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Coronary Heart Disease (CHD)
Conditions with blockage to the heart; a chronic disease in which the arteries supply the heart become narrowed or clogged, results from either atherosclerosis or arteriosclerosis.
Cardiovascular Disease (CVD)
disorders of the heart and blood vessel sys, including stroke and coronary heart disease. Ex. stroke. (Broader)
A chronic disease in which cholesterol and other fats are deposited on the inner walls of the coronary arteries, reducing circ. in heart tissue.
Not enough oxy/blood to heart.
Also called "hardening of the arteries," a disease in which blood vessels lose their elasticity.
Pain in chest often precursor to heart disease.
Medical Treatment
1) Thinning the blood (ex. aspirin)
2) Angioplasty: ____
2) Balloons/nets to unclog artery; sometimes preventatively; very expensive; 2001 $31000 (7-10%yr inc. in general); 1/2mill/yr in U.S. have angioplasty.
Medical Treatment
2) stents: ___
2) Meshlike wire to keep artery open; hve slow released drugs to keep plaque from forming.
Medical Treatment
3) Bypass
3) Part of an artery usu. from leg grafted around blocked coronary artery/to bypass heart. 2001 $46,000, 2004. Ab. incision 8-10"; robotics for smaller incision; long distance surgery.
Dean Ornish Programs A.
Reversal and preventative. Rev: very low fat (10vs.30% of cal from fat); prev: 30% from fat. Specific diet (not longterm?); research support; lowering plaque levels.
Dean Ornish Programs B.
Specific diet (not longterm?); research support; lowering plaque levels; $2mill research grant; stress reduc; comparable to medical txt; began in 1999; covered by Medicare? $7000/person.
Dean Ornish Programs C.
Problems: long term vs. short term surgery; hospitals and pharmaceutical companies lose business; currently insurance does not cover. LDL down 40% without drugs ($12000/yr for drugs); 91% red. in chest pain, less future surgeries, radical idea.
Framingham Heart Study
5000 subjects and 5000 second generation; term "risk factors;" Tests to determine elasticity/stiffness of arteries (block blood flow); Test with images of heart, image of aorta.
Beh. Risk Factors (Changeable)
Cig. smoking, diet, lack of exercise.
Nonchangeable Risk Factors
Sex: Men more likely for CHD 46%, women (35-74 are 40% die of CHD) (500000 CHD vs. 40000 Breast cancer)
Nonchangeable Risk Factors for CHD
Prognosis: 39% of women (vs. 30%) will die of first heart attack; do not recog symptoms, do not seek care as quickly (stents not studied in women, until 1990: hormones, pregnancy); physicians usu do not recog; txt for women less aggressive when plaque discovered.
Type A Beh. Pattern
Dr. Freidman and Rosenman (cardiologists), chairs worn on edges of seats; three components: 1) exagg. sense of time urgency 2) excessive compet. and achiev. striving. 3) Hostility and agg. (excentuating key words, end sent. faster, move/eat rapidly impatience; polyphasic thought)
Type B Beh. Pattern
No impatience, excessively humble,not superiority in games.
Measurements for Type A
Hostility key component; study: shock experimenters (puzzle); Type B not higher shock given with instigation. Anger, Hostility, Aggression(AHA):20% of CHD/heartattacks follow outbursts; sym nerv activity, lower threshold, unhealthy beh to relax; less soc support; stressful wk environ.
Goals for healthy people by 2010; Nat Cancer Instit:
Death rates (colorectal, lung, prostate, breast) all combined are declining. Rate fo cancer incidents/devel the same since 1990 (slight fall in smoking).
Prevention improving (fruit/veg up slightly, alcohol, youth smoking dec. since 1997 vs. rising; screening tests high (stable 2000-2003) Colorectal cancer screening very low (inc.); slightly more sun protec.
Cells multiply in an uncontrolled fashion, tumor of cells growing; benign: not cancerous tumor; malignant: cancerous cells/tumor, can spread; Metastisized: spread to other parts of body. Carcinogen: cancer causing (ex. asbestos). Trends: 1970s fear of communicable spreading
Types of Cancer
Carcinomas (epith cells, common, breast, skin); Sarcomas (muscle, bone, cartilage); Lymphoma (lymph sys); Leukemia:
(blood, bone marrow, often childhood)
Causes for Cancer
4) Genetic risk factors: genes passed on (esp breast cancer gene) small percentage (about 5% of breast cancers linked to specific genes).
Causes for Cancer: 5) Environmental 6) Occupational
5) Radiation from sun; cell phones, powerlines?
6) Occupational: second hand smoking, asbestos (fiber into lung; ex. tiles)
Causes for Cancer: 7) Personality
study in Japan (30000 people, longit, no link); problems with link: hopelessness, insurance companies' personality tests? Ex. Arthritis personality
Breast Cancer
Self examination, preventing long stage cancers: uncomfortable, quick, scared, cost (7% of surveyed cited as reason), not recommended by doctor (30% surveyed), no symptoms or history, not needed (41% surveyed; lack of awareness.)
Breast Cancer
1) Anatomy
2) Carcinoma in situ
1) location of ducts, lobules, muscle, breast bone.
2) confined to lobules/ducts and not to fatty tissue or other parts; lobular (in lobules); ductal (starting in ducts, more common for car. in situ)
Breast Cancer
3) Infiltrating (invasive)
Lobular (can also spread); Ductal: duct but cancer cells break through and invade fatty tissue, lymph...; 80% of breast cancers.
(In general 1-2% of breast cancers are in males.)
After Discovery of Breast Cancer
Uncertainty; if malignant (blood tests to det. spreading; hormone receptor testing, estrogen, progesterone may stimulate growth; hormonal therapy for receptor positive hormones.
Diagnosis stage of cancer (very important)
Stage 1
Stage 1: Tumor less than or equal than 2 cm, has not spread to lymph nodes, central node test: one node, less invasive) Can be removed; 80% survival rate.
Diagnosis stage of cancer Stage 2
2) 2<tumor<5 and/or spread to lymph nodes on same side; 70s% survival rate.
Diagnosis stage of cancer Stage 3
3) A) Tumor > 5cm and/or spread to lymph nodes; large cancer that spread; 56% survival rate.
B) Any size but spread anywhere (chest, etc) 49% survival rate
Diagnosis stage of cancer Stage 4
4) Spread to distant sites regardless of size (ex. from chest to bone); 16% survival rate.
Cancer decisions
Masectomy simple: keep lymph nodes under arm; radical (lymph nodes, part of chest wall, muscles under breast)

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