8- Introduction to the Cardiovascular System

8- Introduction to the Cardiovascular System - Introduction...

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Unformatted text preview: Introduction to the Cardiovascular System With An Review of Ethnic, Racial and Gender Differences in Cardiovascular Disease Arshia Noori, MD Circulatory System The Heart Cardiac Chambers Cardiac Valves Human Aortic & Mitral Valves Anterior and Posterior Views Coronary Anatomy Cardiac Muscle Myocardial Cells Conduction System Sino­Atrial Node Atrio­Ventricular Node Bundle of His Left Bundle Branch Right Bundle Branch Purkinje Fibers Cardiac Contraction Cycle The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses. (After Schwalbe.) Henry Gray (1825–1861). Anatomy of the Human Body. 1918. http://www.bartleby.com/107/220.html Diagram of efferent sympathetic nervous system. Blue, cranial and sacral outflow. Red, thoracohumeral outflow. ———, Postganglionic fibers to spinal and cranial nerves to supply vasomotors to head, trunk and limbs, motor fibers to smooth muscles of skin and fibers to sweat glands. (Modified after Meyer and Gottlieb.) Heart Rate Terminology Bradycardia Tachycardia – Slow heart rate; < 60 beats per minute – Fast heart rate; ≥ 100 beats per minute – Extra inappropriately timed beat – Generally abnormal except for sinus arrhythmia Premature beat or ectopy Arrhythmia Vascular System Distribution of Blood Flow Blood Pressure and Perfusion Measuring Blood Pressure Sympathetic nerves control arteriolar smooth muscle contraction Blood Pressure Regulation Regulation of Blood Pressure Blood Pressure Regulation Figure 15-22: The baroreceptor reflex: the response to increased blood pressure Cardiovascular Pathology Atherosclerosis Hypertension Valvular Congenital Infectious/Immunologic – Coronary Artery Disease – Peripheral Artery Disease Atherosclerosis – a chronic injury and inflammatory process Nature of the process Endothelial injury and subsequent cell dysfunction can be caused by chronic exposure to chemical and/or mechanical irritants - oxidized LDL, homocysteine, toxins, viruses, CO, high blood shear rate, etc. Atherosclerosis Atherosclerosis Plaque Rupture Ethnic and Racial Differences In Aspirin Use in US RACIAL DIFFERENCES IN THE USE OF ASPIRIN ­ Brown et al Ethnicity & Disease, Volume 15, Autumn 2005 Factors Promoting Atherosclerosis Age Gender Genetic predisposition Obesity Smoking Hypertension Diabetes Hyperlipidemia/hypercholesterolemia Chronic inflammation Hispanic/Latinos and Cardiac Risk Factors Mexican­American women are at greater risk for CVD than are non­ Latino white women of comparable socioeconomic status. (Kaiser Permanente, 2001). National Health Interview Survey 1998 show that Hispanics have lower rates of CHD than either non­Hispanic whites or African Americans. CHD mortality rates among Hispanic groups are highest for Puerto Ricans and lowest for Mexican Americans. (Kaiser Permanente, 2001). Among Hispanics/Latinos, the risk of stroke is 1.3 times higher at ages 35 to 64 than for non­Hispanics. (National Women’s Health Information Center, 2003). Hispanic/Latinos and Cardiac Risk Factors Forty­eight percent of Hispanic women aged 65 years and over have been told that they have hypertension, compared with 33% of Hispanic men in the same age group. (Pleis and Coles, 2002). Data from the National Health and Nutrition Examination Survey (NHANES III) show that there are no significant differences in serum total cholesterol levels among Mexican Americans, African Americans, and non­Hispanic whites. (CDC, 2003). Forty percent of Mexican­American women are obese, compared with 30% of non­Hispanic white women. (CDC, 2002). Data from the 1997 National Health Interview Survey show that overall, smoking prevalence among Hispanic adults was 20.4%, compared with 25.3% for whites. Among Hispanic men, 26.2% smoked, compared with 27.4% of white men. For Hispanic women, the smoking rate was 14.3%, compared with 23.3% for white women. (CDC, 1998). Blood Pressure and Smoking Gender and Cardiovascular Mortality National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) of High Blood Cholesterol III Cholesterol and Heart Disease Cholesterol Levels With Age and Gender Ethnic and Racial Differences in Cholesterol Levels in US Asian Indians have lower HDL accounting for their increased risk of CAD despite overall lower number of cardiac risk factors. Blacks also may have a genetic protection from high cholesterol however this protection is dwarfed by the overwhelming risks of Hypertension, diabetes and obesity. Hypertension Hypertension Silent condition on its own. Leads to atherosclerosis and cardiac and vascular muscle dysfunction. Manifests itself as heart attacks, strokes, kidney failure and heart failure. Hypertension Hypertension Compared with Whites, Blacks have a 4.2 times risk of end­stage renal disease, a 1.8 times risk of fatal stroke, a 1.5 times risk of fatal heart disease, and a 1.3 times risk of nonfatal stroke. Diabetes Impact of Diabetes on Heart Disease Invasive Treatment Options Valvular Heart Disease Inflammatory &/or Immunologic Causes of Heart Disease Heart Failure Conclusion Cardiovascular Disease is the number one cause of death in our society. It is a systemic process that starts at a young age. Genetic, racial, ethnic and gender differences exists in the prevalence of this disease. ...
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