Behavioral Health: Kovacs Flashcards
% of morbidity/mortality related to behavioral and social factors
50%
List the Behaviors that Effect Heart Disease
Stress( ie.50 hr work weeks), Lack of exercise, Poor Eating Habits, Smoking
Of the 6 million people who are admitted for chest pain, how many show identifiable cardiac ischemia or major physical disorder related to the symptom ?
50%
Broken Heart Syndrome
Temporary, preceded by a significant emotional event
Symptoms: Chest pain and fear of heart attack
Takotsubo AKA “The Broken Heart Syndrome” presents similar to MI, angina, systolic heart murmur and cardiac failure. Who is most likely to experience this syndrome ?
Post Menopausal women
Significant criteria for Takotsubo include…
EKG Changes*
Elevation of Cardiac enzymes
Left Ventricular segmental akiniesia *
Dyspnea or Syncope
What is absent during Takotsubo which may allow you to rule out other more serious pathologies…
Absence of coronary narrowing
Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
Absence of pheochromocytoma or myocarditis
Why is Takotsubo Syndrome considered dangerous ?
It can lead to sever (but limited) cardiogenic shock
What is often associated with Takotsubo from a behavioral aspect ?
Physical or emotional stress
With proper treatment, 95% will have complete recovery from Takotsubo. Will the changes such as LV segmenal akinesia or cardiac enzyme elevation persist ?
No ! Typically these will both return to normal state.
What is the best treatment for Takotsubo ?
Cardiac rehabilitation and stress reduction therapy
Until proven otherwise, all Takotsubo patients should be treated as …
MI patients to avoid tissue damages
Define Stress
A physical and emotional response to real or perceived threats associated with a rush or neurochemicals and hormones.
What are a few disorders of mental health that can be caused by or lead to stress ?
anxiety
Depression spectrum
What are a few disorders of medical health that can be caused by or lead to stress ?
Heart disease, infection etc.
What does stress engage ?
Autonomic Nervous system (FIght or flight response)…..(in the notes it says SNS but that doesn’t make sense to me. Fight or flight is ANS).
The HPA axis is activated during stress and involves which ‘releasing hormone’ ? What does this cause to be secreted and from where ?
Corticotropin Releasing Hormone
ACTH from the pituitary gland
What is ACTH involved in regulating ?
The release of Cortisol (among other things)
Cortisol is important in regulationg Blood pressure and cardiovascular function, mainly by it’s control of what important hormone ?
Aldosterone :Na+ re-uptake and volume expansion –> increased BP
How do negative emotions such as aggression, competitiveness, anger, impatience, anxiety and depression affect the cardiovascular sysytem ?
Lead to increased activation of the HPA axis and ANS activation (in the notes it says SNS but that doesn’t make sense to me. Fight or flight is ANS). This will lead elevated cortisol levels –> increased BP
In the evolution of Coronary Artery Disease (CAD) due to the Biological Pathway, what is occurring in the ANS ?
Sympathetic up-regulation
Parasympathetic down regulation
In CAD due to the Biological Pathway, are vascular inflammation and endothelial dysfunction part of the central stress response system ?
Not
These are secondary effects due to physical effects which may be linked to the Central Stress Response System
Basically the CSRS leads to dysregulation of the ANS and HPA axis.
What are the three main variables at work in the Behavioral Pathway to CAD ?
Anxiety, Depression and Stree
Anxiety, Depression and Stress can be associated with ….
Chronic Negative outlook (response) to life
Poor Self Care (diet,inactivity, grooming)
Substance abuse
Depression markers in CV disease include
increased platelet reactivity
decreased heart viability –> risk of MI
C-Reactive Protein–> Pro-inflammatory
Poor QoL
Anxiety and Depression are linked with
Sleep impairment Rise in TG's (metabolic syndrome and obesity) Increased/Repeadted ER visits Doctor shopping Increased use of caffeine Weight changes Mood swings CVD
What do happy thoughts do the the PNS ?SNS ?
Enhances the shit out of it. (Ps. this is dumb)…Causes the SNS to retreat
Do negative thoughts have genetic expression ? How ?
Messenger genetics are believed to cross the placenta and influence neural development. Affect penetrance or expressitivity. So all y’all ladies better be having good vibes when you have a bun in the oven.
Which dymnamic risk factors help to optimistically impact people when addressed correctly ?
Encouragement on smoking cessation Finding stress reduction techniques Weight loss intervention Counselling and medication Address depression !
what can be done psychologically to treat CAD ?
Relaxation training
Stress management
Group therapies
Building coping and resiliency
At this time, is there a reasonable degree of medical certainty towards the ability of psychological stress reductions ability to reduced CHD Mortality ?
Sure isn’t. You just have to believe
What are some mal-adaptive strategies for coping with stress ?
Denial
escape
minimize
blame
What are adaptive strategies to dealing with stress ?
accept responsibility or blame
exercise a proactive response
