BBH 101 Smyth EXAM 3 STUDY GUIDE Issues of the Heart biopsychosocial influences on Cardiovascular disease o Contributors to CVD Large range health behaviors diet exercise smoking Environment Genetics Psychosocial factors o Hypertension HIGH blood pressure High BP contributes to heart attacks and stroke Blood pressure BP systolic diastolic Systolic BP is arterial pressure during contraction o Outflow Diastolic BP is arterial pressure during relaxation Increased blood pressure is brought on by o Increased cardiac output more blood leaves the heart i e during exercise during fight or flight o Vasoconstriction of the arteries more blood trying to fit through smaller constricted area Hypotension low blood pressure very rare Doesn t really contribute to heart attack and stroke Leads to fainting o Cardiovascular disease Coronary Heart Disease CHD Arteriosclerosis narrowing of the arteries Angina Pectoris periodic chest pains o Reduced oxygen supply to the heart Myocardial Infarction MI heart attack o Brought on by a cutoff of oxygen to the heart muscle Personality and CHD Type A vs Type B o Type A time urgency competitive strivings easily aroused anger Behavioral and emotional style marked by an aggressive unceasing struggle to achieve more in less time often in competition with other individuals forces 70 of middle age men with CHD were Type A How to assess type A two general approaches Behavioral interview observation o Superior to self report but far more difficult o Try to provoke the type A attitude Self report Toxic component of type A Cynical hostility and anger Suspiciousness resentment frequent anger antagonism distrust of others Why is cynical hostility so bad o Multiple negative pathways to heart risk Increased CV and psychophysical reactivity Promote hostile angry interpersonal exchanges Decreased social support o Type B relaxed non competitive less angry Lifestyle factors that pose CV risk o Family history of CV illness Particularly parent o High blood pressure o Smoking o Obesity o High serum cholesterol o Low physical activity o Chronic stress o Job strain high demand pressure and low control Combination of hostility risk and lifestyle risk o Risk synergizes INTERHEART o Examined the effects of modifiable risk factors associated with myocardial infarction 52 countries 30 000 individuals Examined the odds ratio How much more likely is one to have a heart attack with the risk factor o Diabetes 3 08 x o Current smoker 2 95 x o Psychological distress 2 51 x Stress depression and low self efficacy control o Hypertension 2 48 x o All risk factors combined 129 2 x Lifestyle approaches o Dean Ornish program Identify people at risk Program components recommend help with stress management exercise very low fat diet 1 2 week intensive in patient stay at a resort like place in California Supportive group environment Send you home with healthy cook books set you up with support groups at home etc Lead to improvements in angina and some reversal in arterial blockage o Ongoing work focuses on integration family and social structures in natural environment o Problems Not clear what the active ingredients are Expensive to administer Low retention Low compliance with outpatient Relapse when return to normal environment Pain and Capacity to Endure Pain o Painful events activities occur very often o We often endure pain very well At least for a long period of time o What is pain Injuries diseases illnesses Can become in pain from Sports exercise infant falling tattoos piercings etc o Pain serves a useful purpose it s a symptom Tells us about damage dysfunction threat Pain is often ignored in medical training Pain is and epiphenomenon Need to get to the underlying cause because it is a symptom Pain determines satisfaction with care If your care was good pain should reduce If care was not good pain will remain Evaluating Pain in the Laboratory o Typical goal REDUCE PAIN Cold pressor or electric or thermal heat stimulation o May be standardized externally or internally time severity pain report Evaluating Pain in Natural Settings External Internal o There is no dip stick for pain no biological measure o People with similar conditions experiences can report widely dissimilar levels of pain o Similar to symptom report pain report is influenced by variety of factors Personality expectations situation culture Management of Chronic Pain o Chronic pain management has some general themes Education social skills medication psychological consequences of pain non pharmacological treatment options etc Pain reduction attempts moderate exercise relaxation stretching biofeedback etc Emotional consequences management therapy support groups etc to manage distressing thought patterns depression anxiety etc associated with chronic pain Catastrophizing pessimism lack of control negative outcome expectancies making Pain in Context pain worse than it really is o A variety of cultural rituals especially religious and coming of age rituals can involve pain o Despite objective evidence of damage and or painful stimuli activity continues o Bertrand Russel when asked by his dentist where does it hurt he replied In my mind of Experience of pain course Gate Control theory o Nerve endings in skin send messages to the spinal cord through one of two types of nerve fibers Sharp acute piercing pain messages are relayed through myelinated fast fibers Basically as an express lane to the spinal cord for emergency situations Dull chronic aches and pains are carried by slow nerve fibers that also respond to non painful touch o Nervous system can process only a limited number of sensory signals at one time Relative balance of pain and non pain messages o When the system is at a processing capacity full a neural gate in the spinal cord either blocks or allows the passage of additional signals to the brain gate is not a physical structure but a pattern of competing and or inhibitory neural activity Key point pain signals to the brain can be blocked o There is both ascending and descending Ascending Descending These two can be added together adding touch and thermal endorphins top down o You can partially shut the gate by creating competing sensations i e if you fall and hurt your knee rubbing it hard will send new impulses into the spinal cord and inhibit other pain signals partially why we put ice on a bruise or scratch near the muscle deep tissue electrical stimulation and acupuncture may work in the same way Placebo effect a