SEHH 1015

Healthy Living and Common Health Problems

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Cardiovascular Disease (CVD)
• Diseases that affect the heart and blood vessels:
• Heart disease, heart attack, stroke, angina, blood vessel
diseases, arrhythmias, congenital heart defects, and
other conditions
• CVD is the third leading cause of death in Hong Kong
• In 2022, 10 665* registered deaths are attributed to
cardiovascular diseases, including 6 791* deaths due to
heart diseases. https://www.healthyhk.gov.hk/phisweb/en/chart_detail/24/ ***
• Death by heart conditions and cerebrovascular diseases
history.
• More than 1 in 10 people (30-74yrs) in Hong Kong
heading for heart disease in 2022-2023.
• 30% increase in ‘young stroke’ incidence in Hong Kong
• Cardiovascular system (CVS)
consists of the heart and blood
vessels—both arteries and veins
• Transport blood through the body
• When lungs are included, the
system is known as the
cardiorespiratory or
cardiopulmonary system
• A 4-chambered, fist-sized
muscular organ that Pumps
deoxygenated blood to the lungs
and oxygenated blood to the
rest of the body (Copyright © McGraw-Hill)

• Pulmonary circulation: right side of the heart pumps

blood to the lungs
• Systemic circulation: left side of the heart pumps
blood through the rest of the body
The Heart

• Path of blood flow:

• Superior vena cava and inferior vena cava
• Right atrium
• Right ventricle
• Pulmonary arteries to the lungs
• Pulmonary veins to the left atrium
• Left ventricle
• Aorta
• Each heartbeat consists of two basic parts:
• Systole: heart’s contraction
• Diastole: period of relaxation
• Blood pressure: force exerted by the blood on the
walls of blood vessels
• Created by the pumping action of the heart and the
resistance of the blood vessels
• Reported as systolic pressure over diastolic
pressure; for example, 120 over 80 (or 120/80)
 The Blood Vessels

• Veins carry blood to the heart

• Thin walls
• Arteries carry blood away from the heart
• Has thick elastic walls that expand and relax with
the volume of blood
• Coronary arteries: the two large vessels, right and
left, that supply blood to the heart
• Capillaries are the smallest and thinnest vessels
Major Forms of
Cardiovascular Disease
https://www.nhs.uk/conditions/cardiovascular-disease/

• Atherosclerosis
• Coronary heart disease and heart attack
• Stroke
• Congestive heart failure
• Congenital heart defects
• Rheumatic heart disease
• Heart valve disorders
• Peripheral arterial disease
Atherosclerosis
• Form of arteriosclerosis, or thickening and
hardening of the arteries
• Plaques accumulate in artery walls
• Effects can be deadly
• Coronary heart disease (CHD) or coronary artery
disease (CAD)
• Heart attack; stroke
• Main risk factors: tobacco use, physical inactivity,
high blood cholesterol levels, high blood pressure,
and diabetes
Atherosclerosis:
Coronary Artery Disease
and Heart Attack
• Heart attack, or myocardial infarction (MI), is usually
the result of a chronic disease process
• Damage to heart tissue from lack of oxygenated blood
• Symptoms
• Chest pain or pressure
• Arm, neck, or jaw pain
• Difficulty breathing
• Excessive sweating
• Nausea and vomiting
• Loss of consciousness
• About one-third of heart attack victims do not suffer
chest pain
Coronary Artery Disease and
Heart Attack
• Angina
• Arteries are narrowed by disease
• Stressed heart cannot receive enough oxygen
• Angina pectoris—chest pain—is usually relieved by
rest or nitroglycerin
• Arrhythmias and sudden cardiac death
• Electrical conduction system disrupted
• Ventricular fibrillation
• Cardiac defibrillation
• Automated external defibrillators (AEDs)
Coronary Artery Disease and
Heart Attack
• Helping a heart attack victim
• Most deaths from a heart attack happen within 2 hours
of initial symptoms
• Know the main warning signs
• Aspirin has an immediate anticlotting effect
• If no pulse found: cardiopulmonary resuscitation (CPR)
• Detecting and treating heart disease
• Testing and evaluating:
• Electrocardiogram (ECG or EKG)
• Electron-beam computed tomography (EBCT)
• Echocardiography—ultrasound waves
• Multi-slice computed tomography (MSCT)
• Magnetic resonance imaging (MRI)
• Nuclear myocardial perfusion imaging
• Positron emission tomography (PET)
Coronary Artery Disease and
Heart Attack
• Detecting and treating heart
disease (continue)
• If tests indicate coronary
artery disease: coronary
angiogram
• Treatments:
• Balloon angioplasty and stent
• Low-dose aspirin therapy
• Prescription drugs
• Coronary bypass surgery
Balloon angioplasty and stent
Heart Attack symptoms
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Helping a Heart Attack Victim
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Stroke
• In a stroke, or cerebrovascular accident (CVA), blood
supply is blocked to the parts of the brain, and brain
tissue subsequently dies:
• Ischemic stroke: impeded blood supply to the brain
caused by a clot obstructing a blood vessel
• Thrombotic stroke, caused by a thrombus
• Embolic stroke, caused by an embolus
• Hemorrhagic stroke: a blood vessel ruptures in the
brain
• Intracerebral hemorrhage, within the brain
• Subarachnoid hemorrhage, on the brain’s surface
• Aneurysm: a sac or outpouching formed by a distention
or dilation of the artery wall
Types of Stroke
Stroke
• Effects of a stroke
• Interruption of the blood supply to any area of the
brain prevents the nerve cells from functioning, in
some cases causing death
• Those who survive have some lasting disability
• Paralysis
• Walking disability
• Speech impairment
• Memory loss
• Changes in behavior
Stroke
• Recognizing a stroke:
• Ask the person to smile; unevenness is a sign of a
possible stroke
• Ask the person to hold his/her limbs out; if only one
can be moved or only one can be held still, there is
a stroke possibility
• Trouble speaking may be a sign that a stroke has
occurred
• Decreased sensation, numbness or tingling in limbs
can indicate stroke
• FAST: facial drooping, arm weakness, speech
difficulty, and time to call 9-9-9
Stroke
• Detecting strokes
• Transient ischemic attack (TIA) is a mini-stroke with
temporary stroke-like symptoms
• Computed tomography (CT), MRIs, and ultrasound
are used for diagnosis
• Treatment
• Various drug therapies
• Carotid endarterectomy surgery: plaque is removed
from the artery
• Rehabilitation: physical therapy; speech and
language therapy; occupational therapy
Peripheral Arterial Disease
• Peripheral arterial disease (PAD) refers to
atherosclerosis in the arteries of the limbs, which
can limit or block blood flow
• Patients typically also have CAD
• Risk factors: smoking, diabetes, hypertension, high
cholesterol
• Symptoms:
• Claudication: aching or fatigue in limb
• Rest pain: occurs even when not physically active
Congestive Heart Failure
• Results from impaired heart pumping mechanism
• Cannot maintain regular pumping (more returning than
being pumped out);
• fluid backs up & not enough oxygen-rich blood to body
cells.
• Pulmonary edema: fluid accumulates in the lungs
• Control by:
• Reducing cardiac load
• Eliminating excess fluid
• Restrict salt intake
• Drug therapy
• Cardiac rehabilitation
Other forms of Heart Disease
• Congenital heart defects: malformations of the heart
or major blood vessel
• Hypertrophic cardiomyopathy, which may be identified
by a murmur
• Rheumatic heart disease
• Streptococcal infection leading to rheumatic fever, which
causes damage to the heart muscle and valves
• Heart valve disorders
• Abnormalities in valves between chambers of the heart
• Mitral valve prolapse (MVP)
Risk factors for
Cardiovascular Disease
Major modifiable risk factors : Major non-modifiable
risk factors :
Tobacco use Genetics
Harmful use of alcohol Age
High blood pressure Gender
High cholesterol Race and ethnicity
Physical inactivity
Unhealthy diet
Weight & Obesity
High blood glucose/Diabetes
Other contributing risk factors
Major modifiable risk factors
• Tobacco use
• Nearly 1/5 deaths can be attributed to smoking
• When smokers have heart attacks, they are 2 - 3 times
more likely than nonsmokers to die
• Cigarette smoking also doubles the risk of stroke
• Harmful effects
• Damages the lining of arteries
• Reduces high-density lipoproteins (HDL)
• Raises triglycerides and low-density lipoproteins (LDL)
• Nicotine increases blood pressure & heart rate
• CO displaces O2   O2 in the body
• Causes platelets to form clots in the blood
• Increase fatty deposits in the arteries
Major modifiable risk factors
• High blood pressure, or hypertension
• Too much pressure against arterial walls
• Systolic and diastolic blood pressure (mm Hg)
• Normal blood pressure = ≤120 systolic/80 diastolic
• Primary (essential) hypertension: cause is unknown
• Secondary hypertension: have a know cause
• Low blood pressure, or hypotension, is generally
desirable; but it can get too low
• Not a risk factor for CVD
Major modifiable risk factors
• High blood pressure present a significant health risks,
and is often called a “silent killer”
• Prevalence
• About 27% of the population aged 15 or above in
Hong Kong is estimated to suffer from hypertension
• Over 90% of cases has no identifiable cause.
• Treatment
• Lifestyle changes can control hypertension
• DASH diet; sodium restriction; adequate potassium;
weight control; sleep and reduce smoking and drinking.
Blood pressure classification
by International Society of Hypertension 2021,
based on pharmacological treatment
Blood pressure (mmHg)
Categories
Systolic Diastolic
Normal ≤ 130 ≤ 85
Pre-hypertension 120 - 139 85-89
Stage 1
140-159 90-99
hypertension
Stage 2
≥160 ≥100
hypertension
(WHO and ISH guideline scomparison)
Major modifiable risk factors
• High cholesterol
• Excessive cholesterol clogs the arteries
• Low-density lipoproteins (LDLs)—“bad”
• Shuttle cholesterol from liver to organs and tissues
• Can accumulate on artery walls and be oxidized by free
radicals
• High-density lipoproteins (HDLs)—“good”
• Shuttle unused cholesterol back to liver for recycling
• By removing cholesterol from blood vessels, help protect
against atherosclerosis
• Control high cholesterol
• Guidelines for treatment of blood cholesterol are based
on an individual’s risk of developing CVD in 10 years
• Offers lifestyle modifications
• Suggests Statin therapy at different intensity doses
Cholesterol level
Cholesterol in the body
Major modifiable risk factors
• Physical inactivity
• Exercise reduces risk by:
• Controlling blood pressure and resting heart rate
• Lowering LDLs
• Increasing HDLs
• Maintaining weight
• Improving the condition of blood vessels
• Preventing or controlling diabetes
Major modifiable risk factors
• Obesity
• Risk of CVD is more likely with increasing body mass
index (BMI) ≥ 25
• Strongly associated with:
• Hypertension
• High cholesterol
• Insulin resistance
• Diabetes
• Physical inactivity
• Increasing age
• Vascular endothelial cell dysfunction
• Hypertrophy and hyperplasia of adipose tissue
 Major modifiable risk factors
• Diabetes
• Cases increase steadily, more rapid in low-&mid- income regions
• Children are at increasing risk of developing the disease
• Elevated blood glucose and insulin can damage the endothelial
cells lining the arteries, increase risk to atherosclerosis
• A major cause of blindness, kidney failure, heart attacks, stroke
and lower limb amputation.
• Loss of 5 to 10 years of life
• Healthy diet, regular physical activity, maintaining a normal body
weight and avoiding tobacco(↓risk by 30-40%), can prevent or delay
the onset of type 2 diabetes.
• Diabetes can be treated and progression can be delayed with diet,
physical activity, medication and regular screening and treatment
for complications.
Other modifiable contributing risk factors
• High triglyceride levels are a reliable predictor of
heart disease (ie. ≧ 200 mg/dL=>↑25% death risk)
• Metabolic syndrome significantly increase risk of
CVD, through inflammatory reactions
• Psychological and social factors:
• Stress
• Chronic hostility and anger
• Suppressing psychological distress
• Depression
• Anxiety
• Social isolation
• Low socioeconomic status
• Alcohol and drugs can cause serious cardiac problems
The effects of stress and emotions on the
Cardiovascular System
Major non-modifiable risk factors
• Genetics: CVD has a genetic component associated
with high cholesterol levels, blood clotting, and
obesity
• Age: ≈ 70% of heart attack victims are 65 or older
• Gender: men have higher risk earlier in life
• Estrogen production may protect against CVD in
premenopausal women
• Race and ethnicity: African Americans have a higher
risk of hypertension, heart disease, and stroke
Protecting yourself against CVD
1. Eat heart-healthy
• Decrease Fat (low saturated fats) & Cholesterol intake
• Decrease sodium intake and increase potassium intake
• Avoid excessive alcohol consumption
• Keep total fats less than 30% of total calories
• Increase fiber intake
• Eat foods rich in omega-3 fatty acids
2. Supplementary diet guide
• Intake plant stanols and sterols 植物固醇, to reduce
absorption of cholesterol & help lower LDL
• Maintain adequate intake of
• Folic acid & Vitamins B-6 and B-12 Calcium
• Soy protein
• Complex carbohydrates
• Decrease total daily caloric intake
• DASH diet plan (Dietary Approaches to Stop Hypertension)
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4. Avoid tobacco products

5. Know and manage your blood pressure
6. Know and manage your cholesterol levels
7. Develop effective ways to handle stress and anger
Strategies for reducing your risk of
cardiovascular disease
References

• Centre for Health Protection, Hong Kong. (2019).

Hypertension. Retrieved from
https://www.chp.gov.hk/en/healthtopics/content/2
5/35390.html
• Insel, C. E. P., Roth, W. T., & Insel, P. M. (2022).
Connect core concepts in health. (17th ed.). New
York: McGraw-Hill.