Because learning changes everything.

14: Cardiovascular Disease,

Diabetes, Chronic Lung Diseases,
and Dementia

Your Health Today, 9th Edition

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 Cardiovascular Disease

Cardiovascular disease (CVD): any

disease involving the heart and/or
blood vessels.
• Currently, the leading cause of death in the
U.S., accounting for one in three deaths.

CVD is a general term for

diseases that include heart
attack, stroke, peripheral artery
disease, congestive failure, and
other conditions.

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and females, U.S., 1979 to 2019.
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Figure 14.1 Cardiovascular disease mortality trends for males

Sources: Centers for Disease Control and Prevention/National Center for Health Statistics, www.cdc.gov/nchs; American Heart Association. (2022).
Heart disease and stroke statistics— 2022 update: A report from the American Heart Association. Circulation, 2022 Feb 22;145(8):e153-e639. Doi
3

10.1161/CIR.000000000000105210.1161/CIR.0000000000001052
 Close to half the deaths from CVD (41.3 percent) are caused by coronary heart
disease.

Figure 14.2 Percentage of deaths from types of CVD, U.S.,

2019.
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© McGraw Hill LLC Source: American Heart Association. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139, e56–e528. 4
 The Cardiovascular System 1

Cardiovascular system: the network of heart and

blood vessels that circulate blood throughout the
body.

Pulmonary (lung) circulation: the pumping of

oxygen-poor blood to the lungs and oxygen-rich
blood back to the heart by the right side of the heart.

Systemic (body) circulation: the pumping of oxygen-

rich blood to the body and oxygen-poor blood back
to the heart by the left side of the heart.

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 The Cardiovascular System 2

Inferior and superior vena cava: largest veins.

• Carry oxygen-poor blood from the body back to the heart.
Aorta: largest artery in the body.
• Leaves the heart and branches into smaller arteries, arterioles,
and capillaries carrying oxygen-rich blood to body tissues.

Coronary arteries: medium-sized arteries that supply

oxygen- and nutrient-rich blood to the heart muscle.
Sinus node or sinoatrial (SA) node: a group of cells in
the right atrium where the electrical signal is generated
that establishes the heartbeat.
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 Figure 14.3 The heart, showing interior changes, valves, and
major arteries and veins.
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 Atherosclerosis

Atherosclerosis: a common form of arteriosclerosis that involves a thickening

or hardening of the arteries due to the buildup of fats and other substances.

Damage to the inner lining leads to the formation of a fatty streak—an

accumulation of lipoproteins: a combination of proteins, phospholipids, and
cholesterol.

Together with white blood cells, collagen and other proteins form a plaque
(accumulation of debris).

• Reduces the amount of blood that can reach the tissue.

• Plaque can break off and completely block arteries.

Stretching of the weakened artery wall can also cause an aneurysm, which
that can tear or rupture, causing sudden death.

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 Figure 14.4 The process of atherosclerosis.
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 Coronary Heart Disease and Heart Attack
1

Coronary heart disease (CHD): atherosclerosis of the

coronary arteries, which can result in a heart attack.

CHD is the leading form of all cardiovascular diseases.

About 20.1 million Americans are living with CHD.

Those who survive a heart attack are often left with

damaged hearts and significantly altered lives.

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 Coronary Heart Disease and Heart Attack
2

Ischemia: insufficient supply of oxygen and nutrients

to tissue, caused by narrowed or blocked arteries.

Myocardial infarction (MI): lack of blood flow to the

heart muscle with resulting death of heart tissue,
often called a heart attack.

Coronary thrombosis: blockage of a coronary artery

by a blood clot that may cause sudden death.

Angina: pain, pressure, heaviness, or tightness in

the center of the chest caused by a narrowed
coronary artery.

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 Coronary Heart Disease and Heart Attack 3

The common Pain or discomfort in the center or left side of the chest.
symptoms of a
heart attack.
Pain or discomfort in the jaw, neck, or back.
Pain or discomfort in one or both arms or shoulders.
Weakness or lightheadedness.
Shortness of breath.
During a heart
attack, women
and young adults
are more likely
to have less-
classic symptoms
and to
experience no
chest pain or
discomfort.

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 Arrhythmias and Sudden Cardiac Arrest

Arrhythmia: irregular or disorganized heartbeat.

Normal adult heart rate is 60 to 100 beats per minute.

Sudden cardiac arrest: abrupt loss of heart function caused by an irregular or ineffective heartbeat.

Ventricular fibrillation (VR): a type of arrhythmia in which the ventricles contract rapidly and erratically,
causing the heart to quiver or “tremor” rather than beat.

Common in cases of sudden cardiac death.

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 Stroke 1

Stroke or cerebrovascular accident (CVA):

when blood flow to the brain or part of the
brain is blocked.
• Stroke is a leading cause of death in the U.S., after
heart disease, cancer, and COVID-19. It is a leading
cause of severe, long-term disability.

Ischemic stroke: caused by a blockage

in a blood vessel in the brain; accounts
for 87 percent of all strokes.
• Thrombus. Blood clot in a narrowed artery.
• Embolism. Blood clot elsewhere that travels in
the body.

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 Stroke 2

Hemorrhagic stroke: caused by rupture of a

blood vessel in the brain, with bleeding into
brain tissue.

Transient ischemic attacks (TIAs), or

“ministrokes,” are periods of restricted blood
supply that produce stroke symptoms.

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 Figure 14.5 Types of stroke.
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© McGraw Hill LLC Source: Harvard Health Letter (2000, April). 16

 Congestive Heart Failure

Congestive heart failure: the heart is not

pumping the blood as well as it should,
allowing blood and fluids to back up in
the lungs.
• Can develop after a heart attack or as a result of
hypertension, heart valve abnormality, or disease
of the heart muscle.
• Person with this condition experiences difficulty
breathing, shortness of breath, coughing, fatigue,
and confusion.
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 Promoting Cardiovascular Health 1

Life’s Avoid tobacco.

Simple Eat a healthy diet.
Seven: Be physically active.
Maintain a healthy body mass index.
Maintain healthy blood pressure levels.
Maintain healthy blood glucose levels.
Maintain healthy cholesterol levels.

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 Promoting Cardiovascular Health 2

Avoid tobacco.

Tobacco use is the leading risk factor for all forms of CVD.

Tobacco smoke increases risk in a variety of ways.

• Damages the inner lining of blood vessels, speeding up the
development of atherosclerosis.
• Stimulates the formation of blood clots in the coronary arteries and
triggers spasms that close off the vessels.
• Raises blood levels of low-density lipoprotein (LDL) cholesterol (“bad”
cholesterol).
• Decreases blood levels of high-density lipoprotein (HDL) cholesterol
(“good” cholesterol).

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 Promoting Cardiovascular Health 3

Eat a healthy diet.

• Emphasize fruits, vegetables, whole grains, low-fat dairy
products, fish, and lean meat and poultry.

Be physically active.
• Conditions the heart, reduces high blood pressure, improves
HDL cholesterol levels, helps maintain a healthy weight, and
helps control diabetes.

Maintain a healthy body mass index.

• Excess weight strains the heart and contributes to other risk
factors, such as hypertension, high LDL levels, and diabetes.

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 Promoting Cardiovascular Health 4
Maintain healthy blood pressure levels.
• Blood pressure. Exerted by blood against artery walls.
• Hypertension. High blood pressure, forceful enough to
damage artery walls.
• Untreated hypertension can weaken and scar the arteries
and make the heart work harder; and increases the risk
of heart attack, stroke, congestive heart failure, and
kidney disease.
• Systolic pressure. Produced by the heart contracting and
pushing blood out into the arteries; the first number.
• Diastolic pressure. In the arteries when the heart muscle
is relaxed, and the ventricles are filling.

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 Source: American Heart Association. (2022). Understanding blood pressure readings. Retrieved from
https://www.heart.org/en/health-topics/ high-blood-pressure/understanding-blood-pressure-readings
Systolic (mmHg) Peak pressure
in arteries when heart Diastolic (mmHg) Resting pressure in
Category contracts arteries when heart is relaxed and refilling

Normal Less than 120 and Less than 80

Elevated 120–129 and Less than 80

Hypertension

Stage 1
130–139 or 80–89
Stage 2 140 and above or 90 and above
180 and above and/or 120 and above
Hypertensive
crisis*

Note: A suddenly elevated blood pressure that exceeds 180/120 should be rechecked in five minutes; if it remains
elevated, seek immediate medical care. If it is associated with symptoms of heart disease or stroke, call 911.

Table 14.1 Blood Pressure Guidelines

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 Promoting Cardiovascular Health

Maintain healthy cholesterol levels.

LDLs: “bad cholesterol” associated with atherosclerosis.

The higher the LDL level, the higher the risk.

Cholesterol-lowering statin therapy can reduce risk.

• For those with a history of cardiovascular disease.

• For those with LDL cholesterol over 190 mg/dl.
• For those over 40 with diabetes and LDL cholesterol over 70 mg/dl.
• For those with a 10-year risk of a heart attack greater than 7.5 percent.

HDLs: “good” cholesterol; help clear cholesterol from cells and atherosclerotic
deposits.

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 Diagnostic Testing for Heart Disease

Electrocardiogram (ECG or EKG) to detect

abnormal rhythms, inadequate blood flow, and
heart enlargement.

Echocardiogram (like an ultrasound) to visualize

the heart structure and motion.

Exercise stress test to evaluate heart functioning.

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 Diagnostic Testing for Stroke

A computed tomography (CT) scan or magnetic resonance

imaging (MRI) can generate images of the brain and blood
flow and determine whether a stroke has occurred.

These tests can also show whether a stroke has been

caused by a blockage or by a hemorrhage.

Further testing may be done to find the source of any

blockage.

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 Management of Heart Disease

Multiple categories of Surgeries include

medications can be used— angioplasty (balloon
especially antiarrhythmics, catheter), coronary stent,
antianginals, and and coronary artery
anticoagulants. bypass grafting.

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 Management of Stroke

If thrombotic: thrombolytic medications.

If hemorrhagic: it depends on the underlying

cause of the bleeding; sometimes surgery is
necessary.
Rehabilitation, usually including physical
therapy, is an important component.

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 Diabetes 1

Diabetes: a metabolic disorder in which the production or use of insulin is disrupted.

Most common disorder of the endocrine or metabolic system, and the seventh leading
cause of death in the U.S.

Rates of diabetes have been increasing steadily in the past 30 years.

Minority ethnic groups and low socioeconomic populations are disproportionately

affected, and in these populations, rates continue to rise.

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 Figure 14.6 Normal insulin and glucose uptake,
and with Type 1 and Type 2 diabetes.

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 Type 1 Diabetes
Type 1 diabetes is caused by the destruction of insulin-producing cells in the
pancreas by the immune system.
•Insulin must be provided from an external source to keep blood glucose levels under control.

Onset usually occurs before age 20.

It is probably a result of a combination of genetic, autoimmune, and

environmental factors.

Physical activity is an important component of control and reduction of

long-term complications.

There are rising cases of Type 1 diabetes during the COVID-19 pandemic.

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 Type 2 Diabetes

The pancreas responds by increasing the

Type 2 diabetes is caused production of insulin; but eventually, it
cannot keep up.

by insulin resistance in Accounts for 90 to 95 percent of all

diabetes cases.

insulin receptors. Incidence is rising in parallel with obesity

levels.

Prediabetes: fasting blood glucose levels

between 100 and 125 mg/dl.

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 Risk Factors 1
Type 2 diabetes is a multifactorial disease with an
increased risk if there is a family history of diabetes and
other risk factors.
• Higher abdominal fat.
• Lack of physical activity.
• Being over 45 years old.

Racial and ethnic minorities and people with low

socioeconomic status are disproportionately affected.

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 Prevention and Treatment
Screening involves tests for blood glucose levels.
Dietary changes, exercise, and weight loss can prevent
diabetes, delay its onset, and treat it.
• Treatment includes lifestyle modification, oral medications,
and eventually insulin replacement.

Exercise is especially important.

Long-term control is monitored by a blood test called
the hemoglobin A1c test.
• The closer blood glucose is to the normal range, the lower
the risk of complications.

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 Diabetes Prediabetes

A1c hemoglobin (%) At or above 6.5 5.7–6.4

Fasting glucose test (mg/dL) At or above 126 100–125

2-hour glucose test (mg/dL) At or above 200 140–199

Random glucose test in patients with classic diabetes symptoms (mg/dL) At or above 200 Not applicable

Table 14.2 Diagnostic Criteria for Diabetes and Prediabetes

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 Chronic Lung Diseases

Also known as chronic lower respiratory diseases,

chronic lung diseases are the third leading cause of
death in the U.S.

The two most common forms.

• Asthma—which has a larger genetic component.
• Chronic obstructive pulmonary disease (COPD)—which is more
typical in older adults.

Both are triggered by smoking, infection, and pollution.

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 Common Triggers and Effects and
Disease Characteristics Causes Symptoms Risks Treatment
Asthma Chronic inflammation Smoking; inhaling Death, Avoid triggers. Use medication,
Shortness of
of bronchioles; spasm smoke, air pollution, although including bronchodilators
breath,
of muscles around chemicals, cold air. Viral rarely, if (quick relief) and inhaled
prolonged
bronchioles; excess and bacterial infections. disease is steroids (long-term control).
coughing,
mucus, blocking Allergies. Strenuous poorly Get an annual flu shot and
wheezing.
airflow. Often appears exercise. Strong controlled. recommended COVID-19
Diagnostic
in childhood. emotions, stress. Most common vaccinations. Self-care is
categories
Obesity, heartburn, chronic lung essential.
range from
sleep apnea. condition.
intermittent to
severe.

Chronic Chronic inflammation Smoking; inhaling Bronchial Increased risk Stop smoking. Get an annual
bronchitis and narrowing of smoke, air pollution, congestion, for lung cancer. flu shot and recommended
(component bronchioles (airways chemicals, dust, other chronic cough. COVID-19 vaccinations.
of COPD) inside lungs); excess lung irritants.
mucus.

Emphysema Smoking; inhaling Shortness of Strain on the Stop smoking. Get an annual
Stiffening and
(component smoke, air pollution, breath, gasping heart; flu shot and recommended
of COPD) destruction of alveoli chemicals, dust, other for air. COVID-19 vaccinations.
increased risk
(clusters of air sacs at lung irritants. for heart
end of bronchioles).
disease.
Chronic Chronic bronchitis plus Smoking; inhaling Ongoing Stop smoking. To improve
obstructive emphysema. smoke, air pollution, cough, COPD is third symptoms: inhaled
pulmonary Usually diagnosed in chemicals, dust, other shortness of leading cause bronchodilators and steroids. In
disease middle-aged or older lung irritants. breath, of death in U.S. late stages: oxygen, lung
and a leading
(COPD) adults. wheezing, surgery.
chest cause of
tightness. disability.

Table 14.3 Comparison of Chronic Lung Diseases

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 Figure 14.7 The respiratory system.
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 Asthma 1
Asthma is the most common chronic lung condition.

In asthma, the lining of the airways becomes inflamed

and swollen, narrowing the airway passage, and excess
mucus is produced.

Risk Factors and Triggers:

• Chronic inflammation, obstruction, and constriction
of the airways, causing wheezing, coughing, chest
tightness, and shortness of breath.
• Attack occurs in response to a trigger—an allergen or
an irritant in the air.

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 Asthma 2
Detection and Treatment:
Diagnostic categories include the following.
• Intermittent. No symptoms between episodes.
• Mildly persistent. Symptoms a few times a week.
• Moderate. Daily symptoms limit some normal
activity.
• Severe. Daily symptoms place extreme limits on
normal activity.

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 Asthma 3

Bronchodilators: quick-relief medications used during an

attack to reduce symptoms.
• Delivered through an inhaler.

For long-term control.

• Inhaled steroid that works within the bronchioles to reduce
inflammation.
• Avoidance of common triggers such as tobacco smoke,
allergens, and air pollution.
• Influenza and pneumococcal pneumonia vaccinations are
strongly recommended.

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 Chronic Obstructive Pulmonary Disease

COPD tends to develop from cumulative damage to

airways and alveoli; the primary cause is smoking.

Chronic bronchitis: persistent inflammation of the

bronchioles; excess mucus.
• Bronchial congestion and a chronic cough.

Emphysema: alveoli become less elastic, and walls

between alveoli are damaged or destroyed.
• Person is breathless and gasps for air, and the heart is strained.
• Cannot be reversed; supplemental oxygen may be necessary at
later stages.

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