BIOE 301Lecture 4:Leading Causes of Mortality, Ages 45-60Global Health ChallengesGeoff PreidisMD/PhD candidateBaylor College of [email protected] Developing World1. HIV/AIDS2. Unintentional injuries3. Cardiovascular diseases4. Tuberculosis Developed World1. Unintentional injuries2. Cardiovascular diseases3. Cancer4. Self-inflicted injuriesSummary of Lecture 3:Leading Causes of Mortality Ages 15-441. HIV/AIDS While working at an outreach clinic in Africa, you encounter an HIV-positive woman with a positive pregnancy test. By what routes can her baby contract HIV? What can you do to lower this risk? How effective are the measures you propose?1. HIV/AIDS2. Unintentional Injuries Do unintentional injuries account for more deaths in developed or developing countries? Give several reasons why.3. Cancer and Cardiovascular Diseases Will be discussed today!4. Tuberculosis If your next PPD skin test is positive, what will your doctor do next?4. Tuberculosis Primary or latent? Do you worry about resistance?4. Self-Inflicted Injuries What disease ranks #1 in DALYs in developed countries? How can we prevent these injuries?Lecture 4:Leading Causes of Mortality Ages 45-60 Developing World1. Cardiovascular diseases2. Cancer (malignant neoplasms)3. Unintentional injuries4. HIV/AIDS Developed World 1. Cardiovascular diseases2. Cancer (malignant neoplasms)3. Unintentional injuries4. Digestive Diseases1. Cardiovascular Diseases70ml per beat… 1.3 gallons per minute… 1,900 gallons per day…700,000 gallons per year… 48 million gallons by age 70…1. Cardiovascular Diseases Burden of Cardiovascular Diseases Ischemic Heart Disease Epidemiology Pathogenesis Diagnosis Treatment Cerebrovascular Disease Epidemiology Pathogenesis Diagnosis TreatmentBurden of Cardiovascular Diseases:Ages 15-44 768,000 people ages 15-44 die as a result of cardiovascular disease every year Most common causes: Ischemic heart disease (286,000 deaths) Cerebrovascular disease (159,000 deaths) 2 million people ages 45-60 die as a result of cardiovascular disease every year Most common causes: Ischemic heart disease (1 million deaths) Cerebrovascular disease (625,000 deaths)Burden of Cardiovascular Diseases:Ages 45-60Ischemic Heart Disease: Epidemiology United States 12 million people have coronary artery disease Causes more deaths, disability and economic cost than any other illness Risk factors Positive family history Diabetes Hyperlipidemia Hypertension SmokingIschemic Heart Disease: Pathogenesis Atherosclerosis Causes decrease in myocardial perfusion Most common symptom is angina Stable angina (75% lumen blockage) Typically a 50-60 yo man or 65-75 yo woman Heaviness, pressure, squeezing, smothering or choking Localized to chest, may radiate to left shoulder and arms Lasts 1-5 minutes Unstable angina (more than 80% blockage) Patients with angina that is: New onset and severe and frequent Accelerating Angina at restEvolution of a heart attack:1. Endothelial injury2. Fatty deposits3. Fibrous cap with necrotic core4. Unstable plaques rupture, thrombogenic core causes blood clots5. Blood clots can lead to complete occlusion6. Heart muscle supplied by occluded artery dies7. If patient survives, affected heart muscle is replaced by scar tissueIschemic Heart Disease: Pathogenesis•In the US, 30% of patients do not survive a first heart attack•For 50% of CAD patients, their first symptom is a heart attackIschemic Heart Disease: Diagnosis Usually made by history Physical exam may reveal other disorders Lipid disorders Hypertension Diabetes Testing EKG Stress Testing Coronary arteriographyhttp://www.columbiasurgery.org/divisions/cardiac/images/novartis_207B.jpgIschemic Heart Disease: Treatment Medical management (may relieve symptoms of CAD, but does not reduce coronary blockage) Nitrates Increase myocardial oxygen supply, systemic vasodilation Beta blockers Inhibit increases in heart rate and contractility Decrease myocardial oxygen demand Calcium channel agonists Coronary vasodilators Thrombolysis CABG (Coronary Artery Bypass Grafting) PTCA (Percutaneous Transluminal Coronary Angioplasty)CABGPTCACerebrovascular Disease: Epidemiology Third leading cause of death in the US Most prevalent neurologic disorder 87% caused by ischemia and resulting infarctionCerebrovascular Disease: Pathogenesis Causes of stroke: Blood vessel supplying the brain is blocked Thrombosis (clot in vessel) Embolism (clot breaks off and lodges in blood vessel in brain) Vasoconstriction or spasm Venous collapseCerebrovascular Disease: Pathogenesis Abrupt onset with focal neurologic deficit Usually mini-event or warning signs 15% Transient Ischemic Attacks (TIAs) Reversible ischemia Some lasting 24-72 hours Completed stroke Maximal deficit within hours Often patient awakens with completed stroke Usually preceded by TIA Progressive stroke Ischemia worsens min. to min. or hour to hourCerebrovascular Disease: Diagnosis History Exam Imaging CT Scan MRI MR AngiographyCerebrovascular Disease: DiagnosisCerebrovascular Disease: Treatment Thrombolysis Rehabilitation Experimental Angioplasty Heparin Coumarin Aspirin2. Cancer Cancer Overview Burden of Cancer Pathogenesis of Cancer Cancer Diagnosis Treatment of Cancer Cancer and Infectious Diseases Lung Cancer Epidemiology Clinical Manifestations TreatmentCancer Overview Cancer is a group of diseases characterized by uncontrolled cell growth Cancer cells usually form a tumor Abnormal mass of tissue Growth exceeds that of normal tissue Purposeless and preys on host Two types of tumors: Benign, Malignant Disease results from: Abnormal growth, loss of normal function Invasion, compression of adjacent tissues Metastases to distant sites in the bodyBurden of Cancer 2nd leading cause of death in US 1 of every 4 deaths is from cancer Nearly 1/2 of all men and 1/3 of all women will develop cancer at some point in their lives 5-year survival rate: 59% Annual costs: $107 billionCancer kills 580,000 people ages 15-44 each year throughout the worldMost common causes, ages 15-44:Liver Cancer (68,000 deaths per
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