Metabolic Disorders Flashcards
• Metabolic syndrome • Cardiovascular disease – Coronary artery disease – Stroke – Hypertension • Diabetes mellitus
metabolic disorders
• Heart, blood vessels, and blood
• Transport system of the body
• Arteries carry blood from the heart to other
organs and tissues
• Veins return the blood to the heart after the
oxygen has been used up
cardiovascular system
• Functions as a pump
• Left side takes in blood with oxygen from the
lungs
• Blood is pumped into the aorta and then
passes into smaller vessels to reach cells
• Oxygen and nutrients are exchanged for
waste material
• Blood returns to the right side of the heart
• Valves keep blood flowing in one direction
The Heart
• Adult body – about 5 liters of blood • Plasma (fluid portion) is 55% • Blood cells make up 45% – Manufactured in bone marrow • Blood flow regulates body temperature • Transports nutrients from digestive tract • Carries waste to kidneys
Blood
– Absorb/remove/destroy foreign substances
(immune cells)
– Made up of granulocutes & agranulocytes
(including lymphocytes)
White blood cells (WBCs) or Leukocytes
– Contain hemoglobin
red blood cells (RBCs)
– Clump together to block holes in vessels
– Important role in clotting
platelets
- Leukemia
- Leukopenia
- Leukocytosis
Disorders Related to White Cell
Production
– Cancer of the bone marrow
– Excessive WBCs → ↓RBCs in plasma → anemia
leukemia
– Deficiency of WBCs
– Result of diseases such as tuberculosis, measles, & viral
pneumonia
leukopenia
– Excessive number of WBs
– Response to infections like leukemia, appendicitis,
mononucleosis
leukocytosis
anemia, erythrocytosis, sickle-cell anemia
Disorders Related to Red Cell
Production
– Low RBCs or hemoglobin
– ↓blood transport capabilities (↓O & ↑CO2)
– Can causes permanent damage to NS & chronic weakness
– Causes:
• Iron lost (menstruation)
• Aplastic amenia (not enough RBCs produced by bone marrow)
anemia
– Excess RBCs → ↑blood viscosity & ↓blood flow rate
– Causes
• Lack of O to tissues
• 2° to other diseases
erythrocytosis
– RBCs are sickle-shaped & have abnormal hemoglobin proteins
– RBCs can easily rupture & can cause anemia
– Promotes resistance to malaria
– Genetic & more common in Blacks
sickle-cell anemia
hemophilia, clots (thromboses) in blood vessels, embolus
Clotting Disorders
– Blood can’t clot normally
– Unable to produce thromboplastin & fibrin
hemophilia
blocks flow of blood to organs, coronary thromboses, cerebral thromboses
clots (thromboses) in blood vessels
– A clot that becomes detached
– Can become lodged in a blood vessel and obstruct blood flow
Embolus
• Congenital Defects (present at birth) • Disorders Due to Infections (e.g., rheumatic fever) • Cumulative Wear and Tear (Lifestyle) – Diet – Exercise – Smoking – Stress Exposure
Disorders
- Deposits of cholesterol and other lipids, connective tissue, & muscle tissue
- Calcify into hard, bony substance
- Can occlude arteries
- ATHEROSCLEORSIS
Formation of atheromatous plaques
– Major cause of heart disease in U.S.
– Caused by deposits on the arterial walls
– Blood flow is reduced, damaging tissue
– Inflammation involved
Atherosclerosis
– Loss of elasticity of the arteries
– Harder to tolerate increases in cardiac blood volume
Arteriosclerosis
interleukin-6 (IL-6) and c-reative protein (CRP)
indicators of coronary heart disease
– Damage to the coronary arteries
– Atherosclerosis and arteriosclerosis in coronary arteries
coronary artery disease (CAD)
– Damage to the myocardium due to insufficient blood supply
coronary heart disease (CHD)
– Angina pectoris (chest pain)
– Myocardial infarction (heart attack)
• Two primary clinical manifestations
• #1 Killer in the U.S. (more than 1 in 5 deaths)
-disease of modernization
• a major chronic disease
– Millions of Americans live with its symptoms
coronary Heart disease
• Condition that results from a disturbance in blood flow to the brain
– Death of brain tissue occurs within 3-5 minutes
– Often marked by resulting physical or cognitive impairments and,
in the extreme, death.
– Third major cause of death in the U.S.
stroke
– Bleeding in the brain due to a rupture of a weakened artery
• Aneurysm
• Arteriosclerosis can lead to development of aneurysms
hemorrhagic stroke
– Caused by a clot in the arteries that serve the head and neck
• Atherosclerosis and arteriosclerosis
• Clots from internal injuries
• Bubble of air (air embolism) or infection
common stroke
• Stroke affects all aspects of life
– Personal, Social,Vocational, Physical
• Motor, Cognitive, Emotional, and Relationship problems
– Symptoms and problems differ depending on which side of the brain was damaged
• A chief risk of stroke
– That more strokes will follow in its wake
– Aspirin reduces the risk of recurrent strokes
stroke consequences
- rythmic phases of contraction and relaxtion
- Heart sounds are from the valves closing
- ↑heart rate →↓diastole cycle
- ↑amount of blood in veins → ↑heart rate
cardiac cycle
blood is pumped out of the heart so blood pressure inside the vessels increases
systole cycle
blood pressure drops as the heart muscle relaxesand blood is taken into the heart
diastole cycle
• Measurement of blood pressure
– Ratio of systole to diastole force of blood on the
vessels.
• Blood pressure is influenced by :
– Cardiac output
– Peripheral resistance to blood flow in the small
arteries of the body.
• Hypertension is chronically high blood
pressure.
– Normal: 120/80
– High: >140/90
blood pressure
– Excessively high blood pressure – Occurs when the supply of blood through the blood vessels is excessive, putting pressure on the vessel walls – Risk factor for other medical problems • including kidney failure – 1 in 4U.S. adults has it • No symptoms • 1/3 of these don’t know they have it
hypertension
• Sphygmomanometer
• Systolic blood pressure
– Sensitive to volume of blood leaving the heart
– Sensitive to the artery’s ability to stretch to
accommodate the blood
– Incremental increases are proportionate to increased risk
– Has greater value in diagnosing hypertension
especially in older adults
• Diastolic blood pressure
– Strongly related to cardiovascular risk in younger individuals
how hypertension is measured
- 90-95% of cases are essential hypertension
* 5% of cases are secondary hypertension
what causes hypertension
– Cause is largely unknown
– Related to genetic and environmental factors
– Risk factors
• Prior to age 50, men at greater risk
• After age 55, women and men have 90%chance of developing it
• Higher among minorities (related to lower SES)
• Genetic factors play a role
• Emotional factors, negative affect
essential hypertension
– Caused by failure of kidneys to regulate blood pressure or
– Disorders of the endocrine system
secondary hypertension
– Measurement of electrical impulses produced by the heart
– Can reveal abnormalities in resting heartbeat indicating cardiovascular disease
– However, CAD may not show up as an abnormal ECG
electrocardiogram (ECG)
– Measures heart’s electrical activity during stress (usually exercise)
• Exercise increases oxygen demand by heart making blockage more detectable
• More sensitive than ECG
• Used to measure
– Ischemia
– Heart functioning after MI or coronary bypass
– Sedentary before starting an exercise program
stress test
ECG, stress test, angiography, nuclear perfusion imaging, echocardiography, electron beam computed tomography, multislice spiral computed tomography
measures of cardiovascular function
– Most definitive method for diagnosing CAD
– Used to determine extent of CAD after angina
pectoris, positive stress test, or MI
– Inject heart with dye so that the coronary arteries are visible during X ray
• Cardiac catheterization to deliver dye
angiography
– Advancing age – Problems in glucose metabolism • Type 1 or Type 2 Diabetes Mellitus • Metabolic Syndrome – Risk factor for coronary heart disease, stroke, peripheral vascular disease, Type 2 diabetes – Genetic predisposition/family history – Ethnic background – Gender • Men > women during middle-age years
risk factorsCHD
– Leading killer of women in the U.S.
– Women have 50% chance of dying from 1
st heart attack (30% for men)
• Women seem to be protected at younger ages
relative to men
– Higher levels of HDL premenopausal
– Estrogen diminishes sympathetic nervous system
arousal
• Women have higher risk of CHD after
menopause (obesity, BP, cholesterol, &
triglycerides)
women and chd
_____ less likely to :
– Receive counseling about CHD
– Learn about benefits of exercise, nutrition, & weight reduction
– Get risk factor interventions for CHD
– Receive and use drugs for the treatment of CHD
• However, women have lower quality of life after treatment than do men
• Women report more anxiety after MI
• Gender differences in personality may
differentially predict CHD
WOMEN and chd [relatively little research on chd in women]
___ ___ have higher levels of risk factors for heart disease than other ethnic groups and highest risk of hypertension
- tied to stress of racial discrimination
- stressful locales > hypertension
- darkskinned have higher rates of hypertension
- racial diff decreases in nocturnal blood prssure [non dippin nightly blood pressure:risk factor]
african americans
- Physiological conditions
- Cholesterol
- Lipoproteins
CHD risk factors
– Hypertension
– High serum cholesterol level
• Amount of cholesterol circulating in blood stream
physiological conditions
– Essential for life as a component of cell membranes but too
much is bad
– Related to dietary cholesterol
• Comes from animal fats and oils
cholesterol
– Low-density lipoprotein (LDL) -- BAD – High-density lipoprotein (HDL) -- GOOD – Very low-density lipoproteins or triglycerides – Add together to get Total Cholesterol – Look at ratio of Total to HDL
lipoproteins
– Cigarette smoking – Diet • High saturated fat • High sodium intake • Can diet decrease risk? – Diets high in fruits and vegetables decrease heart disease by 31% and stroke by 19% – Omega-3 fatty acids found in fish – Foods high in antioxidants protect LDL from oxidation» Vitamin E, beta carotene or lycopene, selenium, riboflavin – Obesity • Hard to isolate as independent risk factor because it is also related to hypertension, Type 2 diabetes, and total cholesterol • Abdominal fat – Low levels of physical activity
behavioral risk factors of CHD
– Low educational level and income
– Social support and marriage
– Stress, anxiety, and depression
– Cynical hostility and anger
CHD Psychosocial risk factors
- development associated with hostility, depression, cardiovascular reactivity to stress, acute stress can precipitate sudden clinical events
- balance of control and demand in daily life is associated
- ppl who are under chronic stress more vulnerable to effects of stress on CVD
CHD role of stress
____ is an independent risk factor in its
own right
– Environmentally rather than genetically based
depression
strong associations btwn:
-depression and heart attack
-depression and heart failure among elderly
-hopelessness and heart attack
• Symptoms of depression before coronary
artery bypass graft surgery
– Predictor of long-term mortality
depression and CHD
• Inflammation
– C-reactive protein
• Metabolic syndrome
• Treatment with SSRI’s
– prevent serotonin from attaching to receptors which may reduce formation of clots bypreventing aggregation of platelets in the arteries acting like blood thinners
– No evidence yet linking antidepressants to decreases in CHD incidence or survival
depression and CHD
– Behavioral and emotional style marked by an aggressive, unceasing struggle to achieve more and more in less time – Often in hostile competition with other individuals or forces – Risk factor for coronary artery disease
type A behavior pattern
– Particularly lethal type of hostility
– Characterized by suspiciousness, resentment, frequent anger, antagonism, distrust of others
– Have difficulty extracting social support from others
– Fail to make effective use of available social support
– Particularly problematic if combined with defensiveness
Cynical Hostility
____ predicts metabolic syndrome
and CHD in adulthood
– Both genetic and environmental factors are important
• More interpersonal conflict and less social
support
• Higher reactivity to and longer recovery from
stressful situations
hostility
– Unpleasant emotion accompanied by physiological arousal
– Express as yelling, arguing, temper tantrum
– Suppress by holding in feelings
– Both are bad
• Provoked anger increases cardiovascular reactivity in
ways that predict hypertension
– Especially for men
– Forceful expression of anger may trigger cardiac event
• Suppressed anger
– Stewing about anger (rumination) increases risk
anger
– Vigilant coping
– Attempting to dominate social interactions
– Vital exhaustion
• Extreme fatigue, a feeling of being dejected or defeated, and an enhanced irritability
– Social isolation and chronic interpersonal conflict increase risk of CHD
• Optimism is protective
Other CHD Psychological Risk Factors
• People who smoke – Programs to stop smoking • People with hypertension – Behavioral modification important • People with high cholesterol – Targeted for preventive dietary intervention • Exercise recommendations – Aerobic exercise in particular • Modifying hostility – Relaxation training; speech style interventions
Modification of CHD Risk-Related Behavior can live 6-10 yrs longer
• Drug Treatments– Diuretics reduce blood volume promoting the excretion of sodium
– Beta-adrenergic blockers
• Resist the effects of SNS activation
• Decrease cardiac output
• Unpleasant side effects like fatigue and impotence
• Adherence is a problem
Reduce Hypertension:
drug Treatments
low sodium diet, reduction of alcohol, weight reduction, exercise, caffeine restriction, stress management and relaxation training
common treatments that reduce hypertension
• Diet
– Low in saturated fats
– High in fruits and vegetables
• Increased physical activity
• Medication for people with high cholesterol
– Statins target LDL cholesterol
• Reduce risk for repeated coronary events
– Statin drugs have surpassed all other drug treatments
– Statins appear to be protective against
• Multiple sclerosis
• Alzheimer’s disease
• Some types of cancer
lower cholesterol treatment
– Inducing a state of low arousal
• Biofeedback, progressive muscle relaxation, hypnosis, meditation, deep breathing, imagery
– Stress management programs
• Identify particular stressors and develop plans to deal with them: self-calming talk
– Anger management
• Identify cues, remove self from situation, self-talk, humor, relaxation, discuss feeling constructively
– Combination of diet, exercise, and behavioral
strategies for weight loss
cognitive behavioral treatements to modify psychosocial risk factors
older patients, african american, patients who have consulted physician about symptoms or self treated symptoms, those with history of angina or diabetes
whos more likely to delay treatment
An intervention program designed to help heart patients achieve their optimal – Physical, – Medical, – Psychological, – Social, – Emotional, – Vocational, and – Economic status
cardiac rehab
– Exercise therapy – Psychological counseling – Nutritional counseling – Education about CHD – Medication
• Interventions of cardiac rehab
– Angioplasty
• Insert balloon-tipped catheter into blocked arteries & inflate to reduce blockage
• Can involve placement of a stent (metal device) to keep it open
– Coronary artery bypass graft surgery
• Graft healthy sections of coronary arteries to bypass blocked arteries
– account for drop in deaths for CHD
cardiac rehab procedures
– Aspirin is commonly prescribed
• Inhibits platelets thereby reducing clots
• Men who take ½ aspirin per day significantly reduce risk of fatal
heart attacks
• Women’s risk reduced, too
• Adherence is a problem
– Other clot-dissolving drugs
• Can be delivered with cardiac catheterization during a heart attack
– Beta-adrenergic blockers
– Statins
treatment by medication for cardiac rehab
• Who’s at risk for stress after CAD?
– Younger patients – Female patients – Those with social support gaps – High social conflict – Negative coping styles
– Social support is very important for long-term
prognosis
– Patients without spouse or confidant are twice as
likely to die in the 6 months after first MI
– Spousal conflict happens after MI because patients
lose independence and have difficulty adhering to
lifestyle changes; spouses experience their own
stress
problems of social support with cardiac rehab
– Psychological state that can result after a myocardial
infarction or diagnosis of coronary heart disease
– Perception that abilities and capacities are lower than they actually are
– Patients and spouses are vulnerable to these
misperceptions
– Inform spouses and have them participate
Cardiac invalidism
– A method of reviving the functioning of heart and
lungs after a loss of consciousness in which the
patient’s pulse has ceased or lungs have failed to
function appropriately
• About 70% of potential sudden deaths from
heart attacks occur in the home
CPR cardiopulmonary resuscitation
– Psychotherapy
• Includes treatment for depression
– Cognitive-remedial training
• To restore intellectual functioning
– Training in specific skills development
– Use of structured, stimulating environments to challenge capabilities
Stroke: Types of
Rehabilitative Interventions
• A chronic condition of impaired carbohydrate,
protein, and fat metabolism
– Insufficient secretion of insulin or insulin resistance
• Cells of the body need energy to function
– Glucose is the primary source of energy
– Insulin is a hormone produced by pancreas
– Insulin acts as a “key” to permit glucose to enter cells
– Without insulin, cells don’t get the glucose they need
– Glucose stays in the blood: Hyperglycemia
diabetes
(10% of all diabetes) – Abrupt onset of symptoms – Immune system falsely identifies cells in the pancreas as invaders and destroys them – Pancreas doesn’t produce insulin – Develops relatively early in life
type 1 diabetes
– Cells lose ability to respond fully to insulin (known as
insulin resistance)
– Pancreas temporarily increases insulin production
– Insulin-producing cells may give out
type 2 diabetes
if overweight, get little exercise, high blood pressure, have family with diabetes, had a baby weighing over 9lbs at birth, are member of high risk ethnic group like Africans, latinos, native americans asians, and pacific islanders
risk factors for type 2 diabetes
\_\_\_\_ is associated with – Thickening of the arteries due to buildup of wastes in the blood – High rates of CHD – Kidney failure – Cancer of the pancreas – Nervous system damage • Pain and loss of sensation • Leading cause of blindness among adults
diabetes health implications
• Ideal treatment
– Patient-centered
– Patient-directed, not physician directed
• Type I patients need to
– Monitor glucose levels throughout the day
– Take immediate action when needed
• In addition to injections, pumps and inhalers can be used
• Adherence to self-management programs is low
diabetes self management
• Type II patients
– Often unaware of health risks they face
– Must reduce sugar and carbohydrate intake
– Encouraged to achieve normal weight
– Encouraged to exercise
• Helps use up glucose in the blood
• Adherence is problematic
Diabetes:
Problems in Self-Management
• Stress may cause diabetes
– Implicated in both the Type 1 autoimmune response
– And in the Type 2 glucose control and health
behaviors
• Stress alters regulation of glucose in diabetics
– Alters metabolism and control
• Stress management interventions decrease
stress and depression and improve control of
glucose
diabetes and stress
• Programs to improve adherence include
– Education concerning glucose utilization and
metabolic control of insulin
– Improving a sense of self-efficacy and ability to
regulate behavior
• Interventions
– Type II begin taking statins to lower cholesterol
– Diabetics engage in cognitive-behavioral
interventions: Self-injection, monitoring blood sugar levels, stress management programs
diabetes adherence and interventions
• Adolescents usually have Type I
– More severe
• Restrictions of diabetes interfere with issues of
independence and self-concept
• Peer culture may stigmatize those who are
different
• When parents are actively involved in diabetes
management tasks, there is better control of the
disease
special problems of adolescent diabetics
