Hospitals & Asylums  






American Heart Month since February 1963 HA-14-2-08


By Tony Sanders


Your heart matters.Above all else, guard your heart, for it is the wellspring of life (Proverbs 4:23)


1. Since 1963 Congress and the American Heart Association has required the president to proclaim February "American Heart Month."The AHA recommends that patients with acute heart disease should take the ambulance, otherwise they are likely to be turned away.Cardiovascular diseases, including stroke, are the No. 1 killer in the United States for both men and women.Coronary heart disease is America's No. 1 killer. Stroke is No. 3 and a leading cause of serious disability.Of the estimated 7 million Americans suffering angina and 2.4 million people who died in 2004, 666,000 died from heart disease and 150,000 from stroke.People suffering angina have a 20% chance of suffering a heart attack over ten years.The prevalence of heart disease is increasing amongst younger people and it is time for America to improve outcomes for heart disease at all ages.No expert in love, information on common diseases and conditions of the heart can be found at the National Heart, Lung, and Blood Instituteís Diseases and Conditions Index


2. According to the U.S. government, one in every 300 Americans will be killed by a blocked artery in 2007.Every 34 seconds an American dies as the result of a blocked cardiac artery.As an American, there's a 90 percent chance that poor circulation will trigger a serious health problem at some point in your life. More than 6.8 million Americans undergo heart bypass, balloon angioplasty and other circulation-related procedures each year. 700,000 Americans will suffer a sudden blockage of blood flow to the brain in 2007- 83 every hour of the day. Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. Mortality differs significantly by race or ethnic group as measured by age adjusted death rates.In 1998 these death rates per 100,000 people from heart disease in the United States were 211.8 for black non-Hispanics, compared to 145.3 for white non-Hispanics, 101.5 for Hispanics, 106 for American Indians and 78 for Asians.In contemporary US public health heart disease and diabetes are the most trying illnesses.


3. The objective of this paper is for the Centers for Medicare, Medicaid and SCHIP (CMS) to require ďBiological Weapons are ProhibitedĒ to be inscribed on the letterheads of all their contracts because it is hypothesized that corruption is the leading cause of death, disability and patient care episodes.The prohibition of biological weapons is of vital importance for all Americans, for those cursed with heart disease, it is a matter of life and death.It is a conspiracy offense to disregard complaints of bio-terrorism as mental illness or dementia.People treated for mental illness in the public system are dying 25 years younger than the average American, opposed to 15 years younger a decade ago.Medical education and employment must not omit the prohibition of biological weapons.Offensive prescriptions of law must be immediately amended or repealed.Ultra vires, unauthorized practices of law, delivering toxins in the legal system or infringing upon the health sector, must be dismissed.Records must be sealed.Counsel can be found in medical ethics.Pillowcases, sheets, beds, wardrobes, landladies, nurses, doctors, friends, family members, lovers, medical bills, courts, and politicians may all need to be thrown away to control the conflict of interest with pain. Overexposure to irritants can cause permanent damage.Wounded hearts heal, but not if they are under constant attack.


4. Diseases and conditions of the heartís muscle make it difficult for your heart to pump blood.Oxygen deprivation to the heart muscle itself, usually caused by atherosclerosis, a build up of plaque in the coronary arteries, causes acute pain in the heart known as Angina that affects an estimated 7 million Americans. Damaged or diseased blood vessels make the heart work harder than normal and are often torturously painful. Problems with the heartís electrical system, called arrhythmias, can make it difficult for the heart to pump blood efficiently.Cardiac patients must take care of their health.It is important to avoid LDL cholesterol such as that found in potato chips and trans-fats.One however cannot starve angina, sufficient levels of HDL cholesterol such as that found in fish oil and brown rice are needed.Smoking, coffee and stimulants should be avoided to control blood pressure.If wine doesnít work donít abuse it.Take deep breaths to understand the relation between heart and lungs instead of stopping breathing to feel the pain. Exercise enough to increase your heartbeat, regularly.


5. The normal human heart is a strong, muscular pump a little larger than a fist. Each day an average heart ďbeatsĒ (expands and contracts) 100,000 times and pumps about 2,000 gallons of blood. In a 70-year lifetime, an average human heart beats more than 2.5 billion times. The heart pumps blood continuously through the circulatory system. The circulatory system is the network of elastic tubes that carries blood throughout the body. It includes the heart, lungs, arteries, arterioles (small arteries) and capillaries (very tiny blood vessels). These blood vessels carry oxygen- and nutrient-rich blood to all parts of the body. The circulatory system also includes venules (small veins) and veins. These are the blood vessels that carry oxygen- and nutrient depleted blood back to the heart and lungs. If all these vessels were laid end-to-end, theyíd extend for about 60,000 miles. Thatís enough to encircle the earth more than twice.


6. The heart keeps us alive.The heart muscle, called cardiac muscle, contracts and relaxes about 70 to 80 times per minute without you ever having to think about it. As the cardiac muscle contracts it pushes blood through the chambers and into the vessels. Nerves connected to the heart regulate the speed with which the muscle contracts. When you run, your heart pumps more quickly. When you sleep, your heart pumps more slowly.Considering how much work it has to do, the heart is surprisingly small. The average adult heart is about the size of a clenched fist and weighs about 11 ounces (310 grams). Located in the middle of the chest behind the breastbone, between the lungs, the heart rests in a moistened chamber called the pericardial cavity, which is surrounded by the ribcage. The diaphragm, a tough layer of muscle, lies below. As a result, the heart is a well-protected organ.


Heart Exterior

Illustration of the exterior of a healthy heart


7. The heart is the muscle in the lower half of the picture. The heart has four chambers. The right and left atria (AY-tree-uh) are shown in purple. The right and left ventricles (VEN-trih-kuls) are shown in red.Connected to the heart are some of the main blood vesselsóarteries and veinsóthat make up your blood circulatory system.The ventricle on the right side of your heart pumps blood from the heart to your lungs. When you breathe air in, oxygen passes from your lungs through blood vessels where itís added to your blood. Carbon dioxide, a waste product, is passed from your blood through blood vessels to your lungs and is removed from your body when you breathe air out. The atrium on the left side of your heart receives oxygen-rich blood from the lungs. The pumping action of your left ventricle sends this oxygen-rich blood through the aorta (a main artery) to the rest of your body.


8. On the Right Side of Your Heart the superior and inferior vena cavae are in blue to the left of the muscle as you look at the picture. These veins are the largest veins in your body. They carry used (oxygen-poor) blood to the right atrium of your heart. ďUsedĒ blood has had its oxygen removed and used by your bodyís organs and tissues. The superior vena cava carries used blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries used blood from the lower parts of your body. The used blood from the vena cavae flows into your heartís right atrium and then on to the right ventricle. From the right ventricle, the used blood is pumped through the pulmonary (PULL-mun-ary) arteries (in blue in the center of picture) to your lungs. Here, through many small, thin blood vessels called capillaries, your blood picks up oxygen needed by all the areas of your body.The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (in red to the left of the right atrium in the picture).On the Left Side of Your Heart oxygen-rich blood from your lungs passes through the pulmonary veins (in red to the right of the left atrium in the picture). It enters the left atrium and is pumped into the left ventricle. From the left ventricle, your blood is pumped to the rest of your body through the aorta.


9. Like all of your organs, your heart needs blood rich with oxygen. This oxygen is supplied through the coronary arteries as itís pumped out of your heartís left ventricle. Your coronary arteries are located on your heartís surface at the beginning of the aorta. Your coronary arteries (shown in red in the drawing) carry oxygen-rich blood to all parts of your heart.The right and left sides of your heart are divided by an internal wall of tissue called the septum. The area of the septum that divides the two upper chambers (atria) of your heart is called the atrial or interatrial septum. The area of the septum that divides the two lower chambers (ventricles) of your heart is called the ventricular or interventricular septum. The picture shows your heartís four valves. Shown counterclockwise in the picture, the valves include the aortic (ay-OR-tik) valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary valve, and the mitral (MI-trul) valve.


Heart Interior

Illustration of a Healthy Heart Cross-Section


10. Your heart uses the four valves to ensure your blood flows only in one direction. Healthy valves open and close in coordination with the pumping action of your heartís atria and ventricles. Each valve has a set of flaps called leaflets or cusps. These seal or open the valves. This allows pumped blood to pass through the chambers and into your blood vessels without backing up or flowing backward.Blood without oxygen from the two vena cavae fill your heartís right atrium. The atrium contracts (atrial systole). The tricuspid valve located between the right atrium and ventricle opens for a short time and then shuts. This allows blood to enter into the right ventricle without flowing back into the right atrium.When your heartís right ventricle fills with blood, it contracts (ventricular systole). The pulmonary valve located between your right ventricle and pulmonary artery opens and closes quickly. This allows blood to enter into your pulmonary artery without flowing back into the right ventricle. This is important because the right ventricle begins to refill with more blood through the tricuspid valve. Blood travels through the pulmonary arteries to your lungs to pick up oxygen.


11. Oxygen-rich blood returns from the lungs to your heartís left atrium through the pulmonary veins. As your heartís left atrium fills with blood, it contracts. This event also is called atrial systole. The mitral valve located between the left atrium and left ventricle opens and closes quickly. This allows blood to pass from the left atrium into the left ventricle without flowing back into the left atrium. As the left ventricle fills with blood, it contracts. This event also is called ventricular systole. The aortic valve located between the left ventricle and aorta opens and closes quickly. This allows blood to flow into the aorta. The aorta is the main artery that carries blood from your heart to the rest of your body. The aortic valve closes quickly to prevent blood from flowing back into the left ventricle, which is already filling up with new blood.


12. A heartbeat actually is a complicated series of very precise and coordinated events that take place inside and around your heart. Each side of your heart uses an inlet valve to help move blood between the atrium and ventricle. The tricuspid valve does this between the right atrium and ventricle. The mitral valve does this between the left atrium and ventricle. The "lub" is the sound of the mitral and tricuspid valves closing. Each of your heartís ventricles has an outlet valve. The right ventricle uses the pulmonary valve to help move blood into the pulmonary arteries. The left ventricle uses the aortic valve to do the same for the aorta. The "DUB" is the sound of the aortic and pulmonary valves closing.Each heartbeat has two basic parts: diastole (di-AS-toe-lee, or relaxation) and atrial and ventricular systole (SIS-toe-lee, or contraction). During diastole, the atria and ventricles of your heart relax and begin to fill with blood. At the end of diastole, your heartís atria contract (an event called atrial systole) and pump blood into the ventricles. The atria then begin to relax. Next, your heartís ventricles contract (an event called ventricular systole) and pump blood out of your heart.


13. A heartbeat is a single cycle in which your heartís chambers relax and contract to pump blood. This cycle includes the opening and closing of the two inlet and outlet valves of the right and left ventricles of your heart.Each heartbeat has two basic parts: diastole, and atrial and ventricular systole. During diastole, the atria and ventricles of your heart relax and begin to fill with blood. At the end of diastole, your heartís atria contract (atrial systole), pumping blood into the ventricles, and then begin to relax. Your heartís ventricles then contract (ventricular systole), pumping blood out of your heart.Each beat of your heart is set in motion by an electrical signal from within your heart muscle. In a normal, healthy heart, each beat begins with a signal from the SA node. This is why the SA node is sometimes called your heartís natural pacemaker. Your pulse, or heart rate, is the number of signals the SA node produces per minute.In Atrial Fibrillation (AT), the ventricles may beat up to 100-175 times a minute, in contrast to the normal rate of 60-100 beats a minute.


14. Your heartís electrical system controls all the events that occur when your heart pumps blood. The electrical system also is called the cardiac conduction system. If youíve ever seen the heart test called an EKG (electrocardiogram), youíve seen a graphical picture of the electrical activity of your heart.Your heartís electrical system is made up of three main parts: The sinoatrial (SA) node located in the right atrium of your heart.The atrioventricular (AV) node located on the interatrial septum close to the tricuspid valve.The His-Purkinje system located along the walls of your heartís ventricles.The signal is generated as the two-vena cavae fill your heartís right atrium with blood from other parts of your body. The signal spreads across the cells of your heartís right and left atria. This signal causes the atria to contract. This action pushes blood through the open valves from the atria into both ventricles.The signal arrives at the AV node near the ventricles (see red burst on picture), where it slows for an instant to allow your heartís right and left ventricles to fill with blood. The signal is released and moves to the His-Purkinje bundle located in the walls of your heartís ventricles.From the His-Purkinje bundle, the signal fibers divide into left and right bundle branches through the Purkinje fibers that connect directly to the cells in the walls of your heartís left and right ventricles (see yellow on the picture). As the signal spreads across the cells of your heartís ventricle walls, both ventricles contract, but not at exactly the same moment. The left ventricle contracts an instant before the right ventricle. This pushes blood through the pulmonary valve (for the right ventricle) to your lungs, and through the aortic valve (for the left ventricle) to the rest of your body.As the signal passes, the walls of the ventricles relax and await the next signal.This process continues over and over as the atria refill with blood and other electrical signals come from the SA node.


15. A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isnít restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone youíre with is having a heart attack, call 9-1-1 right away.Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.During a heart attack, if the blockage in the coronary artery isnít treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems. Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.


Heart With Muscle Damage and a Blocked Artery

Figure A shows an overview of the heart and coronary artery.  Figure B shows a cross-section of the coronary artery with plaque buildup and a blood clot.


16. Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. It's thought that nearly 7 million people in the United States suffer from angina. About 400,000 patients go to their doctors with new cases of angina every year. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion. Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when a fatty material called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).Nitrates are the most commonly used medicines to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart while reducing its workload. Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.



Illustration showing a normal artery with normal blood flow and an artery containing plaque buildup.


17. An aneurysm (AN-u-rism) is an abnormal bulge or ďballooningĒ in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body. Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm. Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States. Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old should be checked for abdominal aortic aneurysms.When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta.


18. Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with "watchful waiting." If the diameter of the aorta is small-less than 3 centimeters (cm)-and there are no symptoms, "watchful waiting" and a followup screening in 5 to 10 years may be all that is needed, as determined by the doctor.If the aorta is between 3 and 4 cm in diameter, the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown.If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair. The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision in the abdomen or chest. General anesthesia is needed with this procedure. The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacronģ or Teflonģ. The surgery takes 3 to 6 hours, and the patient remains in the hospital for 5 to 8 days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90 percent of patients make a full recovery.


Placementof an Endovascular Stent Graft

The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta, and the stent-graft is released from the catheter. In figure B, the stent-graft allows blood to flow through the aneurysm.

19. The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graft allows blood to flow through the aneurysm. To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on x ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing.Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.Coronary angioplasty (AN-jee-oh-plas-tee) is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis (ATH-er-o-skler-O-sis). This procedure improves blood flow to the heart.Angioplasty is done on more than 1 million people a year in the United States. Serious complications don't occur often, but can happen no matter how careful your doctor is, or how well he or she does the procedure.


20. Heart surgery is used to correct heart problems. The most common type of heart surgery for adults is coronary artery bypass grafting (CABG). During CABG, surgeons use healthy arteries or veins taken from another part of the body to bypass (that is, go around) blocked arteries. CABG relieves chest pain and reduces the risk of heart attack.Heart surgery also is done to:Repair or replace valves that control blood flow through the heartRepair abnormal or damaged structures in the heartImplant medical devices that regulate heart rhythms or blood flowReplace a damaged heart with a healthy heart from a donor (heart transplant). Traditional heart surgery, often called "open heart surgery," is done by opening the chest wall to operate on the heart. Almost always, the chest is opened by cutting through a patient's breastbone. Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the pumping action of the heart. This allows surgeons to operate on a still heart.Heart surgery is done to correct problems with the heart. More than half a million heart surgeries are done each year in the United States for a variety of heart problems. For very ill people with severe heart problems, heart surgery can reduce symptoms, improve quality of life, and increase lifespan.


21. A stroke occurs when a blood vessel that brings oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesnít get the blood and oxygen it needs.Deprived of oxygen, nerve cells in the affected area of the brain canít work and die within minutes. And when nerve cells canít work, the part of the body they control canít work either. The devastating effects of stroke are often permanent.There are four main types of stroke. Two are caused by blood clots or other particles (ischemic strokes), and two by bleeding (hemorrhage). Cerebral thrombosis and cerebral embolism are caused by clots or particles that plug an artery. They account for about 70Ė80 percent of all strokes. Ruptured blood vessels cause cerebral and subarachnoid hemorrhages. These (bleeding) strokes have a much higher fatality rate than strokes caused by clots.Stroke is a medical emergency. Every second counts!Stroke affects different people in different ways. It depends on the type of stroke, the area of the brain affected and the extent of the brain injury. Brain injury from a stroke can affect the senses, motor activity, speech and the ability to understand speech. It can also affect behavioral and thought patterns, memory and emotions. Paralysis or weakness on one side of the body is common.


22. Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Cardiac rehab helps people who have heart problems to recover after a heart attack, stroke or heart surgery. Prevent future hospital stays, heart problems, and death related to heart problems. Address risk factors that lead to coronary artery disease and other heart problems. These risk factors include high blood pressure, high blood cholesterol (ko-LES-ter-ol), overweight or obesity, diabetes, smoking, lack of physical activity, and depression and other emotional health concerns. Adopt healthy lifestyle changes. These changes may include a heart healthy eating plan, increased physical activity, and learning how to manage stress to improve their health and quality of life.People of all ages can benefit from cardiac rehab. The lifestyle changes made during rehab have few risks. These changes can improve your overall health and prevent future heart problems and even death. Exercise training as part of cardiac rehab may not be safe for all patients.


23. Diabetes is a risk factor for heart attack.Some 21 million Americans have diabetes, meaning their bodies can't properly regulate blood sugar, or glucose. Diabetics already are at increased risk of heart disease. Type 2 diabetes, the most common form, is linked to obesity, which in turn harms the heart. Plus, high blood sugar over time damages blood vessels.The A1C test tracks average glucose levels over two or three months. People without diabetes have A1C levels as low as 5. The American Diabetes Association has long recommended that diabetics aim to get their A1C level below 7, far below the long-common 8 or 9. Every point-drop lowers the risk of serious complications, such as blindness or kidney failure, by 25 percent to 40 percent.Getting too far below an A1C of 7 is very difficult, and very few patients outside of research studies succeed. An NIH study aimed to have aggressively treated patients dip below a level of 6, into near-normal range. Only half got below 6.4, compared to an A1C of 7.5 among study volunteers getting standard treatment.The NIH took the rare step of halting part of the study 18 months early - citing 257 deaths among aggressively treated patients compared to 203 among diabetics given more standard care.The aggressively treated patients suffered about 10 percent fewer heart attacks overall than their counterparts, however, it appeared that if a heart attack did occur, it was more likely to be fatal. In addition, the intensive treatment group had more unexpected sudden deaths, even without a clear heart attack. The NIH's National Heart, Lung and Blood Institute decided that diabetics with heart disease stop at a level of 7 rather than dip below. They have switched all the study participants to standard therapy, and will track their health until June 2009.


Categories for Blood Pressure Levels in Adults (in mmHg, millimeters of mercury)



Systolic (top number)

Diastolic (bottom number)


Less than 120

Less than 80




High blood pressure



     Stage 1



     Stage 2

160 or higher



24. The body is very sensitive to changes in blood pressure. Special cells in the arteries, called baroreceptors (BAR-o-re-SEP-ters), can sense if blood pressure begins to rise or drop. When the baroreceptors sense a rise or drop in blood pressure, they cause certain responses to occur throughout the body in an attempt to bring the blood pressure back to normal. For example, if you stand up quickly, the baroreceptors will sense a drop in your blood pressure. They quickly take action to make sure that blood continues to flow to the brain, kidneys, and other important organs. The baroreceptors cause the heart to beat faster and harder. They also cause the small arteries (arterioles) and veins (the vessels that carry blood back to the heart) to narrow. High blood pressure is a blood pressure reading of 140/90 mmHg or higher. Both numbers are important. Nearly 1 in 3 American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled.Blood pressure changes during the day. It is lowest as you sleep and rises when you get up. It also can rise when you are excited, nervous, or active.Still, for most of your waking hours, your blood pressure stays pretty much the same when you are sitting or standing still. That level should be lower than 120/80 mmHg. When the level stays high, 140/90 mmHg or higher, you have high blood pressure. For example, 160/80 mmHg would be stage 2 high blood pressure. With high blood pressure, the heart works harder, your arteries take a beating, and your chances of a stroke, heart attack, and kidney problems are greater.Hypotension is abnormally low blood pressure. Normal blood pressure is a reading of less than 120/80 mmHg (mmHg = millimeters of mercury, a unit for measuring pressure). Hypotension is blood pressure that is lower than 90/60 mmHg.In a healthy person, hypotension without signs or symptoms is usually not a problem and requires no treatment. Doctors will want to identify and treat any underlying condition that is causing the hypotension, if one can be found. Hypotension can be dangerous if a person falls because of dizziness or fainting. Shock, a severe form of hypotension, is a life-threatening condition that is often fatal if not treated immediately. Shock can be successfully treated if the cause can be found and the right treatment provided in time.


25. It is estimated that 65 million American adults with high blood cholesterol need to make the therapeutic lifestyle changes (TLC) needed to lower their cholesterol and, with it, their risk for heart disease. To understand high blood cholesterol (ko-LES-ter-ol), it is important to know more about cholesterol. Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body needs some cholesterol to work the right way. Your body makes all the cholesterol it needs. Cholesterol is also found in some of the foods you eat. Your body uses cholesterol to make hormones, vitamin D, and substances that help you digest foods. Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both: Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol. High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in your blood, the greater chance you have of getting heart disease. High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol from other parts of your body back to your liver. The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease.


Initial classification based on total cholesterol and HDL cholesterol


Total Cholesterol Level


Less than 200 mg/dL

Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.

200 to 239 mg/dL

Borderline high

240 mg/dL and above

High blood cholesterol. A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL.


HDL Cholesterol Level


Less than 40 mg/dL
(for men)
Less than 50 mg/dL
(for women)

Low HDL cholesterol. A major risk factor for heart disease.

60 mg/dL and above

High HDL cholesterol. An HDL of 60 mg/dL and above is considered protective against heart disease.


26. The American Heart Association endorses the National Cholesterol Education Program (NCEP) guidelines for detection of high cholesterol. The Third Report of the Expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III or ATP III) was released in 2001. It recommends that everyone age 20 and older have a fasting "lipoprotein profile" every five years. This test is done after a 9-12-hour fast without food, liquids or pills. It gives information about total cholesterol, low-density lipoprotein (LDL) or ďbadĒ cholesterol, high-density lipoprotein (HDL) or "good" cholesterol and triglycerides (blood fats). Researchers have established healthy ranges for each of these. They're given in the lists below. If a fasting lipoprotein profile isn't possible, the values for total cholesterol and HDL cholesterol are acceptable. If your total cholesterol is 200 mg/dL or more, or your HDL cholesterol is less than 40 mg/dL (for men) and less than 50 mg/dL (for women), you need to have a lipoprotein profile done to determine your LDL cholesterol and triglyceride levels. If your cholesterol is high or you have other risk factors, your healthcare provider will likely want to monitor your cholesterol more closely. Follow your provider's advice about how often to have your cholesterol tested. He or she will set appropriate management goals based on your LDL cholesterol level and other risk factors.


LDL Cholesterol Level


Less than 100 mg/dL


100 to 129 mg/dL

Near or above optimal

130 to 159 mg/dL

Borderline high

160 to 189 mg/dL


190 mg/dL and above

Very high


27. Your LDL cholesterol goal depends on how many other risk factors you have. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL.If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL.If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes have high triglyceride levels. Normal triglyceride levels vary by age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery walls).  Atherosclerosis increases the risk for heart attack and stroke.


Triglyceride Level


Less than 150 mg/dL


150Ė199 mg/dL

Borderline high

200Ė499 mg/dL


500 mg/dL and above

Very high


28. A 1994 study called the Scandinavian Simvastatin Survival Study (also called 4S) found that lowering cholesterol can prevent heart attacks and reduce death in men and women who already have heart disease and high cholesterol. For over 5 years, more than 4,400 patients with heart disease and total cholesterol levels of 213 mg/dL to 310 mg/dL were given either a cholesterol-lowering drug or a placebo (a dummy pill that looks exactly like the medication). The drug they were given is known as a statin, and it reduced total cholesterol levels by 25 percent and LDL-cholesterol levels by 35 percent. The study found that in those receiving statin, deaths from heart disease were reduced by 42 percent, the chance of having a nonfatal heart attack was reduced by 37 percent, and the need for bypass surgery or angioplasty was reduced by 37 percent. A very important finding is that deaths from causes other than cardiovascular disease were not increased, and so the 42 percent reduction in heart disease deaths resulted in a 30 percent drop in overall deaths from all causes.


29. In 1996 the results of the Cholesterol and Recurrent Events (CARE) Study also showed the benefits of cholesterol lowering in heart disease patients. This study reported that even in patients with seemingly normal cholesterol levels (average of 209 mg/dL), cholesterol lowering with a statin drug lowered the risk of having another heart attack or dying by 24 percent.A study published in 1998, the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study, examined the effects of cholesterol lowering in people with CHD (those who had already experienced a heart attack or had been hospitalized for angina) and who had relatively average cholesterol levels. The LIPID study used a statin drug to lower cholesterol levels in the treatment group. All study participants were counseled about following a cholesterol-lowering diet. The LIPID results showed that a drop of 18 percent in total cholesterol and 25 percent in LDL-cholesterol produced a 24 percent decrease in deaths from CHD among the treatment group compared with the control group. In 2008 the American Journal of Physiology: Health and Circulatory Physiology held that inhibitors of cyclooxygenase (COX)-1, COX-2, and the nonselective COX inhibitor naproxen on coronary vasoactivity and thrombogenicity under baseline and lipopolysaccharide (LPS)-induce inflammatory conditions.Preconditioning (PC) is held to protect against ischemia-reperfusion (I/R) injury but prolonged exposure can lead to permanent damage.


30. On the whole, Americans should reduce the amount of saturated fat, trans fat, cholesterol and total fat in their diet. The risk factors for coronary artery disease include age, male gender, heredity (including race) smoking, high blood pressure, high cholesterol, physical inactivity, obesity, diabetes, and kidney failure.If you have high blood cholesterol, it's very important to control high blood pressure, avoid tobacco smoke and coffee, eat a healthy diet, get regular physical activity, maintain a healthy weight, and control or delay the onset of diabetes. Taking these steps will help lower your risk of heart disease and stroke. If you still need drugs to reduce your blood cholesterol, a healthy diet and active lifestyle will help lower your cholesterol and improve your overall cardiovascular health.Since the degrading revision of Title 45, U.S. Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001 biological research using human test subjects must adhere to the voluntary principles of the Declaration of Helsinki and companion Guiding Principles in the Care and Use of Animals.


31. Living to 100 is easier than you might think. Surprising new research suggests that even people who develop heart disease or diabetes late in life have a decent shot at reaching the century mark.Never before have so many people lived to a healthy old age.From the Bronze Age to the year 1900, life expectancy is estimated to have increased twenty-seven years.Between 1900 and 1909, life expectancy increased by at least that much again.Of all the people who have ever lived to be sixty-five years old, half are estimated to be alive today.In 1900 there were about 3 million people aged sixty-five and over in the United States, making up 4.1 percent of the population.By 1963 the number had grown to 17.5 million; and one could reasonably expect to survive to old age.In 2000 about 35 million citizens were aged sixty-five or over, constituting 12.5 percent of the population.By 2030, this age group will account for about 70 million people, or 20 percent of the population.


32. Life expectancy at age sixty-five is now seventeen years, five years longer than at the turn of the century.Many sixty-five year olds remain physically and mentally active and capable of contributing to society on many levels.Those over age eighty-five, known as the oldest old, are the fastest growing segment of the population.In 1900, they accounted for only 4 percent of all people over age sixty-five.Now that figure is 12 percent and growing, it is expected to triple by 2040 to 14.3 million.Now that figure is 12 percent and growing, it is expected to triple by 2040 to 14.3 million.Even living to one hundred is no longer a rarity. In 1950 there were roughly 3,000 centenarians in the United States.In 2000 centenarians on the rolls of the Social Security Administration numbered about 65,000.In 2010, estimates put the number at well over 100,000, perhaps as high as 200,000.In fifty years the figure may approach 1 million.Some authorities talk seriously of life expectancies of 110 or 120 years and anticipate someday reaching.To get there the baby boomers must prohibit heart disease and diabetes.



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2. American Heart Association. Scientific Statement: Managing Abnormal Blood Lipids. 2005;112:3184-3209

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5. Barrett, Terrance; Hong, Ting-Ting; Huang, Jinbao; Lucchesi, Benedict. Effects of cyclooxygenase inhibition on canine coronary artery blood flow and thrombosis. Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan; and Johnson and Johnson Pharmaceutical Research and Development, San Diego, California. American Journal of Physiology: Heart and Circulatory Physiology 30 September 2007

6. Butler, Karyn; Huffman, Lynn; Kock, Sheryl. Coronary effluent from a preconditioned heart activates the JAK-STAT pathway and induces cardioprotection in a donor heart. Department of Surgery and Institute of Molecular Pharmacology and Biophysics, University of Cincinnati, Cincinnati, Ohio. American Journal of Physiology: Heart and Circulatory Physiology 1 November 2007

7. Cassel, Christine K. Medicare Matters: What Geriatric Medicine Can Teach American Health Care.University of California Press. New York.2005

8. Eldredge, Stasi. Your Captivating Heart: Discover How Godís True Love Can Free A Womanís Soul.Thomas Nelson, Inc. 2007

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13. Title 45, U.S. Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001

14. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. first adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the 29th WMA General Assembly, Tokyo, Japan, October 1975; 35th WMA General Assembly, Venice, Italy, October 1983; 41st WMA General Assembly, Hong Kong, September 1989; 48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996; and the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000. Note of clarification on paragraph 29 added by the WMA General Assembly, Washington 2002. Based on principles formulated in 1909 by Walter B. Cannon. APS Council first adopted the Guiding Principles in 1953. Latest revision approved July 2000. American Physiological Society. Reviewed and approved 2006