1. Heart Disease, Hypertension,
and Stroke

2. 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?

3. 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

4. Mortality Rates
Leading causes of death
 Middle age
 Sudden death due to heart attack or stroke
 Cancer
 Elderly
 Heart disease
 Cancer
 Stroke

5. Why do women live longer
than men?

6. 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

7. 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)

8. 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

9. How do people adapt to
chronic illness?

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. Heart Disease Risk Factors
 High blood pressure
 Family history
 Cigarette smoking
 High LDL and total cholesterol levels
 Physical inactivity
 Diabetes
 Obesity
 Stress

17. 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.

18. Type A Behaviours
 Hostile, cynical
 Judgmental (opinionated)
 Competitive
 Time urgent
 Uses gestures while talking
 Nodding of head while others are talking
 Intense

19. 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.

20. Effects of Stress On Cardiac
Risk

21. 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

22. 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.

23. 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

24. 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

25. Rehabilitation
 Promote recovery and reduce risk of
another attack
 Heart disease is chronic condition
requiring ongoing management.

26. 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

27. 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.

28. 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

29. 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.

30. 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.

31. 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

32. 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)

33. 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.

34. 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.

35. 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.

36. 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.