Transcript Heart Disease and Stroke Update

The Health Impacts of
Cardiovascular Disease
Maricela Wilson, RN BSN
Brain and Spine Neuroscience
Seton Family of Hospitals
What is Cardiovascular Disease
Cardiovascular disease is not actually
one disease -- rather, it is a name
used to describe any disease that
affects the heart or blood vessels
The term technically refers to any disease
that affects the cardiovascular system
(arteries and veins).
What is Cardiovascular Disease?
Cardiovascular disease (or CVD) includes
heart and blood vessel diseases — diseases
that affect the circulatory system.
Are Other organs Affected?
Ischemic Stroke
Coronary Heart Disease
• Angina
• MI (Heart Attack)
• Sudden Cardiac Death
Peripheral Vascular
Disease
American Heart Association's
recommendations for healthy living
Avoid tobacco smoke
Monitor high blood pressure
Eat food low in cholesterol and saturated
fats
Be physically active
Maintain a healthy weight
Have regular medical exams.
Stroke Risk Factors
You Can’t Change
Increasing age
Family health history
and race
Gender (male sex)
Previous heart
attack or stroke
SIX Modifiable Risk Factors for
coronary risk factors
High blood cholesterol
High blood pressure
Physical inactivity
Overweight or obesity
Diabetes
Cigarette smoking and
Perception of Heart
Disease Risk Factors
Mosca, Circulation 2004
45
40
35
30
%
25
20
15
10
5
0
Smoking
High Cholesterol
Family History
HTN
Diabetes
High Tg
Overweight
Lack of exercise
SMOKING
 Most important
preventable cause of
premature deaths
 Higher risk of
developing many chronic
disorders
 Atherosclerosis -buildup
of fatty substances in
the arteries.
Controlling or reversing
atherosclerosis is an important
part of preventing future heart
attack or stroke.
Physical Activity
WALKING:
– single most effective form of
exercise to achieve heart
health simplest way to start
and continue a fitness journey.
costs nothing to get stated
lowest dropout rate
Easy, safe and works
1 hour of walking Increase life
expectancy by 2 hrs per
30 minutes a day provides
heart health benefits
Physically Active People
Save $500 a year in healthcare
costs.
Employers can save $16 for
every $1 they spend on health
and wellness.
Fitness programs have reduced
employer healthcare costs by
20 - 55%.
Reducing just one health risk in
the workplace increases
productivity by 9%
Reducing one health risk
decreases absenteeism by 2%.
Exercise and Heart Disease
Moderate to intense physical activity for 30-45
minutes on most days of the week is recommended
American Heart Association
recommended blood pressure levels
systolic (mm Hg)
Diastolic (mm Hg)
___________________________________________________________
Normal
< 120
and
< 80
Prehypertension 120 –139
or
80-89
High-Stage 1
140 –159
or
90–99
High-Stage 2
160 +
or
100 +
What Do Blood Pressure
Numbers Mean?
Systolic pressure is the
force in the arteries when
the heart beats
Diastolic pressure is when
the heart is at rest .
It's measured in millimeters
of mercury (mm Hg).
High blood pressure (or
hypertension) is defined in
an adult as a blood pressure
greater than or equal to 140
mm Hg systolic pressure or
greater than or equal to 90
mm Hg diastolic pressure
High Blood Pressure
Controlling Blood Pressure
Adults B/P checked at least once every two
years, as there are no symptoms to tell if you
have high blood pressure
Optimal levels : 120 /80 mm Hg
If high
– Modify your lifestyle – Diet, Weight, Exercise, Salt
restriction - Dash Diet ( Dietary Approaches to Stop
Hypertension)
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
new_dash.pdf
– Adhere to the prescribed medication without fail, to
decrease chances of getting heart disease – Do not
stop your medicines without consulting your doctor,
even if the blood pressure becomes normal
Younger vs.. Older Men With
High Blood Pressure
Treatment for hypertension has been associated with
reductions in stroke
(reduced an average of 35%-40%),
heart attack (20%-25%)
heart failure (more than 50%)
 Younger men with high blood pressure typically have
high diastolic pressure
– diastolic pressure rises because the heart is pumping harder
Older men have high systolic pressure
- systolic pressure rises and stiffens arteries.
Diabetes
At any given cholesterol level, diabetic persons
have a 2 or 3 x higher risk of heart attack or
stroke
A diabetic is more likely to die of a heart attack
than a non-diabetic
80% Diabetics die from heart disease
Risk of sudden death from a heart attack for a
diabetic is the same as that of someone who
has already had a heart attack.
ADA Guidelines - Diabetics
•Fasting Blood Sugar – 70-110 mg/dl,
•Blood Sugar Before Meals – 90-130 mg/dl
•Blood Sugar 1-2 Hours After Meals – < 180
mg/dl
Current trends are for even more strict
guidelines.
If your fasting blood sugar is consistently over
110,
then you have a problem and should be taking
action to remedy that problem,
IMMEDIATELY, before your condition
worsens. Because it will!
Lifestyle and Diabetes
Research shows that diabetes can be
prevented by improving diet and physical
activity levels.
Not smoking
No excessive alcohol
People at risk for diabetes who follow a diet
and exercise plan (with only a modest weight
loss) can decrease their risk of developing
diabetes by almost 50%.
Cholesterol ( A type of fat)
Everybody needs cholesterol, it serves a
vital function in the body.
It circulates in the blood.
• Too much cholesterol
can deposit in the
arteries in the form of
plaque and block them
• No symptoms till heart
attack
Where does it come from ?
65%
35%
High Cholesterol
HDL tends to carry cholesterol away
from the arteries and back to the liver,
where it's passed from the body.
HDL removes excess cholesterol
from plaque in arteries, thus slowing
the buildup.
(About one third to one fourth of the total
amount of cholesterol is HDL cholesterol)
LDL cholesterol circulates in the blood,
slowly builds up in the inner walls of
the arteries that feed the heart and
brain. Together with other substances it
can form plaque, a thick, hard deposit
that can clog those arteries. This
condition is known as atherosclerosis.
If a clot forms and blocks a narrowed
artery, it can cause a heart attack or
stroke.
Triglycerides
Your triglyceride level will fall into one of these
categories:
– Normal: less than 150 mg/dL
– Borderline-High: 150–199 mg/dL
– High: 200–499 mg/dL
– Very High: 500 mg/dL
People with high triglycerides often have a
high total cholesterol level
- High LDL (bad) cholesterol and
- Low HDL (good) cholesterol levels.
Myth : fat deposits at old age!
It starts from 2 years of Complicated
age
Foam
Cells
Fatty
Streak
From First
Decade
Intermediate
Lesion
Atheroma
From Third
Decade
Adapted from Pepine CJ. Am J Cardio. 1998;82(suppl 104).
Fibrous
Plaque
Lesion/
Rupture
From Fourth
Decade
Coronary Bypass Graft
OBESITY
Pears and Apples
Apple- shaped are at a higher risk
Pear-shaped paunch store fat on the
hips and thighs, just below the surface of
the skin.
Apple-shaped paunch store body fat
around the abdomen and chest,
surrounding internal organs
Preventing Cardiovascular Disease
Look before your eat
Eat a variety of fruits and vegetables every day. (5 servings they are naturally low in fat and high in vitamins and minerals
and anti oxidants). Eat colored vegetables and fruits
Eat a variety of grain products
Choose nonfat or low-fat products.
Use less fat meats- chicken, fish and lean cuts
Switch to fat-free milk—skimmed milk
 No added salt - Mediterranean Diet
BMI and Waist-to-Height Ratio
http://home.fuse.net/clymer/bmi/
Waist-to-Height Ratio calculated by
dividing a person’s waist
measurement by their height,
usually one inch above the navel.
rule of thumb, 50% is considered the
general healthy cutoff.
The Metabolic Syndrome
Certain “risk factors” for heart disease tend to cluster
together and markedly increase your risk:
– overweight, especially when carried around the waist
– high blood pressure
– cholesterol abnormalities (low HDL and high
triglycerides)
– elevated blood glucose
People with these risk factors need to be treated very
aggressively for heart disease prevention: lifestyle
changes are key!
Heart Attack Warning Signs
Chest discomfort. Most heart attacks involve
discomfort in the center of the chest that lasts more
than a few minutes, or that goes away and comes back.
It can feel like uncomfortable pressure, squeezing,
fullness or pain.
Discomfort in other areas of the upper
body. Symptoms can include pain or discomfort in one
or both arms, the back, neck, jaw or stomach.
Shortness of breath. May occur with or without chest
discomfort.
Other signs: These may include breaking out in a cold
sweat, nausea or lightheadedness
C-Reactive Protein / CRP
• If you have risk factors and a family hx. of Heart
Disease, ask your doctor about doing a CRP
• measures the concentration in blood serum of a special type of protein
produced in the liver that is present during episodes of acute inflammation
or infection
• C-reactive protein (CRP) is one of the acute phase
proteins that increase during systemic inflammation
• CRP levels in the blood may be an additional way to
assess cardiovascular disease risk
• A more sensitive CRP test, called a highly sensitive
C-reactive protein (hs-CRP) assay, is available to
determine heart disease risk.
Cardiovascular Disease Can Be
Different in Women
ABC’s of Heart Attack Prevention
The Impact of Stroke
Stroke is the third-leading cause of death in
the U.S. and a major cause of serious, longterm disability.
Each year about 790,000 Americans have a
stroke, so stroke strikes every 45 seconds.
Someone dies of a stroke every
3 minutes.
The Stroke Belt
Kinds of STROKE
Hemorrhagic Stroke:
Least common, but can be
fatal.
Occurs when weakened vessel in brain
ruptures and bleeds into surrounding
tissue
Ischemic Stroke:
Most common –
83%occurs when clots (thrombus)
block an artery due to fatty deposits or
narrowing in vessel walls
TIA’s transient ischemic attack
Warning signs symptoms occurs for
short time then resolves – Dr. should
be seen immediately-take steps to
prevent a stroke
Recognize Stroke F. A. S. T
F. Face
Facial droop
(ask patient to smile or
stick out their tongue)
A. Arm drift (ask patient
to extend arms, palms
down, with eyes closed)
S. Speech Ask patient
to say “You can’t teach
an old dog new tricks”)
T. Time
Call 9-1-1
Look for abnormalities.
Stroke Warning Signs
Sudden numbness or weakness of the
face, arm or leg, especially on one side
of the body
• Sudden confusion, trouble speaking
or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss
of balance or coordination
• Sudden, severe headache with no
known cause
Why Call 911?
If you experience one or more
symptoms that could indicate
a heart attack or stroke:
CALL 911
Note when the discomfort
started
DO NOT DELAY
Intervention
THANK YOU ;-)
Stroke is an Emergency!
ANY QUESTIONS ?