analyze the new research indicating that heart disease may affect females more than males and comment upon how gender impacts or behaviors related to disease.
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The Single Biggest Health Threat Women Face

Go Red for Women Presents Just a Little Heart Attack

Instructor Guidance
Discussion 2 covers cardiovascular health. You will particularly look at how heart disease
affects women and the programs available to help women identify heart disease and, thus
get early treatment for the condition. The signs and symptoms of heart disease present
differently in women than what is seen in men. You can learn more details about the
symptoms of both men and women at the National Heart, Lung and Blood Institute’s
website: http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/signs (Links to an
external site.)Links to an external site.. How does this information influence a person’s
life? Women are often the caretakers of others so ignore their own health care. This can be
influenced by the woman’s choices, but also by the resources within the
community. “Although the physical effects of cardiovascular disorders are seen mostly
within the individual and immediate family spheres, the physical and larger social
environment (macro perspective) can either promote or create barriers to healthpromoting activities” (Atlas, Matthews, Fritsvold, & Vinall, 2014, Section 6.2, para. 15). An
example of this is whether there is effective public transportation in a community. What
does public transportation have to do with cardiovascular health? When public
transportation is effective, people will walk a block or two to access the transportation
instead of walking out their door to the driveway and getting in the own car, driving to
their destination, and walking a few feet to the door. Far less exercise occurs when a
person drives everywhere. Small bursts of exercise like this can improve a person’s health.
6
Cardiovascular Disorders:
Congenital Heart Defects,
Heart Disease, and Stroke
Ingram Publishing/Thinkstock
Learning Objectives
1. Understand basic distinctions between heart defects, heart disease, and stroke
2. Describe how cardiovascular disorders affect different individual, familial, and social domains
3. Identify the prevalence of cardiovascular disorders within specific populations
4. Compare and contrast prevention and treatment methods for different cardiovascular disorders
5. Describe societal elements that influence diagnosis and care of cardiovascular disorders
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CHAPTER 6
Section 6.1 Introduction to Cardiovascular Disorders
6.1 Introduction to Cardiovascular Disorders
T
he literature about cardiovascular disorders can be confusing. It abounds with abbreviations and different names for the same disorder or procedure. Let’s begin by saying that the
cardiovascular system comprises the heart (cardio) plus the blood vessels, or circulatory
(vascular) system. The most common cardiovascular disorder is high blood pressure, or hypertension, which is covered in Chapter 5.
It is estimated that 83.6 million adults in the United States (or more than one in every three) had
a cardiovascular disorder in 2010 (Go et al., 2013). Table 6.1 shows how many people were diagnosed with different cardiovascular disorders in the United States in 2010, or the prevalence of
various cardiovascular disorders.
Table 6.1: Prevalence of cardiovascular disorders in the United States, 2010
Condition
Prevalence (in millions)
Hypertension
77.9
Angina (chest pain)
7.8
Myocardial infarction (heart attack)
7.6
Stroke (all types)
6.8
Heart failure
6.1
Congenital cardiovascular defects
0.65 to 1.3
Prevalence of cardiovascular disorders in the United States: hypertension = systolic pressure of 140 mmHg or over, or
diastolic pressure of 90 mmHg or over.
Note that individuals may have more than one disorder, so adding up the prevalence of each disorder does not give a
total of unique individuals.
Source: Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., & Borden, W.B. Heart disease and stroke statistics—2013
update: a report from the American Heart Association. Circulation, 127(1), p. 109. Copyright © American Heart Association. Used by
permission
As the report from the American Heart Association, “Heart Disease and Stroke Statistics—2013
Update,” makes clear in 200-plus pages, there are many different cardiovascular disorders (Go et
al., 2013). We will examine three cardiovascular disorders—briefly touching on congenital heart
defects and focusing mainly on heart disease and stroke.
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CHAPTER 6
Section 6.1 Introduction to Cardiovascular Disorders
Case Study: An Example of Cardiovascular Disorders
Ken had been diagnosed with hypertension and was treated for it for many years. One day, when he
was 49 years old, Ken experienced sudden severe chest pain and was taken to the hospital, where he
was admitted. A blocked artery in his heart was opened, and a tiny mesh tube (or stent) was inserted
into it to keep it open. He was released from the hospital a few days later, feeling much better than
before his hospitalization.
Five years later, when Ken was 54, he was working in his construction company office as usual one
morning. His coworkers could hear him talking on the phone when suddenly the talking stopped and
they heard a loud thump. They rushed in and found him unconscious on the floor. Luckily Ken’s coworkers were knowledgeable and alert; one knew cardiopulmonary resuscitation (CPR), and the other one
called 911. Ken didn’t seem to be responding to the CPR, but just a few minutes after the phone call,
they could hear the ambulance siren and the emergency medical technicians arrive. They administered
care and took Ken to the emergency room of the local hospital, where physicians tried to revive him,
but efforts were unsuccessful and he was pronounced dead. As the physician explained to Ken’s wife,
Judith, an electrical problem in his heart caused it to suddenly stop pumping blood. This is known as
cardiac arrest, or sudden cardiac arrest.
History of the Heart
Both the ancient Egyptians and Greeks believed the
heart was the center of human life, both physically
and spiritually. Later, the Romans understood the
central role of the heart in sustaining life. It was in
the second century CE that Roman physician Claudius Galen made several important observations
about the heart based on experiments in monkeys.
Galen’s work, including observations on blood circulation, valves, veins, and arteries, became the basis
for understanding heart function for the next millennium and more. However, his theory about the
four humors in the body needing to be in balance
was later disproven.
Leonardo da Vinci (1452–1519) accurately described
and sketched the four chambers of the heart, the
coronary vascular system, and the heart valves.
He also described arteriosclerosis in great detail
and asked
Leonardo da Vinci/©Bettmann/Corbis
Leonardo da Vinci was able to accurately
describe and sketch the heart.
why the vessels in the old acquire great
length and those which used to be straight
become bent and the coat thickens so much as to close up and stop the movement of the blood, and from this arises the death of the old. (Keele, 1951, p. 212)
He also noted an atrial septal defect, which he found in the course of his dissections. However, he
accepted Galen’s view of heart function (Keele, 1951).
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Section 6.1 Introduction to Cardiovascular Disorders
CHAPTER 6
In 1628, William Harvey first described blood circulation, correctly surmising that the heart
pumps blood throughout the body. In the next century, blood pressure was first measured by
Stephen Hales in 1733, and inventions of the stethoscope (in 1816 by Rene Laennec) and the
electrocardiogram (in 1903 by Willem Einthoven) made possible great strides in our understanding of the heart. Einthoven received the 1924 Nobel Prize in medicine for his invention.
The first major surgery on the great vessels near the heart was performed by Robert Gross in
1938 in an attempt to repair a pulmonary artery defect. This much-heralded operation opened
the modern era of cardiac surgical intervention. World War II probably did much to further the
cause of cardiac surgery, which was performed in the field under less than ideal conditions. The
first successful attempt to repair the hearts of “blue babies” (babies born with tetralogy of Fallot,
a heart defect that causes poor oxygenation of the blood and a resulting bluish tint, or cyanosis,
in the skin) was made by the team of Alfred Blalock, Helen Taussig, and Vivien Thomas at Johns
Hopkins Hospital in 1944.
Before modern times, most people lived active lives and tended to be lean. However, after the
Industrial Revolution in the 19th century, death from cardiovascular disorders began to increase.
Toward the middle of the century, concern about the rising epidemic raised interest in studying
what might be contributing to cardiovascular disorders, including heart disease and stroke.
Congenital Heart Defects
Congenital heart defects (also known as congenital cardiovascular defects) are structural problems in the heart or major blood vessels that form during fetal development and are present at
birth. Most occur very early in development, during
the first few weeks of pregnancy, before the mother
even knows that she is pregnant. In most cases, the
causes of congenital heart defects are unknown. We
do know that maternal obesity, diabetes, and smoking are risk factors, so it is best for women who are
planning to become pregnant to lose weight if necessary, manage their diabetes, and stop smoking.
Some congenital heart defects are minor and disappear as the child grows; some are more serious and
may result in death before birth or require surgery
before birth or soon after birth for survival. More
than one fourth of infants who have died of a birth
defect have had a heart defect (Go et al., 2013).
Some congenital heart defects are not diagnosed
until adolescence or adulthood. In this section, we
briefly cover a few of the more common congenital
heart defects.
iStock/Thinkstock
The human heart.
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Major cardiovascular defects may be identified at
birth because the infant appears blue or has low
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CHAPTER 6
Section 6.1 Introduction to Cardiovascular Disorders
blood pressure. Others are identified within the first few months of life because of breathing difficulties, feeding problems, or lack of normal weight gain. Most major defects require intervention;
some operations can be done without opening the chest, and others require open-heart surgery.
Most children with major defects have to be seen periodically by a pediatric cardiologist. After
surgery, some children lead normal lives, whereas others have limitations to their physical activity.
Table 6.2 shows the prevalence of some of the more common major congenital heart defects. To
fully understand the biology of congenital heart defects, review how a normal heart works. Visit
the American Heart Association at http://www.heart.org/HEARTORG/ to review the basics about
healthy heart functions.
Table 6.2: Prevalence of select congenital heart defects per 10,000 births
Defect
No./10,000 births
Atrioventricular septal defect
4.7
Tetralogy of Fallot
4.0
Transposition of the great arteries
3.0
Hypoplastic left heart syndrome
2.3
Truncus arteriosus
0.7
Source: Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., & Borden, W.B. Heart disease and stroke statistics—2013
update: a report from the American Heart Association. Circulation, 127(1), p. 153. Copyright © American Heart Association. Used by
permission.
Ventricular Septal Defect
Ventricular septal defect (VSD) is the most common congenital heart defect. It is an opening or
hole in the wall (or septum; the plural is septa) between the two lower heart chambers (or ventricles). The opening allows extra blood to be pumped to the lung arteries and creates extra work
for both the lung and the heart. A small VSD does not need intervention, but a larger one causes
problems and has to be closed through open-heart surgery, usually while the child is quite young
(American Heart Association [AHA], 2009b).
Atrial Septal Defect
Atrial septal defect (ASD) is an opening or hole in the wall between the two upper heart chambers (or atria; the singular is atrium). However, all children are born with this hole, which allows
blood to bypass the lungs while the child is in the womb (in utero) and receiving oxygenated blood
from the mother through the placenta. Normally, the ASD closes within a few months after birth,
but sometimes it does not. A small ASD is probably not a problem, but a large ASD needs to be
mechanically closed (AHA, 2009a).
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Section 6.1 Introduction to Cardiovascular Disorders
CHAPTER 6
Case Study: Marfan Syndrome
Ben was adopted when he was 1 day old. Diane and David had talked to his birth mother at length,
although they hadn’t actually met her before Ben was born. Diane remembers thinking that Ben’s
birth mother had unusually long slender fingers. When Ben was 4 months old, his pediatrician told
Diane that she thought he had some features of Marfan syndrome, a rare genetic disorder caused by
a defect in the gene for a connective tissue protein that affects many parts of the body, including the
aorta and heart valves. People with Marfan syndrome are often unusually tall and slender. The pediatrician made arrangements for Ben to be seen by a genetic counselor, who became their base for all
ensuing medical procedures.
Ben was 5 months old when he was examined by a Marfan specialist who confirmed the characteristic
physical traits and tested his blood. He was indeed positive for Marfan, so they arranged for Ben to be
seen by an ophthalmologist, a cardiologist, an orthopedic surgeon, and a pulmonologist. Ben is at the
more severe end of the syndrome, and will probably need cardiac surgery within the next two years.
He has worn glasses since he was 2 years old and has been getting physical and occupational therapy
every week, first at home and later at the school he attends for special needs children.
Other Congenital Heart Defects
Atrioventricular septal defect (also known as atrioventricular canal or endocardial cushion defect)
is a large hole in the wall (septum) at the center of the heart separating the two upper chambers (atria) and the two lower chambers (ventricles). Defects in the valves that normally regulate
movement of blood from upper to lower chambers are usually present as well.
Tetralogy of Fallot has four components. The major ones are a ventricular septal defect and an
obstruction between the right ventricle and the lungs (stenosis—narrowing or constriction—of
the pulmonary valve). In addition, the aorta is misplaced over the septal defect, and the right ventricle muscle is abnormally thick.
Transposition of the great arteries reverses the aorta and pulmonary artery so that the aorta
receives oxygen-poor blood and the lungs receive oxygen-rich blood. It must be repaired for the
child to survive.
In hypoplastic left-heart syndrome, the whole left side of
the heart—including the aorta,
aortic valve, left ventricle, and
mitral valve—is underdeveloped.
This defect is fatal unless treated
within the first month of life.
Truncus arteriosus is the fusion
of two large arteries carrying
blood away from the heart in
addition to a ventricular septal defect. Surgery is needed to
repair this defect.
iStock/Thinkstock
Some children with cardiovascular defects can participate in
normal activities after repair.
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Section 6.1 Introduction to Cardiovascular Disorders
CHAPTER 6
Heart Disease
Heart disease begins with the narrowing of arteries that supply blood, oxygen, and nutrients to
the heart muscle (the coronary arteries). Narrowing results from a deposit of fats and other substances to form a thick film on the interior of the artery walls, a buildup known as plaque. The
process of plaque formation is known as atherosclerosis, or colloquially known as “hardening of
the arteries” because the arteries become stiff as plaque builds on their inner surface. As plaque
builds up, the arteries become narrower and blood flow can slow or stop, reducing the amount of
oxygen that reaches the heart muscle. As mentioned earlier, narrowing of the arteries is known
as stenosis, and the reduction of blood flow, and therefore a reduction of oxygen and nutrients, is
known as ischemia.
Coronary arteries, which branch off from the aorta near the left ventricle, supply the heart with all
the blood, oxygen, and nutrients it needs in order to pump continuously and keep blood flowing
throughout the body. Heart disease is often termed coronary heart disease or coronary artery
disease. The coronary arteries supply the blood and oxygen to the heart that allow this specialized
muscle to continue to work day in and day out. Reduced blood flow through the coronary arteries may create chest pain from reduced oxygen and buildup of waste material. This pain, known
as angina, or angina pectoris, is a symptom of heart disease. Angina is more likely to occur with
increased activity, heavy meals, stress, or emotional upset. It usually goes away with rest or treatment with nitroglycerine, a medicine that relaxes blood vessels (a vasodilator) and allows blood
flow to increase.
Cardiologists distinguish between stable angina and unstable angina. Stable angina happens predictably with exertion, emotional upset, exposure to cold, or overeating and resolves with rest or
taking nitroglycerine. Unstable angina is not predictable, may happen at rest or with light activity, does not resolve with rest or nitroglycerine, and is a warning sign of a possible heart attack.
Stable angina can go unchanged for years, but unstable angina can happen without warning,
even to those who have not experienced stable angina. Unstable angina needs to be evaluated
immediately.
In addition to angina, other common symptoms of heart disease include shortness of breath and
fatigue. Even if there is no obvious pain, reduced blood flow to the heart muscle means that some
of the heart cells die and the heart becomes weaker, which may lead to inadequacy in pumping
enough blood to meet the body’s needs (termed heart failure) or problems in the rate or rhythm
of the heartbeat (arrhythmias).
If a blood vessel to the heart becomes mostly or totally blocked, a heart attack (also known as
myocardial infarction) may result. If blood flow is not restored very quickly, a section of the heart
muscle starts to die. Depending on which coronary artery is blocked and how much of the heart
muscle becomes ischemic, a heart attack may cause permanent disability or death. The faster
blood flow can be restored, the better the outcome will be.
Warning signs of a heart attack include the following:



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chest discomfort that lasts for several minutes or that recurs—may feel like uncomfortable pressure, fullness, squeezing, or pain;
discomfort in other areas of the upper body, including arms, back, neck, jaw,
or stomach;
shortness of breath with or without chest discomfort;
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Section 6.1 Introduction to Cardiovascular Disorders


CHAPTER 6
sweating, nausea or vomiting, or lightheadedness; and
in women, more likely, shortness of breath, nausea or vomiting, and back or jaw pain
as presenting symptoms (AHA, 2013b)
Anyone experiencing any of these symptoms or witnessing them in someone else should call 911
or the local emergency response number within 5 minutes.
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