More women now die of heart disease than men, yet cardiovascular research has long focused on men. Why are symptoms different for women present during a heart attack and why they’re often missed? Discuss after watching…https://www.ted.com/talks/noel_bairey_merz_the_single_biggest_health_threat_women_face
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Chapter 11: Cardiovascular Disease,
Diabetes, and Cancer
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels.
Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardial
infarction (commonly known as a heart attack). Other CVDs include stroke, heart
failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart
arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral
artery disease, thromboembolic disease, and venous thrombosis.
The underlying mechanisms vary depending on the disease. Coronary artery disease, stroke, and
peripheral artery disease involve atherosclerosis, which is the narrowing of the inside of an artery
due to the build up of plaque. This may be caused by high blood pressure, smoking, diabetes,
lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption,
among others. High blood pressure results in 13% of CVD deaths, while tobacco results in 9%,
diabetes 6%, lack of exercise 6% and obesity 5%. Rheumatic heart disease may follow
untreated strep throat. It is estimated that 90% of CVD is preventable.
Coronary heart disease (CHD), also commonly referred to as just heart disease, is a common
term for the buildup of plaque in the heart’s arteries that could lead to heart attack. But is there a
difference between coronary heart disease and coronary artery disease? The short answer is often
no — health professionals frequently use the terms interchangeably. However, coronary heart
disease, or CHD, is actually a result of coronary artery disease, or CAD. With coronary artery
disease, plaque first grows within the walls of the coronary arteries until the blood flow to the
heart’s muscle is limited. View an illustration of coronary arteries below:
Figure 1. Coronary Arteries
The Coronary Arteries are the blood vessels that supply blood to your heart. They branch off of
the aorta at its base. The right coronary artery, the left main coronary, the left anterior
descending, and the left circumflex artery, are the four major coronary arteries. Blockage of
these arteries is a common cause of angina, heart disease, heart attacks and heart failure.
This restriction of the blood supply to the tissues is also called ischemia. It may be chronic,
narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle.
Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or
blood clot.
Anatomy of the Cardiovascular System
To fully understand Cardiovascular Diseases, it may be helpful to understand the anatomy of the
cardiovascular system. It includes the following:









Heart: the pump, divided into four chambers (R/L atria, R/L ventricles)
Arteries: large vessels carrying oxygen-rich blood away from heart; have thick, muscular
wall
Arterioles: smaller arteries
Capillaries: smallest vessels where gas exchange takes place, oxygen is delivered to
tissues and carbon dioxide is carried away
Veinuoles: smallest veins, which carry carbon dioxide-rich blood, back to heart
Veins: biggest vessels that carry carbon dioxide-rich blood back to heart; have one-way
valves to prevent gravity from pulling blood backward (away from heart)
Atria: the collecting chambers of the heart, located on top
Ventricles: the pumping chambers of the heart, located on the bottom
Aorta: the largest vessel (artery) in the body; all arteries branch from it
The right side of the heart (right atrium and right ventricle) takes CO2-rich blood and sends it to
the lungs for oxygenation. The left side of the heart (left atrium and ventricle) takes O2-rich
blood and delivers it to the body. The right side is said to be responsible for pulmonary
circulation; the left side is said to be responsible for systemic circulation. Because of the
distances involved, pulmonary circulation is a relatively low-pressure system, while systemic
circulation is a relatively high-pressure system. In fact, when we measure blood pressure we’re
measuring systemic pressure.
Heart Disease and Stroke Facts
Heart Disease Facts



Heart disease is the leading cause of death for both men and women.
About 610,000 Americans die from heart disease each year—that’s 1 in every 4 deaths.
Coronary heart disease is the most common type of heart disease, killing about 365,000
people in 2014.



In the United States, someone has a heart attack every 42 seconds. Each minute,
someone in the United States dies from a heart disease-related event.
Heart disease is the leading cause of death for people of most racial/ethnic groups in the
United States, including African Americans, Hispanics, and whites. For Asian Americans
or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only
to cancer.
Heart disease costs the United States about $207 billion each year. This total includes
the cost of health care services, medications, and lost productivity.
Risk Factors
High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease.
About half of Americans (49%) have at least one of these three risk factors.
Several other medical conditions and lifestyle choices can also put people at a higher risk for
heart disease, including:





Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Figure 2. Heart Disease Death Rates
Stroke Facts







Stroke is the fifth leading cause of death in the United States, killing more than 130,000
Americans each year—that’s 1 of every 20 deaths.
A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to
the brain or when a blood vessel in the brain bursts.
Someone in the United States has a stroke every 40 seconds. Every four minutes,
someone dies of stroke.
Every year, about 795,000 people in the United States have a stroke. About 610,000 of
these are first or new strokes; 185,000 are recurrent strokes.
Stroke is an important cause of disability. Stroke reduces mobility in more than half of
stroke survivors age 65 and over.
Stroke costs the nation $33 billion annually, including the cost of health care services,
medications, and lost productivity.
You can’t control some stroke risk factors, like heredity, age, gender, and ethnicity. Some
medical conditions—including high blood pressure, high cholesterol, heart disease,
diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA)—
can also raise your stroke risk. Avoiding smoking and drinking too much alcohol, eating
a balanced diet, and getting exercise are all choices you can make to reduce your risk.
Common Stroke Warning Signs and Symptoms
1. Sudden numbness or weakness of the face, arm, or leg—especially on one side of the
body.
2. Sudden confusion, trouble speaking or understanding.
3. Sudden trouble seeing in one or both eyes.
4. Sudden trouble walking, dizziness, loss of balance or coordination.
5. Sudden severe headache with no known cause.
Figure 3. Stroke Death Rates
Coronary Artery Disease (CAD)
Coronary artery disease (CAD) is the most common type of heart disease in the United States.
For some people, the first sign of CAD is a heart attack. Therefore, taking steps to reduce your
risk for CAD is essential.
Research suggests that CAD (also referred to as coronary heart disease, abbreviated CHD) starts
when certain factors damage the inner layers of the coronary arteries. These factors include:




Smoking
High levels of certain fats and cholesterol in the blood
High blood pressure
High levels of sugar in the blood due to insulin resistance or diabetes
Causes of CAD
Figure 4. Plaque Buildup
When damage occurs, your body starts a healing process. The healing may cause plaque to build
up where the arteries are damaged. Plaque is made up of deposits of cholesterol and other
substances in the artery. This progression of plaque build up is called atherosclerosis.
The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can
narrow or block some of your coronary arteries. This reduces the flow of oxygen-rich blood to
your heart muscle.
Eventually, an area of plaque can rupture (break open). If this happens, blood cell fragments
called platelets will stick to the site of the injury and may clump together to form blood clots.
Blood clots narrow the coronary arteries even more and worsen angina (chest discomfort or pain)
or cause a heart attack.
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition
where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia,
also can develop.
Other Conditions Related to Heart Disease
Coronary artery disease is the most common type of heart disease, but there are many other
conditions that affect the heart:








Acute coronary syndrome is a term that includes heart attack and unstable angina.
Angina, a symptom of coronary artery disease, is chest pain or discomfort that occurs
when the heart muscle is not getting enough blood. Angina may feel like pressure or a
squeezing pain in the chest. The pain also may occur in the shoulders, arms, neck, jaw, or
back. It may feel like indigestion. There are two forms of angina—stable or unstable:
o Stable angina happens during physical activity or under mental or emotional
stress.
o Unstable angina is chest pain that occurs even while at rest, without apparent
reason. This type of angina is a medical emergency.
Aortic aneurysm and dissection are conditions that can affect the aorta, the major artery
that carries blood from the heart to the body. An aneurysm is an enlargement in the aorta
that can rupture or burst. A dissection is a tear in the aorta. Both of these conditions are
medical emergencies.
Arrhythmias are irregular or unusually fast or slow heartbeats. Arrhythmias can be
serious. One example is called ventricular fibrillation. This type of arrhythmia causes an
abnormal heart rhythm that leads to death unless treated right away with an electrical
shock to the heart (called defibrillation). Other arrhythmias are less severe but can
develop into more serious conditions, such as atrial fibrillation, which can cause a stroke.
Atherosclerosis occurs when plaque builds up in the arteries that supply blood to the
heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup
causes arteries to narrow over time.
Atrial fibrillation is a type of arrhythmia that can cause rapid, irregular beating of the
heart’s upper chambers. Blood may pool and clot inside the heart, increasing the risk for
heart attack and stroke.
Cardiomyopathy occurs when the heart muscle becomes enlarged or stiff. This can lead
to inadequate heart pumping (or weak heart pump) or other problems. Cardiomyopathy
has many causes, including family history of the disease, prior heart attacks, uncontrolled
high blood pressure, and viral or bacterial infections.
Congenital heart defects are problems with the heart that are present at birth. They are
the most common type of major birth defect. Examples include abnormal heart valves or




holes in the heart’s walls that divide the heart’s chambers. Congenital heart defects range
from minor to severe.
Heart failure is often called congestive heart failure because of fluid buildup in the
lungs, liver, gastrointestinal tract, and the arms and legs. Heart failure is a serious
condition that occurs when the heart can’t pump enough blood to meet the body’s needs.
It does not mean that the heart has stopped but that muscle is too weak to pump enough
blood. The majority of heart failure cases are chronic, or long-term heart failures.
The only cure for heart failure is a heart transplant. However, heart failure can be
managed with medications or medical procedures.
Peripheral arterial disease (PAD) occurs when the arteries that supply blood to the
arms and legs (the periphery) become narrow or stiff. PAD usually results from
atherosclerosis, the buildup of plaque and narrowing of the arteries. With this condition,
blood flow and oxygen to the arm and leg muscles are low or even fully blocked. Signs
and symptoms include leg pain, numbness, and swelling in the ankles and feet.
Rheumatic heart disease is damage to the heart valves caused by a bacterial
(streptococcal) infection called rheumatic fever.
Risk Factors for Coronary Heart Disease
Coronary heart disease risk factors are conditions or habits that raise your risk of coronary heart
disease (CHD) and heart attack. These risk factors also increase the chance that existing CHD
will worsen.
There are many known CHD risk factors. You can control some risk factors, but not others. Risk
factors you can control include:








High blood cholesterol and triglyceride levels (a type of fat found in the blood)
High blood pressure
Diabetes and prediabetes
Overweight and obesity
Smoking
Lack of physical activity
Unhealthy diet
Stress
The risk factors you can’t control are age, gender, and family history of CHD.
Many people have at least one CHD risk factor. Your risk of CHD and heart attack increases
with the number of risk factors you have and their severity. Also, some risk factors put you at
greater risk of CHD and heart attack than others. Examples of these risk factors include smoking
and diabetes. Many risk factors for coronary heart disease start during childhood. This is even
more common now because many children are overweight and don’t get enough physical
activity. Researchers continue to study and learn more about CHD risk factors.
Chapter 11: Cardiovascular Disease,
Diabetes, and Cancer (11.1)
Section 11.1 Stroke
A stroke is a medical condition in which poor blood flow to the brain results in cell death. This
results in part of the brain not functioning properly. The main types of stroke are:



Ischemic stroke.
Hemorrhagic stroke.
Transient ischemic attack (a warning or “mini-stroke”).
Figure 5. Hemorrhagic and Ischemic Strokes
Ischemic Stroke
Most strokes (85%) are ischemic strokes. If you have an ischemic stroke, the artery that supplies
oxygen-rich blood to the brain becomes blocked.
Blood clots often cause the blockages that lead to ischemic strokes.
Hemorrhagic Stroke
A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open).
The leaked blood puts too much pressure on brain cells, which damages them.
High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and
burst—are examples of conditions that can cause a hemorrhagic stroke.
There are two types of hemorrhagic strokes:


Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs
when an artery in the brain bursts, flooding the surrounding tissue with blood.
Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to
bleeding in the area between the brain and the thin tissues that cover it.
Transient Ischemic Attack (TIA)
A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the
major types of stroke because blood flow to the brain is blocked for only a short time—usually
no more than 5 minutes.
It is important to know that:






A TIA is a warning sign of a future stroke.
A TIA is a medical emergency, just like a major stroke.
Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a
stroke or see symptoms in someone around you.
There is no way to know in the beginning whether symptoms are from a TIA or from a
major type of stroke.
Like ischemic strokes, blood clots often cause TIAs.
More than a third of people who have a TIA end up having a major stroke within 1 year if
they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a
TIA.
A health care team can usually find the cause and take steps to prevent a major stroke.
Recognizing and treating TIAs can reduce the risk of a major stroke.
Recognizing a Stroke – Think FAST!
During a stroke, every minute counts! Fast treatment can lessen the brain damage that stroke can
cause. By knowing the signs and symptoms of stroke, you can take quick action and perhaps
save a life—maybe even your own.
Signs of Stroke in Men and Women





Sudden numbness or weakness in the face, arm, or leg, especially on one side of the
body
Sudden confusion, trouble speaking, or difficulty understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance, or lack of coordination
Sudden severe headache with no known cause
Call 9-1-1 right away if you or someone else has any of these symptoms.
Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The stroke
treatments that work best are available only if the stroke is recognized and diagnosed within 3
hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at
the hospital in time.
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T—Time: If you see any of these signs, call 9-1-1 right away.
Note the time when any symptoms first appear. This information helps health care providers
determine the best treatment for each person. Do not drive to the hospital or let someone else
drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the
way to the emergency room.
Chapter 11: Cardiovascular Disease,
Diabetes, and Cancer (11.2)
Section 11.2 Metabolic Syndrome
Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease
and other health problems, such as diabetes and stroke.
The term “metabolic” refers to the biochemical processes involved in the body’s normal
functioning. Risk factors are traits, conditions, or habits that increase your chance of developing
a disease.
In this article, “heart disease” refers to coronary heart disease (CHD). CHD (also called coronary
artery disease, abbreviated CAD) is a condition in which a waxy substance called plaque builds
up inside the coronary (heart) arteries.
Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead
to chest pain, a heart attack, heart damage, or even death.
Metabolic Risk Factors
The five conditions described below are metabolic risk factors. You can have any one of these
risk factors by itself, but they tend to occur together. You must have at least three metabolic risk
factors to be diagnosed with metabolic syndrome.
A Large Waistline
Having a large waistline means that you carry excess weight around your waist (abdominal
obesity). This is also called having an “apple-shaped” figure. Your doctor will measure your
waist to find out whether you have a large waistline.
A waist measurement of 35 inches or more for women or 40 inches or more for men is a
metabolic risk factor. A large waistline means you’re at increased risk for heart disease and other
health problems.
A High Triglyceride Level
Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or
higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is
milligrams per deciliter—the units used to measure triglycerides, cholesterol, and blood sugar.)
A Low HDL Cholesterol Level
HDL cholesterol sometimes is called “good” cholesterol. This is …
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