Cardiovascular Flashcards
cardiovascular disease
heart disease
general term for a variety of conditions involving the structure and functioning of the heart
different conditions have different causes
one of the leading causes of death in adults
1/3 of canadians affected
16% of hospitalizations due to this
types of cardiovascular
disease
ischemic heart disease cerebrovascualr disease peripheral vascular disease heart failure rheumatic heart disease (damage to valves due to rheumatic fever) congenital heart disease angina
ischemic heart disease
circulation of blood to heart muscle compromised; can cause angina
can lead to myocardial infarction (heart attack)
cerebrovascular disease
circulation of blood in blood vessels to the brain are compromised
transient ischemic attack (TIA, blockage for less than 24 hours)
cerebrovascular accident/stroke (long term blockage)
peripheral vascular disease
circulation of blood to legs is compromised
heart failure
pumping of heart is unable to provide enough blood for the rest of body
angina
chest pain
occurs with temporary blockage of oxygen
myocardial infarction
MI
heart attack
infarct
localized area of necrosis from obstruction of blood supply
necrosis
cell death
dyspnea
shortness of breath
ischemia
insufficient supply of blood to an organ usually due to a blocked artery
TIA
transient ischemic attack in the brain
“temporary” stroke
usually no permanent deficits
heart attack does not = cardiac arrest
cardiac arrest = heart has stopped pumping
a heart attack can lead to cardiac arrest but not always
link of hypertension to heart disease
hypertension can lead to ischemic heart disease, myocardial infarction, and cerebrovascular disease
ischemic heart disease can lead to heart failure
hypertension
chronic high blood pressure
risk factor for cardiovascular disease and cerebrovascular disease
“silent killer” due to no symptoms
symptoms of a myocardial infarction (heart attack)
chest discomfort jaw, neck, back, or arm pain gastric pain or heartburn nausea/vomiting shortness of breath cold sweat or lightheadedness pale skin denial weight pressing on chest/radiating pain not sharp pain
heart attack symptoms in women
women may not experience chest pain
women can experience atypical symptoms that are not always recognized
may have lower back pain and just an overall feeling of tiredness and groggyness
most recent data on heart attacks
- 5% canadian adults over 20 live with diagnosed ischemic heart disease
- 1% with a history of a heart attack
coronary artery disease
damage to the coronary arteries (vessels supplying the heart)
arteriosclerosis and atherosclerosis
can lead to heart attack
arteriosclerosis
hardening of blood vessels due to age or due to atherosclerosis
atherosclerosis
build up of plaque compromising blood flow and blood vessel functioning
causes narrowing and hardening of blood vessels
plaque composed of fat, cholesterol, calcium and other substances found in the blood
HDL and LDL
high density lipoproteins (good cholesterol, protective against heart disease and decrease atherosclerosis)
low density lipoproteins (bad cholesterol, associated with plaque buildup)
heart failure
heart failing as a pump due to damage
inability to pump sufficient blood to meet the needs of the cells for oxygen and nutrients
can lead to decreased cardiac output
can result from CVD, hypertension, diabetes, myocardial injury
signs and symptoms of heart failure
fluid overload inadequate tissue perfusion shortness of breath swelling of legs and feet lack of energy difficulty sleeping swollen abdomen loss of appetite increased urination at night confusion impaired memory
heart failure leads to…
systolic heart failure (decreased contraction = decreased amount of blood ejected by ventricles)
diastolic heart failure (decreased filling = higher pressure in ventricles leads to poor in-flow)
*decreased cardiac output
non-modifiable risk factors of cardiovascular disease
age
sex (male have a higher risk than women until menopause and then it is even risk)
family history
ethnic origins
modifiable risk factors of cardiovascular disease
smoking lack of exercise unhealthy eating high cholesterol hypertension sodium stress diabetes substance use *domestic violence
what we know about major chronic diseases
material deprivation and adversity during childhood contribute to heart disease and adult-onset diabetes
material effects, psychosocial responses, and health threatening coping mechanisms play a role
effects of living and working conditions swap the effects of behavioural risk factors
poverty, unemployment, adverse working conditions also play a role
cerebrovascular disease
stroke or cerebrovascular accident (CA)
one of the leading causes of death and disabilty
741,800 over 20 live with effects of a stroke
caused by interruption of normal blood flow to an area of the brain
babies inutero can have strokes
stroke risk factors increase after age 55
signs and symptoms of a stroke
FAST face drooping arm weakness speech difficulty time to call 911 early detection = early treatment = early intervention
modifiable risk factors for storkes
hypertension (high blood pressure single most important stroke risk factor that can be controlled) smoking high cholesterol diabetes atrial fibrillation excessive alcohol recreational drug use (weed, heroine, cocaine, ecstasy) obesity stress
non-modifiable risk factors for strokes
age sex ethnic origin family history prior stroke or TIA
assessing risk factors for stroke
individual level (screening, physical assessment, assessment of the determinants of health) population level (population health approach, measure and analyze)
blood pressure
pressure or force of blood against the walls of blood vessels as it circulates
screening
an example of surveillance
identification of abnormalities, unrecognized disease or defect through tests and procedures
tells us who probably has the disease and who doesn’t
characteristics of screening
screening techniques can be applied rapidly
save time
NOT diagnostic
identifies abnormal findings which can be referred for further evaluation and diagnosis
blood pressure is a key measure of the health of…
the cardiovascular system
hypertension leading to heart failure
hypertension can lead to ischemic heart disease, myocardial infarction, and cerebrovascular disease
ischemic heart disease can lead to heart failure
blood pressure: systolic vs. diastolic pressure
systolic pressure = top number, pressure of the blood exerted on the artery wall as a result of contraction of the left ventricle
diastolic pressure = bottom number, pressure of blood exerted on the artery wall when the ventricle is at rest
factors influencing blood pressure
cardiac output (increase = increase BP, decrease = decrease BP) vascular resistance (increase = increase BP, decrease = decrease BP) volume (increase = increase BP, decrease = decrease BP) viscosity (increase = increase BP) elasticity of arterial walls (increase = increase BP)
factors affecting blood pressure
age exercise stress race obesity sex medications (prescribed or over the counter) sodium intake diurnal variations disease process
typical blood pressures
female = 90/60 (may change after menopause)
male = 120/80
90% will develop hypertension
factors affecting PULSE
age sex stress fever eating food/drink exercise medications hypovolemia pathology
normal pulse
60-100 bpm
bradycardia = slow
tachycardia = fast
prevention levels
primary prevention (population) = health promotion and addressing risk factors, social and genetic factors secondary prevention (people at risk of a health problem) = screening of at risk individual, control of risk factors and early intervention tertiary prevention (people with a health problem) = rehabilitation, preventing complications and improving quality of life
advantages of screening
targets the individual appropriately people are motivated physicians are motivated cost-effective benefits outweigh risks
disadvantages of screening
difficulties and costs
late approach (palliative and temporary)
limited predictive use for this common condition (one risk factor may not result in the disease)
resistance to change
framingham heart study
long term since 1948
looked at individual risk factors for cardiovascular disease
found: smoking increases risk of CVD, hypertension increases risk of stroke, atrial fibrillation increases risk of stroke, psychosocial things increase risk of heart disease, obesity increases risk of heart failure, sleep apneia increases risk of stroke
canadian hypertension education program (CHEP)
goal
to reduce burden of cardiovascular disease in canada through optimized hypertension prevention and management
CHEP activities
regularly updated evidence-based recommendations for the prevention and management of hypertension
knowledge translation and exchange of the recommendations to support implementation
regular evaluation and revision of the program
assessment of patient outcomes
CHEP recommendations
all canadian adults should have their blood pressure assessed at all appropriate clinical visits
facilitate behaviour and lifestyle changes
achieve target blood pressures (140/90 or 130/80 for diabetics)
sustain the behaviour and lifestyle changes
challenges to hypertension management
44% could not identify a normal blood pressure
80% unaware of association between hypertension and heart disease
63% believed hypertension wasn’t serious
38% thought they could control high blood pressure without help from healthcare
not everyone can afford or access help
risk communication
inform and make people understand risk and/or the true value of intervention
world health organization cardiovascular disease stats
#1 cause of death globally 17.5 million people died from CVD in 2012 over 3/4 of CVD deaths occur in low and middle class countries
PHAC CVD
1 in 3 canadians will die from CVD
in 2007 1.3 million canadians had heart disease diagnosis
in 2007 317,500 canadians were living with the effects of a stroke
impact of CVD on individuals and families
perceived poor health
activity restriction
required assistance with activities of daily living
anxiety and depression
progress…
recent decrease in mortality rates
but with aging population it could potentially increase
but increase in prevalence of obesity and diabetes which are both significant risk factors for CVD
9 out of 10 individuals have one of the risk factors
2 out 5 individuals have 3 or more risk factors
financial costs of CVD
direct costs = hospitalizations, physician care, medication
indirect costs = premature death, long-term disability, short-term disability
CHHS-AP 6 recommendations
(canadian heart healthy strategy and action plan) create heart healthy environments help canadians lead healthier lives access to care for indigenous canadians reform health services build knowledge and infrastructure develop right service providers
key elements of a population health approach
measure health of population address determinants of health base decisions on evidence invest upstream apply multiple strategies to act on determinants of health collaborate across levels and sectors employ mechanisms to engage citizens increase accountability for health outcomes
excess sodium…
accumulates in the blood and it attracts and holds water which increases blood volume
increased blood volume requires the heart to work harder and pump more blood through the vessels which increase blood pressure
if it lasts too long it can damage arteries over time
benefits of decreasing dietary sodium
decreased dietary sodium decreases hypertension which decreases CVD which decreases costs to the healthcare system
