Bioengineering and World HealthSummary of Lecture 3: Leading Causes of Mortality Ages 15-441. HIV/AIDS2. Unintentional Injuries3. Cancer and Cardiovascular Diseases4. Tuberculosis4. Self-Inflicted InjuriesLecture 4: Leading Causes of Mortality Ages 45-601. Cardiovascular DiseasesSlide 10Burden of Cardiovascular Diseases: Ages 15-44Burden of Cardiovascular Diseases: Ages 45-60Ischemic Heart Disease: EpidemiologyIschemic Heart Disease: PathogenesisSlide 15Ischemic Heart Disease: DiagnosisSlide 17Ischemic Heart Disease: TreatmentCABGPTCACerebrovascular Disease: EpidemiologyCerebrovascular Disease: PathogenesisSlide 23Cerebrovascular Disease: DiagnosisSlide 25Cerebrovascular Disease: Treatment2. CancerCancer OverviewBurden of CancerBurden of Cancer, Ages 15-44Burden of Cancer, Ages 45-602007 Estimated US Cancer DeathsPathogenesis of CancerSlide 34Slide 35Slide 36Slide 37Cancer DiagnosisSlide 39Slide 40Treatment of CancerImportance of Cancer ScreeningCancer and Infectious Diseases3. Unintentional Injuries4. HIV/AIDS4. Digestive DiseasesBurden of Digestive DiseasesNormal LiverSlide 49CirrhosisHepatitisSummary of Lecture FourLeading Causes of DeathSlide 54Structural ViolenceSlide 56Slide 57Slide 58New World of Global HealthChallenges FacedWhat is a Grand Challenge in Global Health?Grand Challenges in Global HealthCall for Grand ChallengesGoals and Grand ChallengesGrand Challenge ProposalsSlide 66Slide 67Closing ThoughtsSlide 69Slide 70Slide 71Warmly Recommended ReadingBioengineering and World HealthLecture Four:Leading Causes of Mortality, Ages 45-60Global Health Challenges Geoff PreidisMD/PhD candidateBaylor College of [email protected]Developing World1. HIV/AIDS2. Unintentional injuries3. Cardiovascular diseases4. TuberculosisDeveloped World1. Unintentional injuries2. Cardiovascular diseases3. Cancer4. Self-inflicted injuriesSummary of Lecture 3:Leading Causes of Mortality Ages 15-441. HIV/AIDSWhile working at an outreach clinic in Africa, you encounter a critically ill adolescent who tests positive for HIV.How can you estimate the severity of this patient’s disease?What classes of pharmaceuticals are available to treat this patient?2. Unintentional InjuriesDo unintentional injuries account for more deaths in developed or developing countries? Give several reasons why.3. Cancer and Cardiovascular DiseasesWill be discussed today!4. TuberculosisIf your next PPD skin test is positive, what will your doctor do next?4. Self-Inflicted InjuriesWhat disease ranks #1 in DALYs in developed countries?How can we prevent these injuries?Lecture 4:Leading Causes of Mortality Ages 45-60Developing World1. Cardiovascular diseases2. Cancer (malignant neoplasms)3. Unintentional injuries4. HIV/AIDSDeveloped 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 DiseasesBurden of Cardiovascular DiseasesIschemic Heart DiseaseEpidemiologyPathogenesisDiagnosisTreatmentCerebrovascular DiseaseEpidemiologyPathogenesisDiagnosisTreatmentBurden of Cardiovascular Diseases:Ages 15-44768,000 people ages 15-44 die as a result of cardiovascular disease every yearMost 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 yearMost common causes:Ischemic heart disease (1 million deaths)Cerebrovascular disease (625,000 deaths)Burden of Cardiovascular Diseases:Ages 45-60Ischemic Heart Disease: EpidemiologyUnited States12 million people have coronary artery diseaseCauses more deaths, disability and economic cost than any other illnessRisk factorsPositive family historyDiabetesHyperlipidemiaHypertensionSmokingIschemic Heart Disease: PathogenesisAtherosclerosisCauses decrease in myocardial perfusionMost common symptom is anginaStable angina (75% lumen blockage)Typically a 50-60 yo man or 65-75 yo womanHeaviness, pressure, squeezing, smothering or chokingLocalized to chest, may radiate to left shoulder and armsLasts 1-5 minutesUnstable angina (more than 80% blockage)Patients with angina that is:New onset and severe and frequentAcceleratingAngina 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: DiagnosisUsually made by historyPhysical exam may reveal other disordersLipid disordersHypertensionDiabetesTestingEKGStress TestingCoronary arteriographyhttp://www.columbiasurgery.org/divisions/cardiac/images/novartis_207B.jpgIschemic Heart Disease: TreatmentMedical management (may relieve symptoms of CAD, but does not reduce coronary blockage)NitratesIncrease myocardial oxygen supply, systemic vasodilationBeta blockersInhibit increases in heart rate and contractilityDecrease myocardial oxygen demandCalcium channel antagonistsCoronary vasodilatorsThrombolysisCABG (Coronary Artery Bypass Grafting)PTCA (Percutaneous Transluminal Coronary Angioplasty)CABGPTCACerebrovascular Disease: EpidemiologyThird leading cause of death in the USMost prevalent neurologic disorder87% caused by ischemia and resulting infarctionCerebrovascular Disease: PathogenesisCauses of stroke:Blood vessel supplying the brain is blockedThrombosis (clot in vessel)Embolism (clot breaks off and lodges in blood vessel in brain)Vasoconstriction or spasmVenous collapseCerebrovascular Disease: PathogenesisAbrupt onset with focal neurologic deficitUsually mini-event or warning signs 15% Transient Ischemic Attacks (TIAs)Reversible ischemiaSome lasting 24-72 hoursCompleted strokeMaximal deficit within hoursOften patient awakens with completed strokeUsually preceded by TIA Progressive
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