health - cardiovascular disease

  • Created by: Cruick96
  • Created on: 28-04-17 15:07
what is the healthy heart like?
size of clenched fist, 11 ounces, 3 layers of tissue (epicardium, endocardium, myocardium), pumps 5+ quarts of blood each min through 4 chambers
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what are the layers of the heart?
thin outer layer = epicardium, thin inner layer = endocardium, thick middle layer (heart) = myocardium
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how is the myocardium organised?
separated in to 4 chambers that work in coordinated fashion to bring blood in to heart then pump round body.
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what does the myocardium need?
steady supply of oxygen and nutrients in order to stay healthy. the greater the demands on the heart, the more oxygen and nutrients it needs
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where does the myocardium/heart get its blood supply from?
5+ quarts each min through internal chambers of heart, but rather from 2 branches of aorta (maj artery) lying on surface of epicardium. the left n right coronary arteries branch off in to smaller blood vessels and to capillaries
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what is cardiovascular disease?
disorders of the heart and blood vessel system including stroke and coronary heart disease
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what percentage of deaths in US are caused by cardiovascular disease?
34.3% - biggest killer in world
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what is coronary heart disease?
chronic disease in which arteries that supply the heart become narrowed or clogged
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what is atherosclerosis?
development of plaques on walls of the artery, reduces the functioning of the coronary arteries. we all get it. due to accumulation of fats. the arterial lumen becomes occluded, impeding blood flow
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when do these plaques tend to develop?
30's or 40's
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at what age do the plaques become dangerous?
won't threaten life until 70 or older
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what 2 illnesses can atherosclerosis cause?
atherogenesis or arteriosclerosis
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what is atherogenesis?
form of atherosclerosis that can help trigger heart attacks and strokes.
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how is atherogenesis caused?
inflammation in circling blood. process begins w/ damage to blood vessel walls that result in formation of fatty streaks which act as call for help from body's immune system that things are bad. inflammation = body response to injury, blood clots
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what is arteriosclerosis?
hardening of the arteries
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how is arteriosclerosis caused?
coronary arteries lose elasticity making hard to expand and contract. makes difficult for them to handle large volumes of blood during physical exertion. blood clots more likely to form and block an artery that has lost elasticity
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what is angina?
condition of extreme chest pain caused by restriction of blood flow to the heart (ischemia)
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how does atherosclerosis relate to angina?
gradual narrowing of blood vessels, any part of body that depends on blood flow from damaged artery subject to damage. arteries that supply heart narrowed from the plaques, restricting the blood flow
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when do angina attacks usually happen?
during moments of unusual exertion as the body demands greater supplies of blood above what it is accustomed to handling. can happen during strong emotional arousal or extreme cold or heat. mental stress during daily life all increase the risk of it
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what is myocardial infarction?
heart attack - permanent death of heart tissue in response to an interruption of blood supply
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how does myocardial infarction happen?
when a plaque ruptures within a blood vessel, releasing a sticky mass that can further reduce blood flow or obstruct it completely. within secs of this, heart attack occurs. can lead to death
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what is an ischemic stroke?
occurs when atheromous matter enters in to blood stream breaks off and blocks blood flow to the brain which can lead to necrotic injury
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what is haemorrhagic stroke?
occurs when blood vessel bursts inside the brain, increasing pressure on the cerebrum and damaging it by pressing against the skull (also known as cerebral aneurysm)
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which is the more common type of stroke?
ischemic
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how many people are affected by stroke?
750,000 US annually
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how many people die from stroke annually?
137,000 in US (1 in every 18 deaths)
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how many premature deaths were caused by stroke in UK in 2012?
42,000
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in the western world where does stroke stand in causing deaths?
third leading cause of death after myocardial infarction and cancer
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what are the effects of stroke?
speech loss, difficulty understanding speech, numbness, weakness or paralysis of limbs or face, blurred vision, dizziness
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what are silent strokes?
damage tiny clusters of cells within the brain but cause no immediate or obvious symptoms. these strokes go undetected until over time memory loss, dizziness, slurred speech and other symptoms begin to appear
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what percentage of the population have silent strokes?
4%
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what types of drugs can be administered to patients with chd?
nitro-glycerine, beta blockers, vasodilators, anticoagulants, thrombolytic agents
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what is nitro-glycerine?
they increase blood flow to the heart
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what are beta blockers and calcium channel blockers?
lower blood pressure and reduce blood pumping demands placed on the heart
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what are vasodilators?
expand narrowed blood vessels
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what are anticoagulants?
help prevent formation of clots
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what are thrombolytic agents?
if MI diagnosed withing first few hours doctors commonly give intravaneous infusion of it to dissolve blood clots quickly
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what types of surgery are there to treat chd?
coronary artery bypass graft, coronary angioplasty
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what is a coronary artery bypass graft?
used if substantial blockage revealed in 1 or more coronary arteries. incision made in breast bone and small vein harvest from saphenous of mammary brain and grafted around the region of blocked/narrowed artery
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what is coronary angioplasty?
catheter threaded in to leg artery and up in to blocked coronary artery and blood vessel. a balloon at the tip is then inflated to press the plaque against the walls and is then deflated and removed. a metallic mesh tube (stent) often inserted
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why are stents put in?
to reinforce optimal blood flow
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what is the framingham heart study?
landmark prospective study of demographic, biological and psychological risk factors in cvd. 5209 healthy ppl following them over time. every 2 years they complete physical exam (ECG, blood pressure, 80 more tests). identified 2 basic risk factors
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what are the 2 risk factors identified from the framingham heart study?
uncontrollable and controllable
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what are uncontrollable risk factors?
age, gender, family history, race/ethnicity
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what are controllable risk factors?
hypertension, body weight, diet, smoking, cholesterol level
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how did epidemiologists study diseases before the framingham heart study?
examined medical records and death certificates
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how does family history relate to cvd?
strongly predicts cvd. esp. true for those who have close male relative who suffered heart attack before 55 or close female relative who suffered it before 65.
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how does age relate to cvd?
advancing age = risk factor. approx half of all cvd sufferers are over age 65
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how does gender relate to cvd?
risk of cvd rises sharply in men after 40 years. except in women who smoke, risk of cvd remains low until menopause. risk much higher in men until 65 years. takes more lives of women than any other cause.
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how many women does cvd affect?
1 in 3. takes lives of 5x as many as breast cancer
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why does it cause so many deaths amongst women?
tend to be older than their male counterparts, more likely to die following mi (2x as likely)
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why are there gender differences in cvd?
differences in hormones. testosterone linked to aggressiveness, competitiveness and other behaviours that contribute to cvd. testosterone levels peak during early adulthood
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how does race and ethnicity relate to cvd?
AA are at increased risk and Asian and latin americans are at lowered risk compared to european americans. could be due to socioeconomic factors. low ses have more total cvd risk factors. low income women elevated risk factors.
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what is the chicago heart association detection project?
evaluated health outcomes for men aged 18-39 and 40-59. younger men with healthiest lifestyles had life expectancy of 9.5 years longer than others in age group. for healthy men in older group, life expectancy extended by 6 years
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what is hypertension?
when blood pressure too high and it damages the vessels and leads to atherosclerosis
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what is blood pressure?
the force exerted by blood as it pushes out against the walls of the arteries
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what is hypertension caused by?
obesity, lack of exercise, dietary salt and excessive stress can cause hypertension in bio predisposed people. related to anxiety and anger (esp in middle aged men). linked w/ stress, esp in people w/ poor coping mechs or limited coping resources.
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how does heredity affect hypertension?
prevalence of hypertension varies widely amongst racial and ethnic groups. prevalence of ht in aa women and men in us is among highest in world
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how does cardiovascular reactivity relate to hypertension?
prevalence of ht among aa's may reflect greater cardiovascular reactivity to social stress (esp racial discrimination) in form of larger increases in heart rate and blood pressure and greater oupourin of epinephrine cortisol and other stress hormones
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how does obesity relate to cvd?
increases risk of hypertension and cvd. associated w/ high cholesterol. abdominal obesity associated in midsection promotes greatest risk of cvd. ppl w/ this have thicker arteries walls which increases blood pressure and risk of stroke
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how does cholesterol relate to cvd?
high levels increases risk of cvd. level of 240 or over doubles the risk. below 200 assoc. w/ lower risk. if have low hdl and high cholesterol they have highest risk.
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what factors can lower cholesterol?
regular consumption of antioxidant nutrients like vitamin e, beta carotene, selenium and riboflavin. moderate alcohol drinking reduce cholesterol and increase hdl.
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what has been found about antioxidants and cvd?
men w/ highest levels of antioxidants had 2/3s lower risk of cvd than those with lowest levels
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what is metabolic syndrome?
3 or more of these: large waist circumference, elevated serum triglyceride, low hdl cholesterol, elevated blood pressure, glucose intolerance
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what is metabolic syndrome caused by?
obesity, hypertension and poor cholesterol profile
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how many people have metabolic syndrome?
47 million americans
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how does tobacco use relate to cvd?
more than doubles chance of having heart attack and linked to one in every 5 deaths due to chd. twice risk of having stroke, less likely to survive MI. 1 year after quitting cvd risk drops by 50%. 15 years after, same as if never smoked
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what did friedman and rosenman study?
found br pattern (incl competitiveness, strong sense of time urgency and hostility) labelled type a. predict coronary heart problems.
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what have studies on personality found about cvd?
type a have more rapid blood clotting, higher cholesterol levels. display greater autonomic arousal, elevated heart rates, higher blood pressure in relation to challenging events. less likely to remain calm.
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how do we reduce risk of cvd?
limit fat intake, quit smoking, lose excess weight, regular exercise.
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what do neuropsychologists do?
contribute to understanding of human functioning, make inferences from damaged mind (compare to normative measures), neurological assessment, cog assessment
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what types of neurological assessments do neurologists carry out?
CT/MRI scans, EEG scans, other forms of radiological exam
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what types of cog assessments do neurologists carry out?
test batteries: verbal memory, visuospatial awareness, memory etc
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why is it important for health psychologists to look at neurological assessments in heart defects?
establish risk factors to reduce risk of heart problems, survival of coronary illness indivs, debate over whether surgery is needed in severe cases
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what are some of the risks of surgical interventions for heart disease?
sudden cardiac death, neurological impairment, post operative cog dysfunction
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when was the first bypass op?
1964, by garrett
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how are vascular bypass grafts done?
use left anterior descending artery with left internal mammary artery
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how are other arteries bypassed?
using segments of saphenous vein from leg
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what is the patency of the arterial grafts?
between 5 and 12 years. 50% of grafts are occluded in this time.
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what percentage of patients use this surgery?
20%
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how many people undergo coronary artery bypass grafts?
28,000 people in uk per year. (80% are men over 60)
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what are the complications of neurological injury and cardiac surgery?
sudden cardiac death, coma, severe and mild strokes
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how do incidences of these vary?
from 1.5% to 5.2%
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how do short term outcome studies vary? what are their incidences?
so much variability. gill and murkin: 19 studies were single group outcomes. 9 were tested pre op and post op but with no follow up. incidences was 10-79%! may not be deficits, may be other things coming in to account
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what do long term cog assessments do?
test retest intervals of 1 month to 5 years.
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what do the majority of long term cog assessments show?
sig. number of p's showed decline at 10 weeks, drop at 4 years.
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what are some issues with the long term cog assessments?
may not be specific to the surgery - may actually be a result of ageing
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what was newman et al's study?
single group, 261 p's assessed at discharge, 6 weeks, 5 months, 5 yrs. prior screening for comorbid illnesses.
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what was newman et al's study?
single group, 261 p's assessed at discharge, 6 weeks, 5 months, 5 yrs after surgery. prior screening for comorbid illnesses. cog function defined as 1 sd drop or more in tests
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what were the incidences in newman et al's study?
53% at discharge, 36% at 6 weeks, 24% 6 months, 42% 5 years (early improvement, later cog decline)
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what were the predictors of cog decline in newman et al's study?
older age, higher baseline cog performance, lower educational level, cog decline at discharge sig predictors of long term cog decline
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what are the problems with newman et al's study?
no controls were used, used their own test battery and practice. 1 sd method not good
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what was newman et al's group study?
compared cohort of 70 cabg patients w/ 24 thoracic patients. cabg: 49% incidence of neuro dysf at 8%, decreased to 37% after 8 weeks. thor: 33% 8 days, 46% 8 weeks
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what was found in the 12 month follow up of the group study?
only cabg group showed persistent neurological deficits
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how should we measure neuropsychology from heart issues?
need a better definition of change and method of analysis, so many different types of tests out there and batteries. need to control for practice effects, controls, cultural differences. standardised test procedures needed.
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what issues have most neuropsycs looked at?
hypertension, diabetes, prior cardiac surgery, prior mental illness, impaired ventricular function, severity and extent of disease, acute unstable angina, increasing age and male sex
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what are the most commonly reported risk fctors of poor cog outcome with heart disease?
incresing age, extent of cardiac disease, gender
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how does age relate to cardiovascular disease?
increasinly p's over 70 receive cardiac surgery (1/3), studies found assoc. between age and cerebral blood flow autoregulation in cardiopulmonary bypass, greater no. microemboli present in cardiac surgery performed on older ps
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what did massey and others (2000) find about reducing hypertension?
for every 1 drop in diastolic blood pressure there is an estimated 2-3% reduction in risk of myocardial infarction (heart attack)
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what does diastolic blood pressure measure?
pressure between heartbeats
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what does it mean to be sodium sensitive?
happens in people with hypertension, excess sodium (salt) raises their blood pressure. as there is no test for it, almost everyone with hypertension should restrict it to 2000mg a day
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what did ishikawa et al find?
numerous studies show even moderate amounts of physical can help lower resting blood pressure of people with hypertension
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what did nordstrom et al find about cholesterol?
can improve person's cholesterol profile by increasing hdl cholesterol and reducing body mass index
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what is the cardia study?
after adjustment or age, race, sex, smoking, family history, diabetes and chd, pps w/ low fitness levels 3-6x more likely to develop hypertension, diabetes and metabolic syndrome than p's w/ high fitness levels
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what did lee, folsom and blair find?
reg exercise associated w/ sig. reductions in risk of ischemic and hemorrhagic strokes
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what did rothenbacher et al find about exercise and work?
shouldn;t occur in work. 312 ps w/ stable chd, ps who engaged in reg leisure time activity has lower levels of c-reactive protein (linked to inflammatory response) and interleuken 6 (linked w/ immunosuppression
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how do saturated fats increase serum cholesterol?
signal body to produce fewer ldl receptors which help liver to remove cholesterol from body. trans fatty acids increase ldl and triglyceride
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Other cards in this set

Card 2

Front

what are the layers of the heart?

Back

thin outer layer = epicardium, thin inner layer = endocardium, thick middle layer (heart) = myocardium

Card 3

Front

how is the myocardium organised?

Back

Preview of the front of card 3

Card 4

Front

what does the myocardium need?

Back

Preview of the front of card 4

Card 5

Front

where does the myocardium/heart get its blood supply from?

Back

Preview of the front of card 5
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