LECTURE: NOVEMBER 23RD, 2012
TOPIC: CORONARY HEART DISEASE
➔ No lecture slides for next week
➔ CORONARY HEART DISEASE
◦ Illustration of the mind-body connection
◦ What biological mechanisms make stress a contributor to heart disease
◦ #1 killer of both men and women in Canada
◦ Heart and Stroke Foundation: 1 in every 4 Canadians has a heart condition, high blood
pressure, or artery issues → very prevalent disease.
◦ Enormous costs for health care system and economy
➔ Leading Causes of Death
◦ Refer to ppt.
➔ Refer to CoronaryArtery Disease web illustration on ppt.
◦ Atherosclerosis → narrowing of arteries due to a build up of plaque which is made up of
cholesterol and other liquids that circulate one's blood stream.
◦ Arteriosclerosis → hardening of arteries. Lose elasticity when unhealthy. Healthy → should
be able to expand and contract. When the arteries are hard the blood flow is disrupted
because they cannot accommodate increases in blood flow and blood pressure.
◦ If there is a blood clot it is more likely to get stuck because in these cases the arteries cannot
◦ Ischemia → restriction of blood flow. Heart becomes deprived of oxygen. Parts of heart
muscle start to die off. Heart will not function properly.
◦ Coronary Heart Disease → a disorder in which the blockage of these arteries are affecting
the functioning of the heart (blockage not restriction)
◦ Angina Pectoris → painful cramps caused by the muscles contracting around the heart. Can
be felt in the chest, arms, back. It can spread through different body parts. Person has
problems breathing. This is often mistaken for a heart attack. Brought on by some kind of
strain → exercise, lots of stress, eating a large meal. No permanent or lasting damage to the
heart as long as the blockage is partial/temporary. It serves as a warning sign that something
is not functioning right.
◦ Myocardial Infarction (heart attack) → this blockage and lack of oxygen in blood that is
prolonged. Muscle tissue around heart called myocardium is destroyed.
◦ Progression or flow of heart disease.
◦ Those who suffer these symptoms usually do not go to a hospital because they typically
think that maybe they just pulled a muscle and such.
➔ Symptoms of a HeartAttack
◦ Refer to ppt.
◦ Pain felt in a heart attack is usually in the center of the chest not necessarily on the left.
▪ Example: those who have a panic attack will hold onto the left side of their chest
because that is where their heart is being that they feel they are having a heart attack.
▪ This relates to pain perception and interpretation of symptoms.
◦ Difference in men and women
▪ Females have been excluded from medical research in the past therefore for many years
people felt that the symptoms on the ppt.Are only related to men. ▪ Women experience: gastrointestinal symptoms, pain like heart burn esophagus, and
▪ Women put as a lower priority because the doctors thought they just had the flu.
▪ Women are more likely to die from a heart attack because they are more often
▪ Do not know why they are different.
➔ When do heart attacks occur?
◦ Refer to ppt.
◦ When you are awake, body is pumping blood
◦ Monday morning effect for those who work between 6am and 11am due to circadian
rhythms affecting how one's heart functions (tired, get up fast and early and have to be
active so quickly). → more heart attacks happen in this case.
▪ Go get some rest on weekend then Monday comes and you have to get up early and be
active right away.
◦ Hormonal differences → hormones prepare body for activity (helps to get us up but puts a
strain on our cardiovascular system).
▪ Monday mornings carry stress
▪ To do list for the week → psychological stress
➔ Biological Risk Factors
◦ Age (the older you are the higher the risk, age 45 and up it really started to become risky).
▪ Bodies are not as strong anymore
▪ Weakens cardiovascular system
▪ Cannot change this
▪ Difference in hormones in men and women
▪ Some have said that womens' hormones protect them from heart disease
• Once they are going through menopause the risk between men and women becomes
• Higher levels of estrogen and progesterone offers protection to premenopausal
women → related to how blood clots form.
• Birth control pill → contains synthetic hormones (gives hormones in smaller doses
which helps prevent pregnancy). Lowers levels of hormones.
• Side effect → increase risk of blood clot (clots easier because of less hormones).
◦ Acertain age
◦ Have a family history of clots
◦ Do not take pill!
▪ Type I → no control over this because it is genetic
• Risk because the diabetes damages the vasculature and the arteries (weakens these).
• Unmanaged diabetes increases this risk
▪ Type II → damage once again
• Can reduce risk through exercise
• Lifestyle makes a huge difference
• Psychological barriers to people trying to change their lifestyle ◦ Family History
▪ Genetic influences (example: predisposition to heart disease, high blood pressure,
clotting disorders etc)
▪ Perhaps this is not a biological risk factor (something to keep in mind)
▪ Set Point Theory
• We all have this biologically predetermined range of weight that our body is most
• Eat normally → body settles at this set point
• Naturally distributed set point range → some will be naturally heavier and others
• Obesity and Heart Disease → correlation between being in the obese category (BMI
-Body Mass Index that is 30+) and heart disease.
• Cross culturally
◦ High rates of obesity → correlation disappears in some cases
◦ Example: people in the South Pacific (overweight population)
▪ Eat healthy and do not over eat
▪ Little access to bad food because it is a series of islands
▪ Heart disease is very very low
▪ It is NOT the obesity that is a risk factor (not that your body is carrying an
above average amount of weight). It is the BEHAVIOURS that lead people
to become obese.
• Dieting → put our bodies through some strain when depriving the body
of calories. Periods experienced of depriving oneself and then over eating
(yo yo diet).
• Example: starvation study discussed earlier in this class
• Animals put through yo yo diets (experimentally simulate)
◦ Take mammals, rats, mice
◦ Put them on low calorie rat food with little portions → lose weight
◦ Then give them access to delicious foods (high in fat, high in sugar,
they like fruit loops → have similar taste preferences to humans).
◦ This causes them to over eat and gain weight (gain back original
weight plus more).
◦ Autopsy rats and can see damage to myocardium → look like they
have heart disease. More damage to their heart than genetically
produced FAT rats.
◦ Biological evidence in animals for dieting and heart disease. On
average diets do not last. One reason is because you are losing lean
muscle mass which contributes to a metabolism that slows down and
therefore put on weight. When exercising → increase muscle and
◦ When people are told to lose weight they instantly think of going on a diet
▪ This is a risk
▪ Exercise is another option (reduction in risk factors).
▪ People set their goals too high sometimes when they ha