Chapter TwelveChapter Twelve

Cardiovascular Disease and Cardiovascular Disease and CancerCancer

The Cardiovascular The Cardiovascular SystemSystem

• Cardiovascular disease is the leading cause of Cardiovascular disease is the leading cause of death in the United Statesdeath in the United States

• Heart attacks and strokes are the most common Heart attacks and strokes are the most common life-threatening types of heart diseaseslife-threatening types of heart diseases

• Much of these incidences are due to lifestyle Much of these incidences are due to lifestyle concernsconcerns

Characteristics of the Characteristics of the HeartHeart

• 4 chambered pump (atria, ventricles)4 chambered pump (atria, ventricles)• Size of a fistSize of a fist• Weighs about 1 poundWeighs about 1 pound• Function - creates pressure to Function - creates pressure to

circulate blood throughout the bodycirculate blood throughout the body• Blood enters via the Vena Cava into Blood enters via the Vena Cava into

the right atrium (see the right atrium (see Figure 15-2Figure 15-2 on on blood circulation)blood circulation)

Heart Beat StimulationHeart Beat Stimulation

• Signal sends impulses from the heartSignal sends impulses from the heart• SA node (pacemaker of the heart) SA node (pacemaker of the heart)

creates an electrical impulsecreates an electrical impulse• An electrical impulse spreads from the An electrical impulse spreads from the

right side to the left (ECG)right side to the left (ECG)• The pace of the heart is regulated by The pace of the heart is regulated by

the brainthe brain

Risk Factors for Heart Risk Factors for Heart Disease That Can Be Disease That Can Be

Changed (AHA)Changed (AHA)• Tobacco SmokingTobacco Smoking• Physical inactivityPhysical inactivity• High cholesterol High cholesterol

(Figure 15-2)(Figure 15-2)

• HypertensionHypertension• Diabetes MellitusDiabetes Mellitus• Obesity and Obesity and

OverweightOverweight

Reference: American Heart Association

Contributing Risk Factors Contributing Risk Factors for Heart Disease That Can for Heart Disease That Can

Be ChangedBe Changed

• High Triglyceride LevelsHigh Triglyceride Levels• StressStress• Chronic hostility and AngerChronic hostility and Anger• Type D PersonalitiesType D Personalities• Depression/AnxietyDepression/Anxiety• Social IsolationSocial Isolation• Low socioeconomic statusLow socioeconomic status

Major Risk Factors That Major Risk Factors That Cannot Be ChangedCannot Be Changed

• HeredityHeredity• AgingAging• Being MaleBeing Male• EthnicityEthnicity

Possible Risk Factors Possible Risk Factors Currently Being StudiedCurrently Being Studied

• Inflammation and Inflammation and C-Reactive ProteinC-Reactive Protein

• Insulin Resistance Insulin Resistance and Metabolic and Metabolic SyndromeSyndrome

• HomocysteineHomocysteine• Infectious agentsInfectious agents• Lipoprotein (A)Lipoprotein (A)

• LDL Particle sizeLDL Particle size• FibrinogenFibrinogen• Blood viscosity and Blood viscosity and

IronIron• Uric acidUric acid

Major Forms of Major Forms of Cardiovascular DiseaseCardiovascular Disease

• CAD (coronary artery disease)CAD (coronary artery disease)• Atherosclerosis: build up of plaque on the Atherosclerosis: build up of plaque on the

arteriesarteries

• HypertensionHypertension• StrokeStroke• Congestive heart failureCongestive heart failure

HypertensionHypertension

• Blood pressure exceeds a systolic (pressure Blood pressure exceeds a systolic (pressure at contraction) over 140 mm/hg and/or a at contraction) over 140 mm/hg and/or a diastolic (pressure between contraction) diastolic (pressure between contraction) over 90 mm/hgover 90 mm/hg

• Symptoms – the “silent killer” (no Symptoms – the “silent killer” (no symptoms)symptoms)

• Diagnosis – regular checks of resting blood Diagnosis – regular checks of resting blood pressure (average blood pressure < 120/80)pressure (average blood pressure < 120/80)

• Treatment – medication, exercise, dietary Treatment – medication, exercise, dietary changes)changes)

• A cause of heart attacks, strokes, and kidney A cause of heart attacks, strokes, and kidney diseasedisease

AtherosclerosisAtherosclerosis

• Atheroschlerosis is a form of Atheroschlerosis is a form of arteriosclerosis arteriosclerosis (hardening of the arteries)(hardening of the arteries)

• Arteries become narrow due to Arteries become narrow due to plaqueplaque buildupbuildup

• This process deprives blood and vital This process deprives blood and vital oxygen to specific organs, such as the oxygen to specific organs, such as the heart, brain, etc.heart, brain, etc.

• Results in the following:Results in the following:• Coronary Heart DiseaseCoronary Heart Disease• StrokeStroke• Peripheral Arterial DiseasePeripheral Arterial Disease

*Atherosclerosis often begins during childhood

Heart AttackHeart Attack

• Damage to vessels of the coronary arteryDamage to vessels of the coronary artery• Principal cause – atherosclerosis (narrowing of artery)Principal cause – atherosclerosis (narrowing of artery)

– Myocardial infarction: heart attackMyocardial infarction: heart attack• Caused by a coronary thrombosisCaused by a coronary thrombosis

• When the need for oxygen exceeds the supply, the result When the need for oxygen exceeds the supply, the result is chest pain called is chest pain called angina pectorisangina pectoris

Recognizing and Treating a Recognizing and Treating a Heart AttackHeart Attack

• Symptoms – shortness of Symptoms – shortness of breath, long-term chest breath, long-term chest pain (angina), numbness pain (angina), numbness in the left side of face and in the left side of face and armarm

• Diagnosis – ECG, Diagnosis – ECG, angiogram, MRIangiogram, MRI

• Surgical Treatment – Surgical Treatment – bypass, angioplasty, heart bypass, angioplasty, heart transplanttransplant

• Non-surgical Treatment- Non-surgical Treatment- platelet inhibitors, aspirin, platelet inhibitors, aspirin, alcoholalcohol

Cardiopulmonary resuscitation (CPR) is considered an emergency response for heart attack emergencies

Stroke (Cerebrovascular Stroke (Cerebrovascular Accident)Accident)

• Blood supply to the brain is cut offBlood supply to the brain is cut off• Types –ischemic strokes (blockage), Types –ischemic strokes (blockage),

hemorrhagic strokes (ruptures)hemorrhagic strokes (ruptures)• Diagnosis – CT scan, MRIDiagnosis – CT scan, MRI• Treatment – clot dissolving drug Treatment – clot dissolving drug

therapy (TPAs)therapy (TPAs)

Congestive Heart FailureCongestive Heart Failure

• Swollen heart due to the lack of Swollen heart due to the lack of strength known as Pulmonary edemastrength known as Pulmonary edema

• Causes – various causes from other Causes – various causes from other illnesses to damaging heart to existing illnesses to damaging heart to existing injury to the heartinjury to the heart

• Treatment – drugs, modified lifestyleTreatment – drugs, modified lifestyle

Other Forms of Heart Other Forms of Heart DiseaseDisease

• Congenital Heart DiseaseCongenital Heart Disease• Peripheral Artery DiseasePeripheral Artery Disease• Rheumatic Heart DiseaseRheumatic Heart Disease• Heart Valve DisordersHeart Valve Disorders

Protecting Yourself Against Protecting Yourself Against Cardiovascular DiseaseCardiovascular Disease

• Eat Heart-HealthyEat Heart-Healthy• Decrease Fat and Decrease Fat and

Cholesterol IntakeCholesterol Intake• Increase Fiber IntakeIncrease Fiber Intake• Moderate the amount Moderate the amount

of alcohol of alcohol consumptionconsumption

• Decrease Sodium and Decrease Sodium and increase Potassium increase Potassium IntakeIntake

• Exercise RegularlyExercise Regularly

• DASH (Dietary DASH (Dietary Approaches to Stop Approaches to Stop Hypertension)Hypertension)

• Avoid TobaccoAvoid Tobacco• Know and manage Know and manage

your Blood Pressureyour Blood Pressure• Know and manage Know and manage

your Cholesterol your Cholesterol levelslevels

• Develop ways to Develop ways to handle stress and handle stress and angeranger

CancerCancer

• Most cancers take the form of Most cancers take the form of tumors: a mass of tissues that tumors: a mass of tissues that serve no physiological purposeserve no physiological purpose

• Benign: cells similar to surrounding Benign: cells similar to surrounding normal cells and are enclosed in a normal cells and are enclosed in a membrane that prevents them from membrane that prevents them from penetrating neighboring tissuespenetrating neighboring tissues

• Malignant: capable of invading Malignant: capable of invading surrounding structures, producing surrounding structures, producing invasive tumors or uncontrolled growthinvasive tumors or uncontrolled growth

Cell regulation problem causing abnormal cell growth

How Cancer Spreads: How Cancer Spreads: MetastasisMetastasis

• Metastasis is the spreading of Metastasis is the spreading of cancer cells which occurs due to the cancer cells which occurs due to the lack of cellular cohesivenesslack of cellular cohesiveness

• They break away and pass through They break away and pass through the lining of lymph or blood vessels the lining of lymph or blood vessels to invade nearby tissuesto invade nearby tissues

• These new tumors are called These new tumors are called secondary tumors or metastasessecondary tumors or metastases

Types of CancerTypes of Cancer

• Carcinomas – Arise from epithelia, tissues Carcinomas – Arise from epithelia, tissues that cover external body surfaces (organs, that cover external body surfaces (organs, skin, nerves, membranes)skin, nerves, membranes)

• Sarcomas – bone, blood, connective tissue Sarcomas – bone, blood, connective tissue • Lymphomas – immune tissues/system Lymphomas – immune tissues/system • Leukemia - blood and blood forming Leukemia - blood and blood forming

tissues (bone marrow)tissues (bone marrow)

The Incidence of CancerThe Incidence of Cancer

• Each year, 1.4 million people in the Each year, 1.4 million people in the United States are diagnosed with United States are diagnosed with cancercancer

• Cancer death rates have dropped Cancer death rates have dropped more than 10% since 1990more than 10% since 1990

• The American Cancer Society believes The American Cancer Society believes that thousands of cases of colon, that thousands of cases of colon, breast, and uterine cancer could be breast, and uterine cancer could be prevented by lifestyle changesprevented by lifestyle changes

Lung CancerLung Cancer

• Risk Factors Risk Factors – SmokingSmoking– Environmental pollutantsEnvironmental pollutants

• PreventionPrevention– Remove smoke elementRemove smoke element

• TreatmentTreatment– SurgerySurgery– RadiationRadiation– ChemotherapyChemotherapy– MedicationsMedications

Full recovery remains unlikely in all but a small percentages of cases

Colon and Rectal CancerColon and Rectal Cancer

• Considered the second leading cause of Considered the second leading cause of cancer deaths (could arise from pre-cancer deaths (could arise from pre-existing existing polypspolyps))

• Risk FactorsRisk Factors• AgeAge• HeredityHeredity• Lifestyle factorsLifestyle factors

• Detection and TreatmentDetection and Treatment• Removal of polypsRemoval of polyps• Yearly stool blood testYearly stool blood test• Sigmoidoscopy/colonoscopySigmoidoscopy/colonoscopy• SurgerySurgery

Breast CancerBreast Cancer• Most common cancer in WomenMost common cancer in Women

• Risk factorsRisk factors– Early menstrual cycle for womenEarly menstrual cycle for women– Women with no children or having children later in lifeWomen with no children or having children later in life– Hormone replacement therapy useHormone replacement therapy use

• PreventionPrevention– DietDiet– MammographyMammography– Activity levelsActivity levels– Pregnancy and breastfeeding decisionsPregnancy and breastfeeding decisions– Occupational hazardsOccupational hazards– New medicationsNew medications

• TreatmentTreatment– LumpectomyLumpectomy– Drug therapyDrug therapy– Chemotherapy/radiation treatmentsChemotherapy/radiation treatments

Preventive Measures, Preventive Measures, cont’dcont’d

Self checks for breast cancer

Breast cancer is still the #1 cancer for womenBreast cancer is still the #1 cancer for women

Breast self-examination

Prostate CancerProstate Cancer

• Most common cancer in MenMost common cancer in Men• Risk factorsRisk factors

– Age, dietary fat intake, genetic linkAge, dietary fat intake, genetic link

• PreventionPrevention– Dietary intake of Vitamin E and selenium, drug Dietary intake of Vitamin E and selenium, drug

therapytherapy

• Early DetectionEarly Detection– PSA screenings, ultrasound rectal examPSA screenings, ultrasound rectal exam

• TreatmentTreatment– Surgery, radiation, implantation of radioactive Surgery, radiation, implantation of radioactive

seedsseeds

Cervical CancerCervical Cancer

• Risk factorsRisk factors– HPV infectionHPV infection– Smoking and socioeconomic factorsSmoking and socioeconomic factors

• PreventionPrevention– Sexual abstinenceSexual abstinence– Pap testsPap tests– Careful selection of sexual partnersCareful selection of sexual partners

• TreatmentTreatment– Surgery (minor or major)Surgery (minor or major)– Radiation/chemotherapyRadiation/chemotherapy

Uterine CancerUterine Cancer

• Risk FactorsRisk Factors– Early menarche, late menopause, lack of Early menarche, late menopause, lack of

ovulation, never having given birth, ERT, use of ovulation, never having given birth, ERT, use of tamoxifen, and also in diabetics, obese, and tamoxifen, and also in diabetics, obese, and hypertensive womenhypertensive women

• PreventionPrevention– Minimize high levels of estrogen and regular Minimize high levels of estrogen and regular

physician carephysician care

• TreatmentTreatment– Surgery, radiation, chemotherapy, hormone Surgery, radiation, chemotherapy, hormone

treatmenttreatment

Ovarian CancerOvarian Cancer

• PreventionPrevention– Similar to what is recommended for Similar to what is recommended for breast breast

cancercancer– Prophylactic oophorectomyProphylactic oophorectomy

• Early DetectionEarly Detection– Referred as the “silent cancer”Referred as the “silent cancer”

• Annual pelvic examsAnnual pelvic exams• Genetic screeningsGenetic screenings

• TreatmentTreatment– SurgerySurgery– ChemotherapyChemotherapy– Drug therapyDrug therapy

Skin CancerSkin Cancer

• Considered the most common cancer of allConsidered the most common cancer of all• Risk factorsRisk factors

– Severe sunburn during childhood, chronic sun Severe sunburn during childhood, chronic sun exposure during young adulthood (UV)exposure during young adulthood (UV)

• PreventionPrevention– Reduce exposure to sun’s rays, use Reduce exposure to sun’s rays, use

sunscreens,sunscreens,

• Early DetectionEarly Detection– Recognition and early diagnosisRecognition and early diagnosis

• TreatmentTreatment– Surgery, chemotherapy, interleukin-2Surgery, chemotherapy, interleukin-2

Skin CancerSkin Cancer

• Risk factorsRisk factors– Severe sunburn during childhood, chronic Severe sunburn during childhood, chronic

sun exposure during young adulthoodsun exposure during young adulthood

• PreventionPrevention– Reduce exposure to sun’s rays, use Reduce exposure to sun’s rays, use

sunscreens,sunscreens,

• Early DetectionEarly Detection– American Cancer Society guidelines (next American Cancer Society guidelines (next

slide)slide)

• TreatmentTreatment– Surgery, chemotherapy, interleukin-2Surgery, chemotherapy, interleukin-2

Testicular CancerTesticular Cancer

• Risk factorsRisk factors– Family history, environmental factorsFamily history, environmental factors

• PreventionPrevention– Self examsSelf exams

• Early DetectionEarly Detection– Observations and self examsObservations and self exams

• TreatmentTreatment– Surgery, chemotherapy, radiationSurgery, chemotherapy, radiation

Self checks for testicular cancer

Testicular cancer is the #1 cancer for men aged 18-35Testicular cancer is the #1 cancer for men aged 18-35

Testicular self-examination

The Causes of CancerThe Causes of Cancer

• The Role of DNAThe Role of DNA• Role of inheritance of Role of inheritance of

certain genescertain genes• DNA mutations such DNA mutations such

as as oncogenesoncogenes• Cancer promotersCancer promoters

• Dietary FactorsDietary Factors• Dietary Fat and MeatDietary Fat and Meat• AlcoholAlcohol• Fiber intakeFiber intake• Fruits and VegetablesFruits and Vegetables

• Inactivity and Inactivity and ObesityObesity

• MicrobesMicrobes• Carcinogens in the Carcinogens in the

EnvironmentEnvironment• Ingested chemicalsIngested chemicals• Industrial pollutionIndustrial pollution• RadiationRadiation

Detecting CancerDetecting Cancer(Figure 16-5)(Figure 16-5)

Identify the 7 warning signs of cancer

CChange in bowel/bladder habits

AA sore that does not heal

UUnusual bleeding or discharge

TThickening of tissues (schlerotic change)

IIndigestion or difficulty swallowing

OObvious change in a wart/mole

NNagging cough

Diagnosing CancerDiagnosing Cancer

• Detection begins with a physical examDetection begins with a physical exam• Exploratory surgery or a biopsy may Exploratory surgery or a biopsy may

be performed to identify a cancer’s be performed to identify a cancer’s stage or the following:stage or the following:

• MRIMRI• CTCT

• Ultrasonography have been used to Ultrasonography have been used to view tumors and is considered view tumors and is considered completely safecompletely safe

• Avoiding TobaccoAvoiding Tobacco• Controlling Diet and WeightControlling Diet and Weight• Regular ExerciseRegular Exercise• Protecting Skin from the SunProtecting Skin from the Sun• Avoiding Environmental and Occupational Avoiding Environmental and Occupational

CarcinogensCarcinogens• Having regular screening examsHaving regular screening exams

Preventive CancerPreventive Cancer

Chapter TwelveChapter Twelve

Cardiovascular Disease and Cardiovascular Disease and CancerCancer