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59 Cards in this Set

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CVD
Cardiovascular disease includes any disease or condition affecting heart, blood vessels, or circulation of blood
What is the #1 killer in US?
CVD
>___ people die of CVD each day, 1 death/33 seconds
2600
Clinical Manifestations of CVD
Coronary Heart Disease; _____; MI; Atrial fibrillation; Congestive heart failure; Renal vascular disease; peripheral vascular disease; stroke; ED; Atherosclerosis
CV Risk
All factors inclusive; risk factors have multiplicative effect on one another (2+ risk factors increase global risk)
Modifiable Risk Factors
Hypertension; dyslipidemia; diabetes; smoking; obesity; physical inactivity; microalbuminuria<60mL/min
Nonmodifiable Risk Factors
Age: men>45yrs; women>55yrs
Family history/genetic predisposition
Probability of Risk Factors
Millions of Americans have >1 risk factor for CVD
Patients with one risk factor prob have others: "clustering"; 80% who have hypertension have another risk factor
More risk factors=more CVD risk
Americans with CV Risk Factors
Diabetes=16 million
Hypertension=50 million
Dyslipidemia=59 million
Multiplicative Effect
Association of hypertension with other risk factors/dyslipidemia can have more than one effect on CV risk
MRFIT
Multiple Risk Factor Intervention Trial: combo of both hypertension and dyslipidemia can have a dramatic effect on CV mortality risk
Primary vs. Secondary
_____ prevention: reduce risk in pts w/o established CVD
_____ prevention: reduce risk in patients with established CVD
Diabetes Mellitus
Metabolic disorder; pancrease produces little or no insulin
Leading cause of CVD in US
>10 million Americans diagnosed w/ diabetes
Worldwide Diabetes epidemiology:
Number of adults w/ diabetes expected to more than double from 135 million in 95 to 300 million in 2025
Metabolic Features of Diabetes
_______ increased glucose in blood: breakdown of fat and protein; results in weight loss and weakness
Glucosuria: abnormall high concentrations of glucose in urine
Diabetes Diagnosis and Tests
Blood Tests: fasting plasma glucose (FPG) fasting 8-12 hrs
Oral glucose tolerance test (OGTT): fast for >8 hours, glucose levels measure for 2 hrs
Glycosylated hemoglobin (HbA1c)
Diabetes diagnosed when...
FPG>126 mg/dL
OGTT 2-hrs post-glucose load >200 mg/dL
Types of Diabetes
Type 1: complete lack of insulin production/common in childhood and Type 2: inadequate insulin production and insulin resistance
Type 1 Diabetes
Auto immune disease resulting in destruction of pancreatic beta cells
Absolute insulin deficiency
Treated with insulin injections or insulin pump
Represents about __% of all cases
Type 2 Diabetes
-Beta cell dysfunction and insulin resistance; relative insulin deficiency
-Onset in adulthood
-Patients may eventually need insulin for hyperglycemia control
-___ and heredity are contributing factors
-Most common form of Diabetes
Microvascular Complications
Retinopathy
Neuropathy
Nephropathy
Retinopathy
Leading cause of blindess among adults age 20-74; blurred vision; structural changes in retina, leaking/bleeding
Neuropathy
Diabetes most common cause of neuropathy in US; linked to hyperglycemia; metabolic abnormalities in nerve tissue; motor control
Nephropathy
Responsible for half of end-stage renal disease cases
Macrovascular Complications
1. Coronary artery disease (CAD)
2. Cerebrovascular disease
3. PVD
CAD/Cardiovascular disease
Leading cause of diabetes-related deaths; MI, silent
Cerebrovascular disease
Risk of storke is 2-4 times higher among people with diabetes
Peripheral vascular Disease
Peripheral vascular disease can result in tissue death, requiring amputation; affects blood vessels that supply other areas of the body
Diabetes Treatment Options
1. Diet/exercise
2. Diabetic pharmacologic theraphy options: insulin or oral agents
3. CV therapy options: Cholesterol-lowering agents; antihypertensives
Diabetes Treatment Goals
*Patients with diabetes have lower goals than patients w/o diabetes
*FPG (preferred method/easy): 90-130 mg/dL
Bedtime plasma glucose: 110-150 mg/dL
*OGTT (easy as well)
*HbA1c (already diag pts, shows avg blood glucose levels over 2-3 months): <7%
*Blood Pressure: <130/80
*LDL Cholesterol: <100mg/dL
Diabetes and Dyslipidemia
Cause of dyslipidemia: associated with hypertriglyceridemia and low HDL; Type 2 diabetics have a more ___ form of LDL (small, dense LDL)
Considered a CHD risk equivalent in NCEP guidelines: 2/3 of people w/ diabetes die of some form of CVD
Key Trial in Diabetes HPS Design
*HPS: heart protection study
*Double-blind trial in 20,536 adults with CV disease, arterial disease or diabetes
*Pts randomized to simvastatin 40mg/day or pacebo for 5 yrs
*Assessed long-term effect on vascular and all cause mortality
HPS Results
*About 5% treated with placebo had major vascular events during each year of study f/u
*Simvastatin significantly reduced: mortality (12.9%), nonfatal heart attacks (38%) and first strokes (25%)
CARDS
Collaboratie AtoRvastatin Diabetes Study
First study to evaluate the primary prevention of major CV events in pts w/ type 2 diabetes w/o a history of CV disease or stroke
Patients randomized to: Lipitor at 10 mg/day and Placebo
CARDS Results
*Lipitor treatment associated with 37% reduction in the incidence of major CV events
*Lipitor produced a reduction of 36% in coronary events, 31% in coronary revascularization events and 48% in stroke
Types of Obesity
Obesity is a state in which individuals have excess fat tissue mass
Adult Onset and Lifelong Obesity
Two types of obesity
Adult Onset
Affects many individuals in developed countries; normal weight in childhood; gradual weight gain 20-40 yrs old; imbalance between calories in and out
Lifelong Obesity
Childhood start; weight gain as a child; weight increase in women during/after pregnancy; often severely obese, weight>150% of ideal weight
Measuring Obesity: BMI
Widely used method: body mass index
BMI=weight (kg)/height (M2):
Normal=18.5-24.9
Overweight=>25
Obese=>30
Measuring Obesity: Fat Distribution
*Central/truncal obesity: linked with more serious complications
*Waist circumference: measures elevated risk for CHD (35" women; 40" men)
*waist to hip ration: abnormal: >.9 women; >1.0 men
Epidemiology of Obesity
*30.5% of American adults obese between 1999-2000
*300,000 deaths/year due to obesity
*Rising prevalence in kids
Cardiac Consequences: CARDIAC
*Causes increases in Blood volume and cardiac output
*Heart weight and size may increase due to continual increase of cardiac output
Obesity Consequences: DIABETES
*__% of pts with Type 2 diabetes mellitus are obese
*Insulin resistance: increases w/ weight gain and decreases with weight loss
Obesity Consequences: HYPERTENSION
*Increase peripheral resistance
*Increase cardiac output
*Increase sympathetic nervous system tone
Obesity Consequences: CAD
*Obesity linked with CAD by increasing its risk foactors, including: Hypertension; Insulin resistance; Diabetes mellitus; ____
*These are linked to central obesity
*Nurses' Health Study: increased risk for CAD in overweight women
Obesity Consequences: CHF
*Pulmonary and systemic congestion related to: ventricular dysfunction and elevations in filling pressures
*Heart failure results from marked chronic increase in cardiac work
Obesity Consequences: OTHER
Stroke; Pulmonary disease; bone, joint and cutaneous diseases
Benefits of weight loss:
*Improves exercise capacity of pts
*Improves cardiac hemodynamics
*Reduces blood pressure
Metabolic Syndrome
*Constellation of abnormalities that constitute major risk factors for CHD
*Contributing Factors: physical inactivity; central obesity; high dietary intake of carbs and saturated fat; aging; genetic factors
Metabolic Syndrome Diagnosis
According to NCEP ATP III, involves the presence of >3 of:
-Abdominal obesity >40" men, >35" women
-Elevated TG levels >150
_Low HDL Levels <40 men, <50 women
_Elevated BP >130/85
_Fasting glucose >110
Metabolic Syndrome Management
No FDA approved treatment fo rdisease
Treatment aimed at controlling risk factors:
weight control; phys activity; cholesteroal control treatments; treatment of ___; use of aspirin in pts wit CHD treatment of elevated TG and low HDL levels
Action Potential in Cardiac Muscle
Starts at SA Node, Goes to AV Node,delay,then to Bundle of Hiss, out to Perkinje Fibers, E` hits these fibers and they contract
Preload
Degree of ventricular myocardial fiber STRETCH before contraction
Contractility
The capacity of the heart muscle to CONTRACT
After load
The resistance against which the ventricles work during contraction
Stroke Volume
Amount of blood contracted by the ventricle in each contraction/amount of blood going to the body
Things that effect stroke volume
TPR, blood volume, blood viscosity, blood flow
Ejection Fraction
% of Left Ventricular volume after ejection; 50-60% of the amount of blood pumped out into the body