Disorders of the heart and blood vessel system uncluding coronary heart disease and stroke

Leading cause of death is the US and most developed countries 

"Hardeing of the arteries" 

What CVD results from 

bood vessels lose their elasticity 

The development of atherosclerosis that can help trigger heart attacks and strokes 

Trigger is unclear, process begins with damage to the blood vessel wall that results in the formation of "fatty streaks" 

Inflammation in the circulating blood (systematic inflammation) can contribute 

Heart pain 

When the artieries that supply the heart are narrowed with plaques, restriciting blood flow to the heart, the person may experience angina pectoris 

A heart attack 

When sever atherosclerosis or a clot causes a coronoary artery to become completely obstructed, a heart attack happens 

The coronary arteries lose their elasticity, making it difficult for them to expand and contract. 

Makes it difficult to handle the large volumnes of blood needed during physical exertion. 

Blood clots are more likely to form 

Electrocardiogram 

EKG

**Most commonly used**

A measure of the electrical discharges that emanate from the heart (stress test is admisisted when something is wrong) 

Electrodes attatched to key points on the body measure the electrical dischrages given off by the heart when it beats 

**Most accurate**

Dye is injected into the person where the plaque is expected to be so you can see the blocks on an X-Ray

Patients remain awake 

Coronary Artery Bypass Graft

(Treatment) 

A small piece of healthy vein (usually taken from an arm or a leg) is grafted around a blocked coronary artery 

Allows blood to go around the block and flow more freely to the undernourished section of the heart 

Recommened when blockages are severe and when the patient hasnt responded to other forms of surgery

Coronary Angioplasty

(Treatment)

Surgery when a catheter is used to open a blocked coronary artery 

Stent: a fine mettalic mesh tube that is inserted into the artery to reduce the likelihood that it becomes narrowed again 

Atherectomy: blockages are surgically removed or destroyed by laser, a roatating blade, or a diamond studded drill 

Cardiac Medications

(Treatment) 

Nitroglycerine: increases the blood supply to the heart and stabilizes the heart electrically

Beta-Blockers and Calcium-Channel Blockers: lower blood pressure and reduce the pumping demands placed on the heart 

Vasodilators: expand narrowed blood vessels 

Anticoagulants: help prevent the formation of blood clots 

Thrombolytic Agent: quickly dissolves any blood clots when a heart attack is disgnosed early

Nitroglycerine

(Cardiac Medications) 

Beta-Blockers and Calcium-Channel Blockers

(Cardiac medications) 

Vasodilators

(Cardiac medications) 

Anticoagulants 

(Cardiac Medications) 

Identified a number of coronary risk factors 

Demographic, Biological, and Psychological 

• Gender: may be due to sex hormones 
• Testosterone: linked with aggressiveness, competitiveness
• Gender differences: 
• Women are 2x as likely to die after a heart attack
• Womwn with CVD tend to be older
• CVD is diagnosed earlier in men 
• Men recieve more aggressive treatment
• Race and Ethnicity: Due to SES factors 

• Hyptertension
• Obesity
• Cholesterol
• Metabolic Syndrome
• Tobacco Use 

Hypertension

(Controllable risk factor) 

Sustained elevation of diastolic and systolic blood pressure (140/90)

Causes: 

• Not completely sure
• No single cause
• Obesity, lack of exercise, salt intake, stress  

Obesity

_{(Controllable risk factor)} 

Cholesterol

_{(Controllable risk factor)}

240 or more doubles your risk of CVD 

Below 200 is best

Low-High Density Lipoprotein: below 40 mg/DL

Drink more wine?! 

Metabolic Syndrome

_{(Controllable risk factor)}

3 or more symptoms

1. Large waist circumference
2. Glucose intolerance
3. Elevated blood pressure 

Tobacco Use

_{(Controllable risk factor)} 

Competitiveness

A strong sense of time urgency

Hostility 

Coronary prone behavior pattern 

More relaxed 

Who are not overly pressured by time considerations 

Coronary disease resistant 

Hostile adults > more stressful life > little social support 

**Toxic effect**

Hostility > indirect effect through other CVD risk 

Hostile people are more likely to develop CVD becasue they tend to have poorer health habits then less hostile people

Hostility/Anger > Physiological damages 

Frequent episodes of anger produce elevated Cardiovascular and stress hormone responses that damage arteries and contribute to coronary disease 

Lifestyle Modifications

_{(Reducing Risk)} 

• Controlling hypertension: reducing weight, limiting salt and alcohol intake, increacing exercise, and improving cholosterol ratios 
• Better diet: eating more fiber, fruits, vegetables... 
• Relaxation training
• Don't smoke 

Anger

Negative emotion

Accompanied by physiological arousal

Usually shorter in Duration  

**Correlated with coronoary heart disease and artery bloackage: 3x more liekly to have a herat attack, supprseed anger can be just as bad as expressed anger 

 Hostility

Negative attitude

Often long lasting 

Depression: Don't know exactly 

Strongly implicated risk factor in CVD and metabolic syndrome 

Other Factors

• Social isolation
• Clinical anxiety
• SES
• Job anxiety 

Type 1

(Diabetes) 

Autoimmune disorder in which insulin-prouducing cells of the pancreas are destroyed 

Childhood diabetes 

Around 10-12 years of age in girls and 12-14 in boys 

5-10% of all cases 

Symptoms:

• May mimic flu including excessive thirst, frequent urination, unusual weight loss, extreme fatigue and irritability  

Generally involves more serious health complications and the need for daily insulin shots 

Type 2

(Diabetes)

Chronic disease in which the body fails to produce enough or to properly use insulin 

Adulthood diabetes

Onset occurs after age 30

90-95% of all diabetes cases

Symptoms: 

• Blurred vision
• Frequent infections
• Cuts that are slow to heal 
• Tingling or numbess in hands or feet

Requires strict diet and exercise  

Psychological Disorders

(Diabetes) 

• Major depression
• Anxiety
• Eating disorders 

Studying factors in adjusting to disease: 

• Psychological distress
• Personal coping skills 
• Social support 

As well as factors that affect compliance with treatment regimens  

The Heart 

Consists of three layers of tissue 

1. Epicardium: Thin outer layer 
2. Endocardium: Thin inner layer
3. Myocardium: The heart muscle itself, seperated into 4 chambers that work in coordinated fashion to bring blood to the heart and the rest of the body 

Second leading cause of death in the US 

More than 100 different but realated diseases which result from the uncontrolled multiplication and spread of body cells that form tumors 

1. Carcinomas
2. Sarcomas
3. Lympphomas
4. Leukemias 

Cancers of the epithelial cells, which line the outer and inner surfaces of the body 

85% of cancers, 

most popular 

Breast, prostate, lungs, colon, pancreas, and skin cancers

Skin cancer is the most common, affects 1 out of every 6 people 

Cancers that develop from muscle, bone, fat and other connective tissue (cartilages)  

2% of cases 

Cancers of the lymph system

Hodgkins disease

Non-Hodgkins disease 

Cancers of the blood and blood-forming system

(Bone marrow) 

Destroys white blood cells in the bloodstream and bone marrow, which impair the immune system

Affects more adults although it is thought of as a childhood disease 

Where malignant cells are found at several sites, not just one. 

More dangerous and more common

1. SMOKING!!! (1/5 of cancer deaths)
2. Diet/Obesity (1/3 of cancer deaths)
3. Alcohol use, 2 drinks a day creates at least a 25% greater risk of break cancer

1. Toxic Chemicals: asbestos, vinyl chloride, arsenic, some chlorine compounds (cleaning agents) 
2. Radiation: 40-50% of Americans who reach 65 develop skin cancer
3. Melanoma: UV rays, ozone, tanning 

Inherited Cancers

Breast Cancer

Some forms of cancer are inherited

(Skin, ovarian, prostate, pancreas cancer) 

Early onset!!!

Most cases of breast cancer however are non genetic 

Our immune system's ability to mount an effective defense against disease and harmful foregin agents 

Depends on many factors: 

• Our overall health
• The nature of the health-threatening disease or foreign agent
• Percieved stress  

Proposes that stress always suppresses immune responses 

However, not very effective becasue it is difficult to seperate stress from other factors such as smoking, drinking, becoming overweight, and even growing older 

Proposes that only the most chronic stressors cause global immunosuppresion.

Short term stressors either have no effect on immunity or might actually enhance immunity to help prepare us to defend against possible infection or injury

1. Early diagnosis 
2. Surgery
3. Chemotherapy
4. Radiation Therapy
5. Alternative Treatments 

Early Diagnosis

_(Treatment)

**Early detection is key**

Can severly improve a person's chance of survival 

Unfortunately, most do not perform self-examinations and do not follow recommened screening schedules 

Prescreening for those with a family history has become a useful method 

Surgery

_(Treatment)

1. Diagnostic 
2. Preventative 
3. Staging 
4. Curative
5. Restorative 

Diagnostic Surgery

_{(Treatment-Surgery)}

Used to obtain a tissue sample for lab testing in order to confirm a diagnosis and identify the specific cancer. 

Biopsy: a procedure to remove all or part of a tumor for diagnositc tests 

Preventative Surgery

_{(Treatment-Surgery)}

Performed to remove a growth that is not presently malignant but it likely to become so if left untreated.

Sometimes preventative surgery is used to remove an organ when people have an inherited condition that makes developlement of a cancer likely.  

Staging Surgery

(Treatment-Surgery)

Used to determine the extent of a disease 

Laparoscopy: A tube is passed through a tiny incision in the abdomen to examine it's contents and remove tissue samples 

Curative Surgery

_{(Treatment-Surgery)}

Restorative Surgery

_{(Treatment-Surgery)}

Used to restore a person's appearance or function of an organ or body part. 

Breat reconstruction or use of bone grafts or prosethtics 

Used to destroy fast growing cancer cells that have spread to parts of the body far from the primary tumor 

The systematic drugs travel through the bloodstream to reach all areas of the body 

Can be used to cure cancer, to keep the cancer from spreading, to slow the cancer's growth, to kill cancer cells that may have spread to other parts of the body from the original tumor, or to relieve symptoms 

Immunotherapy

_{(Treatment-Chemotherapy)} 

One of the newest forms of chemo, medications are used to enhance the immune system's ability to selectively target cancer cells 

Common Side Effects: 

Nausea and vomitting

Hair loss

Fatigue 

Not Common Side Effects: 

Bleeding

Infections

Anemia

Anti-Cancer Drugs

_{(Chemotherapy)}

Are made to kill fast growing cells, however, because these drugs travel throughout the body, they can affect normal, healthy cells 

Most likely to affect blood cells that form in the bone marrow and cells in the digestive tract, reproductive system, and hair follicles 

Affects only the tumor and the surrounding area

Uses X-Rays and Gamma rays to destroy tumors 

Primary form of treatment 

Can also be used to shrink tumor priar to surgery so that it can be removed more easily or after surgery to stop the growth of any cancer cells that remain 

Similar side effects to Chemotherapy 

Mediation, biofeedback, herbal treatments, aromatherapy, music therapy, prayer and spirtial practices, yoga... 

**Generally unproven**

Have not been scientifically tested

But can be used alongside standard biomedical treatment to relieve symptoms or side effects, to ease pain, and to improve the overall quality of life 

Acquired immune deficiency syndrome 

Oppurtunistic Infections (Hard to manage) 

1-26 infections 

Only get with depleted immune system

Tuberculosis: leading infection with places with less money 

Sexually transmitted infections 

Infections that are spread primarily through person-to-person sexual contact 

Human Immunodeficiency Virus 

Can get AIDs defining illness due to weakened immune system 

T-Cell count falls below 200 

Normal: 500

Symptoms

Extreme fatigue 

High fever

Extreme weight loss 

First seen in 1980, when 55 young men had similar symptoms with an unknown cause 

Canadian Flight Attendant: Gaetan Dugas 

Had 250 sexual partners a year

Died in 1984

Many men who were sick were linked to Dugas

After he died, HIV was announced 

Last 1980s, AIDS began to threaten not only white gay men in the US. It began surfacing among other ethnic groups 

100,000th person died of AIDs: 1991
200,000th person died of AIDs: 1993  
400,000 cases in 1994  

11 people are infected every minute, unprotected heterosexual sex is the predominant way to transfer 

Rare cancer of blood vessels serving the skin, mucous membranes, and other glands in the body 

Usually found among the elderly 

• Women are particually vulnerable 
• People are living longer with AIDs due to advanced HIV therapy 

• Hemophiliacs: often need blood transfusions
• Children: get from pregnant mom through placenta and birth 
• Sharing of any virus infected lymphocytes in bodily fluids-blood, semen, vaginal and cervical secretions and breast milk 
• Without a supportive environment of blood, semen, or cytoplasam of the host cell, the virus dies quickly 

It works by injecting a copy of its own genetic material (genome) into the DNA of a T-Cell (the host cell). 

Can only replicate inside cells, taking over their machinery to reproduce 

Stage 1

_HIV

Soon after the inital HIV infection, the immune system destroys most virus, symptoms are mild or nonexistent 

Lasts: 1-8 weeks

Stage 2

_HIV

**Latency Period**
The T-Cell concentration falls and HIV concentration rises; accompained by symptoms such as swollen lymph nodes

Lasts: For months or years 

Within 5 years, most people progess to stage 3

Stage 3

_HIV

As T-Cells are further reduced, immune function is impaired, and oppurtunistic infections occur 

Kaposi's Syndrome 

Lymphoma

Pneumocystis Carinii Pneumonia (PCP): infects the lungs, 60% cause of death 

Stage 4 

_HIV

Finally almost all natural immunity is lost and full-blown AIDs occurs 

T-Cell Count is below 200 

Without treatment, death usually occurs within a year or two 

Highly Active Antiretroviral Treatment 

Involves a combination of antiretroviral drugs that attack different parts of HIV or stop the virus from entering cells. The treatment does not get rid of HIV, it slows the pace at which the virus continues to reproduce 

Commonly used drug in HAART: Zidovudine (AZT) 

Reverse transcriptasae Inhibitors - blocks replication of the HIV virus by inhibiting production of reverse transcriptase, the enzyme HIV needs to reproduce itself. 

AZT: Reduces AIDs symptoms, increases T-Cell levels, and may prolong the patient's life

Anemia, which requires frequent blood transfusions 

Reduced white blood cell formation, which increases the risk of other infections 

Headaches

Itching

Mental Confusion 

AZT effectiveness wears off as the virus becomes resistent to it 

Percieved Social Norms

_{Social-Cognitive Theory}

Self-Efficacy Beliefs 

_{Social-Cognitive Theory} 

Social Skills

_{Social-Cognitive Theory}

The ability to respond assertively in negotiating risky behaviors 

Gay men who practice high-risk behaviors also score lower on percieved safer-sex norms, safer-sex efficacy, self-efficacy and social skills 

• Changes family structures and roles, often reversing developmental patterns 
• Children may die before parents OR parents may die leaving children to become independent 
• Friends may turn away from the uninfected family even after the victim dies 
• Surviving partner:
• Fear of lonliness, fear of HIV itself, fear of dying without anyone to care for them, Anger at partners "abandonment", fear of being tarnished beause of partners disease/reputation 

Long term patients... 

Those who act as caregivers for a long time and who rate their patients health at very poor are less likely to report good health that those who have been providing healthcare for a short time to a person living with AIDS or HIV in comparatively good health