12. CORONARY HEART DISEASE of Human Being

CORONARY HEART DISEASE.pptx

1. CORONARY HEART DISEASE Taylor, S. E . ( 1999). Health Psychology . USA: McGraw- Hill Companies, Inc.

2. CHD It was not a major cause of death until the 20th century. CHD is a disease of modernization CHD is also a major chronic disease

3. What is CHD? Coronary heart disease (CHD) is a general term that refers to illnesses caused by atherosclerosis , the narrowing of the coronary arteries, the vessels that supply the heart with blood. When these vessels become narrowed or closed, the flow of oxygen and nourishment to the heart is partially or completely obstructed. Temporary shortages of oxygen and nourishment frequently cause pain, called angina pectoris , that radiates across the chest and arm. When severe deprivation occurs, a heart attack ( myocardial infarction ) can result.

4. Risk Factors for CHD BIOLOGICAL FACTORS high cholesterol, high blood pressure, elevated levels of inflammation and diabetes, BEHAVIORAL FACTORS cigarette smoking , obesity and physical inactivity Identifying people with metabolic syndrome also helps predict heart attacks. Metabolic syndrome is diagnosed when a person has three or more of the following problems: obesity centered around the waist ; high blood pressure; low levels of HDL, the so called good cholesterol; difficulty metabolizing blood sugar , an indicator of risk for diabetes; and high levels of triglycerides , which are related to bad cholesterol. Risk factors for heart disease begin to cluster by age 14, especially for those low in SES. However , all known risk factors together account for less than half of all newly diagnosed cases of CHD ; accordingly, a number of risk factors remain to be identified .

5. Biological Reactivity to Stress Biological reactivity to stress contributes to the development of CHD , that is, the increases and decreases of physiological activity that can accompany stress. The cumulative effects of reactivity damage the endothelial cells that line the coronary vessels : this process enables lipids to deposit plaque, increasing inflammation and leading to the development of lesions.

6. STRESS AND CHD Stress is an important culprit in the development of CHD and may interact with genetically based weaknesses to increase its likelihood. Acute stress involving emotional pressure , anger, extreme excitement, negative emotions, and sudden bursts of activity can precipitate sudden clinical events, such as a heart attack , angina, or death. The stress reactivity associated with these events can lead to plaque rupture and risk of a clot. This process may explain why stress can trigger acute coronary events such as heart attacks. Stress has been linked directly to increased inflammatory activity as well. Low social status is implicated in the development and course of coronary artery disease. Risk factors for heart disease are more common in individuals low in SES , especially men, and the symptoms of cardiovascular disease develop earlier. These patterns reflect the greater chronic stress that people experience , the lower they are on the socioeconomic ladder.

7. People who think of themselves as low in social standing are also more likely to have cardiovascular profiles reflecting the metabolic syndrome. Stress in the workplace can lead to the development of coronary heart disease. An imbalance between control and demands in daily life more generally (not only at work) is a risk for atherosclerosis . Social instability is linked to higher rates of CHD. Migrants have a higher incidence of CHD than do geographically stable individuals .

8. Women and CHD Although the onset of CHD typically occurs about 10 years later in women than men, more women die of heart disease than men do. Heart disease typically occurs later for women, it is more dangerous when it does occur. Women have a 50 percent chance of dying from a first heart attack, compared to 30 percent for men. Of those who survive their heart attack , 38 percent will die within a year, compared to 25 percent of men .

9. Women may be protected against early onset coronary disease by factors related to estrogen . Women who are more physically active , who get regular exercise, and who have low body fat, low cholesterol , and low triglyceride levels are less likely to develop heart disease. Social support , especially in the marriage, is associated with less advanced disease in women. Depression, anxiety, hostility, suppression of anger, and stress are all tied to elevated risk for coronary heart disease among women.

10. Personality , Cardiovascular Reactivity, and CHD Negative emotions, including anger and hostility, increase risk for metabolic syndrome. In adulthood , men show higher hostility, which may partially explain their heightened risk for CHD, relative to women. The expression of hostile emotions, such as anger and cynicism , is more reliably tied to higher cardiovascular reactivity than is the state of anger or hostility. When coupled with anger and depression, hostility predicts high levels of C-reactive protein, an indicator of inflammation.

11. Depression and CHD Depression affects the development, progression, and mortality from CHD. Depression is linked to risk factors for coronary heart disease, metabolic syndrome , inflammation , the likelihood of a heart attack, heart failure among the elderly, and mortality following coronary artery bypass graft surgery. Moreover , a recent study found that treatment for depression reduced inflammation.

12. Other Psychosocial Risk Factors and CHD Vigilant coping Anxiety Vital exhaustion Hostility Social isolation The tendency to experience negative emotions and to inhibit their expression in interpersonal situations (sometimes referred to as Type D [distressed ] personality ) may be a risk factor for CHD. On the protective side, positive emotions, emotional vitality , mastery, optimism, and general well-being protect against depressive symptoms in heart disease.

13. Management of Heart Disease The Role of Delay One reason for high rates of mortality and disability following heart attacks is that patients often delay several hours or even days before seeking treatment. Some people interpret the symptoms as more mild disorders, such as gastric distress, and treat themselves. People who believe their symptoms are caused by stress delay longer. Depression promotes delay as well.

14. Initial Treatment Some people have coronary artery bypass graft (CABG) surgery to treat blockage of major arteries. Following myocardial infarction (MI), the patient is typically hospitalized in a coronary care unit in which cardiac functioning is continually monitored. Once the acute phase of illness has passed, a program of education and intervention begins.

15. Cardiac Rehabilitation Cardiac rehabilitation is the active and progressive process by which people with heart disease attain their optimal physical , medical, psychological, social, emotional, vocational , and economic status. The goals of rehabilitation are to produce relief from symptoms, reduce the severity of the disease, limit further progression of disease, and promote psychological and social adjustment. Underlying the philosophy of cardiac rehabilitation is the belief that such efforts can stem advancing disease, reduce the likelihood of a repeat MI, and reduce the risk of sudden death. Successful cardiac rehabilitation depends critically on the patient’s active participation and commitment. An underlying goal of such programs is to restore a sense of mastery or self-efficacy ; in its absence , adherence to rehabilitation and course of illness is poor.

16. Treatment by Medication Beta-adrenergic blocking agents i.e. drugs that resist the effects of sympathetic nervous system stimulation. These drugs can have negative side effects including fatigue and impotence, and so targeting adherence is important. Aspirin helps prevent blood clots by blocking one of the enzymes that cause platelets to aggregate. Drugs called statins are now frequently prescribed for patients following an acute coronary event, particularly if they have elevated lipids.

17. Diet and Activity Level Dietary instructions and put on an exercise program involving walking, jogging, bicycling , or other exercises at least three times a week for 30–45 minutes.

18. Stress Management Stress management is an important ingredient in cardiac rehabilitation because stress can trigger fatal cardiac events. Younger patients, women, and people with little social support , high social conflict , and negative coping styles are most at risk for high stress, and therefore might be especially targeted for stress management interventions These problems can be solved by employing methods such as stress management programs . The patient is taught how to recognize stressful events, how to avoid stress when possible, and what to do about stress if it is unavoidable. Training in specific techniques, such as relaxation and mindfulness , improves the ability to manage stress.

19. Targeting Depression Cognitive-behavioral therapy for depression can have beneficial effects on risk factors for advancing disease , although benefits can be modest.

20. Problems of Social Support Social support and marriage can help heart patients recovery. Lack of social support during hospitalization predicts depression during recovery, and a supportive marriage predicts long-term survival following coronary artery bypass graft surgery, a common treatment for cardiac patients. Cardiac invalidism can be one consequence of MI : Patients and their spouses see the patient’s abilities as lower than they actually are.

21. Evaluation of Cardiac Rehabilitation Evaluations show that the addition of psychosocial treatments for depression , social support, and other psychosocial issues to standard cardiac rehabilitation programs can reduce psychological distress and the lower the likelihood that cardiac patients will experience cardiac symptoms, suffer a recurrence, or die following an acute cardiac event.