Cardiovascular Disease and Stroke Taking Action Today

Cardiovascular Disease and Stroke Taking Action Today

Maricela Wilson, RN BSN

Brain and Spine Neurosciences

Seton Healthcare Family

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The Circulatory SystemThe Circulatory System

The circulatory The circulatory system is made up of system is made up of vessels and muscles vessels and muscles that help and control that help and control the flow of the blood the flow of the blood around the body. around the body.

(This process is called (This process is called circulation). circulation).

The main parts of The main parts of the system are the the system are the heart, arteries, heart, arteries, capillaries and veins.capillaries and veins.

Risk Factors for CVD/Stroke

Heart Disease Risk FactorsMosca, Circulation 2004

SIX Modifiable Risk Factors for coronary risk factors

High blood pressure

High blood cholesterol

Diabetes

Physical inactivity

Overweight or obesity

Cigarette smoking

Risk Factors You Can’t Change

Increasing ageIncreasing age

Family health historyFamily health history

Race Race (HTN, Sickle cell)(HTN, Sickle cell)

Previous heart attack or Previous heart attack or

strokestroke

Gender (male sex)Gender (male sex) menopausemenopause

Birth controlBirth control

CholesterCholesterolol

Diabetes

systolic (mm Hg) Diastolic (mm Hg)

_______________________________________

Normal < 120 and < 80

Pre-hypertension 120 –139 or 80-89

High-Stage 1 140 –15 or 90–99

High-Stage 2 160 + or 100 +

American Heart Association Recommended Blood Pressure

Levels

Systolic pressure - force in arteries

when the heart beats

Diastolic pressure - the heart at rest

It's measured in millimeters of mercury (mm Hg).

High blood pressure/hypertension)

Classified : Essential or Secondary

-Essential or primary B/P with unknown cause

-Secondary hypertension is high B/P with a known direct cause, such as kidney disease, tumors, or birth control pills ( medication),etc.

What Do Blood Pressure Numbers Mean ?

http://www.medicalnewstoday.com/articles/162762.php

Blood Pressure 1/2, 1/2, 1/2

½ of the people who have high blood pressure know they have it,

½ of those who know they have it, are being treated for it.

½ of those being treated for it, have their blood pressure under control.

Nationwide, about 25 percent of hypertensive patients who are controlling their blood pressure.

Adults B/P checked at least once every two years,

Optimal levels : (equal to or less than) 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 as prescribed– Do not stop your medicines without consulting your doctor,

even if the blood pressure becomes normal

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/

Heart Disease and Stress

Excessive stress may precipitate the following•^ blood pressure•^ fat and cholesterol•^ deposition of fat in coronary arteries•Constriction of coronary arteries.•Increased chances of blood clotting.•Increased level of blood sugar.

Effects of Hypertension on the Organs

Cholesterol ( A type of fat)Cholesterol ( A type of fat)Everybody needs cholesterol, it serves a vital Everybody needs cholesterol, it serves a vital

function in the body.function in the body.

It circulates in the blood.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%65% 35%35%

Cholesterol Levels

People with high triglycerides often have a

-High total cholesterol level

- High LDL (bad) cholesterol

-Low HDL (good) cholesterol levels.

High Cholesterol HDL tends to carry cholesterol awayHDL tends to carry cholesterol away

from the arteries and back to the liver, from the arteries and back to the liver, where it's passed from the body. where it's passed from the body.

HDL removes excess cholesterol HDL removes excess cholesterol

from plaque in arteries, thus slowingfrom plaque in arteries, thus slowing

the buildup. the buildup.

(About one third to one fourth of the (About one third to one fourth of the total amount of cholesterol is HDL total amount of cholesterol is HDL cholesterolcholesterol))

LDL cholesterol circulates in the blood, LDL cholesterol circulates in the blood, slowly builds up in the inner walls of the slowly builds up in the inner walls of the arteries that feed the heart and brain. arteries that feed the heart and brain. Together with other substances it can Together with other substances it can form plaque, a thick, hard deposit that form plaque, a thick, hard deposit that can clog those arteries. This condition is can clog those arteries. This condition is known as known as atherosclerosis. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke.

http://www.medmovie.com/mmdatabase/MedMovieRedirect.aspx?ClientID=29&MedID=ahaw_0010i

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, IMMEDIATELY,

Have your dr. order a Hemoglobin A1c Hgb A1c < 7% (3 month history )

Normal - US(mg/dl)

Fasting Glucose < 100 *

2 hr after eating

< 140

A1c glycosylated hemoglobin)

< 6% (0.060)

Non- Diabetic

DiabetesCaused by too little insulin, resistance to insulin, or both.

When glucose or sugar enters the blood stream the pancreas makes insulin

Insulin moves glucose from the bloodstream into muscle, fat, and liver cells, to be used as fuel.

People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either:

The pancreas does not make enough insulinOr the cells do not respond to insulin normally OR both of the above

Insulin is a hormone produced by the pancreas to control blood sugar.

DiabetesData from the 2011 National Diabetes Fact Sheet (Jan. 26, 2011)Total prevalence of diabetes:•25.8 million children and adults in the US•8.3% of the population have diabetes.•Diagnosed: 18.8 million people•Undiagnosed: 7.0 million people•Prediabetes: 79 million people*

have a 2 or 3 x higher risk of heart attack or stroke

more likely to die of a heart attack

80% die from heart disease

Risk of sudden death from a heart attack for a diabetic is the same as that of someone who already had a heart attack.

People at risk for diabetes who follow a diet and exercise plan & only a modest weight loss) can decrease their risk of developing diabetes by almost 50%

OBESITY

Myth : fat deposits at old age! It starts from 2 years of age

FoamCells

FattyStreak

IntermediateLesion Atheroma

FibrousPlaque

ComplicatedLesion/Rupture

Adapted from Pepine CJ. Am J Cardio. 1998;82(suppl 104).

From FirstDecade

From ThirdDecade

From FourthDecade

Abdominal Weight – Visceral Fat

Excess of visceral fat is Excess of visceral fat is known as known as central obesity, or "belly fat", in which the abdomen in which the abdomen protrudes excessively. protrudes excessively.

There is a strong There is a strong correlation between central correlation between central obesity and cardiovascular disease

Excess visceral fat is linked Excess visceral fat is linked to to

--type 2 diabetes insulin resistance

-inflammatory diseases-inflammatory diseases

- and other obesity-related - and other obesity-related diseases diseases

Every pound of fat roughly 7 miles

of capillaries.

http://en.wikipedia.org/wiki/Central_obesity

http://en.wikipedia.org/wiki/Obesity

http://en.wikipedia.org/wiki/Cardiovascular_disease

http://en.wikipedia.org/wiki/Cardiovascular_disease

http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2

BMI Waist-to-Height Ratio

http://home.fuse.net/clymer/bmi/

Doing the numbers, men should have a waist about 54% of their height, and women about 52%. You can figure out where you fall by dividing your waist measurement in inches by your height in inches (add 60 to the number of inches you are over 5 feet).

• Gather information on your immediate family-• Learn about your extended family– • Gather family heart-health risk factor information conditions: Hypertension High cholesterol Smoking, Diabetes Overweight or obesity.

What heart or cardiovascular conditions have been diagnosed in family members? • Age of dx.

Examples include:• Aneurysm, Congestive heart failure, Coronary heart disease Heart attack (myocardial infarction),Stroke

Irregular heartbeat (arrhythmia)Heart muscle disease

(cardiomyopathy)

Family History

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–1 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14 1 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

What is the Cardiovascular Disease Triad

-PVD is present when blood vessels are affected by atherosclerosis.-In the absence of diabetes heavy cigarette smokingthe single most important risk factor i

-The brain receives its blood supply from four main arteries:-2 carotid arteries -2 vertebral arteries.

-The heart receives a blood supply of from the coronary arteries.

-Coronary heart disease result from narrowing of the coronary arteries

How does a Heart Attack Happens

Perception of Heart Disease Risk Factors

Mosca, Circulation 2004Mosca, Circulation 2004

Smoking

High Cholesterol

Family History

HTN

Diabetes

High Tg

Over wt.

Lack of exercise

My Plate

Balancing Calories ● Enjoy your food, but eat less.

● Avoid oversized portions. Foods to Increase ● Make half your plate fruits and vegetables. ● Make at least half your grains

whole grains. ● Switch to fat-free or low-fat

(1%) milk. Foods to Reduce ● Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers. ●Drink water instead of sugary

drinks.

SMOKING

Most important Most important preventable cause of preventable cause of premature deathspremature deaths

Higher risk of Higher risk of developing many developing many chronic disorderschronic disorders

Atherosclerosis -Atherosclerosis -buildup of fatty buildup of fatty substances in the substances in the arteries.arteries.

Controlling or reversing Controlling or reversing atherosclerosis is an atherosclerosis is an important part of preventing important part of preventing future heart future heart attack or attack or stroke.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.

30 minutes a day provides heart health benefits

Good Reasons to Exercise

Increase blood flow by up to 200%

Reduce blood pressure by up to 60 points

Reduce arterial plaque by 50%

Inhibit formation of clots and inflammation in blood vessels

Reduce cholesterol by up to 20%

Nitric oxide is produced by our endothelial cells, which live on the inside layer of our blood vessels

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%.

The Metabolic Syndrome

Certain “risk factors” for heart disease tend to cluster together and markedly increase your risk:

overweight, especially when carried around the waisthigh blood pressurecholesterol 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!

What is Heart Disease and What is Heart Disease and Cardiovascular Disease?Cardiovascular Disease?

Heart Disease and CVD used interchangeably

Heart Disease is any condition that affects

damages the heart or blood vessels

Heart failure – sudden wt. gain Heart beating fast, S.O.B, coughing, wheezing, dizzy, faint, trouble sleeping

Cardiomyopathy - weakening of the heart often inadequate heart pumping or other heart function problems

Arrhythmias –heart beats to slow, to fast, Irregular Endocarditis Atrial fib Cardiovascular disease diseases

The Heart Facts The heart is located almost in the

center of the chest, between the lungs, slightly sticks out and taps against the left side of the chest,

Beats about 100,000 times in one day; about 35 million times a year

Give a tennis ball a good, hard squeeze. You're using about the same amount of force your heart uses to pump blood out to the body

In one day, the blood travels a total of 19,000 km (12,000 miles)

The heart pumps about 1 million barrels of blood during an average lifetime—that's enough to fill more than 3 super tankers.

Chest discomfort. Most heart attacks involve discomfort in the

center of the chest; 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

Heart Attack Warning Signs

Severe shortness of breath

Unusual or unexplained fatigue (tiredness)

Unfamiliar dizziness or light-headedness

Unexplained nausea (feeling sick to the stomach) or vomiting

Sharp upper body pain in the neck, back, and jaw

Cold sweats, and you know it's not menopause

Unusually heavy pressure on the chest, like there's a ton of weight on you

Heart Attack Signs for Women

Cardiovascular Disease Can Be Different in Women

On average, Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.

Today, more than 8 percent of Hispanics, age 18 and older, have heart disease.

That’s why we invite you to be a part of Go Red Por Tu Corazon and educate Hispanic women about the threat of heart disease

Help empower them to make life-saving choices for themselves and their families.

Hands Only CPR

Understanding Stroke

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

The Stroke Belt

The Impact of Stroke

Stroke is the third-leading cause of

death in the U.S. and a major cause of

serious, long-term disability.

Each year about 790,000 Americans

have a stroke, so stroke strikes every 45

seconds.

Someone dies of a stroke every

3 minutes.

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 in the YoungCarotid and Vertebral

arteries main arteries that supply blood to the brain

Spontaneous dissection less than 2% •accounts for up to ¼ of all strokes in young and middle-age people• 12,000 and 15,000 are affected by spontaneous dissection of the carotid or vertebral arteries.

-RE: Ischemic stroke : diabetic, obese, have lipid disorders, and use tobacco or abuse alcohol-Dr. improved their diagnosis and reporting of stroke in young people-Birth control

Intervention

Why Call 911?

Cholesterol

Blood Pressure

Diabetes

Smoking

Wt. loss and

Physical Activity

It’s In Your HandsTake Action TODAY!

Living Better with Life’s Simple 7TM

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Our Goal: To improve the cardiovascular health of all Americans by 20 percent while reducing deaths from

cardiovascular disease and stroke by 20 percent.

Live Better. Embrace Health with Life’s Simple Seven.

Our Mission: Building healthier lives free of cardiovascular disease & stroke.

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Life’s Simple 7TM

Better U Makeoverhttp://www.goredforwomen.org/betteru/index.aspxA FREE 12-week online nutrition and fitness program that can makeover your heart and change your life. Includes step-by-step guidance, daily expert tips, an online journal and downloadable coaching tools.https://www.goredforwomen.org/hcu/index.aspx •know your risk for developing heart disease in the next 10 years?•assesses your main cardiovascular health risk factors.•Personal Action Plan. It's your customized guide to help you achieve your fitness and nutrition goals and live heart smart.

Take the Go Red Heart CheckUp today to learn your risk. It only

takes a few minutes and can save your life.

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Cardiovascular Disease and Stroke Taking Action Today

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