Transcript Heart Disease, Hypertension, and Stroke Psychological Issues in Advanced and Terminal Illness    Average life expectancy in North America is 76 years. Leading causes of death.

Heart Disease, Hypertension,
and Stroke
Psychological Issues in
Advanced and Terminal Illness
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Average life expectancy in North America is
76 years.
Leading causes of death in adults are
chronic illness
What are the leading causes of death
across the life span?
Mortality Rates
Leading causes of death
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< 1 year
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Children > 1 year old
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congenital abnormalities;
sudden infant death syndrome (SIDS)
Accidents (40% of all deaths)
Cancer (especially leukemia)
Adolescence
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Unintentional injury
Homicide
AIDS
Mortality Rates
Leading causes of death
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Middle age
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Sudden death due to heart attack or stroke
Cancer
Elderly
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Heart disease
Cancer
Stroke
Why do women live longer
than men?
Potential Reasons for Gender
Differences in Mortality
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Females are more hardy
Males engage in riskier behaviours (factor after
birth and infancy)
Men engage in riskier sports
Males tend to hold high stress or higher risk jobs
Men tend to have poorer health habits (e.g., drink
more alcohol)
Social support may be more protective in women
Risk Factors
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Family history
Marital status (adds 10 yrs in men; 4 yrs in
women)
Economic status
Body weight
Exercise
Alcohol (add 2 years if drink 1-3 drinks/day)
Risk Factors - continued
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Smoking
Disposition (add 2 yrs if reasoned, practical)
Education
Environment (add 4 yrs if rural)
Sleep (more than 9 hours subtract 5 years)
Temperature (add 2 yrs if thermostat is <
68)
Health care – regular check ups add 3 yrs
How do people adapt to
chronic illness?
Adapting Under Good
Circumstances
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First concern upon hearing diagnosis is
fears about mortality.
Optimistic but tentative about plans
May try to normalize activities
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Risk is they may over-extend
May have feelings of helplessness
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Risk is to become overly dependent
Three Themes of Adaptation
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Find meaning: why illness happened or
rethink priorities
Gain sense of control
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control symptoms and treatment
Restore self-esteem
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Often by comparison with worse off others
Adapting Under Bad
Circumstances
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Relapse seen as a bad sign with poor
prognosis
Re-focuses one on the illness
Need to undergo the coping process
again but likely less hopeful than
before.
Heart Disease
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Due to narrowing or blocking of the
coronary arteries.
Angina pectoris
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painful cramp in chest, arm, neck, or back due
to brief blockage of oxygenated blood to the
heart.
More often during exercise, stress, cold
temperature, digesting large fat meal.
Little or no permanent damage
Heart Disease
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Myocardium
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Myocardium infarction (heart attack)
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Muscle tissue around the heart
Prolonged blockage of blood to an area of the
heart resulting in muscle tissue damage.
Symptoms of a heart attack
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Pressure in chest, fullness, squeezing pain.
Pain spreading to shoulders, neck, or arms
Lightheadedness, fainting, sweating, nausea
Who Is At Risk of Heart
Disease?
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Prevalence increases with age, particularly
after 45 years of age
Prior to 50s, 60s, men at greater risk than
women but increases in women after
menopause.
More women than men are likely to die
from a heart attack
Blacks at higher risk, Asians at lower risk
Heart Disease Risk Factors
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High blood pressure
Family history
Cigarette smoking
High LDL and total cholesterol levels
Physical inactivity
Diabetes
Obesity
Stress
Why high blood pressure a
risk factor?
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Heart has to work harder.
Since heart muscle is working harder, it can
become enlarged.
Wear and tear on the arterial wall can
increase the likelihood of lipid and calcium
deposits adhering to the arterial wall. This
leads to hardening of the arteries.
Type A Behaviours
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Hostile, cynical
Judgmental (opinionated)
Competitive
Time urgent
Uses gestures while talking
Nodding of head while others are talking
Intense
Physiological Reactivity
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Physiological and cardiovascular reactivity
to acute stress (“hot reactors”).
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Exaggerated increases in blood pressure,
heart rate, catecholamines, corticosteroids
High levels of these hormones can
damage heart and blood vessels
Presence of epinephrine (a catecholamine)
increases the formation of clots.
Effects of Stress On Cardiac
Risk
Psychosocial Predictors
of Sudden Cardiac Death (BDI>10)
1.00
0.95
Proportion
Surviving
0.90
Placebo, BDI <10
Placebo, BDI >10
AMIO, BDI <10
AMIO, BDI >10
0.85
0
200
400
Survival in days
600
800
When do heart attacks occur?
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Less likely during sleep.
Among the employed, more often on a
Monday between 6 and 11 am.
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In part due to waking and becoming active
shortly after dreaming which increases BP.
In part because of circadian rhythm effects,
increases in arousal hormones and blood
pressure.
Medical Treatment
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Initial treatment may involve clot-dissolving
medication and close monitoring
Balloon angioplasty
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Tiny balloon is inserted into blocked vessel and
inflated to open blood vessel
Bypass surgery
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Use grafted vessel (e.g., piece from leg) to
bypass blockage in artery to the heart
Medical Treatment
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Medications (e.g., beta blockers, calcium
channel blockers) to protect heart and
improve function.
Risk management
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Control of high blood pressure
Control of lipid abnormalities
Rehabilitation
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Promote recovery and reduce risk of
another attack
Heart disease is chronic condition requiring
ongoing management.
Rehabilitation Includes:
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Exercise
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Physiological and psychological benefits
Weight management
Smoking cessation
Lipid and BP management include dietary
changes to control lipids
Reduce excessive alcohol intake
Stress management
Rehabilitation
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Exercise is the key component but:
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For those who continue benefits include:
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50% drop-out rate within first 6 months
Improved self concept, perceived health,
sexual activity, involvement in social activities.
Those who stop are more likely to:
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Smoke, have poorer cardiac function, have
higher body weight, be more sedentary,
experience greater anxiety and depression.
Symptoms of a Stroke
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Sudden
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weakness or numbness of the face, arm, or leg
(usually on one side of the body)
dimness or loss of vision (usually one eye)
Loss of speech or trouble talking or
understanding speech
Unexplained, severe headache
Dizziness, unsteadiness, or sudden fall
What is a stroke?
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Tissue damage to area of the brain due to
disruption in blood supply, depriving that
area of the brain of oxygen.
Causes of Strokes
1.
Infarction – blockage in cerebral artery
that cuts off or reduces blood supply
a)
b)
2.
Thrombosis – blood clot
Embolus – piece of plaque becomes lodged
in the artery.
Hemorrhage – happens suddenly. Less
frequent than infarction but more
damaging and more likely to cause death.
Stroke Risk Factors
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Rare up to age 55, than risk increases
sharply with age (doubling with each
decade).
More common in men but women more
likely to die from them.
Rates highest among blacks and lowest
among Asians.
Family history
Stroke Risk Factors
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High blood pressure
Cigarette smoking
Heart disease, diabetes, and their risk
factors such as obesity and physical
inactivity.
High red blood cell count (making the
blood thicker and likelier to clot).
Mini-strokes – transient ischemic attacks
(TIA)
Effects of a Stroke
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Some motor, sensory, cognitive, or speech
impairment usually occurs
Limitations may be permanent but lessen
in severity over time.
Younger patients recover better
Impairments caused by hemorrhages more
easily overcome than those caused by
infarctions.
Effects of Stroke
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Motor impairments often due to paralysis
on one side of the body (side opposite to
brain damage).
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After about 6 weeks of rehab about 50% of
patients can perform independently (many
with cane or walker).
Language, learning, memory, and
perception problems depend on location of
the injury.
Effects of Stroke
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Left-hemisphere damage more commonly
associated with language problems called
aphasia.
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Receptive aphasia – difficulty understanding
verbal information.
Expressive aphasia – difficulty producing and
using language.
Damage to right side of brain often
associated with difficulties in visual
processing and emotions.
Psychosocial Aspects of Stroke
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Denial is common
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Unclear whether psychological or physiological
basis.
This ambiguity also applies to depression when
it occurs after a stroke.
Less than ½ of the patients return to work
following a stroke.