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59 Cards in this Set
- Front
- Back
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CVD
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Cardiovascular disease includes any disease or condition affecting heart, blood vessels, or circulation of blood
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What is the #1 killer in US?
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CVD
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>___ people die of CVD each day, 1 death/33 seconds
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2600
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Clinical Manifestations of CVD
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Coronary Heart Disease; _____; MI; Atrial fibrillation; Congestive heart failure; Renal vascular disease; peripheral vascular disease; stroke; ED; Atherosclerosis
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CV Risk
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All factors inclusive; risk factors have multiplicative effect on one another (2+ risk factors increase global risk)
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Modifiable Risk Factors
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Hypertension; dyslipidemia; diabetes; smoking; obesity; physical inactivity; microalbuminuria<60mL/min
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Nonmodifiable Risk Factors
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Age: men>45yrs; women>55yrs
Family history/genetic predisposition |
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Probability of Risk Factors
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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 |
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Americans with CV Risk Factors
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Diabetes=16 million
Hypertension=50 million Dyslipidemia=59 million |
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Multiplicative Effect
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Association of hypertension with other risk factors/dyslipidemia can have more than one effect on CV risk
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MRFIT
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Multiple Risk Factor Intervention Trial: combo of both hypertension and dyslipidemia can have a dramatic effect on CV mortality risk
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Primary vs. Secondary
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_____ prevention: reduce risk in pts w/o established CVD
_____ prevention: reduce risk in patients with established CVD |
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Diabetes Mellitus
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Metabolic disorder; pancrease produces little or no insulin
Leading cause of CVD in US >10 million Americans diagnosed w/ diabetes |
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Worldwide Diabetes epidemiology:
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Number of adults w/ diabetes expected to more than double from 135 million in 95 to 300 million in 2025
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Metabolic Features of Diabetes
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_______ increased glucose in blood: breakdown of fat and protein; results in weight loss and weakness
Glucosuria: abnormall high concentrations of glucose in urine |
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Diabetes Diagnosis and Tests
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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) |
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Diabetes diagnosed when...
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FPG>126 mg/dL
OGTT 2-hrs post-glucose load >200 mg/dL |
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Types of Diabetes
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Type 1: complete lack of insulin production/common in childhood and Type 2: inadequate insulin production and insulin resistance
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Type 1 Diabetes
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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 |
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Type 2 Diabetes
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-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 |
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Microvascular Complications
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Retinopathy
Neuropathy Nephropathy |
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Retinopathy
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Leading cause of blindess among adults age 20-74; blurred vision; structural changes in retina, leaking/bleeding
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Neuropathy
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Diabetes most common cause of neuropathy in US; linked to hyperglycemia; metabolic abnormalities in nerve tissue; motor control
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Nephropathy
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Responsible for half of end-stage renal disease cases
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Macrovascular Complications
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1. Coronary artery disease (CAD)
2. Cerebrovascular disease 3. PVD |
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CAD/Cardiovascular disease
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Leading cause of diabetes-related deaths; MI, silent
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Cerebrovascular disease
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Risk of storke is 2-4 times higher among people with diabetes
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Peripheral vascular Disease
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Peripheral vascular disease can result in tissue death, requiring amputation; affects blood vessels that supply other areas of the body
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Diabetes Treatment Options
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1. Diet/exercise
2. Diabetic pharmacologic theraphy options: insulin or oral agents 3. CV therapy options: Cholesterol-lowering agents; antihypertensives |
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Diabetes Treatment Goals
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*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 |
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Diabetes and Dyslipidemia
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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 |
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Key Trial in Diabetes HPS Design
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*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 |
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HPS Results
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*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%) |
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CARDS
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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 |
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CARDS Results
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*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 |
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Types of Obesity
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Obesity is a state in which individuals have excess fat tissue mass
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Adult Onset and Lifelong Obesity
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Two types of obesity
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Adult Onset
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Affects many individuals in developed countries; normal weight in childhood; gradual weight gain 20-40 yrs old; imbalance between calories in and out
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Lifelong Obesity
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Childhood start; weight gain as a child; weight increase in women during/after pregnancy; often severely obese, weight>150% of ideal weight
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Measuring Obesity: BMI
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Widely used method: body mass index
BMI=weight (kg)/height (M2): Normal=18.5-24.9 Overweight=>25 Obese=>30 |
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Measuring Obesity: Fat Distribution
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*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 |
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Epidemiology of Obesity
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*30.5% of American adults obese between 1999-2000
*300,000 deaths/year due to obesity *Rising prevalence in kids |
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Cardiac Consequences: CARDIAC
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*Causes increases in Blood volume and cardiac output
*Heart weight and size may increase due to continual increase of cardiac output |
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Obesity Consequences: DIABETES
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*__% of pts with Type 2 diabetes mellitus are obese
*Insulin resistance: increases w/ weight gain and decreases with weight loss |
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Obesity Consequences: HYPERTENSION
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*Increase peripheral resistance
*Increase cardiac output *Increase sympathetic nervous system tone |
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Obesity Consequences: CAD
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*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 |
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Obesity Consequences: CHF
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*Pulmonary and systemic congestion related to: ventricular dysfunction and elevations in filling pressures
*Heart failure results from marked chronic increase in cardiac work |
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Obesity Consequences: OTHER
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Stroke; Pulmonary disease; bone, joint and cutaneous diseases
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Benefits of weight loss:
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*Improves exercise capacity of pts
*Improves cardiac hemodynamics *Reduces blood pressure |
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Metabolic Syndrome
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*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 |
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Metabolic Syndrome Diagnosis
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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 |
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Metabolic Syndrome Management
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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 |
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Action Potential in Cardiac Muscle
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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
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Preload
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Degree of ventricular myocardial fiber STRETCH before contraction
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Contractility
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The capacity of the heart muscle to CONTRACT
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After load
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The resistance against which the ventricles work during contraction
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Stroke Volume
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Amount of blood contracted by the ventricle in each contraction/amount of blood going to the body
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Things that effect stroke volume
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TPR, blood volume, blood viscosity, blood flow
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Ejection Fraction
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% of Left Ventricular volume after ejection; 50-60% of the amount of blood pumped out into the body
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