IM cvd

40 %
60 %
Information about IM cvd
Education

Published on January 28, 2008

Author: Dorotea

Source: authorstream.com

Integrative Medicine Approach to Cardiovascular Disease:  Integrative Medicine Approach to Cardiovascular Disease Case Presentation: Maria Olivas is a 55 year old Mexican-American woman who is new patient in your schedule. She is a hospital follow up for a non-Q wave MI. She was discharged a week ago after an admission for atypical chest pain that resulted in a mild MI. She had untreated hypertension and diabetes as well as hyperlipidemia. All diagnosed at the time of the admission since she had not been to a physician in 5 years. Slide2:  Case Presentation (continued): She tells you she is worried about her health. She does not like to take medications and was given many at the hospital. She wants you to see if you can cut some out. She has custody of two grandchildren and works cleaning houses and needs to get back to work. Past Medical History:  Past Medical History Recently diagnosed with HTN, type II DM and Hyperlipidemia Medications: Metformin 500 mg BID Atenolol 25 mg QD Lisinopril 20 mg QD ASA 325 mg QD Simvastatin 10 mg QD Allergies: NKDA Hospitalizations: 3 NVDs Last admission for the non Q wave MI Family History:  Family History Mother died of heart problems at age 65. Father died at age 45 from a car accident. 4 younger siblings unknown health problems 30 year old daughter with substance abuse problems 28 and 32 year old sons healthy Social History:  Social History Separated, lives with 28 year old son and 13 and 14 year old grand-daughters. Works cleaning houses. Quit smoking 15 years ago, does not drink alcohol, no history of substance use. Born in Tucson to Mexican parents, did not finish high school. Diet: typical mexican diet Exercise: what she does at work Summary of review of systems:  Summary of review of systems Weight gain since menopause (25 pounds in 5 years) Fatigue Heartburn Palpitations, Dizziness Insomnia Back pain on/off, bilateral knee pain and right shoulder pain All other negative Summary of the physical exam:  Summary of the physical exam Wt 185 lb, Ht 5-3, BP 135/88, HR 70 Waist/Hip ratio 1.2 Normal hearth and lung exam Distal pulses intact No lower extremity edema Summary of the laboratory findings:  Summary of the laboratory findings Fasting blood sugar 140 with a Hgb A1C of 8.3 Renal panel, Liver panel, CBC and TSH were normal Cholesterol 240, Triglycerides 350, HDL 40 and LDL 200, ratio 6.0 What is missing from the history?:  What is missing from the history? Nutritional supplements and details of her diet Herbal remedies Support system/ spirituality Understanding of her health problems/cultural influences/belief system Alternative/complementary healers Stress level and management Motivation for change of lifestyle issues Risk factors by the American Heart Association:  Risk factors by the American Heart Association Can NOT be changed Increasing age Gender Heredity/Race CAN be changed Tobacco smoke Increased cholesterol High blood pressure Physical inactivity Obesity/Overweight Diabetes Other (ETOH, Stress) TIME Magazine; February 23, 2004 Vol. 163 No. 8:  TIME Magazine; February 23, 2004 Vol. 163 No. 8 Annual per Capita Increase in Foods Over Past 10 Years:  Annual per Capita Increase in Foods Over Past 10 Years Calories  200 Cal/d Cheese  17 lb/yr Soda  100% Meats (Away from home)  30% French Fries 50% of all vegetables Children 2:1 refined/complex carbs Obesity  25-30% (not included in report) National Conference on Cardiovascular Disease Prevention. Bethesda, MD. Sept. ‘99 Fat Classification:  Fat Classification Saturated Fats Monounsaturated Fats Omega-9 family Polyunsaturated Fats Essential Fatty Acids (EFAs) Omega-6 Family Omega-3 Family Linoleic Acid (LA) alpha linolenic acid (ALA) gamma linolenic acid (GLA) Eicosapentaenoic acid (EPA) Arachidonic acid (AA) Docosahexaenoic acid (DHA) Slide15:   Inflammation  Plt. Aggregation  Inflammation  Plt. Aggregation Slide16:  Omega 6:3 Ratio 0 5 10 15 20 25 Omega 6 Omega 3 1909 (4:1) 1985 (25:1) Slide18:  30 year shelf life Polyunsaturated Partially Hydrogenated Slide19:  J of Amer College of Cardiology. 33(4),1050. 1999 “Impaired Endothelial Function Following a Meal Rich in Used Cooking Fat.” Blood flow measured through brachial artery before and after meal rich in old deep frying fat in fast food restaurant. Four hours later, brachial artery had poor dilation with perfusion. What else are Omega-3 Fatty Acids good for?:  What else are Omega-3 Fatty Acids good for? Preterm labor: Low consumption associated with increased risk. BMJ 324(7335) 2002 Depression/Bipolar: Mood elevation and stabilization effects. Arch Gen Psychiatry 56(5) 1999 Cognitive decline/AD: DHA levels decline with age associated dementia and are low in those with AD. Lipids 35(12) 2000 Lipids/Endothelial Function: Enhance statin’s effect on lipids and improve endothelial function. JAMA 287(5) 2002, Eur Heart J 23(3) 2002 INTERHEART Study 11119 cases and 13648 controls from 52 countries :  INTERHEART Study 11119 cases and 13648 controls from 52 countries Risk of Acute MI Stress at Work, Home, finances, major life events. Stress similar between sexes, geography, cultures and age groups Smoking #1 Stress #2 with HTN & Abd Obesity. Lancet. 2004 Sep 11;364(9438):953-62. Stress/Depression and Inflammation:  Stress/Depression and Inflammation Inflammation Stress/Depression IL-6 Depressive symptoms caused by administration of cytokines to patients with cancer or hepatitis C :  Depressive symptoms caused by administration of cytokines to patients with cancer or hepatitis C Depressed mood Dysphoria Anhedonia (reduced capacity to experience pleasure) Helplessness Mild to severe fatigue Anorexia and weight loss Hypersomnia Psychomotor retardation Decreased concentration Confusion Depression in Medical Illness. West J Med 2000;173(5) Depression and Inflammation:  Depression and Inflammation Depressed had 40% greater CRP than non-depressed. Depressed had higher levels of cytokines; IL-1, IL-6, IL-8, & TNF Depressed adults weighed more with a BMI of 30.5 vs. 25.9 Miller, G. Washington University, St. Louis. American Psychosomatic Medicine Conference, 2003. USA Today, 3/03. Psychosomatic Medicine 65(3) 2003 Reversible cardiomyopathy with severe emotional stress:  Reversible cardiomyopathy with severe emotional stress 19 pts w/ LV dysfunction post emotional stress EF = 20% Prolonged Q-T  Monocyte infiltration Mod  Traponin I  catecholimines 95% had nl arteries NEJM. 2005:352;539-548 J Am Coll Card: Vol 45(5);2005:  J Am Coll Card: Vol 45(5);2005 Depression  risk of death from Heart Dz by 50%!:  Depression  risk of death from Heart Dz by 50%! 90,000 women Followed for 4 years >50 yrs of age Independent risk factor particularly in those with no hx of CAD Increased inflammatory cytokines Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI). Arch Intern Med. 2004 Feb 9;164(3):289-98. Hostility, Time Urgency & Impatience (The CARDIA Study) JAMA. 2003 Oct 22;290(16):2138-48.:  Hostility, Time Urgency & Impatience (The CARDIA Study) JAMA. 2003 Oct 22;290(16):2138-48. Young adults: 18-30 yrs of age Doubled incidence of HTN Higher intake of fish (omega-3 fatty acids) associated with lower hostility. Eur J Clin Nutr. 2004 Jan;58(1):24-31. Hostility:  Hostility CARDIA study 374 18-30 yo EG Hostility index ’85-’86 CT scans of C. arteries in ’95-’96 Those with > median hostility score had 2x risk of coronary Ca++ Those with > median hostility had 9x risk of coronary Ca++ than those with < mean hostility score. JAMA. 2000; 283:2546-2551 Slide32:  Adapted from Ironson et al. Am J of Card. 70:281-5, 1992. The Physician and Sportsmedicine, 28; Sept. 2000. Suppression of Anger:  Suppression of Anger African-Americans perceiving racism with anger suppression  B.P. Less drop in B.P. with sleep Psychosomatic Med. 2003;65:746-750 The sorrow that hath no vent in tears, may make other organs weep William Boyd, MD Forgiveness:  Forgiveness 108 College Students Had events where they felt deeply hurt or betrayed Those with highest “Acts of Forgiveness” =  BP Forgiveness =  sympathetic tone A Change of Heart. J Behav Med. 2003:26;373-393 I have decided to stick with love. Hate is too great a burden to bear.:  I have decided to stick with love. Hate is too great a burden to bear. -Martin Luther King- The Infomedical Cycle:  The Infomedical Cycle Rakel DP, Shapiro DA. Mind-Body Medicine. In; Textbook of Family Practice. 6th ed. “There is nothing good or bad but thinking makes it so.”:  “There is nothing good or bad but thinking makes it so.” Hamlet Knowledge can bias what we see:  Knowledge can bias what we see Stored visual information can affect processing of visual images. Our knowledge can influence what we see and interpret in our environment. Nature 378(6556):496-8, 1995 Our life experiences shape our perception:  Our life experiences shape our perception Perceived Support/Caring:  Perceived Support/Caring Russek & Schwartz Psychosom. Med.1997;59:144-149 35 year follow-up of the Harvard Mastery Stress Study Perception of parental caring/relationship predicted health status in mid-life Those who suffered from CAD gave their parents significantly lower ratings. Repeated Stress triggers inflammation:  Repeated Stress triggers inflammation Recurring mild stressors result in less glucocorticoid sensitivity and less inhibition of inflammation. Proceedings of the National Academy of Science. 96(25) Oct, 1999. Happiness and Heart Risk Markers…Hot off the Press!!:  Happiness and Heart Risk Markers…Hot off the Press!! 216 Middle-Aged Londoners (116 Men, 100 women) Measured mood throughout the day Happy people had  Fibrinogen  Cortisol Men had lower resting HR  Unhappy = 4x  fibrinogen vs happy Independent of distress Steptoe A, et al. Positive Affect and Health-Related Neuroendocrine, Cardiovascular and Inflammatory Processes. PNAS On-line. April, 2005. Head for the eye!:  Head for the eye! Peace……… It does not mean to be in a place where there is no noise, trouble or hard work. It means to be in the midst of those things and still be calm in your heart. -unknown:  Peace……… It does not mean to be in a place where there is no noise, trouble or hard work. It means to be in the midst of those things and still be calm in your heart. -unknown Mindfulness Meditation:  Meditation Longitudinal study by Blue Cross/Shield showed 60%   in medical expenses vs. controls Canada: Taught 677 people Meditation. 50%  in health care costs after 7 yrs. Neuroplasticity: Intentionchanges in mind changes in body:  Neuroplasticity: Intentionchanges in mind changes in body 25 in Meditation Group 16 in wait list control Meditation group had increase in left prefrontal cortex activity. Magnitude of L sided activation correlated with increase in Ab titer to influenza vaccine. Richard J. Davidson, Ph.D., Jon Kabat-Zinn, Ph.D., et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine. 2003 Drop Beneath your mind’s thoughts and …..observe.:  Drop Beneath your mind’s thoughts and …..observe. Thoughts Judgment Emotions Awareness I am an old man and have known a great many troubles, but most of them never happened. -Mark Twain- Emotions and Heart Rhythm:  Emotions and Heart Rhythm McCraty R. Bioelectromagnetic Interactions Within and Between People. HeartMath Research Center. Laughter is Good for the Heart:  Laughter is Good for the Heart 150 people given humorous manuscripts. Those with heart disease were 45% less likely to laugh. Those who did laugh were less likely to have heart disease and had less hostility. Inverse association between sense of humor and coronary heart disease. Int J Cardiol. 80(1), 2001 Slide51:  Physical Lifestyle choices Psychological stress Sense of meaning and purpose Social isolation Mental chaos The Web of Healing Influences:  The Web of Healing Influences Medications Surgery Nutrition Hope Meaning & Purpose Spirituality Social Support Genetics Lifestyle Physical Conditioning Community Belief & Culture Relationships What does an Integrated provider has to offer Maria?:  What does an Integrated provider has to offer Maria? Empowerment, a belief in the self-healing qualities of human beings. Connection, a provider who will know “who” she is, and will help her make changes in her own terms. Knowledge in allopathic as well as other healing practices that could help treat illness and prevent further damage. A provider who embodies a balanced life and could be present when seeing her as a patient. Slide55:  Q & A

Add a comment

Related presentations

Related pages

CVD Cheerleader Vereinigung Deutschland|Home

CVD Cheerleader Vereinigung Deutschland im American Football Verband Deutschland e.V.
Read more

Chemische Gasphasenabscheidung – Wikipedia

Unter dem Begriff chemische Gasphasenabscheidung (englisch chemical vapour deposition, CVD), selten auch chemische Dampfphasenabscheidung, versteht man ...
Read more

cvd.de

Hier sollte eine Beschreibung angezeigt werden, diese Seite lässt dies jedoch nicht zu.
Read more

Plasmaunterstützte chemische Gasphasenabscheidung ...

Während bei der CVD die Dissoziation (das Aufbrechen) der Moleküle des Reaktionsgases durch externe Zufuhr von Wärme sowie die freigewordene Energie der ...
Read more

Das CvD - Christian-von-Dohm-Gymnasium Goslar

Das CvD-Gymnasium mit ca. 800 Schülerinnen und Schülern befindet sich im Schulzentrum Goldene Aue, in dem auch noch die gleichnamige Realschule mit ca ...
Read more

Kooperationspartner - Christian-von-Dohm-Gymnasium Goslar

Kooperationen. Das CvD pflegt verschiedene Kooperationen mit in- und ausländischen Partnern. Die Kooperationen mit Institutionen überwiegend aus der ...
Read more

CVD – Schichtsysteme - eifeler Group – High Tech ...

CVD = Chemical Vapour Deposition, ist die Abscheidung von Hartstoffschichten in einem chemischen Gasphasenprozess. Bei Temperaturen von ca. 1000 °C ...
Read more

CVD Chemical Vapor Deposition

CVD Chemical Vapor Deposition. ein Verfahren der Oberflächen-Beschichtungstechnik (Chemische Dampfphasenabscheidung) Was bedeutet CVD? CVD ist eine ...
Read more

cvd-diamant-werkzeuge.de.de - Willkommen

im Forum CVD-Diamant-Werkzeuge. Viele Zerspanungsaufgaben erfordern die extreme Härte von Diamant als Schneidstoff. Mit der CVD-Synthese (Chemische ...
Read more

Thermisches CVD @ TU Braunschweig

Thermisches CVD Beim thermischen CVD wird die chemische Reaktion durch die thermische Energie der Precursoren bzw. Edukte angeregt. Aus dieser thermischen ...
Read more