Chapter 10 Flashcards
Is dying of heart break scientifically possible? If so, what is it called and how does it work?
> It is referred to as “broken-heart syndrome” (or takotsubo syndrome in Japan)
> it is a stress-induced cardiomyopathy (disease of the heart muscle)
> When an individual endures a significant amount of emotional distress, the body is flooded with hormones that directly impact the heart.
> Rapid and immense levels of these hormones can influence the heart to enlarge and pump blood inefficiently
> these effects are typically transient and most individuals fully recover within two months; however, this intense hormonal cascade can lead to heart failure and in rare cases death
Diseases of the cardiovascular system include those that occur in what organ, what two sytems?
> those that occur within the heart and the blood transport or circulatory system (i.e., veins and arteries).
Is CVD a leading cause of death? If so, for which countries?
> these diseases are among the leading causes of death for North American men and women
Are people living with chronic CVD? (What do the mortality rates say…)
> Fortunately, due to advances in treatment, mortality rates from cardio-vascular disease (CVD) have significantly declined in developed nations such as Canada and the United States
> Since mortality rates have de-clined, and onset of disease has not, this means that many people are living with chronic CVD.
What factors are associated with the onset of CVD and its progression, as well as the quality and quantity of life of those with CVD?
> psychological factors
such as depression or behavioural changes that come with the diagnosis?
The optimal management of heart disease requires what?
> requires multiple behavioural changes, such as abstinence from tobacco, regular physical activity, and adhering to a heart-healthy diet
Coping with a heart condition and its treatment can also contribute stress in interpersonal relationships and role functioning (e.g., paid and unpaid work), thus impacting what?
> impacting quality of life.
The biopsychosocial model provides a framework describing how behavioural and social factors contribute to the onset of CVD- how does it work?
> Specifically, injury to the endo-thelium is often caused by hypertension (high blood pressure), diabetes (problems regulating blood sugar), and hyperlipidemia (too much cholesterol).
> These injuries are associated with modifiable behavioural and social risk factors such as smoking, abdominal obesity, physical inactivity, unhealthy diet, and psychosocial distress
A temporary restriction of blood flow is known as what?
> ischemia (tissue cells remain alive but their functioning is disrupted), in which the heart tissue by the vessel is deprived of oxygen.
In the instance of complete blockage, there is no distribution of oxygen and other nutrients to the tissues supplied by that artery- what is this called when it occurs in the arteries?
> When this occurs in the coronary arteries serving the myocardium (heart muscle), this is known as a “heart attack,” or myocardial infarction (mi).
The continuum from unstable angina (i.e., ischemia causing chest pain that does not remit with rest) to MI is known as what?
> as acute coronary syndrome
What is the end stage of heart disease?
> Heart failure is an end-stage of heart disease, when the heart cannot pump sufficient blood to meet the demands of the body
What is the average life span of heart disease?
> the average lifespan of heart-failure patients is approximately five years following hospital discharge
What are other forms of heart disease?
> there are other heart diseases related to the function of the valves (ensures directional flow)
> the contraction of the heart (disturbances called arrhythmias,
> some of which can cause sudden cardiac death
> the heart muscle (i.e., cardiomyopathies),
> infections,
> structural defects (i.e., congenital heart disease).
What are the warning signs of a heart attack?
> Chest discomfort- uncomfort-able pressure, squeezing, fullness, or pain.
> Discomfort of other areas of the upper body—one or both arms, the back, neck, jaw, or stomach.
> Shortness of breath—with or without chest discomfort.
> Other signs—may include breaking out in a cold sweat, nausea, or light-headedness.
What are the symptoms of heart attack for men?
> “experience classic warning signs”
> Uncomfortable pressure, fullness, squeezing or pain in the centre of the chest that goes away and comes back
> Pain that spreads to the shoulders, neck, or arms
> Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath
When are the symptoms of heart attack for women?
> Shortness of breath or difficulty breathing
> Nausea, vomiting or dizziness
> Back or jaw pain
> Unexplained anxiety, weakness, or fatigue
> Palpitations, cold sweats, or paleness
> may experience the classic symptoms, but they are often milder
What is the trigger for heart attacks in women?
( What type of stress )
Emotional Stress
What is the trigger for heart attacks in men?
> Men most often report physical exertion prior to heart attacks.
In Canada, how many individuals experience an MI each year? How many of these result in death?
> over 70,000
14,211 result in death
How many in the US experience MI and how many will experience angina?
> In the United States, recent annual estimates suggest that 750,000 adults will have an MI and 3.4 million will experience angina each year
There is an associated financial burden; CVD costs the Canadian and American economies what?
> more than $12.1 billion and $316.6 billion, respectively
What are the disparities in heart disease? (specifically with relation to ethnicity)
> CD tends to occur in men and women of African ancestry at an earlier age than in Caucasians
> death rates are higher in persons of African ancestry across all age categories
> ethnic minority groups have been shown to have relatively more limited awareness regarding CVD risk factors and less access to health care
What do the disparities of CVD highlight in terms of treatment?
> these discrepancies high-light the need for individualized, culturally sensitive methods of CVD prevention, diagnosis, and treatment
What are the major signs of heart failure?
C,T, SOB, PE, PLE, SINTA, PAGW, SINAAL
> coughing
Tiredness
Shortness of breath
Pulmonary edema (excess fluid in lungs)
Pleural effusion (excess fluid around lungs)
Swelling in abdomen (ascites)
Pumping action of the heart grows weaker
Swelling in ankles and legs
What are the disparities by sex and socio-economic status for CVD?
> women often receive less aggressive treatment and are more likely to die in the early months after a heart attack
> CVD risk factors are most common among people in lower income brackets
Is heart failure increasing in prevalence? If so, do to what?
> Heart failure is increasing in prevalence, in part due to our aging population demographic
Once a patient is diagnosed with acute coronary syndrome, it is important to do what? How is it done?
> it is important to acutely restore blood flow to the heart.
> Often, revascularization interventions are performed in hospital to restore sufficient blood flow.
What are the two revascularization interventions?
> Revascularization pro-cedures include angioplasty, also known as percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery.
What is PCI? How long does it take to complete?
> PCI is a procedure in which a catheter is used to place a mesh tube in the coronary vessels that have nar-rowed.
> This mesh tube (“stent”) is then expanded so blood can again flow through the vessel to the heart muscle
> a day procedure
What is CABG? How long does it take to complete?
> CABG uses arteries or veins from another area of the body to circumvent the blocked flow in the coronary arteries restoring the delivery of the blood supply to heart tissues
> CABG requires an approximately week-long hospitalization and extended re-covery period at home.
What is the breakdown of the percentage of costs due to cardiovascular disease in Canada?
1) Indirect costs− 65.7%
2) Mortality (as cost of premature death) 41.7%
3) Direct costs − 34.3%
4) Long-term disability 18.7%
5) Hospital care 17.8%
6) Drugs 9.6%
7) Physician care 6.9%
8) Short-term disability 5.3%
With respect to CVD, what is secondary prevention?
> Secondary prevention refers to the initiation of treatments to stop or slow the progression of diseases and disabilities once they have already occurred.
Secondary prevention of acute coronary syndrome specifically includes what?
> reducing CVD risk factors through behavioural approaches (e.g., exercise, smoking cessation) and pharmacotherapy (e.g., aspirin, cholesterol-lowering drugs).
When the pumping function is permanently damaged, as in heart failure, is there a cure? what about treatment?
> no cure.
Heart transplantation is the most enduring treatment approach.
*However, there are insufficient organs available to meet need
Because there are not enough heart organs, what is a new advancing approach?
> Mechanical circulatory support = the ventricular assist device
What is a benefical strategy to reduce psychological distress in those with acute coronary syndrome and CVD?
What type of interview?
> Motivational interviewing
Following PCI or CABG, what are patients ideally referred to?
> ideally referred to CR, which is a compre-hensive secondary prevention program that provides risk-factor modification through education, behavioural counselling and structured exercise train-ing.
> CR programs provide social support to patients with CVD, and may offer stress-management classes and programs targeting psychological distress
> Participation in CR significantly reduces cardiovascular mortality and repeat hospitalization rates, regardless of the setting in which the program is offered
Although they are highly effective, CR programs are underused, what is a reason why?
> Barriers to CR are multifactorial and thus efforts to improve access to and participation in CR should target patients, providers, and the broader health-care system
Traditional risk factors (e.g., diabetes, hypertension, smoking, dyslipidemia) only explain how many CVD cases?
> only explain about two-thirds of new CVD cases
