Cardiovascular Disease

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Cardiovascular Disease
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Hyperlipidemia

• Elevated Cholesterol
• Poor Cardiac Risk Ratio
• Elevated Triglyceride

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Elevated Cholesterol

• Elevated Low Density Lipoprotein
• Low Density Lipoprotein carries cholesterol from
  the liver to the periphery. This lipoprotein is
  most closely associated with increased risk of
  coronary artery disease and heart attack.

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LDL

• It is now thought prudent to maintain LDL levels
  of 130 mg/dl or lower.
• HDL levels of 35 mg/dl or greater are desirable.
• Total cholesterol to HDL ratio should be 41 or
  less, i.e.(Total Cholesterol 200, HDL 50).

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High Density Lipoprotein

• HDL carries cholesterol from periphery back to
  liver to be excreted or recycled.
• High levels are favorable.
• With sufficiently high HDL, a person can have a
  higher total cholesterol and still be protected
  against coronary artery disease.

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High Triglycerides

• The combination of high LDL and high
  trigylcerides is the most lethal
• High triglycerides is related to sugar intake

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Risk Factors for CAD

• Age (male 45 female 55)
• Family History
• Cigarette Smoking
• Hypertension 140/90
• Low HDL
• Diabetes Mellitus

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Coronary Artery Disease

• Following significant atherosclerotic
  accumulation in coronary arteries, symptoms will
  develop.
• Angina pectoris is the chest pain associated with
  coronary artery disease

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Angina

• Chest pain of
• Pain is brought on by exertion and relieved by
  rest
• Can be described as sharp and stabbing or
  pressure-like and squeezing
• Not all persons with CAD have this symptom

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Angina (continued)

• If blockage exists in the absence of angina it is
  termed silent ischemia.
• The pain of angina is due to lactic acid build up
  in ventricles as a result of poor oxygenation due
  to blocked vascular supply of nutrients to heart
  muscle.

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Stable Angina

• The previously described angina is called stable
  or simple angina.

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Pre-infarction Angina

• There is another form called unstable angina or
  pre-infarction angina.
• It can occur at any time (even at rest or during
  the night)
• Denotes worsening of narrowed arteries
• I.E. Pre-Infarction

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Prinzmetal Variant

• A third type is due to vasospasm, called
  prinzmetal variant.
• This is related closely to stress
• There may be little or no coronary artery
  occlusion
• There may be superimposed CAD

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Angina

• May be improved with Vitamin E supplementation
• Do NOT tell the patient this!
• Just recommend the E and see what happens
• As chiropractors we are NOT authorized to treat
  heart disease.

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Pain Relief

• Mechanism of pain relief offered by Vitamin E
  supplementation is that Vitamin E acts as an
  anti-platelet aggregation factor
• Platelets that aggregate form small clots,
  blocking arterioles, causing ischemia

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B-6

• Supplemental Vitamin B-6 lowers levels of
  homocystine. Homocystine is a major cause of
  atherosclerotic plaque formation

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Coenzyme Q-10

• Beneficial nutrient for heart muscle
• Administration following heart attack improves
  recovery and is related to reduced repeat attacks
• Maintenance with Co-Q-10 thought to be preventive
• Widely used in Europe

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Copper

• Trace amounts of copper needed for all elastic
  tissue.
• Relevant to aortic disease

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Vitamin C

• The antioxidant role of C is beneficial in
  preventing atherosclerosis and in preventing
  already existing disease from progressing.
• Collagen component keeps vessels healthy

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Multiple Minerals

• A good balance of minerals play a role in
  electrolyte balance and benefits heart
  performance.

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Other Recommendations

• Exercise on a regular basis
• Weight Loss
• Prevent glucose intolerance
• Stress Reduction
• PMA

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Nutritional Help

• Dont attempt or claim to help CAD with
  nutritional intervention
• However
• With proper counseling, however, pain relief may
  be a realistic goal.

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Myocardial Infarction

• Without intervention eventually the ischemia will
  become necrosis
• This is an M.I.
• There are varying degrees of intensity of M.I.s,
  from silent to immediate death.

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Signs Symptoms

• A list of signs and symptoms is useful, but
  remember not every patient has any or all of
  these SSs.
• Retrosternal chest pain (squeezing pressure
  or intense pain)
• MAY radiate to arm (often left), shoulder (often
  left) neck or jaw

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SS (Continued)

• Levines Sign (fist over heart)
• Dyspnea
• Anxiety
• Nausea Vomiting
• Diaphoresis
• Orthopnea

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SS (continued)

• May have been preceded by angina.
• Females often have only extreme fatigue as
  precursor

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Exam Findings M.I.

• Elevated jugular pulse
• Increased heart rate
• May have faint heart sounds
• S3 and/or S4
• Increased breath sounds
• Blood pressure MAY lower
• Fever (after 24 hours)

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M.I.

• If M.I. Diagnosed or Suspected
• Transfer patient to hospital via ambulance.
• Immediately call ambulance
• Keep patient quite and comfortable
• If family member present suggest an aspirin
• Do NOT adjust (unless requested or close friend
  or family)

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Lab Values

• CPK Myocardial Band (earliest sign)
• LDH
• SGOT
• ESR (latest and longest lasting)
• WBC elevation

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CPK

• Used to monitor progress or number of attacks
• Raises within 4-6 hours and returns to normal
  within 3 days (failure denotes repeated attacks)

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ECG

• Not appreciably predictive
• Not necessarily correlated with clinical
• Characteristics
• Elevated S-T segment
• Abnormal Q wave
• T-wave inversion

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Differentials

• Acute pericarditis
• Fever precedes pain
• Pleuritic pain
• Pain relieved positionally
• Friction rub
• No ECG changes
• SGOT LDH normal

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Differentials

• Pulmonary Embolism
• Dyspnea more severe
• Recent surgical procedure or bedridden
• No history of angina
• Cardiac findings may be similar however, PE
  must be transferred via ambulance as well.

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Aortic Dissection

• Younger patient
• May have collagen disease or Marfans
• History of hypertension
• Stroke-like symptoms may accompany
• Must be transferred via ambulance anyway

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Recommendations

• Coronary Artery Disease improves with
• Weight Loss
• Regular Exercise
• Stress Reduction
• Positive Mental Attitude
• Anecdotal evidence of help through adjustments

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Other Cardiovascular Conditions

• Aortic Dissection

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Aortic Dissection

• A false channel is forged in aorta and blood
  travels down this false channel. Can be a lengthy
  dissection into abdomen or a rather small
  dissection exits lumen and re-enters in a
  relatively small area.

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Aortic Dissection

• A rare and often fatal condition
• Approximately 2000 cases in U.S. per year
  (although with better diagnosis this number is
  rising)
• Associated with hypertension
• Associated with aortic valve disease

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Signs Symptoms

• Sudden, severe retrosternal chest pain
• May faint or have paresis
• If arterial branches cut off, may suffer organ
  failure
• If brain loses blood supply, stroke symptoms
• May extend into abdomen with symptoms

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Treatment

• Emergency medical treatment necessary
• Transfer via ambulance
• Need immediate lowering of blood pressure
• Surgery sometimes required, but poor prognosis
• Generally a younger person than in M.I.
• Smokers are more prone

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Non-dissecting Aneurysms

• Abdominal aorta is most common
• Other vessels may have, especially popliteal
• In brain, often called berry aneurysm

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Abdominal Aneurysm

• Very common condition
• In men over 65 years old
• Especially in smokers
• Especially in obese
• Often diagnosed as an incidental finding on
  abdominal radiograph
• Lateral film most likely to demonstrate

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Signs Symptoms

• Often is asymptomatic
• May see as pulsating mass
• May have abdominal bruit upon auscultation
• Aortic pulsations may palpate as wider than normal

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Chiropractic Treatment

• Should plan to alter techniques used to prevent
  damages
• Refer for diagnostic ultrasound (for evaluation)
• Often surgery is performed, unless a poor risk
  then may watchit
• DC better watch it too!

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Techniques

• No abdominal suspension
• No lumbar rolls
• Padding for prone lying