BBH 101 Exam 3 Professor Smyth Complete study guide and class notes March 17 th 2014 I ISSUES OF THE HEART CARDIOVASCULAR A Contributors to CVD 1 Diet 2 Exercise 3 Smoking 4 Psychosocial factors B Hypertension 1 Blood pressure BP i Systolic BP arterial pressure during contraction a Larger number ii Diastolic BP arterial pressure during relaxation iii Increased BP brought on by a b Vasoconstriction of the arteries 2 Hypertension is sustained high blood pressure Increased cardiac output more blood leaving the heart i Hypertension contributes to heart attacks and strokes ii Heart is still having to work hard even when at rest C Artery blockage sticks 1 Healthy artery does not have plaque and the inside walls are slippery so nothing i Smoking and hypertension increases adhesive capabilities making fatty molecules more likely to stick 2 Atherosclerosis narrows artery with plaque i Clogs artery 3 Unstable plaque i Can disassociate from cell wall and float through arteries and cause mechanical problems in heart and other organs D Coronary Heart Disease CHD 1 Atherosclerosis 2 Angina pectoris the narrowing of the arteries periodic chest pains i Result of reduced oxygen supply to heart 3 Myocardial infarction heart attach i Brought on by a cutoff of oxygen to the heart II PERSONALITY AND CORONARY HEART DISEASE A Type A 1 Time urgency 2 Competitive strivings 3 Easily aroused anger B Type B 1 Relaxed 2 Non competitive 3 Less angry C Type A and heart health 1 Early clinical impressions i Formulated by two physicians ii Had a subset of men whom they were treating for heart disease early a Young b Disproportionally type A 2 A behavioral and emotional style marked by an aggressive unceasing struggle to achieve more in less time often in competition with other individuals forces 3 Personality shapes behavior 4 Early research supported a cardiovascular risk from Type A i Found that 70 of middle aged men with CHD were Type A a Compared to 46 of middle aged men who were healthy D Are you type A 1 Two general approaches to assessing i Interview observation a Superior to self report but more difficult ii Self report E The toxic component of Type A 1 Cynical hostility and anger i Suspiciousness ii Resentment iii Frequent anger iv Antagonism v Distrust of others 2 A person who believes the world is out to get them 3 Multiple negative pathways to heart risk i Increased cardiovascular and psychophysical reactivity March 13 2014 I CYNICAL HOSTILITY A Why is cynical hostility so bad 1 Multiple negative pathways to heart risk 2 Increased CV and psychophysical reactivity 3 Promote hostile angry interpersonal exchanges i 12 3 hostile exchanges day in the study 4 Decreased social support i Losing protective factor B Evaluating cynical hostility 1 Total up numerical answers 0 60 i 0 10 low risk ii 11 20 Some risk iii 21 35 moderate risk iv 36 high risk more than twice as likely v 40 50 more than four times as likely formal management required 2 Interacts strongly with lifestyle risks i Protected by healthy lifestyle exacerbated by unhealthy lifestyle II FACTORS THAT POSE CARDIOVASCULAR RISK A Lifestyle factors 1 Family history of cardiovascular illness i Parents particularly 2 High blood pressure 3 Smoking 4 Obesity 5 High serum cholesterol 6 Low physical activity 7 Chronic stress 8 Job strain i High demand pressure and low control B Combination of hostility risk and lifestyle risk 1 Risk synergizes 2 Protected b healthy lifestyle 3 Exacerbated by unhealthy lifestyle C Total CV risk estimate 1 Exponential growth curve 2 Psychosocial risks interact with lifestyle risks III RISK FACTORS FOR MYOCARDIAL INFARCTION A Interheart 1 Examined the effects of modifiable risk factors associated with myocardial infarction heart attack 2 Sampled people from 52 counrties i 30 000 individuals 3 Examined odd ratios B Most important risk factors 1 Diabetes 3 08x as likely 2 Smoking current 2 95x as likely 3 Psychosocial factors 2 51x as likely i Stress depression and low perceived control 4 Hypertension 2 48x as likely 5 Abdominal obesity 2 24x as likely 6 All risk factors combined 129 2x as likely 7 Effects were almost identical across the wide range of countries IV LIFESTYLE APPROACHES A Dean Ornish program 1 Late 80s early 90s 2 Total lifestyle change program 3 Stress management exercise and a very low fat diet i Only 8 of caloric diet comes from fat 4 1 2 week intensive in patient 5 1 year of group sessions once week i Supportive group environment 1 Not clear what the active ingredients are 2 Expensive to administer 3 Low retention 4 Low compliance with outpatient 5 Relapse when return to normal environment 6 Led to improvements in angina and some reversal in arterial blockage B Problems C Ongoing work focuses on integrating family and social structures in natural environment 1 Work churches etc th 2014 March 24 I PAIN A Betrand Russell on pain course When asked by his dentist Where does it hurt he replied In my mind of B Pain and the capacity to endure pain There is something about the experience of pain that is in the brain Painful activities events occur very often We often endure them quite well i At least for a period of time ii Pain is okay unless it is too much or too long C What sort of things Injuries some diseases Sports exercise infant falling tattoos piercing etc Ritualistic behaviors bondage S M etc people willfully engage in these behaviors II PAIN EVALUATION A Pain serves a useful purpose B Pain is often ignored in medical training Tells us about damage dysfunction threat Pain in epiphenomenon Need to get to underlying cause Pain is symptom but we want to know where the pain is coming from in order to be treated But important existentially i Pain also determines to a large degree satisfaction with care 1 2 1 2 1 2 3 1 1 2 3 4 ii Pain is the number one reason that people seek medical treatment C Evaluation pain in the laboratory Typical goal is to induce pain Cold pressor Electric stimulation May be standardized externally or internally i External Time severity ii Internal Pain report i Generalizability Although useful some problems exist with this method a To the real world ecological validity b To other kinds of pain stimulus generalizability D Evaluating pain in natural setting There is no dip stick for pain People with similar conditions experiences can report widely dissimilar Similar to symptom report pain report is influenced by a variety of factors E Pain in Context 1 A variety of cultural rituals