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Rice BIOE 301 - Technologies for Treatment of Heart Disease

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Technologies for Treatment of Heart DiseaseLectures 17-193.18.08Louise Organ(and Vishal Gupta)[email protected] Last Tuesday 3/11• Cost-effectiveness of new technologies• Advantages and disadvantages– Balancing effectiveness with cost-effectiveness• What’s a good sell?• What’s ethical?• Variations between developed and developing countriesFour Questions• What are the major health problems worldwide?• Who pays to solve problems in health care?• How can technology solve health care problems?• How are health care technologies managed?Outline: Treatment of Heart Disease• Burden of cardiovascular disease (CVD)• Cardiovascular system• Measuring cardiovascular health• Valve diseases• Atherosclerosis and treatments–Stroke– Heart attack• Heart failure and treatmentsMuddiest point/Clearest pointBurden of Cardiovascular Disease (CVD)What is Cardiovascular Disease (CVD)• Generally: all diseases that involve the heart and blood vessels– Valve diseases• Typically: those diseases related to atherosclerosis– Cerebrovascular disease •Stroke– Ischemic heart disease • Coronary artery disease (CAD)Global Burden of CVD• In 1999: CVD contributed to a third of global deaths – 80% are in low and middle income countries• By 2010: CVD is estimated to be the leading cause of death in developing countries – General improvements in health make CVD a factor in overall mortality rates• In 2003: 16.7 million deaths due to CVD– Cost of care for these conditions is high2002 Worldwide MortalityMortality in Developing CountriesUS Burden of CVD•CVD:– 61 million Americans (≈ 25% of population)– Accounts for > 40% of all deaths -- 950,000/year• Cost of CVD disease: – $351 billion• $209 billion for health care expenditures• $142 billion for lost productivity from death and disability• Stroke – Third leading cause of death in the US• Ischemic Heart/CAD– Leading cause of death in US– Coronary heart disease is a leading cause of premature, permanent disability among working adults US Burden of CVD: Heart Attack• Consequences of ischemic heart disease– Narrowing of the coronary arteries that supply blood to the heart• Each year:– 1.3 million Americans suffer a heart attack – 460,000 (≈ 40%) are fatal– Half of those deaths occur within 1 hour of symptom onset, before person reaches hospital• Onset is often sudden– Importance of preventionRisk Factors of CVD• Risk Factors:– Tobacco use– Low levels of physical activity– Inappropriate diet and obesity– High blood pressure– High cholesterol For almost all individuals these are modifiable!!!Early Detection of CVD• Screening for CVD:– Measure blood pressure (BP) annually• 12-13 point reduction in blood pressure can reduce heart attacks by 21%– Check cholesterol every 5 years• 10% drop in cholesterol can reduce heart attacks by 30%• Patient compliance– High BP: not under control in 70% of patients– High cholesterol: not under control in 80% of patientsThe Cardiovascular SystemCardiovascular System• Anatomy and Physiology– Vessels– Heart–Valves• How to we assess our risk factors?– Measure BP and cholesterol levels• How to we measure the health and functionality of our cardiovascular system?– Listen to heart sounds– Quantitative parameters for heart functionFig 14.7 a-d – The Cardiovascular System Silverthorn 2ndEd Fig 14.7 e-h – The Cardiovascular system Silverthorn 2ndEdThe Heart as a Pump• The right atria fills with blood returning to heart from the vena cava– Tricuspid valve separates right ventricle• Right ventricle pumps blood to lungs to be oxygenated– Pulmonary valve separates pulmonary artery• Left atria fills with oxygen rich blood from pulmonary vein– Mitral (bicuspid) valve separates the left ventricle• Left ventricle pumps blood to body – Aortic value separates the aorta• Filling is the “resting” state -- diastole• Pumping/contraction is the “active” state -- systolehttp://www.pbs.org/wgbh/nova/eheart/human.html Four Heart Valveshttp://www.uabhealth.org/14549/• Two types–AV• Atria/ventricle• 2 or 3 flaps• Right: tricuspid • Left: mitral/bicuspid– Semilunar• Blood leaves the heart•3 cusps• Right: pulmonary• Left: aorticMeasuring CV HealthMeasuring CV Health• Heart sounds• Blood Pressure (BP)• Serum cholesterol levels/lipid panel• Echocardiogram• ElectrocardiogramMeasuring CV Health: Heart Sounds• Heart sounds are produced by valve closure• Normal heart sound is “lub-dup”– Lub: AV valves close– Dup: Semilunar valves close• Abnormalities can produceheart murmurs– Not always though– EchocardiographyMeasuring CV Health: Blood Pressure• Normal blood pressure:– Varies from minute to minute– Varies with changes in posture– Should be < 120/80 mm Hg for an adult• The higher/top number + systolic• The lower/bottom number =diastolic• Pre-hypertension:– Blood pressure that stays between 120-139/80-89 • Hypertension:– Blood pressure above 140/90 mm Hg• My blood pressure = 108/64http://www.medicaldiscoverynews.com/shows/bloodpressure.How Do We Measure Blood Pressure?http://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH15/FG15_07jSphygmomanometer• Increase cuff pressure > systolic– No blood flow in arm• Gradually release pressure• Cuff pressure = systolic– Turbulent rush of blood gives Korotkoff sounds• Cuff pressure = diastolic– No compression of tBlood Pressure Activity• Groups of 6– Even numbers since you’ll need a partner• Measure each person’s blood pressure twice• Write down the results each time• Get an average BP for each person• Get an average for your entire group• We’ll make a class average and compareMeasuring CV Health: Serum Cholesterol• LDL (low-density)– “bad” cholesterol– Cholesterol builds up inside blood vessels • HDL (high-density)– “good” cholesterol– Removes cholesterol from vessels to liver for excretionhttp://www.medicaldiscoverynews.com/shows/transfats.htmlInterpretation of Serum Lipid LevelsTotal CholesterolLDL HDLTriglyceridesOptimal Under 100 Above 60Desirable Under 200 Under 130 Below 150Borderline200-239 130-159 150-199AbnormalOver 240 Over 160 Below 40 Above 200Serum Cholesterol Levels: Case StudyInterpretation of Serum Lipid LevelsTotal CholesterolLDL HDLTriglyceridesOptimal Under 100 Above 60Desirable Under 200


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