Biology Investigatory Project 45472e

Certificate This is to certify that Miss. Jiya Nair of class XII A of K V NO. 1 Port Blair has completed his project titled “To DETERMINE THE VARIOUS TYPE OF HEART DISEASE” under my guidance and to my atmost satisfaction keeping in the norms laid by the CBSE Board in partial fulfilment of project of Biology Practical Examination conducted by AISSCE.

Principal

Teacher-In-charge

External Examiner

Acknowledgem ent I wish to express my deep gratitude and sincere thanks to the Principal Mrs. Raji, KV NO. 1 PORT BLAIR for her encouragement and for all facilities provided for this project work. I heartly Mr. Arjunan Pandiyan chemistry teacher who guided me to success completion of this project. And also sincerely thanks my parents and my classmates who helped me to carry out this project work successfully.

Contents

1. INTRODUCTION 2. OBJECTIVE 3. MATERIALS REQUIRED 4. PROCEDURE 5. OBSERVATION 6. CONCLUSION 7. BIBLIOGRAPHY INTRODUCTION

Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis. The underlying mechanisms vary depending on the disease. Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis. This may be caused by high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption, among others. High blood pressure results in 13% of CVD deaths, while tobacco results in 9%, diabetes 6%, lack of exercise 6% and obesity

5%.Rheumatic heart untreated strep throat.

disease

may

follow

It is estimated that 90% of CVD is preventable. Prevention of atherosclerosis involves improving risk factors through: healthy eating, exercise, avoidance of tobacco smoke and limiting alcohol intake. Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial. Treating people who have strep throat with antibiotics can decrease the risk of rheumatic heart disease. The use of aspirin in people, who are otherwise healthy, is of unclear benefit. Cardiovascular diseases are the leading cause of death globally. This is true in all areas of the world except Africa. Together they resulted in 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990. Deaths, at a given age, from CVD are more common and have been increasing in much of the developing world, while rates have declined in most of the developed world since the 1970s. Coronary artery disease and stroke for 80% of CVD deaths in males and 75% of CVD deaths in

females. Most cardiovascular disease affects older adults. In the United States 11% of people between 20 and 40 have CVD, while 37% between 40 and 60, 71% of people between 60 and 80, and 85% of people over 80 have CVD. The average age of death from coronary artery disease in the developed world is around 80 while it is around 68 in the developing world. Disease onset is typically seven to ten years earlier in men as compared to women. There are many different types of heart disease. Some are congenital (people are born with heart problems), but a majority of heart diseases develop over the course of time and affect people later in life.

OBJECTIVE: To study the various types of heart diseases

MATERIALS REQUIRED: 1) A sample of heart 2) A white paper to note down observations 3) A pen

Procedure: 1. STUDY OF A HEART WITH CORONARY ARTERY DISEASE

Coronary

artery

disease (CAD),

also

known

as ischemic heart disease (IHD), refers to a group of diseases

which

includes stable

angina, unstable

angina, myocardial infarction, and sudden cardiac death. It

is

within

the

group

of cardiovascular

diseases of which it is the most common type. A common

symptom

is chest

pain or

discomfort

which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually

symptoms

occur

with

exercise

or

emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur

and

sometimes

present. Occasionally,

no

the

first

symptoms sign

is

are

a heart

attack. Other complications include heart failure or an abnormal heartbeat. Risk

factors

include high

pressure, smoking, diabetes, exercise, obesity, high diet, depression,

blood and

lack cholesterol,

blood of poor

excessive alcohol. The

underlying mechanism involves reduction of blood

flow

and

oxygen

to

the heart

to atherosclerosis of

the arteries

number

may

of

tests

help

of

muscle due the

with

including: electrocardiogram, cardiac

heart. A diagnoses stress

testing, coronary computed

tomographic

angiography, and coronary angiogram, among others. Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin), beta

blockers,

or nitroglycerin may be recommended. Procedures such

as percutaneous

coronary

intervention (PCI)

or coronary artery by surgery (CABG) may be

used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk. In 2015 CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.9% of all deaths making

it

the most

common

cause

of

death globally. The risk of death from CAD for a given age has decreased between 1980 and 2010, especially in developed countries. The number of cases of CAD for a given age has also decreased between 1990 and 2010.In the United States in 2010 about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45. Rates are higher among men than women of a given age.

2. STUDY OF HEART WITH ISCHEMIA

ISCHEMIA is a condition where the flow of oxygenrich blood to a part of the body is restricted. Cardiac ischemia refers to lack of blood flow and oxygen to the heart muscle. Cardiac ischemia happens when an artery becomes narrowed or blocked for a short time, preventing oxygen-rich blood from reaching the heart. If ischemia

is

severe

or

lasts too long, it can cause

a heart

attack (myocardial infarction) and can lead to heart tissue death. In

most

cases,

a

temporary blood shortage to the heart causes the pain of angina pectoris. But in other cases, there is no pain. These cases are called silent ischemia. Silent ischemia may also disturb the heart’s rhythm. Abnormal

rhythms

such

as

ventricular

tachycardia or ventricular fibrillation can interfere with the heart’s pumping ability and can cause fainting or even sudden cardiac death.

3. STUDY OF ANGINA OF HEART

Angina, also known as angina pectoris, is chest pain or pressure, usually due to not enough blood flow to the heart muscle. Angina is usually due to obstruction or spasm of the coronary arteries. Other causes include anemia, abnormal heart rhythms, and heart failure. The main mechanism of coronary artery obstruction is an atherosclerosis. The term derives from the Latin angere ("to strangle") and pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a myocardial infarction (heart attack) and a heart attack can occur without pain). In some cases, angina can be quite severe, and in the early 20th century this was a known sign of impending death. However, given current medical therapies, the outlook has improved substantially. People with an average age of 62 years, who have moderate to severe degrees of angina (grading by classes II, III, and IV) have a 5-year survival rate of approximately 92%. Worsening angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped

with similar conditions as the acute coronary syndrome). As these may precede a heart attack, they require urgent medical attention and are, in general, treated in similar fashion to myocardial infarction. Stable angina Also known as 'effort angina', this refers to the classic type of angina related to myocardial ischemia. A typical presentation of stable angina is that of chest discomfort and associated symptoms precipitated by some activity (running, walking, etc.) with minimal or non-existent symptoms at rest or after istration of sublingual nitroglycerin. Symptoms typically abate several minutes after activity and recur when activity resumes. In this way, stable angina may be thought of as being similar to intermittent claudication symptoms. Other recognized precipitants of stable angina include cold weather, heavy meals, and emotional stress.

Unstable angina

Unstable angina (UA) (also "crescendo angina"; this is a form of acute coronary syndrome) is defined as angina pectoris that changes or worsens. It has at least one of these three features: it occurs at rest (or with minimal exertion), usually lasting more than 10 minutes it is severe and of new onset (i.e., within the prior 4–6 weeks) it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than before). UA may occur unpredictably at rest, which may be a serious indicator of an impending heart attack. What differentiates stable angina from unstable angina (other than symptoms) is the Pathophysiology of the atherosclerosis. The Pathophysiology of unstable angina is the reduction of coronary flow due to transient platelet aggregation on apparently normal endothelium, coronary artery spasms, or coronary thrombosis. The process starts with atherosclerosis, progresses through inflammation to yield an active unstable plaque, which undergoes thrombosis and results in acute myocardial ischemia, which, if not reversed, results in cell necrosis (infarction). Studies show that 64% of all unstable anginas occur between 22:00 and 08:00 when patients are at rest.

4. STUDY A HEART WITH MYOCARDIAL INFARCTION

Myocardial infarction (MI), commonly known as a heart attack occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it occurs in the centre or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30% of people have typical symptoms. Women more often have atypical symptoms than men. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, carcinogenic shock, or cardiac arrest. Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol intake, among others. The complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI. MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant

emotional stress, and extreme cold, among others. A number of tests are useful to help with diagnosis, including electrocardiograms (ECGs), blood tests, and coronary angiography. An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI (STEMI) if ST elevation is present. Commonly used blood tests include trooping and less often creatine kinase MB. Treatment of an MI is time-critical. Aspirin is an appropriate immediate treatment for a suspected MI. Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes. Supplemental oxygen is recommended in those with low oxygen levels or shortness of breath. In a STEMI, treatments attempt to restore blood flow to the heart, and include percutaneous coronary intervention (PCI), where the arteries are pushed open and may be stented, or thrombolysis, where the blockage is removed using medications. People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use of PCI in those at high risk. In people with blockages of multiple coronary arteries and diabetes, coronary artery by surgery (CABG) may be recommended rather than angioplasty. After an MI, lifestyle modifications, along with long term

treatment with aspirin, beta blockers, and statins, are typically recommended. Instable angina, the developing atheroma is protected with a fibrous cap. This cap may rupture in unstable angina, allowing blood clots to precipitate and further decrease the area of the coronary vessel's lumen. This explains why, in many cases, unstable angina develops independently of activity.

5. STUDY OF HEART FAILURE

Heart failure (HF), often referred to as congestive heart failure (CHF), is when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. Signs and symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night. A limited ability to exercise is also a common feature. Chest pain, including angina, does not typically occur due to heart failure. Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause. These cause heart failure by changing

either the structure or the functioning of the heart. There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on whether the ability of the left ventricle to contract is affected, or the heart's ability to relax. The severity of disease is usually graded by the degree of problems with exercise. Heart failure is not the same as myocardial infarction (in which part of the heart muscle dies) or cardiac arrest (in which blood flow stops altogether). Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia, and thyroid disease. The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography. Blood tests, electrocardiography, and chest radiography may be useful to determine the underlying cause. Treatment depends on the severity and cause of the disease. In people with chronic stable mild heart failure, treatment commonly consists of lifestyle modifications

such as stopping smoking, physical exercise, and dietary changes, as well as medications. In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitorsor angiotensin receptor blockers along with beta blockers are recommended. For those with severe disease, aldosterone antagonists, or hydralazine with a nitrate may be used. Diuretics are useful for preventing fluid retention. Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended. In some moderate or severe cases, cardiac resynchronization therapy (CRT) or cardiac contractility modulation may be of benefit. A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease that persists despite all other measures.

6. TO STUDY A HEART WITH Heart arrhythmia

Heart

arrhythmia (also

as arrhythmia, dysrhythmia, heartbeat) is

a

the heartbeat is

group

of

irregular,

known or irregular

conditions too

fast,

in

which

or

too

slow. A heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia and a heart rate that is too slow – below 60 beats per minute

–

is

called bradycardia. Many

types

of

arrhythmia have no symptoms. When symptoms are present these may include palpitations or feeling a pause between heartbeats. In more serious cases there

may

be lightheadedness, ing

out, shortness of breath, or chest pain. While most types of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in cardiac arrest. There are four main types of arrhythmia: extra beats, supraventricular arrhythmias,

tachycardias, ventricular

and bradyarrhythmias. Extra

beats

include premature atrial contractions, premature ventricular

contractions,

and premature

junctional

contractions. Supraventricular

tachycardias include atrial fibrillation, atrial flutter, and paroxysmal

supraventricular

tachycardia. Ventricular include ventricular

arrhythmias fibrillation and ventricular

tachycardia. Arrhythmias are due to problems with the electrical

conduction

system

of

the

heart. Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. A number of tests can help with diagnosis

including

an electrocardiogram(ECG)

and Holter monitor. Most

arrhythmias

treated. Treatments medical

can may

procedures

be

effectively

include

medications,

such

as

inserting

a pacemaker, and surgery. Medications for a fast heart rate may include beta blockers or agents that attempt to restore a normal heart rhythm such as procainamide. This latter group may have more significant side effects especially if taken for a long period of time. Pacemakers are often used for slow heart rates. Those with an irregular heartbeat are

often treated with blood thinners to reduce the risk of complications. Those who have severe symptoms from an arrhythmia may receive urgent treatment with

a controlled

electric

shock in

the

form

of cardioversion or defibrillation. Arrhythmia affects millions of people. In Europe and North America, as of 2014, atrial fibrillation affects about 2% to 3% of the population. Atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, up from 29,000 in 1990. Sudden cardiac death is the cause of about half of deaths due to cardiovascular disease or about 15% of all deaths globally. About 80% of sudden cardiac death is the result of ventricular arrhythmias. Arrhythmias may occur at any age but are more common among older people.

7. TO STUDY A HEART WITH Peripheral artery disease

Peripheral artery disease (PAD) is a narrowing of the arteries other than those that supply the heart or the brain. When narrowing occurs in the heart, it is called coronary artery disease, while, in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved. The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication. Other symptoms including skin ulcers, bluish skin, cold skin, or poor nail and hair growth may occur in the affected leg. Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. Up to 50% of cases of PAD are without symptoms. The main risk factor is cigarette smoking. Other

risk

factors

include diabetes, high blood pressure, and high blood cholesterol. The underlying mechanism is

usually atherosclerosis. Other

causes

include artery spasm. PAD is typically diagnosed by

finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided

by

the

systolic

blood

arm. Duplex

pressure

of

the

ultrasonography

and angiography may also be used. Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks. It is unclear if screening for disease is useful as it has not been properly studied. In those with intermittent claudication from PAD, stopping smoking

and

therapy improves

supervised exercise outcomes. Medications,

including statins, ACE inhibitors, and cilostazol also may help. Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease. Anticoagulants such as warfarin are not typically of benefit. Procedures used

to

treat

the

disease

include by

grafting, angioplasty, and atherectomy.

OBSERVATIONS

 Risk factors There are many risk factors for heart diseases: age, gender,

tobacco

use,

physical

excessive alcohol consumption,

inactivity,

unhealthy

diet,

obesity, genetic predisposition and family history of cardiovascular disease, raised blood pressure (hypertension), mellitus),

raised raised

(hyperlipidemia),

blood

sugar

blood

(diabetes cholesterol

undiagnosed celiac

disease,

psychosocial factors, poverty and low educational status,

and air

pollution. While

the

individual

contribution of each risk factor varies between different communities or ethnic groups the overall contribution

of

these

risk

factors

is

very

consistent. Some of these risk factors, such as age, gender or family history/genetic predisposition, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, social

change,

prevention

of

drug

treatment

hypertension,

(for

example

hyperlipidemia,

and

diabetes).People with obesity are at increased risk of atherosclerosis of the coronary arteries.  Genetics Genetic

factors

influence

the

development

of

cardiovascular disease in men who are less than 55 years-old and in women who are less than 65 years old. Cardiovascular disease in a person's parents

increases

their

risk

by

3

fold.

Multiple single nucleotide polymorphisms (SNP) have been found to be associated with cardiovascular disease in genetic association studies, but usually their individual influence is small, and genetic contributions to cardiovascular disease are poorly understood.  Age Age

is

the

most

important

risk

factor

in

developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade

of life. Coronary fatty streaks can begin to form in adolescence. It is estimated that 82 percent of people who die of coronary heart disease are 65 and

older. Simultaneously,

the

risk

of

stroke

doubles every decade after age 55. Aging

is

also

with

changes

associated in

the

mechanical and structural properties of the vascular wall, which leads to the loss of

arterial

elasticity

and

reduced arterial compliance and may subsequently lead to coronary artery disease.  Sex Men are at greater risk of heart disease than premenopausal women. Once past menopause, it has been argued that a woman's risk is similar to a man's although more recent data from the WHO

and UN disputes this. If a female has diabetes, she is more likely to develop heart disease than a male with diabetes. Coronary heart diseases are 2 to 5 times more common among middle-aged men than women. Among women, estrogen is the predominant sex hormone. Estrogen may have protective effects on glucose metabolism and hemostatic system, and may have

direct

effect

in

improving endothelial

cell

function. The production of estrogen decreases after menopause and this may change the female lipid metabolism toward a more atherogenic form by decreasing the HDLcholesterol level while increasing LDL and total cholesterol levels.  Tobacco Cigarettes are the major form

of

tobacco. Risks

smoked to

health

from tobacco use result not only from direct consumption of

tobacco, but also from exposure to second-hand smoke. Approximately

10%

of

cardiovascular

disease is attributed to smoking; however, people who quit smoking by age 30 have almost as low a risk of death as never smokers.  Physical inactivity Insufficient physical activity (defined as less than 5 x 30 minutes of moderate activity per week, or less than 3 x 20 minutes of vigorous activity per week) is currently the fourth leading risk factor for mortality worldwide. In 2008, 31.3% of adults aged 15 or older (28.2% men and 34.4% women) were insufficiently physically active. The risk of ischemic heart disease and diabetes mellitus is reduced by almost a third in adults who participate in 150 minutes of moderate physical activity each week (or equivalent). In addition, physical activity assists weight loss and improves blood glucose control, blood

pressure,

lipid

profile

and

insulin

sensitivity. These effects may, at least in part, explain its cardiovascular benefits.

 Diet High dietary intakes of saturated fat, trans-fats and salt and low intake of fruits, vegetables and fish are linked to cardiovascular risk, although whether all these associations are a cause is disputed.

The

attributes

approximately

worldwide

to

World low

Health 1.7

Organization

million

fruit

and

deaths

vegetable

consumption. The amount of dietary salt consumed is also an important determinant of blood pressure levels

and

overall

consumption

of

cardiovascular high-energy

risk. Frequent

foods,

such

as

processed foods that are high in fats and sugars, promotes obesity and may increase cardiovascular risk. A

Cochrane

review

found

that

replacing

saturated fat with polyunsaturated fat (plant based oils) reduced cardiovascular disease risk. Cutting

down

on

saturated

fat

reduced

risk

of

cardiovascular disease by 17% including heart disease and stroke.

The relationship between

alcohol consumption and cardiovascular disease is complex, and may depend on the amount of alcohol consumed. There is a direct relationship between high levels of alcohol consumption and risk of cardiovascular disease. Drinking at low levels without

episodes

of heavy

drinking

may

be

associated with a reduced risk of cardiovascular disease  Celiac disease

Untreated celiac

disease can

cause

the

development of many types of cardiovascular diseases, most of which improve or resolve with a gluten-free diet and intestinal healing. However, delays in recognition and diagnosis of celiac disease can cause irreversible heart damage.  Socio economic disadvantage There is relatively little information regarding social patterns of cardiovascular disease within low- and middle-income countries, but within high-income

countries

low

income

and

low

educational status are consistently associated with greater risk of cardiovascular disease. Policies that

have

inequalities subsequent

resulted have

in

increased

been

associated

socio-economic

socio-economic with

greater

differences

in

cardiovascular disease implying a cause and effect relationship.

Psychosocial

factors,

environmental

exposures, health behaviours, and health-care access and quality contribute to socio-economic differentials

in cardiovascular disease. The

Commission

on

Social Determinants of Health recommended that more

equal

education,

distributions housing,

of

power,

environmental

wealth, factors,

nutrition, and health care were needed to address inequalities in cardiovascular disease and noncommunicable diseases.  Air pollution Particulate matter has been studied for its shortand

long-term

exposure effects on

cardiovascular

disease. Currently, PM2.5 is

the

major

focus,

in

which

gradients are used to determine CVD risk.

For

every

10

μg/m3 of

PM2.5 long-term

exposure, there was an estimated 8–18% CVD mortality

risk. Other

research

has

implicated

PM2.5 in irregular heart rhythm, reduced heart rate

variability notably

(decreased heart

vagal

tone),

failure. PM2.5 is

and

also

most linked

to carotid artery thickening and increased risk of acute myocardial infarction.

RESULT AND CONCLUSION

Cardiovascular risk assessment Existing

cardiovascular

disease

or

a

previous

cardiovascular event, such as a heart attack or stroke, is the strongest predictor of a future cardiovascular

event. Age,

sex,

smoking,

blood

pressure, blood lipids and diabetes are important predictors of future cardiovascular disease in people who are not known to have cardiovascular disease. These measures, and sometimes others, may be combined into composite risk scores to estimate an individual's future risk of cardiovascular disease. Numerous risk scores exist although their respective merits are debated. Other diagnostic tests and

biomarkers

remain

under

evaluation

but

currently these lack clear-cut evidence to their routine use. They include family history, coronary sensitivity

artery calcification score, high C-reactive

protein (hs-CRP), ankle–

brachial pressure index, lipoprotein subclasses and

particle

concentration,

lipoprotein(a),

apolipoproteins A-I and B, fibrinogen, white blood

cell count, homocysteine, N-terminal pro B-type natriuretic peptide (NT-proBNP), and markers of kidney function. High blood phosphorus is also linked to an increased risk. Occupational exposure Little is known about the relationship between work and cardiovascular disease, but links have been established between certain toxins, extreme heat and cold, exposure to tobacco smoke, and mental health concerns such as stress and depression. Chemical risk factors A 2015 SBU-report looking at non-chemical factors found an association for those: With mentally stressful work with a lack of control over their working situation — with an effort-reward imbalance Those who work night schedules; or have long working weeks Those who are exposed to noise Specifically the risk of stroke was also increased by exposure to ionizing radiation. Hypertension develops

more often in those who experience job strain and who have shift-work. Differences between women and men in risk are small, however men risk suffering and dying of heart attacks or stroke twice as often as women during working life. Non-chemical risk factors Workplace exposure to silica dust or asbestos is also associated with pulmonary heart disease. There is evidence that workplace exposure to lead, carbon disulphide, phenoxyacids containing TCDD, as well as working in an environment where aluminium is being

electrolytically

produced,

is

associated

with stroke. Somatic mutations As of 2017, evidence suggests that certain leukemiaassociated mutations in blood cells may also lead to

increased

risk

of

cardiovascular

disease.

Several large-scale research projects looking at human genetic data have found a robust link between the presence of these mutations, a condition known as clonal hematopoiesis,

and cardiovascular disease-related incidents and mortality. Pathophysiology Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material) Population-based studies show that atherosclerosis, the major precursor of cardiovascular disease, begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study demonstrated that intimal lesions appear in all

the aortas and more than half of the right coronary arteries of youths aged 7–9 years. This is extremely important considering that 1 in 3 people die from complications attributable to atherosclerosis. In order to stem the tide, education and awareness that cardiovascular disease poses the greatest threat, and measures to prevent or reverse this disease must be taken. Obesity and diabetes mellitus are often linked to cardiovascular disease, as are a history of chronic kidney disease and hypercholesterolaemia. In fact, cardiovascular disease is the most lifethreatening of the diabetic complications and diabetics are two- to four-fold more likely to die of cardiovascular-related causes than nondiabetics. Screening Screening ECGs (either at rest or with exercise) is not recommended in those without symptoms who are at low risk. This includes those who are young without risk factors. In those at higher risk the evidence for screening with ECGs is inconclusive.

Additionally echocardiography, myocardial perfusion imaging, and cardiac stress testing is not recommended in those at low risk who do not have symptoms. Some biomarkers may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the clinical value of some biomarkers is questionable. Prevention Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Currently practiced measures to prevent cardiovascular disease include: Tobacco cessation and avoidance of secondhand smoke. Smoking cessation reduces risk by about 35%. A low-fat, low-sugar, high-fiber diet including whole grains and fruit and vegetables. Dietary interventions are effective in reducing cardiovascular risk factors over a year, but the longer term effects of such interventions and their impact on cardiovascular disease events is uncertain.

At least 150 minutes (2 hours and 30 minutes) of moderate exercise per week. Exercise-based cardiac rehabilitation reduces risk of subsequent cardiovascular events by 26%, but there have been few high quality studies of the benefits of exercise training in people with increased cardiovascular risk but no history of cardiovascular disease. Limit alcohol consumption to the recommended daily limits; People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease. Lower blood pressure, if elevated. A 10 mmHg reduction in blood pressure reduces risk by about 20%. Decrease non-HDL cholesterol. Statin treatment reduces cardiovascular mortality by about 31%. Decrease body fat if overweight or obese. The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited. In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk.

Decrease psychosocial stress. This measure may be complicated by imprecise definitions of what constitute psychosocial interventions. Mental stress– induced myocardial ischemia is associated with an increased risk of heart problems in those with previous heart disease. Severe emotional and physical stress leads to a form of heart dysfunction known as Takotsubo syndrome in some people. Stress, however, plays a relatively minor role in hypertension. Specific relaxation therapies are of unclear benefit. Diet A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death. Evidence suggests that the Mediterranean diet may improve cardiovascular outcomes. There is also evidence that a Mediterranean diet may be more effective than a low-fat diet in bringing about long-term changes to cardiovascular risk factors (e.g., lower cholesterol level and blood pressure). The DASH diet (high in nuts, fish, fruits and vegetables, and low in sweets, red

meat and fat) has been shown to reduce blood pressure, lower total and low density lipoprotein cholesterol and improve metabolic syndrome; but the longterm benefits outside the context of a clinical trial have been questioned. A high fiber diet appears to lower the risk. Total fat intake does not appear to be an important risk factor. A diet high in trans fatty acids, however, does increase rates of cardiovascular disease. Worldwide, dietary guidelines recommend a reduction in saturated fat. However, there are some questions around the effect of saturated fat on cardiovascular disease in the medical literature. Benefits from replacement with polyunsaturated fat appears greatest; however, supplementation with omega-3 fatty acids (a type of polysaturated fat) does not appear to have an effect. Medication Blood pressure medication reduces cardiovascular disease in people at risk, irrespective of age, the baseline level of cardiovascular risk, or baseline blood pressure.

The commonly-used drug regimens have similar efficacy in reducing the risk of all major cardiovascular events, although there may be differences between drugs in their ability to prevent specific outcomes. Larger reductions in blood pressure produce larger reductions in risk, and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure. Statins are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease. Antidiabetic medication may reduce cardiovascular risk in people with Type 2 Diabetes, although evidence is not conclusive. Aspirin has been

found to be of only modest benefit in those at low risk of heart disease as the risk of serious bleeding is almost equal to the benefit with respect to cardiovascular problems. In those at very low risk it is not recommended. The United States Preventive Services Task Force recommends against use of aspirin for prevention in women less than 55 and men less than 45 years old; however, in those who are older it is recommends in some individuals. The use of vasoactive agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense. Physical activity A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide. The authors estimated that 121,000 deaths from coronary heart disease could have been averted in Europe in 2008, if physical inactivity had been removed. A Cochrane review found some evidence that yoga has beneficial effects on

blood pressure and cholesterol, but studies included in this review were of low quality.

conclusion

Management Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions. Influenza may make heart attacks and strokes more likely and therefore influenza vaccination may decrease the chance of cardiovascular events and death in people with heart disease. Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle income levels. Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for qualityadjusted life-year (QALY) in regions of low and middle income.

BIBLIOGRAPHY 1.

https://en.wikipedia.org/wiki/Cardiovascular _disease

2.

http://www.heart.org/HEARTORG/Conditions /What-is-CardiovascularDisease_UCM_301852_Article.jsp

3.

https://www.medicalnewstoday.com/article s/237191.php