Hospitals & Asylums
American Heart Month since February 1963
HA-14-2-08
By Tony Sanders
Your heart matters. Above all else, guard your heart, for it is
the wellspring of life (Proverbs 4:23)
1.
Since 1963 Congress and the American Heart Association has required the
president to proclaim February "American Heart Month." The AHA recommends that patients with acute
heart disease should take the ambulance, otherwise they are likely to be turned
away. Cardiovascular diseases,
including stroke, are the No. 1 killer in the United States for both men and
women. Coronary heart disease is
America's No. 1 killer. Stroke is No. 3 and a leading cause of serious
disability. Of the estimated 7 million
Americans suffering angina and 2.4 million people who died in 2004, 666,000
died from heart disease and 150,000 from stroke. People suffering angina have a 20% chance of suffering a heart
attack over ten years. The prevalence
of heart disease is increasing amongst younger people and it is time for
America to improve outcomes for heart disease at all ages. No expert in love, information
on common diseases and conditions of the heart can be found at the National
Heart, Lung, and Blood Institute’s Diseases and Conditions
Index
2. According to the U.S. government, one in every 300 Americans will be killed by a blocked artery in 2007. Every 34 seconds an American dies as the result of a blocked cardiac artery. As an American, there's a 90 percent chance that poor circulation will trigger a serious health problem at some point in your life. More than 6.8 million Americans undergo heart bypass, balloon angioplasty and other circulation-related procedures each year. 700,000 Americans will suffer a sudden blockage of blood flow to the brain in 2007- 83 every hour of the day. Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. Mortality differs significantly by race or ethnic group as measured by age adjusted death rates. In 1998 these death rates per 100,000 people from heart disease in the United States were 211.8 for black non-Hispanics, compared to 145.3 for white non-Hispanics, 101.5 for Hispanics, 106 for American Indians and 78 for Asians. In contemporary US public health heart disease and diabetes are the most trying illnesses.
3. The objective of this paper is for the Centers for
Medicare, Medicaid and SCHIP (CMS) to require “Biological Weapons are
Prohibited” to be inscribed on the letterheads of all their contracts because
it is hypothesized that corruption is the leading cause of death, disability
and patient care episodes. The prohibition of biological weapons is of
vital importance for all Americans, for those cursed with heart disease, it is a
matter of life and death. It is a
conspiracy offense to disregard complaints of bio-terrorism as mental illness
or dementia. People treated for mental
illness in the public system are dying 25 years younger than the average
American, opposed to 15 years younger a decade ago. Medical education and employment must not omit the prohibition of
biological weapons. Offensive
prescriptions of law must be immediately amended or repealed. Ultra vires, unauthorized practices of law,
delivering toxins in the legal system or infringing upon the health sector,
must be dismissed. Records must be
sealed. Counsel can be found in medical
ethics. Pillowcases, sheets, beds,
wardrobes, landladies, nurses, doctors, friends, family members, lovers,
medical bills, courts, and politicians may all need to be thrown away to
control the conflict of interest with pain. Overexposure to irritants
can cause permanent damage. Wounded hearts heal, but not if they are
under constant attack.
4. Diseases and conditions of
the heart’s muscle make it difficult for your heart to pump blood. Oxygen deprivation to the heart muscle
itself, usually caused by atherosclerosis, a build up of plaque in the coronary
arteries, causes acute pain in the heart known as Angina that affects an
estimated 7 million Americans. Damaged or diseased blood vessels make the heart
work harder than normal and are often torturously painful. Problems with the
heart’s electrical system, called arrhythmias, can make it difficult for the
heart to pump blood efficiently. Cardiac
patients must take care of their health.
It is important to avoid LDL cholesterol such as that found in potato
chips and trans-fats. One however
cannot starve angina, sufficient levels of HDL cholesterol such as that found
in fish oil and brown rice are needed.
Smoking, coffee and stimulants should be avoided to control blood
pressure. If wine doesn’t work don’t
abuse it. Take deep breaths to
understand the relation between heart and lungs instead of stopping breathing
to feel the pain. Exercise enough
to increase your heartbeat, regularly.
5. The normal human heart is a strong, muscular pump a
little larger than a fist. Each day an average heart “beats” (expands and
contracts) 100,000 times and pumps about 2,000 gallons of blood. In a 70-year lifetime,
an average human heart beats more than 2.5 billion times. The heart pumps blood
continuously through the circulatory system. The circulatory system is the
network of elastic tubes that carries blood throughout the body. It includes
the heart, lungs, arteries, arterioles (small arteries) and capillaries (very
tiny blood vessels). These blood vessels carry oxygen- and nutrient-rich blood
to all parts of the body. The circulatory system also includes venules (small
veins) and veins. These are the blood vessels that carry oxygen- and nutrient depleted
blood back to the heart and lungs. If all these vessels were laid end-to-end, they’d
extend for about 60,000 miles. That’s enough to encircle the earth more than
twice.
6.
The heart keeps us alive. The heart
muscle, called cardiac muscle, contracts and relaxes about 70 to 80 times per
minute without you ever having to think about it. As the cardiac muscle
contracts it pushes blood through the chambers and into the vessels. Nerves
connected to the heart regulate the speed with which the muscle contracts. When
you run, your heart pumps more quickly. When you sleep, your heart pumps more
slowly. Considering how much work it
has to do, the heart is surprisingly small. The average adult heart is about
the size of a clenched fist and weighs about 11 ounces (310 grams). Located in
the middle of the chest behind the breastbone, between the lungs, the heart
rests in a moistened chamber called the pericardial cavity, which is surrounded
by the ribcage. The diaphragm, a tough layer of muscle, lies below. As a
result, the heart is a well-protected organ.
Heart Exterior
7. The heart is the muscle in the lower half of the picture. The heart has four chambers. The right and left atria (AY-tree-uh) are shown in purple. The right and left ventricles (VEN-trih-kuls) are shown in red. Connected to the heart are some of the main blood vessels—arteries and veins—that make up your blood circulatory system.The ventricle on the right side of your heart pumps blood from the heart to your lungs. When you breathe air in, oxygen passes from your lungs through blood vessels where it’s added to your blood. Carbon dioxide, a waste product, is passed from your blood through blood vessels to your lungs and is removed from your body when you breathe air out. The atrium on the left side of your heart receives oxygen-rich blood from the lungs. The pumping action of your left ventricle sends this oxygen-rich blood through the aorta (a main artery) to the rest of your body.
8. On the Right Side of Your Heart the superior and
inferior vena cavae are in blue to the left of the muscle as you look at the
picture. These veins are the largest veins in your body. They carry used
(oxygen-poor) blood to the right atrium of your heart. “Used” blood has had its
oxygen removed and used by your body’s organs and tissues. The superior vena
cava carries used blood from the upper parts of your body, including your head,
chest, arms, and neck. The inferior vena cava carries used blood from the lower
parts of your body. The used blood from the vena cavae flows
into your heart’s right atrium and then on to the right ventricle. From the
right ventricle, the used blood is pumped through the pulmonary (PULL-mun-ary)
arteries (in blue in the center of picture) to your lungs. Here, through many
small, thin blood vessels called capillaries, your blood picks up oxygen needed
by all the areas of your body. The
oxygen-rich blood passes from your lungs back to your heart through the
pulmonary veins (in red to the left of the right atrium in the picture). On the Left Side of Your Heart oxygen-rich blood from your
lungs passes through the pulmonary veins (in red to the right of the left
atrium in the picture). It enters the left atrium and is pumped into the left
ventricle. From the left ventricle, your blood is pumped to the rest of your
body through the aorta.
9. Like all of your organs,
your heart needs blood rich with oxygen. This oxygen is supplied through the
coronary arteries as it’s pumped out of your heart’s left ventricle. Your
coronary arteries are located on your heart’s surface at the beginning of the
aorta. Your coronary arteries (shown in red in the drawing) carry oxygen-rich
blood to all parts of your heart. The
right and left sides of your heart are divided by an internal wall of tissue
called the septum. The area of the septum that divides the two upper chambers
(atria) of your heart is called the atrial or interatrial septum. The area of
the septum that divides the two lower chambers (ventricles) of your heart is
called the ventricular or interventricular septum. The picture shows your
heart’s four valves. Shown counterclockwise in the picture, the valves include
the aortic (ay-OR-tik) valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary
valve, and the mitral (MI-trul) valve.
Heart Interior
10. Your heart uses the four
valves to ensure your blood flows only in one direction. Healthy valves open
and close in coordination with the pumping action of your heart’s atria and
ventricles. Each valve has a set of flaps called leaflets or cusps. These seal
or open the valves. This allows pumped blood to pass through the chambers and
into your blood vessels without backing up or flowing backward. Blood without oxygen from the two vena cavae
fill your heart’s right atrium. The atrium contracts (atrial systole). The
tricuspid valve located between the right atrium and ventricle opens for a
short time and then shuts. This allows blood to enter into the right ventricle
without flowing back into the right atrium.
When your heart’s right ventricle fills with blood, it contracts
(ventricular systole). The pulmonary valve located between your right ventricle
and pulmonary artery opens and closes quickly. This allows blood to enter into
your pulmonary artery without flowing back into the right ventricle. This is
important because the right ventricle begins to refill with more blood through
the tricuspid valve. Blood travels through the pulmonary arteries to your lungs
to pick up oxygen.
11. Oxygen-rich blood returns
from the lungs to your heart’s left atrium through the pulmonary veins. As your
heart’s left atrium fills with blood, it contracts. This event also is called
atrial systole. The mitral valve located between the left atrium and left
ventricle opens and closes quickly. This allows blood to pass from the left
atrium into the left ventricle without flowing back into the left atrium. As
the left ventricle fills with blood, it contracts. This event also is called
ventricular systole. The aortic valve located between the left ventricle and
aorta opens and closes quickly. This allows blood to flow into the aorta. The
aorta is the main artery that carries blood from your heart to the rest of your
body. The aortic valve closes quickly to prevent blood from flowing back into
the left ventricle, which is already filling up with new blood.
12. A heartbeat actually is a
complicated series of very precise and coordinated events that take place
inside and around your heart. Each side of your heart uses an inlet valve to
help move blood between the atrium and ventricle. The tricuspid valve does this
between the right atrium and ventricle. The mitral valve does this between the
left atrium and ventricle. The "lub" is the sound of the mitral and
tricuspid valves closing. Each of your heart’s ventricles has an outlet valve.
The right ventricle uses the pulmonary valve to help move blood into the
pulmonary arteries. The left ventricle uses the aortic valve to do the same for
the aorta. The "DUB" is the sound of the aortic and pulmonary valves
closing. Each heartbeat has two basic
parts: diastole (di-AS-toe-lee, or relaxation) and atrial and ventricular
systole (SIS-toe-lee, or contraction). During diastole, the atria and
ventricles of your heart relax and begin to fill with blood. At the end of
diastole, your heart’s atria contract (an event called atrial systole) and pump
blood into the ventricles. The atria then begin to relax. Next, your heart’s
ventricles contract (an event called ventricular systole) and pump blood out of
your heart.
13. A heartbeat is a single
cycle in which your heart’s chambers relax and contract to pump blood. This
cycle includes the opening and closing of the two inlet and outlet valves of
the right and left ventricles of your heart.
Each heartbeat has two basic parts: diastole, and atrial and ventricular
systole. During diastole, the atria and ventricles of your heart relax and
begin to fill with blood. At the end of diastole, your heart’s atria contract
(atrial systole), pumping blood into the ventricles, and then begin to relax.
Your heart’s ventricles then contract (ventricular systole), pumping blood out
of your heart. Each beat of your heart
is set in motion by an electrical signal from within your heart muscle. In a
normal, healthy heart, each beat begins with a signal from the SA node. This is
why the SA node is sometimes called your heart’s natural pacemaker. Your pulse,
or heart rate, is the number of signals the SA node produces per minute. In Atrial Fibrillation (AT), the ventricles
may beat up to 100-175 times a minute, in contrast to the normal rate of 60-100
beats a minute.
14. Your heart’s electrical system
controls all the events that occur when your heart pumps blood. The electrical
system also is called the cardiac conduction system. If you’ve ever seen the
heart test called an EKG
(electrocardiogram), you’ve seen a graphical picture of the electrical activity
of your heart. Your heart’s electrical
system is made up of three main parts: The sinoatrial (SA) node located in the
right atrium of your heart. The
atrioventricular (AV) node located on the interatrial septum close to the
tricuspid valve. The His-Purkinje
system located along the walls of your heart’s ventricles. The signal is generated as the two-vena
cavae fill your heart’s right atrium with blood from other parts of your body.
The signal spreads across the cells of your heart’s right and left atria. This
signal causes the atria to contract. This action pushes blood through the open
valves from the atria into both ventricles.
The signal arrives at the AV node near the ventricles (see red burst on
picture), where it slows for an instant to allow your heart’s right and left
ventricles to fill with blood. The signal is released and moves to the
His-Purkinje bundle located in the walls of your heart’s ventricles. From the His-Purkinje bundle, the signal fibers
divide into left and right bundle branches through the Purkinje fibers that
connect directly to the cells in the walls of your heart’s left and right
ventricles (see yellow on the picture). As the signal spreads across the cells
of your heart’s ventricle walls, both ventricles contract, but not at exactly
the same moment. The left ventricle contracts an instant before the right
ventricle. This pushes blood through the pulmonary valve (for the right
ventricle) to your lungs, and through the aortic valve (for the left ventricle)
to the rest of your body. As the signal
passes, the walls of the ventricles relax and await the next signal. This process continues over and over as the
atria refill with blood and other electrical signals come from the SA node.
15. A heart attack occurs when
blood flow to a section of heart muscle becomes blocked. If the flow of blood
isn’t restored quickly, the section of heart muscle becomes damaged from lack
of oxygen and begins to die. Heart
attack is a leading killer of both men and women in the United States. But
fortunately, today there are excellent treatments for heart attack that can
save lives and prevent disabilities. Treatment is most effective when started
within 1 hour of the beginning of symptoms. If you think you or someone you’re
with is having a heart attack, call 9-1-1 right away. Heart attacks occur most often as a result of a condition called
coronary artery disease (CAD). In CAD, a fatty material called plaque (plak)
builds up over many years on the inside walls of the coronary arteries (the
arteries that supply blood and oxygen to your heart). Eventually, an area of
plaque can rupture, causing a blood clot to form on the surface of the plaque.
If the clot becomes large enough, it can mostly or completely block the flow of
oxygen-rich blood to the part of the heart muscle fed by the artery. During a heart attack, if the blockage in
the coronary artery isn’t treated quickly, the heart muscle will begin to die
and be replaced by scar tissue. This heart damage may not be obvious, or it may
cause severe or long-lasting problems. Figure A is an overview of a heart and
coronary artery showing damage (dead heart muscle) caused by a heart attack.
Figure B is a cross-section of the coronary artery with plaque buildup and a blood
clot.
Heart With
Muscle Damage and a Blocked Artery
16. Angina (an-JI-nuh or AN-juh-nuh)
is chest pain or discomfort that occurs when an area of your heart muscle
doesn't get enough oxygen-rich blood. It's thought that nearly 7 million people
in the United States suffer from angina. About 400,000 patients go to their
doctors with new cases of angina every year. Angina may feel like pressure or
squeezing in your chest. The pain also may occur in your shoulders, arms, neck,
jaw, or back. It can feel like indigestion. Angina itself isn't a disease.
Rather, it's a symptom of an underlying heart problem. Angina is usually a
symptom of coronary artery disease (CAD), the most common type of heart
disease. CAD occurs when a fatty material called plaque (plak) builds up on the
inner walls of the coronary arteries. These arteries carry oxygen-rich blood to
your heart. When plaque builds up in the arteries, the condition is called
atherosclerosis (ATH-er-o-skler-O-sis).
Nitrates are the most commonly used medicines to treat angina. They
relax and widen blood vessels. This allows more blood to flow to the heart
while reducing its workload. Nitroglycerin is the most commonly used nitrate
for angina. Nitroglycerin that dissolves under your tongue or between your
cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form
of pills and skin patches is used to prevent attacks of angina. These forms of
nitroglycerin act too slowly to relieve pain during an angina attack.
Atherosclerosis
17. An aneurysm (AN-u-rism) is
an abnormal bulge or “ballooning” in the wall of an artery. Arteries are blood
vessels that carry oxygen-rich blood from the heart to other parts of the body.
An aneurysm that grows and becomes large enough can burst, causing dangerous,
often fatal, bleeding inside the body. Most aneurysms occur in the aorta. The
aorta is the main artery that carries blood from the heart to the rest of the
body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart
and travels through the chest and abdomen. An aneurysm that occurs in the aorta
in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm
that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.
Aneurysms also can occur in arteries in the brain, heart, intestine, neck,
spleen, back of the knees and thighs, and in other parts of the body. If an
aneurysm in the brain bursts, it causes a stroke. About 15,000 Americans die each year from ruptured aortic
aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men
over age 50 in the United States. Many cases of ruptured aneurysm can be
prevented with early diagnosis and medical treatment. Because aneurysms can
develop and become large before causing any symptoms, it is important to look
for them in people who are at the highest risk. Experts recommend that men who
are 65 to 75 years old should be checked for abdominal aortic aneurysms. When found in time, aneurysms can usually be
treated successfully with medicines or surgery. If an aortic aneurysm is found,
the doctor may prescribe medicine to reduce the heart rate and blood pressure.
This can reduce the risk of rupture.
Large aortic aneurysms, if found in time, can often be repaired with
surgery to replace the diseased portion of the aorta.
18.
Treatment recommendations for aortic aneurysms are based on the size of the
aneurysm. Small aneurysms found early can be treated with "watchful
waiting." If the diameter of the aorta is small-less than 3 centimeters
(cm)-and there are no symptoms, "watchful waiting" and a followup
screening in 5 to 10 years may be all that is needed, as determined by the
doctor. If the aorta is between 3 and
4 cm in diameter, the patient should return to the doctor every year for an
ultrasound to see if the aneurysm has grown.
If the aorta is between 4 and 4.5 cm, testing should be repeated every 6
months. If the aorta is larger than 5
cm (2 inches around or about the size of a lemon) or growing more than 1 cm per
year, surgery should be considered as soon as possible. Two main types of surgery to repair aortic
aneurysms are open abdominal or open chest repair and endovascular repair. The
traditional and most common type of surgery for aortic aneurysms is open
abdominal or open chest repair. It involves a major incision in the abdomen or
chest. General anesthesia is needed with this procedure. The aneurysm is
removed and the section of aorta is replaced with an artificial graft made of
material such as Dacron® or Teflon®. The surgery takes 3 to 6 hours, and the
patient remains in the hospital for 5 to 8 days. It often takes a month to
recover from open abdominal or open chest surgery and return to full activity.
Open abdominal and chest surgeries have been performed for 50 years. More than 90
percent of patients make a full recovery.
Placement of an Endovascular Stent Graft
19. The illustration shows the
placement of an endovascular stent graft in an aortic aneurysm. In figure A, a
catheter is inserted into an artery in the groin (upper thigh). It is then
threaded up to the abdominal aorta, and the stent graft is released from the
catheter. In figure B, the stent graft allows blood to flow through the
aneurysm. To perform endovascular repair, the doctor first inserts a catheter
into an artery in the groin (upper thigh) and threads it up to the area of the
aneurysm. Then, watching on x ray, the surgeon threads the graft (also called a
stent graft) into the aorta to the aneurysm. The graft is then expanded inside
the aorta and fastened in place to form a stable channel for blood flow. The
graft reinforces the weakened section of the aorta to prevent the aneurysm from
rupturing. Endovascular repair surgery
reduces recovery time to a few days and greatly reduces time in the hospital.
The procedure has been used since 1999. Not all aortic aneurysms can be
repaired with this procedure. The exact location or size of the aneurysm may
prevent the stent graft from being safely or reliably positioned inside the
aneurysm. Coronary angioplasty
(AN-jee-oh-plas-tee) is a medical procedure in which a balloon is used to open
a blockage in a coronary (heart) artery narrowed by atherosclerosis
(ATH-er-o-skler-O-sis). This procedure improves blood flow to the heart. Angioplasty is done on more than 1 million
people a year in the United States. Serious complications don't occur often,
but can happen no matter how careful your doctor is, or how well he or she does
the procedure.
20.
Heart surgery is used to correct heart problems. The most common type of heart
surgery for adults is coronary artery bypass grafting (CABG). During CABG, surgeons use
healthy arteries or veins taken from another part of the body to bypass (that
is, go around) blocked arteries. CABG relieves chest pain and reduces the risk
of heart
attack. Heart surgery also is done to: Repair or replace valves that control blood
flow through the heart Repair abnormal
or damaged structures in the heart
Implant medical devices that regulate heart rhythms or blood flow Replace a damaged heart with a healthy heart
from a donor (heart transplant). Traditional heart surgery, often called
"open heart surgery," is done by opening the chest wall to operate on
the heart. Almost always, the chest is opened by cutting through a patient's
breastbone. Once the heart is exposed, the patient is connected to a heart-lung
bypass machine. The machine takes over the pumping action of the heart. This
allows surgeons to operate on a still heart.
Heart surgery is done to correct problems with
the heart. More than half a million heart surgeries are done each year in the
United States for a variety of heart problems. For very ill people with severe
heart problems, heart surgery can reduce symptoms, improve quality of life, and
increase lifespan.
21. A
stroke occurs when a blood vessel that brings oxygen and nutrients to the brain
bursts or is clogged by a blood clot or some other particle. Because of this rupture
or blockage, part of the brain doesn’t get the blood and oxygen it needs. Deprived of oxygen, nerve cells in the affected
area of the brain can’t work and die within minutes. And when nerve cells can’t
work, the part of the body they control can’t work either. The devastating effects
of stroke are often permanent. There
are four main types of stroke. Two are caused by blood clots or other particles
(ischemic strokes), and two by bleeding (hemorrhage). Cerebral thrombosis and
cerebral embolism are caused by clots or particles that plug an artery.
They account for about 70–80 percent of all strokes. Ruptured blood vessels
cause cerebral and subarachnoid hemorrhages. These (bleeding) strokes
have a much higher fatality rate than strokes caused
by clots. Stroke is a medical emergency.
Every second counts! Stroke affects
different people in different ways. It depends on the type of stroke, the area
of the brain affected and the extent of the brain injury. Brain injury from a
stroke can affect the senses, motor activity, speech and the ability to
understand speech. It can also affect behavioral and thought patterns, memory and
emotions. Paralysis or weakness on one side of the body is common.
22.
Cardiac rehabilitation (rehab) is a medically supervised program that helps
improve the health and well-being of people who have heart problems. Rehab programs include exercise training,
education on heart healthy living, and counseling to reduce stress and help you
return to an active life. Cardiac rehab helps people who have heart problems to
recover after a heart
attack, stroke or heart surgery. Prevent future hospital stays,
heart problems, and death related to heart problems. Address risk factors that
lead to coronary artery disease and other heart problems. These risk factors
include high blood pressure, high blood cholesterol (ko-LES-ter-ol), overweight
or obesity, diabetes, smoking, lack of physical activity, and depression and
other emotional health concerns. Adopt healthy lifestyle changes. These changes
may include a heart healthy eating plan, increased physical activity, and
learning how to manage stress to improve their health and quality of life. People of all ages can benefit from cardiac
rehab. The lifestyle changes made during rehab have few risks. These changes
can improve your overall health and prevent future heart problems and even
death. Exercise training as part of cardiac rehab may not be safe for all
patients.
23. Diabetes is a
risk factor for heart attack. Some 21
million Americans have diabetes, meaning their bodies can't properly regulate
blood sugar, or glucose. Diabetics already are at increased risk of heart disease.
Type 2 diabetes, the most common form, is linked to obesity, which in turn
harms the heart. Plus, high blood sugar over time damages blood vessels. The A1C test tracks average glucose levels
over two or three months. People without diabetes have A1C levels as low as 5.
The American Diabetes Association has long recommended that diabetics aim to
get their A1C level below 7, far below the long-common 8 or 9. Every point-drop
lowers the risk of serious complications, such as blindness or kidney failure,
by 25 percent to 40 percent. Getting
too far below an A1C of 7 is very difficult, and very few patients outside of
research studies succeed. An NIH study aimed to have aggressively treated
patients dip below a level of 6, into near-normal range. Only half got below
6.4, compared to an A1C of 7.5 among study volunteers getting standard
treatment. The NIH took the rare step
of halting part of the study 18 months early - citing 257 deaths among
aggressively treated patients compared to 203 among diabetics given more
standard care. The aggressively treated
patients suffered about 10 percent fewer heart attacks overall than their
counterparts, however, it appeared that if a heart attack did occur, it was
more likely to be fatal. In addition, the intensive treatment group had more
unexpected sudden deaths, even without a clear heart attack. The NIH's National
Heart, Lung and Blood Institute decided that diabetics with heart disease stop
at a level of 7 rather than dip below. They have switched all the study participants
to standard therapy, and will track their health until June 2009.
Categories
for Blood Pressure Levels in Adults (in mmHg, millimeters of mercury)
|
Category |
Systolic (top number) |
Diastolic (bottom number) |
|
Normal |
Less than 120 |
Less than 80 |
|
Prehypertension |
120–139 |
80–89 |
|
High
blood pressure |
|
|
|
Stage
1 |
140–159 |
90–99 |
|
Stage
2 |
160 or higher |
100 |
24. The body is very sensitive
to changes in blood pressure. Special cells in the arteries, called
baroreceptors (BAR-o-re-SEP-ters), can sense if blood pressure begins to rise
or drop. When the baroreceptors sense a rise or drop in blood pressure, they
cause certain responses to occur throughout the body in an attempt to bring the
blood pressure back to normal. For example, if you stand up quickly, the
baroreceptors will sense a drop in your blood pressure. They quickly take
action to make sure that blood continues to flow to the brain, kidneys, and
other important organs. The baroreceptors cause the heart to beat faster and
harder. They also cause the small arteries (arterioles) and veins (the vessels
that carry blood back to the heart) to narrow. High blood pressure is a blood
pressure reading of 140/90 mmHg or higher. Both numbers are important. Nearly 1
in 3 American adults has high blood pressure. Once high blood pressure
develops, it usually lasts a lifetime. The good news is that it can be treated
and controlled. Blood pressure changes
during the day. It is lowest as you sleep and rises when you get up. It also
can rise when you are excited, nervous, or active. Still, for most of your waking hours, your blood pressure stays
pretty much the same when you are sitting or standing still. That level should
be lower than 120/80 mmHg. When the level stays high, 140/90 mmHg or higher,
you have high blood pressure. For example, 160/80 mmHg would be stage 2 high
blood pressure. With high blood pressure, the heart works harder, your arteries
take a beating, and your chances of a stroke, heart attack, and kidney problems
are greater. Hypotension is abnormally
low blood pressure. Normal blood pressure is a reading of less than 120/80 mmHg
(mmHg = millimeters of mercury, a unit for measuring pressure). Hypotension is
blood pressure that is lower than 90/60 mmHg.
In a healthy person, hypotension without signs or symptoms is usually
not a problem and requires no treatment. Doctors will want to identify and treat
any underlying condition that is causing the hypotension, if one can be found.
Hypotension can be dangerous if a person falls because of dizziness or
fainting. Shock, a severe form of hypotension, is a life-threatening condition
that is often fatal if not treated immediately. Shock can be successfully
treated if the cause can be found and the right treatment provided in time.
25.
It is estimated that 65 million American adults with high blood cholesterol
need to make the therapeutic lifestyle changes (TLC) needed to lower their
cholesterol and, with it, their risk for heart disease. To understand high blood cholesterol
(ko-LES-ter-ol), it is important to know more about cholesterol. Cholesterol is
a waxy, fat-like substance that is found in all cells of the body. Your body
needs some cholesterol to work the right way. Your body makes all the
cholesterol it needs. Cholesterol is also found in some of the foods
you eat. Your body uses cholesterol to make hormones, vitamin D, and substances
that help you digest foods. Blood is watery, and cholesterol is fatty. Just
like oil and water, the two do not mix. To travel in the bloodstream,
cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens).
The small packages are made of fat (lipid) on the inside and proteins on the
outside. Two kinds of lipoproteins carry cholesterol throughout your body. It
is important to have healthy levels of both: Low-density lipoprotein (LDL)
cholesterol is sometimes called bad cholesterol. High LDL cholesterol leads to
a buildup of cholesterol in arteries. The higher the LDL level in your blood,
the greater chance you have of getting heart disease. High-density lipoprotein
(HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol
from other parts of your body back to your liver. The liver removes the
cholesterol from your body. The higher your HDL cholesterol level, the lower
your chance of getting heart disease.
|
Initial
classification based on total cholesterol and HDL cholesterol |
|
Total Cholesterol Level |
Category |
|
Less
than 200 mg/dL |
Desirable
level that puts you at lower risk for coronary heart disease. A cholesterol
level of 200 mg/dL or higher raises your risk. |
|
200
to 239 mg/dL |
Borderline high |
|
240
mg/dL and above |
High
blood cholesterol. A person with this level has more than twice the risk of
coronary heart disease as someone whose cholesterol is below 200 mg/dL. |
|
HDL Cholesterol Level |
Category |
|
Less
than 40 mg/dL |
Low HDL cholesterol. A major risk factor for heart disease. |
|
60
mg/dL and above |
High HDL cholesterol. An HDL of 60 mg/dL and above is
considered protective against heart disease. |
26.
The American Heart Association endorses the National Cholesterol Education
Program (NCEP) guidelines for detection of high cholesterol. The Third Report
of the Expert panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III or ATP III) was released in
2001. It recommends that everyone age 20 and older have a fasting
"lipoprotein profile" every five years. This test is done after a 9-12-hour
fast without food, liquids or pills. It gives information about total
cholesterol, low-density lipoprotein (LDL) or “bad” cholesterol, high-density
lipoprotein (HDL) or "good" cholesterol and triglycerides (blood
fats). Researchers have established healthy ranges for each of these. They're
given in the lists below. If a fasting lipoprotein profile isn't possible, the
values for total cholesterol and HDL cholesterol are acceptable. If your total
cholesterol is 200 mg/dL or more, or your HDL cholesterol is less than 40 mg/dL
(for men) and less than 50 mg/dL (for women), you need to have a lipoprotein
profile done to determine your LDL cholesterol and triglyceride levels. If your
cholesterol is high or you have other risk factors, your healthcare provider will likely want to monitor
your cholesterol more closely. Follow your provider's advice
about how often to have your cholesterol tested. He or she will set appropriate
management goals based on your LDL cholesterol level and other risk factors.
|
LDL Cholesterol Level |
Category |
|
Less
than 100 mg/dL |
Optimal |
|
100
to 129 mg/dL |
Near or above optimal |
|
130
to 159 mg/dL |
Borderline high |
|
160
to 189 mg/dL |
High |
|
190
mg/dL and above |
Very high |
27. Your LDL cholesterol goal depends on
how many other risk factors you have. If you don't have coronary heart disease or diabetes and
have one or no risk factors, your LDL goal is less than 160 mg/dL.If you don't
have coronary heart disease or diabetes and have two or more risk factors, your
LDL goal is less than 130 mg/dL.If you do have coronary heart disease or
diabetes, your LDL goal is less than 100 mg/dL. Triglyceride is the most common
type of fat in the body. Many people who have heart disease or diabetes have
high triglyceride levels. Normal triglyceride levels vary by age and sex. A
high triglyceride level combined with low HDL cholesterol or high LDL
cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in
artery walls). Atherosclerosis increases the risk for heart attack and
stroke.
|
Triglyceride Level |
Category |
|
Less
than 150 mg/dL |
Normal |
|
150–199 mg/dL |
Borderline high |
|
200–499 mg/dL |
High |
|
500
mg/dL and above |
Very high |
28. A 1994 study called the Scandinavian
Simvastatin Survival Study (also called 4S) found that lowering cholesterol can
prevent heart attacks and reduce death in men and women who already have heart
disease and high cholesterol. For over 5 years, more than 4,400 patients with
heart disease and total cholesterol levels of 213 mg/dL to 310 mg/dL were given
either a cholesterol-lowering drug or a placebo (a dummy pill that looks
exactly like the medication). The drug they were given is known as a statin,
and it reduced total cholesterol levels by 25 percent and LDL-cholesterol
levels by 35 percent. The study found that in those receiving statin, deaths
from heart disease were reduced by 42 percent, the chance of having a nonfatal
heart attack was reduced by 37 percent, and the need for bypass surgery or
angioplasty was reduced by 37 percent. A very important finding is that deaths
from causes other than cardiovascular disease were not increased, and so the 42
percent reduction in heart disease deaths resulted in a 30 percent drop in
overall deaths from all causes.
29. In 1996 the results of the
Cholesterol and Recurrent Events (CARE) Study also showed the benefits of
cholesterol lowering in heart disease patients. This study reported that even
in patients with seemingly normal cholesterol levels (average of 209 mg/dL),
cholesterol lowering with a statin drug lowered the risk of having another heart
attack or dying by 24 percent. A study
published in 1998, the Long-Term Intervention with Pravastatin in Ischaemic
Disease (LIPID) study, examined the effects of cholesterol lowering in people
with CHD (those who had already experienced a heart attack or had been
hospitalized for angina) and who had relatively average cholesterol levels. The
LIPID study used a statin drug to lower cholesterol levels in the treatment
group. All study participants were counseled about following a
cholesterol-lowering diet. The LIPID results showed that a drop of 18 percent
in total cholesterol and 25 percent in LDL-cholesterol produced a 24 percent
decrease in deaths from CHD among the treatment group compared with the control
group. In 2008 the American Journal of
Physiology: Health and Circulatory Physiology held that inhibitors of cyclooxygenase
(COX)-1, COX-2, and the nonselective COX inhibitor naproxen on
coronary vasoactivity and thrombogenicity under baseline and lipopolysaccharide
(LPS)-induce inflammatory conditions. Preconditioning
(PC) is held to protect against ischemia-reperfusion (I/R) injury
but prolonged exposure can lead to permanent damage.
30.
On the whole, Americans should reduce the amount of saturated fat, trans fat, cholesterol and total
fat in their diet. The risk factors for coronary artery disease include age,
male gender, heredity (including race) smoking, high blood pressure, high
cholesterol, physical inactivity, obesity, diabetes, and kidney failure. If you have high blood cholesterol, it's
very important to control high blood pressure, avoid tobacco smoke and coffee, eat
a healthy diet, get regular physical activity, maintain a healthy weight, and
control or delay the onset of diabetes. Taking these steps will help lower your
risk of heart disease and stroke. If you still need drugs to reduce your blood
cholesterol, a healthy diet and active lifestyle will help lower your
cholesterol and improve your overall cardiovascular health. Since the degrading revision of Title 45,
U.S. Code of Federal Regulations, Part 46, Protection of Human Subjects,
Revised November 13, 2001, effective December 13, 2001 biological research
using human test subjects must adhere to the voluntary principles of the Declaration
of Helsinki and companion Guiding
Principles in the Care and Use of Animals.
31. Living to 100 is easier than you
might think. Surprising new research suggests that even people who develop
heart disease or diabetes late in life have a decent shot at reaching the
century mark. Never before have so many people lived to
a healthy old age. From the Bronze Age
to the year 1900, life expectancy is estimated to have increased twenty-seven
years. Between 1900 and 1909, life
expectancy increased by at least that much again. Of all the people who have ever lived to be sixty-five years old,
half are estimated to be alive today. In
1900 there were about 3 million people aged sixty-five and over in the United
States, making up 4.1 percent of the population. By 1963 the number had grown to 17.5 million; and one could
reasonably expect to survive to old age.
In 2000 about 35 million citizens were aged sixty-five or over,
constituting 12.5 percent of the population.
By 2030, this age group will account for about 70 million people, or 20
percent of the population.
32.
Life expectancy at age sixty-five is now seventeen years, five years longer
than at the turn of the century. Many
sixty-five year olds remain physically and mentally active and capable of
contributing to society on many levels.
Those over age eighty-five, known as the oldest old, are the fastest
growing segment of the population. In
1900, they accounted for only 4 percent of all people over age sixty-five. Now that figure is 12 percent and growing,
it is expected to triple by 2040 to 14.3 million. Now that figure is 12 percent and growing, it is expected to
triple by 2040 to 14.3 million. Even
living to one hundred is no longer a rarity. In 1950 there were roughly 3,000
centenarians in the United States. In
2000 centenarians on the rolls of the Social Security Administration numbered
about 65,000. In 2010, estimates put
the number at well over 100,000, perhaps as high as 200,000. In fifty years the figure may approach 1
million. Some authorities talk
seriously of life expectancies of 110 or 120 years and anticipate someday
reaching. To get there the baby boomers must prohibit
heart disease and diabetes.
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