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Transcript of Listen to your heart: Good Cardiovascular Health for Life · PDF file1 Listen to your heart:...
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Listen to your heart: Good Cardiovascular Health for Life
Luis R. Castellanos MD, MPH
Assistant Clinical Professor of Medicine
University of California San Diego School of Medicine
Sulpizio Family Cardiovascular Center, La Jolla, CA
Financial Disclosures: None
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UC San Diego Health System
Sulpizio Cardiovascular Center
San Diego’s First Comprehensive Cardiovascular Center
42nd in America by U.S. News & World Report
Top 10 – Most Beautiful Hospitals in America
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UC San Diego Health System
Objectives & Take Home Points
Epidemiology and Significance of Cardiovascular Diseases
Causes of CV Diseases
Medical Treatments
Invasive Therapies
Preventive Measures
Listen to Your Heart
5 Source: AHA Heart Disease and Stroke Statistics – 2013 Update.
Major Causes of Deaths in the U.S. 2009
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
All Ages <85 85+
Deaths
Alzheimer
CLRD
Cancer
All Other CVD
Stroke
Heart Disease
UCSD Sulpizio Cardiovascular Center
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Approximately 80 million Americans suffer from Cardiovascular
Diseases (CHD, HF, HTN, Stroke, PAD)
Close to 50% of CV deaths occur from Coronary Heart Disease
Source: ACC/AHA Heart and Stroke Statistics, 2012. From MMWR, 2008;57:1221-26.
UCSD Sulpizio Cardiovascular Center
7 Source: AHA Heart Disease and Stroke Statistics – 2013 Update.
UCSD Sulpizio Cardiovascular Center
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UCSD Sulpizio Cardiovascular Center
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Progression of Atherosclerosis
UCSD Sulpizio Cardiovascular Center
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Tobacco Smoking
Family History of Early CAD
Dyslipidemia (High cholesterol)
Diabetes Mellitus
Hypertension (High blood pressure)
Advanced Age (> 65 years)
Metabolic Syndrome
Cardiovascular Risk Factors:
UCSD Sulpizio Cardiovascular Center
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Source: www.cdc.gov
Diabetes
Obesity (BMI ≥30 kg/m2)
<4% 4%-4.9% 5%-5.9% ≥6%
10%-14% 15%-19% 20%-24% ≥25%
2004 1994
UCSD Sulpizio Cardiovascular Center
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Smoking Trends for men and women
UCSD Sulpizio Cardiovascular Center
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Heart Attack
Coronary
Artery Disease
UCSD Sulpizio Cardiovascular Center
Death
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Cardiac Evaluation:
Listen to your Heart Chest pain or pressure Shortness of breath or Fatigue Palpitations
UCSD Sulpizio Cardiovascular Center
History and Physical Exam
EKG
Stress Testing Exercise Treadmill Pharmacologic Stress Test
• Dobutamine Echo
• Nuclear Imaging
• Dobutamine MRI
• Cardiac CT Angiogram
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Coronary Artery Disease & Cardiac CT Angiogram
UCSD Sulpizio Cardiovascular Center
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Coronary Angiography: Definitive Evaluation of CAD
UCSD Sulpizio Cardiovascular Center
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UCSD Sulpizio Cardiovascular Center
Coronary Artery Bypass Graft Surgery – Traditional Approach
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Peripheral Arterial Disease:
UCSD Sulpizio Cardiovascular Center
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Peripheral Arterial Disease: Before Revascularization After
UCSD Sulpizio Cardiovascular Center
Images provided by Dr. Mitul Patel and UCSD and Health System
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Carotid Arterial Disease - Revascularization
Before After
UCSD Sulpizio Cardiovascular Center
Images provided by Dr. Mitul Patel and UCSD and Health System
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UCSD Sulpizio Cardiovascular Center
Aortic Stenosis
Normal Severe Aortic Stenosis
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UCSD Sulpizio Cardiovascular Center
Severe Aortic Stenosis – Traditional Approach
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UCSD Sulpizio Cardiovascular Center
Severe Aortic Stenosis – Percutaneous Approach Transcatheter Aortic Valve Replacement - TAVR
Images by Dr. Mahmud and Dr. Patel at UCSD Division of Cardiovascular Medicine, 2013.
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UCSD Sulpizio Cardiovascular Center
Severe Aortic Stenosis
Before TAVR After TAVR
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Dyslipidemia
Diabetes Mellitus
Advance Age
Hypertension
Metabolic Syndrome
Family History of Early CAD
Prevention of CAD, PAD and Valvular Disease
Tobacco Smoking
Targeting Cardiac Risk Factors:
UCSD Sulpizio Cardiovascular Center
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Brisk walking for 30 minutes per day
Intermittent periods of activity, 10 min intervals for a total of 30 minutes per day
Exercise routine 5 to 7 times per week
Additional health benefits from more vigorous activity
Improving Cardiovascular Health
Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.
UCSD Sulpizio Cardiovascular Center
27 Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.
Effect of Exercise on Survival
UCSD Sulpizio Cardiovascular Center
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Cardiac Rehabilitation after MI, CABG,
Valve surgery or CHF
UCSD Sulpizio Cardiovascular Center
Mortality Benefits
17% reduction in recurrent Heart Attacks
15% overall mortality reduction
Morbidity Benefits
31% reduction in hospital readmissions
63% reduction in depression
Clark AM, et al. Meta-analysis; secondary prevention programs for patients with coronary artery disease.
Ann Intern Med 2005;143:659-72.
2Milani RV, et al. Impact of cardiac rehabilitation on depression and its associated mortality. The American
Journal of Medicine (2007);120,799-906
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Non-Invasive Strategies
Improvement in Cardiovascular Health via:
Healthy cardiac diet
Smoking cessation
Diabetes and BP control
Lipid lowering strategies
Exercise and weight loss
Invasive Strategies
Percutaneous Interventions – PCI and TAVR
Traditional Coronary Bypass Graft Surgery
Summary
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Any Questions ?
Thank You!
UCSD Sulpizio Cardiovascular Center