Heart Disease,

Hypertension, and Stroke

 Psychological Issues in
Advanced and Terminal
Illness
 Average life expectancy in North
America is 76 years.

 Leading causes of death in adults are

chronic illness

 What are the leading causes of death

across the life span?
 Mortality Rates
Leading causes of death
 < 1 year
 congenital abnormalities;
 sudden infant death syndrome (SIDS)
 Children > 1 year old
 Accidents (40% of all deaths)
 Cancer (especially leukemia)
 Adolescence
 Unintentional injury
 Homicide
 AIDS
 Mortality Rates
Leading causes of death
 Middle age
 Sudden death due to heart attack or
stroke
 Cancer
 Elderly
 Heart disease
 Cancer
 Stroke
Why do women live longer
than men?
 Potential Reasons for
Gender Differences in
Mortality
 Females are more hardy
 Males engage in riskier behaviours (factor after
birth and infancy)
 Men engage in riskier sports
 Males tend to hold high stress or higher risk jobs
 Men tend to have poorer health habits (e.g.,
drink more alcohol)
 Social support may be more protective in women
 Risk Factors
 Family history
 Marital status (adds 10 yrs in men; 4 yrs in
women)
 Economic status
 Body weight
 Exercise
 Alcohol (add 2 years if drink 1-3
drinks/day)
 Risk Factors - continued
 Smoking
 Disposition (add 2 yrs if reasoned, practical)
 Education
 Environment (add 4 yrs if rural)
 Sleep (more than 9 hours subtract 5 years)
 Temperature (add 2 yrs if thermostat is < 68)
 Health care – regular check ups add 3 yrs
How do people adapt to
chronic illness?
Adapting Under Good
Circumstances
 First concern upon hearing diagnosis
is fears about mortality.
 Optimistic but tentative about plans
 May try to normalize activities
 Risk is they may over-extend
 May have feelings of helplessness
 Risk is to become overly dependent
Three Themes of
Adaptation
 Find meaning: why illness
happened or rethink priorities
 Gain sense of control
 control symptoms and treatment
 Restore self-esteem
 Often by comparison with worse off
others
Adapting Under Bad
Circumstances
 Relapse seen as a bad sign with
poor prognosis
 Re-focuses one on the illness
 Need to undergo the coping
process again but likely less
hopeful than before.
 Heart Disease
 Due to narrowing or blocking of the
coronary arteries.
 Angina pectoris
 painful cramp in chest, arm, neck, or back
due to brief blockage of oxygenated blood
to the heart.
 More often during exercise, stress, cold
temperature, digesting large fat meal.
 Little or no permanent damage
 Heart Disease
 Myocardium
 Muscle tissue around the heart
 Myocardium infarction (heart attack)
 Prolonged blockage of blood to an area of the heart
resulting in muscle tissue damage.
 Symptoms of a heart attack
 Pressure in chest, fullness, squeezing pain.
 Pain spreading to shoulders, neck, or arms
 Lightheadedness, fainting, sweating, nausea
 Who Is At Risk of Heart
Disease?
 Prevalence increases with age,
particularly after 45 years of age
 Prior to 50s, 60s, men at greater risk
than women but increases in women
after menopause.
 More women than men are likely to die
from a heart attack
 Blacks at higher risk, Asians at lower risk
 Heart Disease Risk Factors
 High blood pressure
 Family history
 Cigarette smoking
 High LDL and total cholesterol levels
 Physical inactivity
 Diabetes
 Obesity
 Stress
 Why high blood pressure a
risk factor?
 Heart has to work harder.
 Since heart muscle is working harder,
it can become enlarged.
 Wear and tear on the arterial wall can
increase the likelihood of lipid and
calcium deposits adhering to the
arterial wall. This leads to hardening
of the arteries.
 Type A Behaviours
 Hostile, cynical
 Judgmental (opinionated)
 Competitive
 Time urgent
 Uses gestures while talking
 Nodding of head while others are talking
 Intense
 Physiological Reactivity
 Physiological and cardiovascular reactivity
to acute stress (“hot reactors”).
 Exaggerated increases in blood pressure,
heart rate, catecholamines, corticosteroids
 High levels of these hormones can
damage heart and blood vessels
 Presence of epinephrine (a
catecholamine) increases the formation of
clots.
Effects of Stress On
Cardiac Risk
Psychosocial Predictors
of Sudden Cardiac Death (BDI>10)
1.00

0.95

Proportion
Surviving

0.90
Placebo, BDI <10
Placebo, BDI >10
AMIO, BDI <10
AMIO, BDI >10

0.85
0 200 400 600 800
Survival in days
 When do heart attacks
occur?
 Less likely during sleep.
 Among the employed, more often on
a Monday between 6 and 11 am.
 In part due to waking and becoming
active shortly after dreaming which
increases BP.
 In part because of circadian rhythm
effects, increases in arousal hormones
and blood pressure.
 Medical Treatment
 Initial treatment may involve clot-
dissolving medication and close
monitoring
 Balloon angioplasty
 Tiny balloon is inserted into blocked vessel
and inflated to open blood vessel
 Bypass surgery
 Use grafted vessel (e.g., piece from leg) to
bypass blockage in artery to the heart
 Medical Treatment
 Medications (e.g., beta blockers,
calcium channel blockers) to protect
heart and improve function.
 Risk management
 Control of high blood pressure
 Control of lipid abnormalities
 Rehabilitation
 Promote recovery and reduce risk of
another attack

 Heart disease is chronic condition

requiring ongoing management.
 Rehabilitation Includes:
 Exercise
 Physiological and psychological benefits
 Weight management
 Smoking cessation
 Lipid and BP management include
dietary changes to control lipids
 Reduce excessive alcohol intake
 Stress management
 Rehabilitation
 Exercise is the key component but:
 50% drop-out rate within first 6 months
 For those who continue benefits include:
 Improved self concept, perceived health, sexual
activity, involvement in social activities.
 Those who stop are more likely to:
 Smoke, have poorer cardiac function, have higher
body weight, be more sedentary, experience
greater anxiety and depression.
 Symptoms of a Stroke
 Sudden
 weakness or numbness of the face, arm,
or leg (usually on one side of the body)
 dimness or loss of vision (usually one eye)
 Loss of speech or trouble talking or
understanding speech
 Unexplained, severe headache
 Dizziness, unsteadiness, or sudden fall
 What is a stroke?

 Tissue damage to area of the brain

due to disruption in blood supply,
depriving that area of the brain of
oxygen.
 Causes of Strokes
1. Infarction – blockage in cerebral artery that
cuts off or reduces blood supply
a) Thrombosis – blood clot
b) Embolus – piece of plaque becomes lodged in
the artery.
2. Hemorrhage – happens suddenly. Less
frequent than infarction but more damaging
and more likely to cause death.
 Stroke Risk Factors
 Rare up to age 55, than risk increases
sharply with age (doubling with each
decade).
 More common in men but women
more likely to die from them.
 Rates highest among blacks and
lowest among Asians.
 Family history
 Stroke Risk Factors
 High blood pressure
 Cigarette smoking
 Heart disease, diabetes, and their
risk factors such as obesity and
physical inactivity.
 High red blood cell count (making the
blood thicker and likelier to clot).
 Mini-strokes – transient ischemic
attacks (TIA)
 Effects of a Stroke
 Some motor, sensory, cognitive, or
speech impairment usually occurs
 Limitations may be permanent but
lessen in severity over time.
 Younger patients recover better
 Impairments caused by hemorrhages
more easily overcome than those
caused by infarctions.
 Effects of Stroke
 Motor impairments often due to
paralysis on one side of the body
(side opposite to brain damage).
 After about 6 weeks of rehab about 50%
of patients can perform independently
(many with cane or walker).
 Language, learning, memory, and
perception problems depend on
location of the injury.
 Effects of Stroke
 Left-hemisphere damage more
commonly associated with language
problems called aphasia.
 Receptive aphasia – difficulty
understanding verbal information.
 Expressive aphasia – difficulty producing
and using language.
 Damage to right side of brain often
associated with difficulties in visual
processing and emotions.
 Psychosocial Aspects of
Stroke
 Denial is common
 Unclear whether psychological or
physiological basis.
 This ambiguity also applies to depression
when it occurs after a stroke.
 Less than ½ of the patients return to
work following a stroke.