family history of diabetes • African-American, Asian-American, Latino/Hispanic-American, Native American or Pacific Islander descent • A history of gestational diabetes (diabetes during pregnancy) or delivering a baby over 9 lbs. • If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. • They use a fasting glucose test or oral glucose testhow the body handles standard glucose levels

32. Treatment • Type I diabetes, the pancreas doesn’t produce insulin. In type II the pancreas produces it, but doesn’t use it properly. So in both cases, people might have to take insulin. • Syringe: A needle connected to a hollow tube that holds the insulin and a plunger that pushes the insulin down into and through the needle • Insulin pen: A device that looks like a pen and holds insulin but has a needle for its tip • Insulin pump: A small machine (worn on a belt or kept in a pocket) that holds insulin, pumps it through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days

33. stroke • Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 4 cause of death and a leading cause of disability in the United States. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.

34. Statistics about strokes • About 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds. • Stroke kills more than 137,000 people a year. That's about 1 out of every 18 deaths. It's the No. 4 cause of death. • On average, every 4 minutes someone dies of stroke. • About 40 percent of stroke deaths occur in males, and 60 percent in females. • The 2006 stroke death rates per 100,000 population for specific groups were 41.7 for white males, 41.1 for white females, 67.7 for black males and 57.0 for black females. • Americans will pay about $73.7 billion in 2010 for stroke-related medical costs and disability.

35. Division of brain

36. Types of stroke • Ischemic( clots) • Hemorrhagic (bleeds) • TIA (Transient Ischemic Attack) • Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases.

37. Cont. • Bleeds • TIA

38. Who’s at risk • Age-The chance of having a stroke approximately doubles for each decade of life after age 55 • Race- African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity. • Gender- stronger possibility in men than woman(However, more than half of total stroke deaths occur in women.) • Heredity- family history or prior stroke symptoms • Symptoms- how to tell? FAST

39. Preventative measures/treatment • Anticoagulants/Antiplatelets • Carotid Endarterectomy • Angioplasty/Stents • http://www.youtube.com/watch?v=yXONEHmupy0&feature=related • http://www.youtube.com/watch?v=XkElztcWpa0 • http://www.youtube.com/watch?v=VGvKUPJ7a_U • http://www.youtube.com/watch?v=Qvk9OwGh_JA