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Cardiovascular Care

Cardiovascular Care. Kenneth H. Cohen , M.D.,F.A.C.C. Ronald D. D’Agostino , D.O., F.A.C.C., F.A.C.P. Henry Gomez , M.D., F.A.C.C. Jeffrey M. Bernstein , M.D. Internal Medicine, Cardiology and Cardiovascular Diseases Diplomates American Board of Internal Medicine and Cardiovascular Diseases

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Cardiovascular Care

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  1. Cardiovascular Care Kenneth H. Cohen, M.D.,F.A.C.C. Ronald D. D’Agostino, D.O., F.A.C.C., F.A.C.P. Henry Gomez, M.D., F.A.C.C. Jeffrey M. Bernstein, M.D. Internal Medicine, Cardiology and Cardiovascular Diseases Diplomates American Board of Internal Medicine and Cardiovascular Diseases 1129 Northern Blvd - Suite 408 Manhasset, NY 11030 516-627-2121

  2. “Everything you wanted to know about cardiovascular care but the HMO’s were afraid you’d ask.”

  3. Ronald D. D’Agostino D.O., F.A.C.C.,F.A.C.P Specializing in: Cardiology Cardio-vascular Diseases Atherosclerosis Angina & Myocardial Infarction Hypertension Renal Artery Stenosis Valvular Heart Disease Peripheral Vascular Disease Cardiomyopathy & Hypertrophy Carotid Diseases Congestive Heart Failure Stroke Prevention & Treatment Arrythmias Diabetes Management

  4. “HOW IMPORTANT IS THE HEART! IT IS THERE THAT CHARACTER IS FORMED. IT ALONE HOLDS THE SECRETS OF TRUE SUCCESS.” CHARLES SWINDOLL

  5. Cardiovascular Disease Statistics • Claims more lives each year than the next 7 leading causes of death combined • More than 2600 Americans die each day from cardiovascular disease (1 death every 33 seconds) • Since 1900, cardiovascular disease has been the #1 cause of death each year (except 1918) • 1 in 5 people has some form of cardiovascular disease • 1 in 3 men can expect to develop a major cardiovascular disease by age 60. The odds for women are 1 in 10 • American Heart Association 2000 Heart & Stroke Statistical Update

  6. Hypertension

  7. Approximately 50 Million Americans Have Hypertension Controlled27.4% Uncontrolled72.6% (13.7 million) (36 million) (American Heart Association. 2001 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association. 2000)

  8. Hypertension High Blood Pressure • Systolic - (top number) The measurement of the pressure placed on artery walls when the heart is working. • Diastolic - (bottom number) The measurement of the pressure placed on the artery walls when the heart is at rest.

  9. Warning Signs • No warning signs for high blood pressure • Called the “silent killer” • The only way to diagnose high blood pressure is to have your pressure taken. • New guidelines: (JNC-7) define high blood pressure and the treatment guidelines for healthcare providers

  10. JNC-7 • B/P <120 systolic/<80 diastolic = • normal • B/P 120-139 systolic/80-89 diastolic = • pre-hypertension • B/P 140-159 systolic/90-99 diastolic = • stage 1 hypertension Treatment is based on risk factors for disease. No one drug is right for every person. Treatment is always tailored for the individual.

  11. The Cardiovascular Continuum: High BP to Heart Failure Normal Higher Elevated Blood Pressure Left Ventricular Dysfunction Health Status/QOL Heart Failure Death Lower Time (years) (Adapted from Dzau V, Braunwald E. Am Heart J. 1991)

  12. HYPERTENSION • Elevated blood pressure damages the walls of the arteries. • May increase the development of atherosclerosis • May lead to the development of heart failure • Increased blood pressure may also lead to damage in other organs including the brain, eyes and kidneys

  13. Lifestyle Modifications to Prevent and Manage HTN • Avoid tobacco • Reduce weight • Moderate consumption of: • alcohol • sodium • saturated fat • cholesterol • Maintain adequate intake of dietary: • potassium • calcium • magnesium • Increase physical activity (JNC VI. Arch Intern Med. 1997)

  14. Lifestyle Modifications • Stop smoking and reduce intake of saturated fat and cholesterol • Lose weight if overweight • Limit alcohol intake • Increase aerobic physical activity • Limit sodium intake • Maintain adequate intake of K+, Ca++, and Mg++ for general health JNC VI, 1997.

  15. Cardiovascular Disease

  16. Cardiovascular Disease • HEART & BLOOD VESSEL DISEASE IS THE # 1 KILLER OF AMERICANS : • Elevated cholesterol is a major risk factor. • The higher the total cholesterol, the greater the risk of cardiovascular disease. • The higher the cholesterol level, the greater the chances of dying from CV disease.

  17. Cardiovascular Disease • Coronary Artery Disease • Angina • Myocardial Infarction • Peripheral Arterial Disease • Carotid Artery Disease • Aortic Aneurysm • Renal Artery Disease • Blockages affecting the circulation to the legs

  18. UNCHANGEABLE RISK FACTORS • Age • Gender • Genetics - Family history • Diabetes

  19. LIFESTYLE CHOICESChangeable Factors • SMOKING • DIET • INACTIVITY • OBESITY • Diabetes Control

  20. RISK FACORS • THE MORE RISK FACTORS YOU HAVE, THE GREATER THE RISK OF CARDIOVASCULAR DISEASE!

  21. Atherosclerosis Time Line CV Events MI/Stroke Obstruction Symptoms CHF Birth Fatty Streak Plaque formation Intimal Changes Age 0 10 20 30 40 50 60 70 80 Not everyone progresses along the continuum as described above

  22. Cholesterol

  23. WHAT IS CHOLESTEROL? • -WAXY, FAT-LIKE SUBSTANCE (LIPID) • ESSENTIAL TO THE BODY’S CELLS • HELPS IN DIGESTION OF FOOD • INSULATION OF NERVES • PRODUCTION OF CERTAIN HORMONES • YOU CANNOT LIVE WITHOUT IT!

  24. CHOLESTEROL • YOUR BODY MAKES CHOLESTEROL • THE LIVER MAKES APPROXIMATELY 80% OF THE BLOOD CHOLESTEROL • APPROXIMATELY 20% COMES FROM THE FOODS YOU EAT

  25. CHOLESTEROL • To be carried by the blood, the body coats cholesterol with proteins called: APOPROTEINS • Once coated, they form a package called: LIPOPROTEINS • Lipoproteins carry both cholesterol & Triglycerides.

  26. LIPOPROTEINS • Some lipoproteins are called Low Density (LDL). They contain lots of cholesterol. • Some lipoproteins are called High Density (HDL). They contain mostly protein. • Other lipoproteins are called Very Low Density Lipoproteins (VLDL). They contain cholesterol, triglycerides & protein.

  27. LDL - “BAD CHOLESTEROL” • LDL particles (carry cholesterol), attach to cell surfaces & are then brought into cells. • If there are too many LDL particles in the blood, if the liver cells (LDL receptors) do not receive LDL particles, or if there are too few LDL receptors in the liver the body’s cells become saturated with cholesterol from LDL products.

  28. LDL CHOLESTEROL • CHOLESTEROL IS THEN DEPOSITED ON ARTERY WALLS.

  29. HDL-“GOOD” CHOLESTEROL • The “good” role of HDL then comes in: • These particles “pick up” the cholesterol deposited on the artery walls and bring it to the liver for removal.

  30. LDL VERSUS HDL • If too much cholesterol from LDL particles remains on artery walls the arteries begin to narrow - ATHEROSCLEROSIS. • This is the reason why a high HDL:LDL ratio is good. It can protect you.

  31. TRIGLYCERIDES • Form of fat • Most of the body’s fat is in the form of Triglycerides stored in fat tissue; a small portion is found in the bloodstream. • Normally, used by the body for energy. • Body produces Triglycerides. • Found in the diet: meats, cheese, fish, nuts & vegetable oils.

  32. ELEVATED TRIGLYCERIDES • EXCESSIVE ALCOHOL INTAKE • OBESITY • HIGH CARBOHYDRATE DIET • DIABETES (POORLY CONTROLLED)

  33. GENETICS • Genes can give you cells that do not remove LDL from blood, or a liver that makes too much cholesterol or too little HDL.

  34. SMOKING • Damages the walls of blood vessels making them more prone to fatty deposits. • Nicotine constricts blood vessels • Decreases HDL (good cholesterol) by 15% • If you stop smoking, HDL may improve

  35. OBESITY • INCREASED WEIGHT - INCREASED TRIGLYCERIDES • INCREASED WEIGHT - DECREASED HDL & INCREASED VLDL • DECREASED EXERCISE - DECREASED HDL

  36. DIABETES • ELEVATED TRIGLYCERIDES • DECREASED HDL

  37. Inflammation and CRP

  38. Inflammatory Pathways in Atherogenesis Pro-inflammatory Risk Factors Primary Pro-Inflammatory Cytokines (eg, IL-1, TNF-a) IL-6 “Messenger” Cytokine ICAM-1 Selectins, HSPs, etc. CRP SAA Endothelium and other cells Liver Circulation Adapted from Libby P et al. Circulation. 1999;100:1148–1150.

  39. Chest Pain

  40. Heart Attack/MI • Caused by a blockage of one of the heart’s arteries • The area of blockage then causes the heart muscle to infarct or die. • The area that dies does not return to life. • The key is to limit the extent of the damage, or to prevent damage from happening in the first place

  41. Warning Signs • Sudden onset of chest pressure or tightness • May be described as: squeezing or like an elephant sitting on the chest • May be associated with shortness of breath, a feeling of indigestion, sweating • Pain may travel to back, jaw, arm, elbow or shoulder

  42. Prevention • Decrease Risk Factors • Pay attention to the symptoms you may be having: • Chest pain or pressure with exercise/relieved with rest • Shortness of breath with exercise/relieved with rest • Any change in your ability to walk or exercise due to pressure, pain or shortness of breath

  43. DIAGNOSTIC TESTING

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