Health Psychology Chapter 9: Cardiovascular Disease/Strokes/Diabetes Oct 31-Nov 7, 2007 Classes...
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Transcript of Health Psychology Chapter 9: Cardiovascular Disease/Strokes/Diabetes Oct 31-Nov 7, 2007 Classes...
Health Psychology
Chapter 9: Cardiovascular Disease/Strokes/Diabetes
Oct 31-Nov 7, 2007Classes #29-32
Heart Disease
Due to narrowing or blocking of the coronary arteries.
Angina pectoris painful cramp in chest, arm, neck, or back due
to brief blockage of oxygenated blood to the heart.
More often during exercise, stress, cold temperature, digesting large fat meal.
Little or no permanent damage
Heart Disease
Myocardium Muscle tissue around the heart
Myocardium infarction (heart attack) Prolonged blockage of blood to an area of the
heart resulting in muscle tissue damage. Symptoms of a heart attack
Pressure in chest, fullness, squeezing pain. Pain spreading to shoulders, neck, or arms Lightheadedness, fainting, sweating, nausea
Who Is At Risk of Heart Disease?
Prevalence increases with age, particularly after 45 years of age
Prior to 50s, 60s, men at greater risk than women but increases in women after menopause.
More women than men are likely to die from a heart attack
Blacks at higher risk, Asians at lower risk
Heart Disease Risk Factors
High blood pressure Family history Cigarette smoking High LDL and total cholesterol levels Physical inactivity Diabetes Obesity Stress
Why high blood pressure a risk factor?
Heart has to work harder. Since heart muscle is working harder, it
can become enlarged. Wear and tear on the arterial wall can
increase the likelihood of lipid and calcium deposits adhering to the arterial wall. This leads to hardening of the arteries.
Type A Behaviors
Hostile, cynical Judgmental (opinionated) Competitive Time urgent Uses gestures while talking Nodding of head while others are talking Intense
Physiological Reactivity
Physiological and cardiovascular reactivity to acute stress (“hot reactors”). Exaggerated increases in blood pressure,
heart rate, catecholamines, corticosteroids High levels of these hormones can
damage heart and blood vessels Presence of epinephrine (a
catecholamine) increases the formation of clots.
Framingham's Heart Study (1948)
Uncontrollable Risk FactorsFamily History and AgeGenderRace and Ethnicity
Controllable Risk FactorsHypertensionObesityCholesterol level
When do heart attacks occur?
Less likely during sleep. Among the employed, more often on a
Monday between 6 and 11 am. In part due to waking and becoming active
shortly after dreaming which increases BP. In part because of circadian rhythm effects,
increases in arousal hormones and blood pressure.
Medical Treatment
Initial treatment may involve clot-dissolving medication and close monitoring
Balloon angioplasty Tiny balloon is inserted into blocked vessel
and inflated to open blood vessel Bypass surgery
Use grafted vessel (e.g., piece from leg) to bypass blockage in artery to the heart
Medical Treatment
Medications (e.g., beta blockers, calcium channel blockers) to protect heart and improve function.
Risk management Control of high blood pressure Control of lipid abnormalities
Rehabilitation
Promote recovery and reduce risk of another attack
Heart disease is chronic condition requiring ongoing management.
Rehabilitation Includes:
Exercise Physiological and psychological benefits
Weight management Smoking cessation Lipid and BP management include dietary
changes to control lipids Reduce excessive alcohol intake Stress management
Rehabilitation
Exercise is the key component but: 50% drop-out rate within first 6 months
For those who continue benefits include: Improved self concept, perceived health,
sexual activity, involvement in social activities.
Those who stop are more likely to: Smoke, have poorer cardiac function, have
higher body weight, be more sedentary, experience greater anxiety and depression.
What is a stroke?
Tissue damage to area of the brain due to disruption in blood supply, depriving that area of the brain of oxygen.
Symptoms of a Stroke
Sudden weakness or numbness of the face, arm, or leg
(usually on one side of the body) dimness or loss of vision (usually one eye) Loss of speech or trouble talking or
understanding speech Unexplained, severe headache Dizziness, unsteadiness, or sudden fall
Causes of Strokes
1. Infarction – blockage in cerebral artery that cuts off or reduces blood supply
a) Thrombosis – blood clotb) Embolus – piece of plaque becomes lodged
in the artery.
2. Hemorrhage – happens suddenly. Less frequent than infarction but more damaging and more likely to cause death.
Stroke Risk Factors
Rare up to age 55, than risk increases sharply with age (doubling with each decade).
More common in men but women more likely to die from them.
Rates highest among blacks and lowest among Asians.
Family history
Stroke Risk Factors
High blood pressure Cigarette smoking Heart disease, diabetes, and their risk
factors such as obesity and physical inactivity.
High red blood cell count (making the blood thicker and likelier to clot).
Mini-strokes – transient ischemic attacks (TIA)
Effects of a Stroke
Some motor, sensory, cognitive, or speech impairment usually occurs
Limitations may be permanent but lessen in severity over time.
Younger patients recover better Impairments caused by hemorrhages
more easily overcome than those caused by infarctions.
Effects of Stroke
Motor impairments often due to paralysis on one side of the body (side opposite to brain damage). After about 6 weeks of rehab about 50% of
patients can perform independently (many with cane or walker).
Language, learning, memory, and perception problems depend on location of the injury.
Effects of Stroke
Left-hemisphere damage more commonly associated with language problems called aphasia. Receptive aphasia – difficulty understanding
verbal information. Expressive aphasia – difficulty producing and
using language. Damage to right side of brain often
associated with difficulties in visual processing and emotions.
Psychosocial Aspects of Stroke
Denial is common Unclear whether psychological or
physiological basis. This ambiguity also applies to depression
when it occurs after a stroke. Less than ½ of the patients return to work
following a stroke.
Diabetes
Survey on 2,000 People with Diabetes (Fall 2001)
Findings: 68% do not consider cardiovascular
disease to be complication of diabetes 50%+ don’t feel risk for heart condition
or stroke 60% don’t feel at risk for high blood
pressure or cholesterol Awareness lowest among elderly,
minorities
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Diabetes-CVD Facts
More than 65% of all deaths in people with diabetes are caused by cardiovascular disease.
Heart attacks occur at an earlier
age in people with diabetes and often result in premature death.
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Diabetes-CVD Facts
Up to 60% of adults with diabetes have high blood pressure.
Nearly all adults with diabetes have one or more cholesterol problems, such as: high triglycerides low HDL (“good”) cholesterol high LDL (“bad”) cholesterol
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The Good News…
By managing the ABCs of diabetes, people with diabetes can reduce their risk for heart disease and stroke.
A stands for A1CB stands for Blood pressureC stands for Cholesterol
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Ask About Your A1C
A1C measures average blood glucose over the last three months.
Get your A1C checked at least twice a year.
A1C Goal = less than 7%
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Key Steps for Lowering A1C
Eat the right foods.
Get daily physical activity.
Test blood glucose regularly.
Take medications as prescribed.
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Beware of Your Blood Pressure
High blood pressure raises your risk for heart attack, stroke, eye problems and kidney disease.
Get your blood pressure checked at every visit.
Target BP = less than 130/80
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Key Steps for Lowering Blood Pressure
Eat more fruits and vegetables! Reduce the amount of salt in diet. Lose weight. Lower alcohol intake. Quit smoking. Take blood pressure pills.
many people require more than one pill
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Check Your Cholesterol
Several kinds of blood fats:LDL (“bad”) cholesterol - can
narrow or block blood vesselsHDL (“good”) cholesterol - helps
remove cholesterol depositsTriglycerides - can raise your risk
for heart attacks/stroke
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Key Steps for Controlling Your Cholesterol
Eat less saturated fat Foods high in saturated fat: fatty meats, high-fat
dairy products, tropical oils Eat foods high in fiber
Examples: oatmeal, beans, peas, citrus fruits
Take cholesterol-lowering medication Exercise regularly
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Meal Planning
Work with a dietitian to develop your own, personalized meal plan to help you:
Lose weight, if needed.Choose foods low in saturated fat.
Count carbohydrates (carbs).
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Exercise
A little bit goes a long way: Try being more active throughout the
day.Examples: work in the garden, play
with the kids, take the stairs
Walk - work up to at least 30 minutes of walking on most days; you can even split this into a 10-minute walk after each meal.
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Other Strategies
Get help to quit smoking.
Talk to your health care provider about taking aspirin and other medications to reduce your risk for heart disease and stroke.
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General Tips
Take steps to lower your risk of D-CVD complications: A1C < 7. Blood pressure < 130/80. Cholesterol (LDL) < 100. Cholesterol (HDL) > 40 (men) and > 50 (women). Triglycerides < 150. Get help to quit smoking. Be active. Make healthy food choices. Talk to your doctor about medication.
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