Heart Diesease Hypertension Stroke
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Heart Disease, Hypertension, and Stroke
Psychological Issues in Advanced and Terminal Illness
Average life expectancy in North America is 76 years.
Leading causes of death in adults are chronic illness
What are the leading causes of death across the life span?
Mortality Rates Leading causes of death
< 1 year
Children > 1 year old
congenital abnormalities; sudden infant death syndrome (SIDS) Accidents (40% of all deaths) Cancer (especially leukemia)
Adolescence
Unintentional injury Homicide AIDS
Mortality Rates Leading causes of death
Middle age
Sudden death due to heart attack or stroke Cancer
Elderly
Heart disease Cancer Stroke
Why do women live longer than men?
Potential Reasons for Gender Differences in Mortality
Females are more hardy Males engage in riskier behaviours (factor after birth and infancy) Men engage in riskier sports Males tend to hold high stress or higher risk jobs Men tend to have poorer health habits (e.g., drink more alcohol) Social support may be more protective in women
Risk Factors
Family history Marital status (adds 10 yrs in men; 4 yrs in women) Economic status Body weight Exercise Alcohol (add 2 years if drink 1-3 drinks/day)
Risk Factors - continued
Smoking Disposition (add 2 yrs if reasoned, practical) Education Environment (add 4 yrs if rural) Sleep (more than 9 hours subtract 5 years) Temperature (add 2 yrs if thermostat is < 68) Health care – regular check ups add 3 yrs
How do people adapt to chronic illness?
Adapting Under Good Circumstances
First concern upon hearing diagnosis is fears about mortality. Optimistic but tentative about plans May try to normalize activities
Risk is they may over-extend
May have feelings of helplessness
Risk is to become overly dependent
Three Themes of Adaptation
Find meaning: why illness happened or rethink priorities Gain sense of control
control symptoms and treatment
Restore self-esteem
Often by comparison with worse off others
Adapting Under Bad Circumstances
Relapse seen as a bad sign with poor prognosis Re-focuses one on the illness Need to undergo the coping process again but likely less hopeful than before.
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
Myocardium infarction (heart attack)
Muscle tissue around the heart 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 Behaviours
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.
Effects of Stress On Cardiac Risk
Psychosocial Predictors of Sudden Cardiac Death (BDI>10) 1.00
0.95
Proportion Surviving 0.90
Placebo, BDI <10 Placebo, BDI >10 AMIO, BDI <10 AMIO, BDI >10
0.85 0
200
400
Survival in days
600
800
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 clotdissolving 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:
For those who continue benefits include:
50% drop-out rate within first 6 months 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.
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
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.
Causes of Strokes 1.
Infarction – blockage in cerebral artery that cuts off or reduces blood supply a) b)
2.
Thrombosis – blood clot Embolus – piece of plaque becomes lodged in the artery.
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.
Psychological Issues in Advanced and Terminal Illness
Average life expectancy in North America is 76 years.
Leading causes of death in adults are chronic illness
What are the leading causes of death across the life span?
Mortality Rates Leading causes of death
< 1 year
Children > 1 year old
congenital abnormalities; sudden infant death syndrome (SIDS) Accidents (40% of all deaths) Cancer (especially leukemia)
Adolescence
Unintentional injury Homicide AIDS
Mortality Rates Leading causes of death
Middle age
Sudden death due to heart attack or stroke Cancer
Elderly
Heart disease Cancer Stroke
Why do women live longer than men?
Potential Reasons for Gender Differences in Mortality
Females are more hardy Males engage in riskier behaviours (factor after birth and infancy) Men engage in riskier sports Males tend to hold high stress or higher risk jobs Men tend to have poorer health habits (e.g., drink more alcohol) Social support may be more protective in women
Risk Factors
Family history Marital status (adds 10 yrs in men; 4 yrs in women) Economic status Body weight Exercise Alcohol (add 2 years if drink 1-3 drinks/day)
Risk Factors - continued
Smoking Disposition (add 2 yrs if reasoned, practical) Education Environment (add 4 yrs if rural) Sleep (more than 9 hours subtract 5 years) Temperature (add 2 yrs if thermostat is < 68) Health care – regular check ups add 3 yrs
How do people adapt to chronic illness?
Adapting Under Good Circumstances
First concern upon hearing diagnosis is fears about mortality. Optimistic but tentative about plans May try to normalize activities
Risk is they may over-extend
May have feelings of helplessness
Risk is to become overly dependent
Three Themes of Adaptation
Find meaning: why illness happened or rethink priorities Gain sense of control
control symptoms and treatment
Restore self-esteem
Often by comparison with worse off others
Adapting Under Bad Circumstances
Relapse seen as a bad sign with poor prognosis Re-focuses one on the illness Need to undergo the coping process again but likely less hopeful than before.
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
Myocardium infarction (heart attack)
Muscle tissue around the heart 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 Behaviours
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.
Effects of Stress On Cardiac Risk
Psychosocial Predictors of Sudden Cardiac Death (BDI>10) 1.00
0.95
Proportion Surviving 0.90
Placebo, BDI <10 Placebo, BDI >10 AMIO, BDI <10 AMIO, BDI >10
0.85 0
200
400
Survival in days
600
800
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 clotdissolving 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:
For those who continue benefits include:
50% drop-out rate within first 6 months 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.
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
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.
Causes of Strokes 1.
Infarction – blockage in cerebral artery that cuts off or reduces blood supply a) b)
2.
Thrombosis – blood clot Embolus – piece of plaque becomes lodged in the artery.
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.
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