1. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Thirteen: Heart Disease, Hypertension, Stroke, and Type II Diabetes

2. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coronary heart disease Hypertension Stroke Type II diabetes 2

3. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Caused by atherosclerosis Narrowing of coronary arteries High cholesterol High blood pressure Elevated levels of inflammation Diabetes Cigarette smoking Obesity Lack of exercise Risk factors 3

4. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 4 (Source: National Heart, Lung, and Blood Institute, 2010a)

5. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Helps predict heart attacks when identified Diagnosed when a person has: Obesity centered around the waist High blood pressure Low levels of HDL Difficulty metabolizing blood sugar High levels of triglycerides 5

6. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Plays a role in the development of CHD Cumulative effects lead to damage of the endothelial cells Reflected in a prolonged recovery period 6

7. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chronic and acute stress is linked to CHD and adverse clinical events Interacts with genetic factors to increase likelihood of CHD Associated with increased inflammatory activity 7

8. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Low economic status Bad family environment Lack of social support Illness Workplace related stress Loss of control over life Social instability Urbanization 8

9. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Leading cause of death in women in developed nations Estrogen prevents early onset of CHD Reduces sympathetic nervous system arousal Lowers incidence of high blood pressure and neuroendocrine and metabolic responses Risk increases after menopause 9

10. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Negative emotions increase risk for metabolic syndrome and CHD Hostility can occur from: Insecure and negative feelings Bad child rearing practices Bad family environment Genetic factors 10

11. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Linked with higher incidence of CHD Leads to interpersonal conflicts and reduced social support Is a social manifestation of cardiovascular reactivity Hostile emotions Show a weak antagonistic response to sympathetic activity Show larger and longer-lasting blood pressure responses Hostile individuals 11

12. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Depression affects the development, progression, and mortality from CHD Linked to risk factors for: Coronary heart disease Metabolic syndrome Inflammation and likelihood of a heart attack Heart failure among the elderly and mortality after coronary artery bypass graft surgery 12

13. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Vigilant copingAnxietyVital exhaustion HostilitySocial isolation 13

14. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Role of delay - One of the reasons for high rates of mortality and disability following heart attacks Initial treatment Coronary artery bypass graft (CABG) surgery to treat blockage of major arteries Patients are closely monitored following myocardial infarction (MI) 14

15. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Anxiety predicts complications during the hospital phase Reinfarction and recurrent ischemia Cardiac rehabilitation: Helps patients to attain their optimal physical, medical, psychological, social, emotional, vocational, and economic status 15

16. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Treatment by medication Self-administration of beta-adrenergic blocking agents Aspirin - Prescribed for people recovering from or at risk for heart attacks Statins - Prescribed for patients following an acute coronary event Patients are given dietary instructions and put on an exercise program 16

17. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Stress management - Patients are taught to recognize stressful situations and avoid or manage stress Targeting depression - Cognitive-behavioral therapy is used Social support Predicts exercise tolerance Targeted for intervention during recovery 17

18. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Problems of social support Primary relationships are threatened Conflict over changes in lifestyle can increase marital strife Cardiac invalidism: Patients and their spouses see the patient’s abilities as lower than they actually are Consequence of MI 18

19. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Evaluation of cardiac rehabilitation Patients’ risks for heart disease can be reduced by interventions that target weight, blood pressure, smoking, and quality of life Psychosocial treatments for psychosocial issues should be added to standard cardiac rehabilitation programs 19

20. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular disease (CVD): Occurs when the supply of blood through the vessels is excessive Cardiac output is too high Occurs in response to peripheral resistance Is a risk factor for other disorders Heart disease and kidney failure 20

21. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Can affect cognitive functioning if untreated Measured by the levels of systolic and diastolic blood pressure Causes 90% is of unknown origin 5% by failure of the kidneys 21

22. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Risk factors Childhood temperament and blood pressure reactivity Gender Genetic factors Emotional factors Family environment Stress 22

23. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tied to stress of racial discrimination and low SES Hereditary factors Prevalent in people with lower income Obesity John Henryism: Personality predisposition to cope actively with psychosocial stressors 23

24. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Drug treatments Low-sodium diet Reduction of alcohol Weight-reduction in overweight patients Exercise Caffeine restriction 24

25. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cognitive-behavioral treatments Biofeedback Progressive muscle relaxation Hypnosis Meditation Deep breathing and imagery Anger management 25

26. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Evaluation of cognitive-behavioral interventions Reduce drug requirements Best approach to the management of hypertension - Combination of cognitive- behavioral techniques and drugs Problems - Hidden disease Diagnosis occurs during standard medical examinations as the disease is symptomless 26

27. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Results from a disturbance in blood flow to the brain Causes Blood flow to localized areas of the brain is interrupted Cerebral hemorrhage 27

28. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Source: American Heart Association, 2004a. 28

29. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. High blood pressureHeart diseaseCigarette smokingHigh red blood cell countTransient ischemic attacksNegative emotionsSudden change in posture to a startling eventPsychological distress 29

30. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Consequences Motor problems Cognitive problems Emotional problems Rehabilitative interventions Medication Psychotherapy Cognitive remedial training 30

31. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Movement therapies Use of structured, stimulating environments to challenge capabilities Neurorehabilitation - Rewiring the brain so that areas of the brain other than the one affected by the stroke can come to take on those functions 31

32. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Frequent urinationFatigue and dryness of the mouthImpotenceIrregular menstruationLoss of sensationFrequent infection of the skin, gums, or urinary systemPain or cramps in legs, feet, or fingersSlow healing of cuts and bruisesIntense itching and drowsiness 32

33. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Source: American Diabetes Association, 2012. 33

34. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coronary heart disease Blindness among adults Kidney failureFoot ulcers Eating disorders Nervous system damage Alzheimer’s disease Vascular dementia Difficulties in sexual functioning Risk for depression Cognitive dysfunction Risk of heart attack and stroke 34

35. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Sensitive to the effects of stress Self-management Dietary intervention - Reduce sugar and carbohydrate intake Patients are encouraged to: Achieve normal weight Exercise Improves adherence 35

36. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Interventions Cognitive-behavioral interventions Weight control improves glycemic control Self-management and problem-solving skills Social skills training Behavior modification Pharmacological therapy Lifestyle intervention and medication can greatly reduce the incidence of diabetes 36