Lecture9 terminalillness heartdiesease_stroke.ppt
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Transcript of Lecture9 terminalillness heartdiesease_stroke.ppt
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Heart Disease, Hypertension, and Stroke
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Psychological Issues in Advanced and Terminal Illness
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?
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Mortality RatesLeading causes of death
< 1 year congenital abnormalities; sudden infant death syndrome (SIDS)
Children > 1 year old Accidents (40% of all deaths) Cancer (especially leukemia)
Adolescence Unintentional injury Homicide AIDS
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Mortality RatesLeading causes of death
Middle age Sudden death due to heart attack or
stroke Cancer
Elderly Heart disease Cancer Stroke
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Why do women live longer than men?
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Potential Reasons for Gender Differences in Mortality
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
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Risk Factors 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)
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Risk Factors - continued 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
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How do people adapt to chronic illness?
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Adapting Under Good Circumstances First concern upon hearing
diagnosis is fears about mortality. Optimistic but tentative about plans May try to normalize activities
Risk is they may over-extend May have feelings of helplessness
Risk is to become overly dependent
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Three Themes of Adaptation Find meaning: why illness
happened or rethink priorities Gain sense of control
control symptoms and treatment Restore self-esteem
Often by comparison with worse off others
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Adapting Under Bad Circumstances 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.
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Heart Disease Due to narrowing or blocking of the
coronary arteries. Angina pectoris
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
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Heart Disease Myocardium
Muscle tissue around the heart Myocardium infarction (heart attack)
Prolonged blockage of blood to an area of the heart resulting in muscle tissue damage.
Symptoms of a heart attack Pressure in chest, fullness, squeezing pain. Pain spreading to shoulders, neck, or arms Lightheadedness, fainting, sweating, nausea
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Who Is At Risk of Heart Disease?
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
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Heart Disease Risk Factors High blood pressure Family history Cigarette smoking High LDL and total cholesterol levels Physical inactivity Diabetes Obesity Stress
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Why high blood pressure a risk factor?
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.
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Type A Behaviours Hostile, cynical Judgmental (opinionated) Competitive Time urgent Uses gestures while talking Nodding of head while others are talking Intense
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Physiological Reactivity Physiological and cardiovascular
reactivity to acute stress (“hot reactors”). 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.
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Effects of Stress On Cardiac Risk
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Psychosocial Predictors Psychosocial Predictors of Sudden Cardiac Death (BDIof Sudden Cardiac Death (BDI>>10)10)
0 200 400 600 8000 200 400 600 800
1.001.00
0.950.95
0.900.90
0.850.85
Survival in daysSurvival in days
Placebo, BDI <10Placebo, BDI <10
Placebo, BDI Placebo, BDI >>1010
AMIO, BDI <10AMIO, BDI <10
AMIO, BDI AMIO, BDI >>1010
ProportionProportionSurvivingSurviving
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When do heart attacks occur?
Less likely during sleep. Among the employed, more often on
a Monday between 6 and 11 am. 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.
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Medical Treatment Initial treatment may involve clot-
dissolving medication and close monitoring
Balloon angioplasty Tiny balloon is inserted into blocked vessel
and inflated to open blood vessel Bypass surgery
Use grafted vessel (e.g., piece from leg) to bypass blockage in artery to the heart
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Medical Treatment Medications (e.g., beta blockers,
calcium channel blockers) to protect heart and improve function.
Risk management Control of high blood pressure Control of lipid abnormalities
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Rehabilitation Promote recovery and reduce risk of
another attack
Heart disease is chronic condition requiring ongoing management.
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Rehabilitation Includes: Exercise
Physiological and psychological benefits Weight management Smoking cessation Lipid and BP management include
dietary changes to control lipids Reduce excessive alcohol intake Stress management
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Rehabilitation Exercise is the key component but:
50% drop-out rate within first 6 months For those who continue benefits include:
Improved self concept, perceived health, sexual activity, involvement in social activities.
Those who stop are more likely to: Smoke, have poorer cardiac function, have
higher body weight, be more sedentary, experience greater anxiety and depression.
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Symptoms of a Stroke Sudden
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
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What is a stroke?
Tissue damage to area of the brain due to disruption in blood supply, depriving that area of the brain of oxygen.
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Causes of Strokes
1. Infarction – blockage in cerebral artery that cuts off or reduces blood supply
a) Thrombosis – blood clotb) Embolus – piece of plaque becomes
lodged in the artery.
2. Hemorrhage – happens suddenly. Less frequent than infarction but more damaging and more likely to cause death.
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Stroke Risk Factors 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
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Stroke Risk Factors 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)
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Effects of a Stroke 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.
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Effects of Stroke Motor impairments often due to
paralysis on one side of the body (side opposite to brain damage). 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.
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Effects of Stroke Left-hemisphere damage more
commonly associated with language problems called aphasia. 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.
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Psychosocial Aspects of Stroke
Denial is common 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.