1. An Invitation to Health Chapter 14 Keeping Your Heart Healthy Dr. Lana Zinger ©2004 Wadsworth Publishing Co.

2. The Healthy Heart

4. Chambers of the Heart Right Atrium Receives blood through the superior and inferior vena cava. Left Ventricle Pumps blood rich in oxygen through the aorta to the arteries to nourish the body systems. Left Atrium Receives oxygenated blood from the lungs. Right Ventricle Pumps blood in need of oxygen to the lungs.

5. The Path Of Blood Flow

6. Death Rates for Cardiovascular Disease in the United States, 1940 & 2000

7. Heart Healthy Benefits of Regular Physical Activity Reduction in body weight. Reduction in blood pressure. Reduction of LDL and total cholesterol. Increase in HDL cholesterol. Increased insulin sensitivity. American Heart Association, American College of Sports Medicine and the CDC 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week. Institute of Medicine 60 minutes of daily physical activity to counter the obesity epidemic.

8. Heart Healthy Nutrition Plenty of fruits and vegetables. Plenty of fruits and vegetables. Cholesterol Lowering Foods: Cholesterol Lowering Foods: Oats, barley, soy protein, and nuts. Oats, barley, soy protein, and nuts. Fish 2 times a week (AHA). Fish 2 times a week (AHA). Insufficient Evidence to Recommend For or Against the Use of: Insufficient Evidence to Recommend For or Against the Use of: Supplements of vitamin A, C, or E. Supplements of vitamin A, C, or E. Multivitamins with folic acid. Multivitamins with folic acid. Antioxidant combinations. Antioxidant combinations.

9. The Lifestyle Syndrome Definition: A cluster of conditions and diseases that result from: Definition: A cluster of conditions and diseases that result from: Consuming too many calories. Consuming too many calories. Ingesting too much saturated fat, sodium, and alcohol. Ingesting too much saturated fat, sodium, and alcohol. Not burning up enough calories. Not burning up enough calories. Smoking or being exposed to tobacco smoke. Smoking or being exposed to tobacco smoke. Consequences: Consequences: Hypertension, metabolic syndrome, obesity, high cholesterol, cardiovascular disease, cancer, osteoarthritis, depression, sexual dysfunction, and diabetes mellitus. Hypertension, metabolic syndrome, obesity, high cholesterol, cardiovascular disease, cancer, osteoarthritis, depression, sexual dysfunction, and diabetes mellitus.

10. Risk Factors for Cardiovascular Disease Factors You Can Control Physical Inactivity Physical Inactivity Tobacco Tobacco Obesity Obesity Blood Fats Blood Fats Metabolic Syndrome Metabolic Syndrome Diabetes Mellitus Diabetes Mellitus Factors You Can’t Control Heredity Race and Ethnicity Age Gender Bacterial Infection

11. Tobacco and Heart Disease Smoking is the single most significant risk factor for CV disease and peripheral vascular disease. Smoking is the single most significant risk factor for CV disease and peripheral vascular disease. Each year smoking causes 250,000+ deaths from cardiovascular disease. Each year smoking causes 250,000+ deaths from cardiovascular disease. Active vs. passive smoking. Active vs. passive smoking. How Smoking Damages The Heart: How Smoking Damages The Heart: Nicotine overstimulates the heart. Nicotine overstimulates the heart. Carbon monoxide reduce the oxygen supply to the heart. Carbon monoxide reduce the oxygen supply to the heart. Tars and other smoke residues increase the risk of cholesterol build-up in the arteries. Tars and other smoke residues increase the risk of cholesterol build-up in the arteries. Smoking increases blood clotting. Smoking increases blood clotting. Smoking causes irreversible damage to the arteries. Smoking causes irreversible damage to the arteries.

12. Measurement of Blood Pressure

13. Blood Pressure Systolic Blood Pressure Pressure exerted by blood against walls of the arteries during forceful contraction of the heart. Diastolic Blood Pressure Pressure exerted by blood against the walls of the arteries during relaxation of the heart. Definition: Definition: A measure of the force exerted against the walls of the vessels by the blood flowing through them. Sphygmomanometer & Stethoscope

14. What Is a Healthy Blood Pressure? 120-139/80-90 mm Hg 140-159/90-99 mm Hg HYPERTENSION PREHYPERTENSION 115/75 mm Hg HEALTHY READING 160+/100+ mm Hg

15. Consequences of High Blood Pressure

16. Understanding Blood Lipids Low Density Lipoprotein(LDL) Lipoprotein(LDL) Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol. cholesterol to arterial walls; “bad” cholesterol. Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol. cholesterol to arterial walls; “bad” cholesterol. High Density Lipoprotein(HDL) Lipoprotein(HDL) Very Low Density Lipoprotein(VLDL) Lipoprotein(VLDL) Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol. stream and returns it to the liver; “good” cholesterol. Fatty substance that picks up cholesterol in the blood- stream and returns it to the liver; “good” cholesterol. stream and returns it to the liver; “good” cholesterol. The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream. The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream. TriglyceridesTriglycerides Fats that flow through the blood after meals and have been linked to increased risk of coronary artery disease. Fats that flow through the blood after meals and have been linked to increased risk of coronary artery disease.

17. Metabolic Syndrome Syndrome X or Insulin-Resistant Syndrome Definition: A cluster of medical abnormalities that increases the risk of heart disease and diabetes. Definition: A cluster of medical abnormalities that increases the risk of heart disease and diabetes. Probable Causes: Genetics, lack of exercise, and overeating. Probable Causes: Genetics, lack of exercise, and overeating. Diagnostic Criteria: Diagnostic Criteria: Waist Circumference: Men > 40 inches; Women >35 inches. Waist Circumference: Men > 40 inches; Women >35 inches. Triglycerides: >150 mg/dL. Triglycerides: >150 mg/dL. High-Density Lipoproteins: Men <40 mg/dl; Women <50 mg/dl. High-Density Lipoproteins: Men <40 mg/dl; Women <50 mg/dl. Blood Pressure:130 mm Hg (systole)/85 mm Hg (diastole). Blood Pressure:130 mm Hg (systole)/85 mm Hg (diastole). Fasting Blood Sugar: >110 mg/dl. Fasting Blood Sugar: >110 mg/dl.

18. Preventing Hypertension Lifestyle Changes Lifestyle Changes Losing weight. Losing weight. Regular exercise. Regular exercise. Dietary Approaches To Stop Hypertension (DASH Diet). Dietary Approaches To Stop Hypertension (DASH Diet). Restriction of daily sodium intake. Restriction of daily sodium intake.

19. Serum Cholesterol Guidelines AmountRating Total Cholesterol <200 mg/dl 200-239 mg/dl >240 mg/dl Desirable Borderline High High Risk LDL Cholesterol Less than 100 mg/dl 100-129 mg/dl 130-159 mg/dl 160-189 mg/dl 190+ mg/dl Optimal Near Optimal Borderline High High Very High HDL cholesterol >45 mg/dl 36-44 mg/dl <35 mg/dl Desirable Borderline High High Risk

20. Lowering Cholesterol Therapeutic Life Changes (TLC) Dietary changes Weight management Physical activity Medications Statins Bile Acid Sequestrants Nicotinic acid (niacin) Fibrates

21. Novel Risk Factors for Heart Disease C-Reactive Protein (CRP) Lipoprotein (a) Fibrinogen Homocysteine Lipoprotein Particle Size and Density

22. Development of Atherosclerosis Fatty Streaks Develop on the Arterial Walls at Injury Spots Growth and Hardening of Fatty Streaks Plaque Formation (well developed by age 30) Narrowing and Loss of Elasticity of the Arteries Restriction of Blood Flow to the Heart or Brain Limited Oxygen Delivery to the Heart or Brain Blood Pressure Elevation Blood Clot Formation and Thrombosis Angina, Heart Attack and/or Stroke

23. The Atherosclerotic Process

24. Unclogging The Arteries Cholesterol-lowering drugs Cholesterol-lowering drugs Low-fat diet Low-fat diet Dean Ornish Diet (without medications) Dean Ornish Diet (without medications) Very low-fat diet (8% of total daily calories) Very low-fat diet (8% of total daily calories) Moderate exercise for 1 hour three times per week. Moderate exercise for 1 hour three times per week. Stress counseling. Stress counseling. One hour of yoga, meditation, breathing, and progressive relaxation per day. One hour of yoga, meditation, breathing, and progressive relaxation per day.

25. Factors That Trigger Coronary Artery Spasms Clumping of Platelets Stress SmokingIncreasedCalciumFlow

26. Acute Myocardial Infarction Heart Attack Definition Definition: A condition that occurs when blood supply to the heart muscle is cut off and the tissue dies. Crushing or heavy discomfort or pain in the chest Heartburn symptoms accompanied by nausea and vomiting Chest pain that spreads to the shoulders, neck, jaw or arms Lightheadedness, dizziness or fainting Sweating

27. Treatments That Save Hearts Clot-dissolving drugs Clot-dissolving drugs Thrombolytic Thrombolytic Platelet receptor blocker Platelet receptor blocker Early administration of appropriate medications. Early administration of appropriate medications. Intravenous nitroglycerin Intravenous nitroglycerin Beta-blockers Beta-blockers Angioplasty Angioplasty

28. Arrythmias Irregular Heart Beat Bradycardia: Bradycardia: Heart rate of fewer than 60 beats per minute. Heart rate of fewer than 60 beats per minute. Tachycardia: Tachycardia: Heart rate of more than 100 beats per minute. Heart rate of more than 100 beats per minute. Potential Causes: Potential Causes: Atherosclerosis, hypertension, mineral imbalance, alcohol, tobacco, cocaine, or other drugs. Atherosclerosis, hypertension, mineral imbalance, alcohol, tobacco, cocaine, or other drugs. Symptoms: Symptoms: Fatigue, lightheadedness, loss of consciousness, death, and organ damage. Fatigue, lightheadedness, loss of consciousness, death, and organ damage. Diagnosis: Diagnosis: Electrocardiogram. Electrocardiogram. Treatment: Treatment: Medications and/or pacemakers. Medications and/or pacemakers.

29. Other Crises Of The Heart Mitral-Valve Prolapse Congestive Heart Failure CongenitalDefects Rheumatic Fever

30. Heart Savers Diagnostic Tests Diagnostic Tests Electrocardiogram (ECG, EKG) Thallium scintigraphy Coronary angiography Treatments Treatments Aspirin therapy Medications Diuretics, beta-blockers, calcium channel blockers, angiotensin- converting enzyme inhibitors (ACE). Surgical Procedures Coronary bypasspercutaneous transluminal coronary angioplasty, heart transplant, and left-ventricular-assist devices (LVADs).

31. Stroke Definition Definition When the blood supply to a portion of the brain is blocked. Also called a cerebrovascular accident. Statistics Statistics Strokes are the 3 rd leading cause of death in the U.S. Worldwide stroke are the second leading cause of death. Types Types Ischemic stroke vs. hemorrhagic stroke vs. transient ischemic attacks. Causes Causes Cerebral thrombosis, cerebral embolism, head injury and bursting of an aneurysm.

32. Warning Signs of a Stroke Sudden numbness or weakness of the face, arm, or leg – particularly on one side of the body. Sudden confusion, difficulty in speech or understanding. Sudden trouble seeing out of one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. A sudden severe headache of unknown cause.

33. Risk Factors for Strokes Gender Race Age Hypertension High Red Blood Cell Count Heart Disease Blood Fats Diabetes Mellitus

34. Prevention and Treatment for Strokes A baby aspirin a day keeps strokes away. A baby aspirin a day keeps strokes away. Surgery Surgery Carotid endartectomy Carotid endartectomy Brain angioplasty Brain angioplasty Medications Medications Thrombolytic drugs Thrombolytic drugs Tissue-type plasminogen activator (tPa) Tissue-type plasminogen activator (tPa) Heparinoids Heparinoids Nimodipine Nimodipine

35. Heart-Smart Strategies For Life Don’t smoke Watch your weight Cut down on saturated fat and cholesterol Get moving Lower your stress levels Know your family history Get your blood pressure checked regularly Tame your temper Get a lipoprotein profile Take appropriate medications