Cardiovascular Disease Treatment
This section of the book contains four chapters that deal with diseases. Uninformed people claim that âthere is nothing you can do to avoid disease,â ample evidence indicates that positive personal health choices can help reduce your risk of developing many diseases, from cardiovascular disease treatment cancer to sexually transmitted diseases, including HIV and AIDS.
In this chapter, we will explain what you can do to reduce your risk of developing cardiovascular diseases.
Real Life Real choices
Straight from the Heart: One Kidâs Story
- Name: Greg Chulick
- Age: 10
- Occupation: Student, boy Scout, Little Leaguer
If Greg Chulick had a nickel for every time heâs heard those words from an older relative, heâd be a lot closer to affording that Duke snider card at the baseball bonanza store downtown.
He knows there are a lot of great things about being his age: like lazy afternoons fishing for carp in the Cridersâ pond, playing first base on the Little League team, and going on overnights with his scout troop.
Greg Chulick History
And now itâs Gregâs turn. Heâs got the sore throat that wonât go away, the sore throat that isnât just any sore throat, except thatâs what everyone thought Joey had…
As you study this chapter, think about what Greg is experiencing and prepare yourself to answer the question in Your Turn at the end of the chapter.
Great progress has been made with respect to CVD the focus of this chapter.
Greg Chulick Treatment
The American Heart Association, in its 1997 Heart and Stroke Facts, credits this reduction to a combination of (a) prevention-oriented education programs that lead to lifestyle changes and (b) medical advances in the diagnosis and treatment of CVD. Interestingly, if all forms of cardiovascular disease were eliminated life expectancy in the U.S would increase by almost ten years.
This chapter provides material to help you understand how the heart works. Beyond this, it will help you identify your CVD risk factors and suggest ways you can alter certain lifestyle behaviors to reduce your risk of developing heart disease.
The Vascular System
The term vascular system refers to the bodyâs blood vessels.
After the blood leaves the capillaries and beings its return to the heart, it drains into small veins or venules.
The blood in the venules flows into increasingly larger vessels called veins.
Figure 10-1 Of 954,720 deaths in United States in 1994 caused by cardiovascular diseases, over half were attributable to heart attack.
Estimated Prevalence of Major Cardiovascular Diseases*
|Cardiovascular Disease||Estimated Prevalence of Major|
|Coronary heart disease||11,200,000|
|Congenital heart disease||950,000|
|Rheumatic heart disease||1,350,000|
The heart does not lie completely in the center of the chest.
Two upper chambers called atria, and two lower chambers, called ventricles, from the heart. Study Figure 10-2 and follow the flow of blood through the heartâs four chambers.
To function well, the heart muscle must receive adequate amounts of oxygen. The two main coronary arteries ( and their many branches) accomplish this.
These arteries are located outside of the heart. If the coronary arteries are diseased and not functioning well, a heart attack is possible.
The heart contracts and relaxes through the delicate interplay of cardiac muscle tissue and cardiac electrical centers, called nodes.
- Cardiovascular Pertaining to the heart (cardio) and blood vessels (vascular)
- thorax the chest; the portion of the torso above the diaphragm and within the rib cage.
- Coronary arteries vessels that supply oxygenated blood to heart muscle tissues.
- Cardiac muscle specialized smooth muscle tissue that forms the middle (muscular) layer of the heart wall.
Figure 10-2 The heart functions as a complex double pump. The right side of the heart pumps deoxygenated blood to the lungs. The left side of the heart pumps oxygenated blood through the aorta to all parts of the body. Note the thickness of the walls of the ventricles. These are the primary pumping chambers.
The average-sized adult has approximately six quarts of blood in his or her circulatory system.
- Transportation of nutrients, oxygen, wastes, hormones, and enzymes
- Regulation of water content of body cells and fluids
- Buffering to help maintain the appropriate pH balance of body fluids
- Regulation of body temperature: the water component in the blood absorbs heat and transfers it
- Prevention of blood loss; by coagulating or clotting, the blood can alter its form to prevent blood loss through injured vessels
- Protection against toxins and microorganisms, accomplished by chemical substances called antibodies and specialized cellular elements circulating in the bloodstream.
Cardiovascular Disease Risk Factors
By protecting your cardiovascular system, you lay the groundwork for a more exciting, productive, and energetic life.
Improvements in certain lifestyle activities can pay significant dividends as your life unfolds.
Complete the personal Assessment to estimate your risk for heart disease
The American Heart Association encourages people to protect and enhance their heart health by examining the ten cardiovascular risk factories that are related to various forms of heart disease.
A cardiovascular risk factor is an attribute that a person has or is exposed to that increases the likelihood that he or she will develop some forms of heart disease.
Three risk factors are ones you will be unable to change. An additional four risk factors are ones you can clearly change.
Three final risk factors are ones that are thought to be contributing factors to heart disease.
These risk factors are summarized in the Star Box on page 303. Letâs look at these three groups of risk factors separately.
Risk Factors That Cannot Be Changed
The three risk factors that you cannot change are increasing age, male gender, and heredity.
Prevention of Heart Disease Begins in Childhood
For many aspects of wellness, preventive behaviors are often best learned in childhood, where they can be repeated and reinforced by family members and caregivers.
Intervention programs that target children have been shown to be effective in preventing hypertensive cardiovascular disease.28
The disease progresses according to each individualâs level of risk factors.
In response, experts have identified five major areas as targets for cardiovascular health promotion in childhood: obesity, cardiovascular fitness, hypertension, hypercholesterolemia (high blood levels of cholesterol), and smoking prevention.25
Get Started Prevent of Heart Disease
Sadly, the present state of health of Americaâs youth shows severe deficiencies in these areas.
Teenage children are becoming increasingly overweight and obese.
These unhealthy behaviors are lying the foundation for coronary artery disease, hypertension, and stroke in the future.
Programs that seek to instill healthy behaviors in children can have a real benefit.
The study found the greatest benefit in two types of programs: improving home nutrition and improving fitness.27 those of us who are parents must make better efforts to encourage our children to eat more nutritiously and be physically active. We can discourage cigarette use.
Perhaps the best thing all adults can do for our youth is to set a good example by adopting our own heart-healthy behaviors.
Like increasing age and male gender, this risk factor cannot be changed.
In this latter case, children are said to have a genetic predisposition (tendency) to develop heart disease as they grow and develop throughout their lives.
These people have every reason to be highly motivated to reduce the risk factors they can control.
What Is Your Risk for Heart Disease
|Your serum cholesterol level is:||Your HDL cholesterol is:|
|0-190 or below||2 Over 60|
|+ 2 191 to 230||0 45 to 60|
|+ 6 131 to 289||+ 2 35 to 44|
|+ 16 Over 320||+ 6 29 to 34|
|+ 16 Over 320||+ 16 Below 23|
You smoke now or have in the past:
- +1Â Â Quit 2 to 4 years ago
- +3Â Â Quit about 1 year ago
- You now smoke:
- +9 Â Â½ to 1 pack a day
- +12 1 to 2 packs a day
The quality of the air you breath is;
- Unpolluted by smoke, exhaust, or industry at home and at work
- +2 Live or work with smokers in the unpolluted area
- +4 Live and work with smokers in the unpolluted area
- +6 Live or work with smokers and live or work in an air-polluted area
- +8 Live and work with smokers and live and work in an air-polluted area
Your blood pressure is:
- 120/75 or below
- +2 120/75 to 140/85
- +6 140/85 to 150/90
- +8 150/90 to 175/100
- +10 175/100 to 190/110
- +12 190/110 or above
Your exercise habits are:
- Exercise vigorously 4 or 5 times a week
- +2Â Â Exercise moderately 4 or 5 times a week
- +4 Â Exercise only on weekends
- +8Â Â Little or no exercise
Your weight is:
- Always or near ideal weight
- +1Â Â Now 10% overweight
- +2Â Â Now 20% overweight
- +3Â Â Now 30% or more overweight
You feel overstressed :
- Rarely at work or at home
- +3Â Â Somewhat not at work home
- +7Â Â Somewhat at work and at home
- +9Â Â Usually at work or at home
- +12 Usually at work and at home
Your diabetic history is:
- Blood sugar always normal
- +2Â Â Blood glucose slightly high (prediabetic) or slightly low (hypoglycemic)
- +4Â Â Diabetic beginning after age 40 requiring strict dietary or insulin control
You drink alcohol beverages:
- +2Â Â Two to three 5-ounce glasses of wine or 12-ounce glasses of beer or Â½ -ounce cocktails about 5 times a week
Add all sources and check below
- 0 to 20: Low risk. Excellent family history and lifestyle habits.
- 21 to 50: Moderate risk. Family history or lifestyle habits put you at some risk. You might lower your risks and minimize your genetic predisposition if you change any poor habits.
- 51 to 74: High risk. Habits and family history indicate a high risk of heart disease. Change your habits now.
- Above 75: Very high risk. Family history and a lifetime of poor habits put you at very high risk of heart disease. Eliminate as many of the risk factors as you can.
Were you surprised by your score on this assessment? What were your most significant risk factors? Do you plan to make any changes in your lifestyle to reduce your cardiovascular risks? Why or why not?
Risk Factors for Cardiovascular Disease
Factors That Cannot Be Changed
- Increasing age
- Male gender
Factors That Can be Changed (âBig Fourâ Risk Factors)
- Physical inactivity
- High blood cholesterol level
- High blood pressure
- Individual response to stress
Risk factors That Can be Changed
Four cardiovascular risk factors are influenced, in large part, by our lifestyle choices. These risk factors are smoking, physical inactivity, high blood cholesterol levels, and high blood pressure. Healthful behavior changes you make concerning these four risk factors can help you protect and strengthen your cardiovascular system.
The other three controllable risk factors are important, this one may the most critical risk factor. Smoking cigarettes is a major risk factor associated with sudden cardiac death.
Studies suggest that the risk of death caused by heart disease is increased by about 30 percent in people exposed to secondhand smoke in the home.
For years it was commonly believed that if you had smoked for many years, it was pointless to try to quit; the damage to oneâs health could never be reversed.
For people who have smoked a pack or less of cigarettes per day, within three years after quitting smoking, their heart disease risk is virtually the same as those who never smoked.2
Lack of exercise is a significant risk factor for heart disease. Regular aerobic exercise (discussed in physical fitness exercises) helps strengthen the heart muscle, maintain healthy blood vessels, and improve the ability of the vascular system to transfer blood and oxygen to all parts of the body.
Perhaps people feel that they do not have enough time or that they must work out strenuously.
This is not a large price to pay for a lifetime of cardiovascular health. Find a partner and get started!
If you have any known health condition that could be aggravated by physical activity, check with a physician first.
Women and Heart Disease
Do you think heart disease is a problem just men? You might be surprised to discover that data from the American Heart Association indicate that 52 percent of all cardiovascular disease deaths are in women.
There are 20,800 women under age 65 who die from coronary artery disease who are under age 55.
A total of 60 percent of the death from stroke and high blood pressure are in women, compared with 40 percent in men.
Among people having heart attacks, one study found the drug TPA to save 17 lives per 1,000 women and 7 per 1,000 men7.
Best Women Heart Disease
In both cases, the study suggested the reason may be that women may not recognize the symptoms of a heart attack.
Women often experience abdominal pain and fatigue with chest pain. For a look at the differences in the way women and men are diagnosed and treated in cases of cardiovascular disease, see diabetes in cardiovascular disease on amazon products.
The protective mechanism for young women seems to be the female hormone estrogen. Estrogen appears to help women maintain a beneficial profile of blood fats.
This is one of the reasons that the increasing number of physicians are prescribing estrogen replacement therapy (ERT) for many postmenopausal women.
The general recommendations for maintaining heart health through a good diet, adequate physical activity, monitoring blood pressure and cholesterol levels, controlling weight, avoiding smoking, and managing stress will benefit women at every stage of life.
Do Women Receive Equal Treatment in Cardiovascular Disease?
The short answer is no; women do not receive the same level of diagnosis or treatment for cardiovascular disorders as do men. The procedures and therapies we currently use were developed predominantly or completely for men.24
Researchers report that the history of medicine shows a disregard for womenâs health problems that may prevail even today.
These differences may be a result of the difference in the way women experience cardiac symptoms.
Other possibilities are problems in the referrals women receive, or in the way women perceive themselves and their illness.
In response, the medical professional is now attempting to provide equitable health care for women and to conduct research that will describe womenâs cardiac symptoms and their responses to cardiovascular treatments.
High Blood Cholesterol
The third controllable risk factor for heart disease is high blood cholesterol levels.
Fortunately, blood cholesterol levels are relatively easy to measure. Many campus health and wellness centers provide cholesterol screenings for employees and students.
These screenings help identify people whose cholesterol levels (or profiles) may be dangerous. Medical professionals have been unable to determine the link between a personâs diet and his or her cholesterol levels.
People with high blood cholesterol levels are encouraged to consume a heart-healthy diet (see prevent diabetes food) and to become physically active.
Hormone Replacement Therapy Gains Popularity
We donât know exactly how the hormone therapy works. An effect on blood vessel walls; or a reduction in the development of atherosclerosis, the accumulation of plaques on the interior of blood vessel walls.
Hormone Replacement Therapy
Researchers are studying the question. Unfortunately, hormone-replacement might not be for all women. Experts disagree about the possible side effects of this therapy.
Dependent gynecologic tumors or breast cancer must be evaluated on an individual basis, and these women must compare the potential benefits with the potential risks.
High Blood Pressure
The fourth of the four cardiovascular risk factors that can be changed is high blood pressure or hypertension.
High blood pressure can seriously damage a personâs heart and blood vessels.
High blood pressure treatment increases the risk of stroke, heart attack, congestive heart failure, and kidney disease.
This is a positive message about high blood pressure.
Other Risk Factors That Contribute to Heart Disease
The American Heart Association identifies three other risk factors that are associated with an increased risk of heart disease. These risk factors are diabetes, obesity, and individual response to stress.
With weight management, exercise, dietary changes, and drug therapy, diabetes can be relatively well controlled in most people.
To accomplish this, you can elect to make a commitment to a reasonable sound diet and an active lifestyle.
Individual Response to Stress
Unresolved stress over a long period may be a contributing factor to the development of heart disease.
Forms of Cardiovascular Disease
The American Heart Association describes the three major forms of CVD as coronary heart disease, hypertension, and stroke.
Each form exists in varying degrees of severity. All forms are capable of causing secondary damage to other body organs and systems.
Coronary Heart Disease
Any damage to these important vessels can cause a reduction of blood flow (with its vital oxygen and nutrients) to specific areas of the heart muscle. The ultimate result of inadequate blood supply is an attack.
The principal cause of coronary heart disease is atherosclerosis. Atherosclerosis produces a narrowing of the long-term buildup of fatty deposits, called plaque, on the inner walls of the arteries.
This buildup reduces the blood supply to specific portions of the heart.
This damage is known as myocardial infarction. Inlay terms, this event is called a heart attack. The health action guide formula on muscular endurance fitness explains how to recognize the signs of a heart attack and what to do next.
Cholesterol and Lipoproteins
For many years, scientists have known that atherosclerosis is a complicated disease that has many causes.
Some 52 percent of American adults aged twenty and older exceeds the âborderline highâ 200 mg/ dl cholesterol level.
Experts estimate that nearly 40 percent of American youth aged nineteen and under have: borderline highâ cholesterol levels of 170 mg/dl or above.
Initially, most people can help lower their serum cholesterol levels by adopting three dietary changes: lowering the intake of saturated fats, lowering caloric intake to a level that does not exceed body requirements.
Some will not respond at all to dietary changes and may need to take cholesterol-lowering medications and increase physical activity.
HDLS & LDLS
Lipoproteins are particles that circulate in the blood and transport lipids (including cholesterol).2 The two major classes of lipoproteins are low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs).
After much study, researchers have determined that high levels of LDL are a significant cause of atherosclerosis. LDLs are more likely to deposit excess cholesterol into the artery walls.
This contributes to plaque formation.
HDLs are thought to transport cholesterol out of the bloodstream.
High-Density Lipoproteins & Low-Density Lipoproteins
Reducing total serum cholesterol levels is a significant step in reducing the risk of death from coronary heart disease.
Atherosclerosis the buildup of plaque on the inner walls of arteries.
Figure 10-3Â Â Progression of atherosclerosis. How plaque deposits gradually accumulate to narrow the lumen (interior space) of an artery.
This pain is caused by a reduced supply of oxygen to heart muscle tissue.
Angina reportedly can range from a feeling of mild indigestion to severe viselike pressure in the chest. The pain may extend from the center of the chest to the arms and even up to the jaw.
Some cardiac patients relieve angina with the drug nitroglycerin, a powerful blood vessel dilator.
This prescription drug, available in slow-release transdermal patches or small pills that are placed under the patient’s tongue, causes the coronary arteries to dilate and allow a greater flow of blood into heart muscle tissue.
Emergency response to Heart Crises
Heart attacks are not always fatal. The consequences of any heart attack depend on the location of the damage to the heart, the extent to which heart muscle is damaged, and the speed with which adequate circulation is restored.
Recognizing a heart attack is critically important (See Amazon product on heart attack).
Public education programs sponsored by the American Red Cross and the American Heart Association teach people how to recognize, evaluate, and manage heart attack emergencies.
Frequently, colleges offer CPR classes through health science or physical education departments. We encourage each student to enroll in a CPR course.
|Total Cholesterol Level||Classification||Recommended Follow-up|
|<200 mg/dl||Desirable blood cholesterol level||Repeat test within 5 years|
|200-239 mg/dl||Borderline-high blood cholesterol level||Without definite CVD or two other CHD risk factors(one of which may be male gender): dietary modification and annual retesting|
With definite CHD or two other CHD risk factors: lipoprotein analysis; further action based on LDL-cholesterol level
|<240 mg/dl||High blood cholesterol level||Lipoprotein analysis; further action based on LDL-cholesterol level|
Initially, an ECG might be taken. This test analyzes the electrical activity of the heart.
Recently, researchers have greatly expanded the use of magnetic resonance imaging (MRI) in cardiovascular diagnosis.
Best Diagnosis MRI
Physicians use such tools to study the function of the heart and diagnose cardiac problems. Other radiopharmaceuticals are used to reveal metabolic disorders, hypoxia, and disturbances in the function of the myocardium of the heart.11
After the extent of damage has been determined, a physician or team of physicians can decide on a medical course of action. Treatments can be divided into two broad categories: surgical and nonsurgical.
The purpose of such surgery is to detour (bypass) areas of coronary artery obstruction by using a section of a vein from the patientâs leg (often the saphenous vein) or an artery from the patientâs chest (the internal mammary artery) and grafting it from the aorta to a location just beyond the area of obstruction. Multiple areas of obstruction result in double, triple. or quadruple bypasses. In 1992 the average cost of coronary bypass surgery was $44,200.1
Physicians manipulate the coronary arteries through the small ports, and they view their work through a fiber-optic camera called a thoracoscope. This new technique results in much less pain and blood loss, a shorter hospital stay, and a quicker recovery for the patient.
Angioplasty. Angioplasty, an alternative to bypass surgery, involves the surgical insertion of a doughnut-shaped âballoonâ directly into the narrowed coronary artery (Figure 10-4).
Rear-rowing of the artery will occur in about one-quarter of angioplasty patients.2 Each year, about 400,000 people with heart disease undergo angioplasty.
In 1990 the EDA approved a new device for clearing heart and leg arteries. This device is called a motorized scraper. Inserted through a leg artery and held in place by a tiny inflated balloon, this motor-driven cutter shaves off plaque deposits from inside the artery.
The use of laser beams to dissolve plaque that blocks arteries has been slowly evolving. The FDA has approved three laser devices for use in clogged leg arteries. In February 1992 the FDA approved the use of an excimer laser for use in coronary arteries.13
Heart transplants and artificial hearts.
Figure 10-4 Angioplasty. , A âballoonâ is surgically inserted into the narrowed coronary artery. B, The balloon is inflated, compressing the plaque and fatty deposits against the artery walls.
One study found that the IIa/IIIb inhibitors reduce heart attacks in patients with unstable angina, or severe chest pain, by about half.14 Observers say this new class of drugs will have a tremendous effect on the treatment of heart problems.
Aspirin and Clopidogrel
Studies released in the late 1980s highlighted the role of aspirin in reducing the risk of a heart attack in men who had no history of previous attacks.
Aspirin works by making the blood less able to clot, which reduces the likelihood of blood vessel blockages.
Experts currently disagree about the age at which this preventive action should begin. Alcohol. For years, scientists have been uncertain about the extent to which alcohol consumption is related to a reduced risk of heart disease.
Experts caution that heavy drinking increases cardiovascular risks and that nondrinkers should not start to drink just to reduce heart disease risk.
Can Alcohol Be Good for Your Heart?
You have probably seen the controversial headlines over the past couple of years, starting that moderate consumption of alcohol may actually reduce your risk of coronary heart disease. Such research is controversial experts fear they may encourage problem drinking of turn abstainers into problem drinkers.
Klatsky identifies two possible explanations for the cardiovascular benefits: (1) that alcohol raises the level of protective high-density lipoprotein (HDL) cholesterol in the blood, making atherosclerosis less likely, and (2) that alcohol inhibits blood clotting by helping to dissolve clots in blood vessels.
One study reported that having two drinks a day reduces by a third the risk of developing clogged arteries in the legs.21
Just as your carâs water pump recirculates water and maintains water pressure, your heart recirculates blood and maintains blood pressure.
Your blood pressure is a measure of the force that your circulating blood exerts against the interior walls of your arteries and veins.
Blood pressure is measured with a sphygmomanometer.
A sphygmomanometer is attached to an arm-cuff device that can be inflated to stop the flow of blood temporarily in the brachial artery.
This artery is a major supplier of blood to the lower arm. It is located on the inside of the upper arm, between the biceps and triceps muscles.
Hypertension refers to consistently elevated blood pressure.
American Heart Association Reports
Brittle, calcified blood vessels can burst unexpectedly and produce serious strikes (brain accidents), kidney failure (renal accidents), or eye damage (retinal hemorrhage).
Clearly, hypertension is a potential killer.
People with this disorder cannot feel the sensation of high blood pressure.
Hypertension is not thought of as a curable disease; As a responsible adult, you should use every opportunity you can to measure your blood pressure regularly.
Prevention and Treatment
For overweight or obese people, a reduction in body weight may produce a significant drop in blood pressure.
Reducing salt intake would have little effect on the blood pressure of the rest of the population.
In recent years, behavioral scientists have reported the success of meditation, biofeedback, controlled breathing, and muscle relaxation exercises in reducing hypertension.
Disease and Its Prevention
Diuretic drugs work by forcing fluid from the bloodstream, thereby reducing blood volume.
Some people taking these medications report uncomfortable side effects, including depression, reduced libido (sex drive), muscle weakness, impotence, dizziness, and fainting.
Learning From Our Diversity
Dancing Their Hearts Out: African-American and Hispanic-American Adolescents Improve Cardiovascular Fitness
Try telling a teenager that he or she is at risk for cardiovascular disease, and youâll probably get a reaction ranging from polite skepticism to a burst of laughter.
Improve Cardiovascularly Fitness
A key to preventing or delaying the onset of CVD is regular physical activity, and school physical education programs can encourage students to participate by making activities appealing and enjoyable.
That was the rationale behind Dance for Health, an intervention program designed to provide an enjoyable aerobic routine for low-income African-American and Hispanic-American adolescents.
In the first year of the intervention, some 110 boys and girls ages ten to thirteen took part in the aerobic dance pilot program for twelve weeks.
The next year, a culturally sensitive health education class twice a week and went to a dance-oriented physical education class three times a week.
The bottom line?
Do you have a favorite aerobic activity? Why do you like it, and how often do you do it?
The third major CVD is a stroke. Stroke is a general term for a wide variety of crises (sometimes called cerebrovascular accidents [CV As] or brain attacks) that result from blood vessel damage in the brain.
About a half-million people suffer a stroke in the United States each year, and of these, about a third die.
Any disturbance in the proper supply of oxygen and nutrients to the brain can pose a threat.
Perhaps the most common form of stroke results from the blockage of a cerebral (brain) artery.
The resultant accidents (cerebral thrombosis or cerebral embolism) cause 70 percent to 80 percent of all strokes. The portion of the brain deprived of oxygen and nutrients can literally die.
The third type of stroke can result from an artery that bursts to produce a crisis called cerebral hemorrhage (Figure 10-5C).
The fourth form of stroke is a cerebral aneurysm. An aneurysm is a ballooning or outpouching on a weakened area of an artery (Figure 10-5 D). Aneurysms may occur in various locations of the body and are not always life-threatening.
It is quite possible that many aneurysms are congenital defects.
- retinal hemorrhage uncontrolled bleeding from arteries within the eyeâs retina.
- cerebrovascular occlusions (ser ee bro vas Kyou lar) blockages to arteries supplying blood to the cerebral cortex of the brain; strokes.
Figure 10-5 Causes of stroke
A person who reports any warning signs of stroke or any small stroke called a transient ischemic attack (TIA), is given a battery of diagnostic tests, which could include a physical examination, a search for possible brain tumors, tests to identify areas of the brain affected, electroencephalogram, cerebral arteriography, and CAT (computerized axial tomography) scan or MRI (magnetic resonance imaging) scan.
Researchers recently made a breakthrough in the treatment of stroke, with the discovery that the clot-dissolving drug TPA and the cell-rebuilding drug citicoline could reduce the severity of strokes.
Now, experts find that TPA can actually reduce the severity of a stroke as it is occurring. To be effective, TPA must be administered in the first 3 hours of the stroke.
More recently, researchers have found that the drug citicoline, administered within twenty-four hours of a stroke, appears to help injured brain cell membranes repair themselves.
18 This limits the number of brain cell deaths and enables the brain to repair damaged circuits or create new ones.
Some patients require surgery (to repair vessels and relieve pressure) and acute care in the hospital.
The advances made in the rehabilitation of stroke patients are amazing. Some severely affected patients have little hope of improvement, our continuing advances in the application of computer technology to such disciplines as speech and physical therapy offer encouraging signs for stroke patients and their families.
Congenital Heart Disease
The American Heart Association estimates that each year about 32,000 babies are born with a congenital heart defect. In 1993,5,388 children (mostly infants) died of congenital heart disease.1
A variety of abnormalities may be produced by congenital heart disease, including valve damage, holes in the walls of the septum, blood vessel transposition, and underdevelopment of the left side of the heart.
All of these problems ultimately prevent a newborn baby from receiving adequate oxygenation of tissues throughout the body. A bluish skin color (cyanosis) is seen in some infants with such congenital heart defects.
- transient ischemic attack (TIA) (trans see ent its key mick) stroke-like symptoms caused by temporary spasm of cerebral blood vessels.
- MRI scan magnetic resonance imaging scan; an imaging procedure that uses a giant magnet to generate an image of body tissue.
Rheumatic Heart Disease
Rheumatic heart disease is the final stage in a series of complications started by a streptococcal infection of the throat. This bacterial infection, if untreated, can result in an inflammatory disease called rheumatic fever ( and a related condition, scarlet fever).
Rheumatic fever is a whole-body (systemic) reaction that can produce fever, joint pain, skin rashes, and possible brain and heart damage.
A person who has had a rheumatic fever is more susceptible to subsequent attacks. Rheumatic fever tends to run in families.
The number of Americans who died from rheumatic fever and rheumatic heart disease in 1994 was 5,540.1Damage from rheumatic fever centers on the heart’s valves. For some reason, the bacteria tend to proliferate in the heart valves.
Peripheral Artery Disease
These changes result from years of damage to the peripheral blood vessels. Important causes of PAD are cigarette smoking, high-fat diet, obesity, and sedentary occupations.
PAD severely restricts blood flow to the extremities.
The most serious consequence of PAD is the increased likelihood of developing ulcerations and tissue death.
Improve blood lipid levels (through diet, exercise, or drug therapy), reduce hypertension, reduce body weight, and to eliminate smoking. Blood vessel surgery may be a possibility.
Congestive Heart Failure
Congestive heart failure is a condition in which the heart lacks the strength to continue to circulate blood normally throughout the body.
Venous blood flow starts to âback upâ. Fluid can collect in the lungs and cause breathing difficulties and shortness of breath, and kidney function may be damaged.5
Congestive heart failure can result from heart damage caused by congenital heart defects, lung disease, rheumatic fever, heart attack, atherosclerosis, or high blood pressure. Without medical care, congestive heart failure can be fatal.19
ArrhythmiasArrhythmias are disorders of the heart’s normal sequence of electrical activity. They result in an irregular beating pattern of the heart.
Hearts that beat too slowly are unable to pump a sufficient amount of blood throughout the body. The body becomes starved of oxygen, and loss of consciousness and even death can occur. The heart that beats too rapidly does not allow the ventricles to fill sufficiently.
This pattern may lead to fibrillation, which is the life-threatening, rapid uncoordinated contractions of the heart.
The person most prone to arrhythmia is a person with some form of heart disease, including atherosclerosis, hypertension, or inflammatory or degenerative conditions.2
The prevalence of arrhythmia tends to increase with age
Certain congenital defects may make a person more likely to have an arrhythmia. Some chemical agents, including high or low levels of minerals (potassium, magnesium, and calcium) in the blood, addictive substances (alcohol, tobacco, other drugs), and various cardiac medications can all provoke arrhythmias.
After diagnosis, a range of therapeutic approaches can be used, including simple monitoring (if the problem is relatively minor), drug therapy, use of a pacemaker, or the use of implantable defibrillators.
- complications of rheumatic fever.
- murmur an atypical heart sound that suggests backwashing of blood into a chamber of the heart from which it has just left.
- peripheral artery disease (PAD)
- congestive heart failure inability of the heart to pump out all the blood that returns to it; can lead to dangerous fluid accumulations in veins, lungs, and kidneys.
Some people develop serious diseases of the heart valves.
- The cardiovascular system consists of the heart, blood, and blood vessels.
- The vascular system comprises the bodyâs blood vessels, including arteries, veins, arterioles, capillaries, and venules.
- The blood continuously performs many functions, including the transportation of nutrients and oxygen.
- The âbig fourâ risk factors are smoking, high blood pressure, high blood cholesterol level, and physical inactivity. These are controllable risk factors.
- Regular aerobic exercise helps strengthen the heart muscle, maintain healthy blood vessels, and improve the vascular systemâs ability to transport blood and oxygen to the body.
- People with high blood cholesterol should eat a heart-healthy diet and become physically active.
- Heredity, being male, and increasing age are risk factors that cannot be controlled.
- Contributing risk factors for heart disease are diabetes, obesity, and individual response stress.
- The three most significant and common forms of heart disease are coronary artery disease, high blood pressure, and stroke.
- Moderate alcohol consumption may be related to a lower risk of heart disease.
- Hypertension is the condition can produce strokes, kidney failure, eye damage, and other serious problems
- There are four types of strokes: cerebral thrombosis, cerebral embolism, cerebral hemorrhage, and cerebral aneurysm.
- The new clot-dissolving drug TPA can reduce the severity of a stroke as it occurs.
- Other heart diseases include congenital heart disease, rheumatic heart disease, peripheral artery disease, congestive heart failure, and heart arrhythmias.
Hypertension in Africa-Americans: Targeting Prevention
For the African-American community, one particular problem is hypertension.
Nature versus Nurture
Studies have shown that environmental stress may contribute to increased hypertension in African-Americans.
A study conducted by Dr. Norman Anderson of Duke University3 shows that chronic stress may lead to an increase in the release of the hormone norepinephrine to the bloodstream.
Norepinephrine reduces the amount of salt eliminated from the kidneys, and the resulting increase in blood salt content can lead to increased blood pressure.
The high rate of chronic exposure to stress in many African-American communities has been well documented3.
If these studies hold true for humans, it would lend credence to the idea that certain stressful factories found in some African-American communities could cause hypertension.
Anger in response to racism may be a significant contributing factor in increased hypertension in African-Americans.
Hypertension African American
Such conclusions seem to suggest that socioeconomic factories are the main cause of hypertension among African-Americans. A study performed on twenty-six African-American women on strict low-fat diets seems to support this.
Microscopic studies of blood vessels in African-Americans with severe hypertension revealed that renal arterioles were thickened and had reduced flow.
This thickening, not found in the renal arterioles of hypertensive whites, was caused by hypertrophy ( excess growth) of smooth muscle cells in the muscle walls of the arterioles.
This thickening reduced the size of the lumen (inside opening) of the vessels, and the resulting reduced blood flow may have caused increased blood pressure.
The smooth muscle cells were thought to be responding abnormally to growth factors, which caused the hypertrophy to occur2.
High Blood Pressure in African American
Stress factors unique to the African-American community may serve to aggravate or intensify an existing physical predisposition toward hypertension.
It has already been shown that the tendency toward developing hypertension can be passed from parents to their children.
Add several unique stress factors to a population already predisposed to high blood pressure, and the potential exists for high numbers of people to develop hypertension.
Commenting on the UT-SLU study, Dr. Elijah Saunders agreed thatâ racism and Black rage are emotional stressors that could worsen a physiological tendency towards hypertensionâ4.
A combination of genetic factors and stress may be responsible for the high incidence of hypertension among African-Americans.
Treatment of Hypertension in African-Americans
The good news is that African-Americans respond to medical treatment in a similar manner to whites.
African American with Hypertension
Thirty-five percent of all adult women African-American women are between 38 percent and 48.6 percent9,10.
By recommending lifestyle modifications, prescribing medications, or both, a physician can help manage this condition or help prevent its inset. The keys to living with hypertension are awareness, treatment, and control.
Suggested Lifestyle Modifications to Control Â or Reduce the Risk of Hypertension 6.10
Lose weight if you are overweight or obese
Losing 5% to 10% of your body weight drastically reduces your disease risk factors
Reduce sodium intake
Consume <2,400mg of sodium per day. Excess sodium raises blood pressure in salt-sensitive people.
Sedentary people have a 50% greater chance of developing hypertension. One simple plan for increasing your physical activity is to walk briskly 30 to 45 minutes three to five times per week.
Maintain an adequate intake of calcium and magnesium
These minerals are important to blood pressure regulation. Eat two to three portions of low-fat milk or cheese per day.
Prenatal visits help to ensure the delivery of healthy babies whose kidneys are adequately developed.
Take prescribed medication as directed
Hypertension is called the âsilent killerâ people who have it donât feel sick. It is critical to take your medication no matter how good you feel.
Consult your physician regularly
He or she can help you comply with and personalize your hypertension control program.
For Discussion . . . .
Were you aware of how serious hypertension can be? Which ones would be the easiest to follow?
The most difficult?