ANATOMY IN ACTION SERIES: Highlights of Cardiovascular Disease
Educational articles designed to help CAs understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Laurie Mueller, BA, DC, CFMP
Cardiovascular Disease (CVD)
Pleart disease isthe number one cause of death in the United States, killing more than 370,000 people a year, and claims more lives annually than all forms of cancer combined. In 2013, cardiovascular deaths represented 31% of all global deaths, with 80% of those taking place in lowand middle-income countries. It continues to be a leading global cause of death and accounts for more than 17.3 million deaths peryear worldwide. That number is expected to grow to more than 23.6 million by 2030.
CVD is not an uncommon finding in older and elderly adults. However, it isn't restricted to that patient demographic. We are seeing more of this chronic disease manifest in our younger populations too. CVD is really a broad-scope term that can also include or lead to a variety of related issues, such as heart disease, peripheral artery disease (PAD), atherosclerosis, high blood pressure (HBP), dyslipidemia, myocardial infarction (Ml, or heart attack), stroke, COPD, and other processes that are part of this family.
Anatomy and Physiology Highlights
Recall that the vascular system is a closed system. The blood is contained within vessels and pumped by the heart. Blood delivers oxygen carried by red blood cells (RBCs) and nutrients like amino acids, glucose, mineral salts, and fatty acids, which our body needs for survival. The cardiovascular system also works very closely with the lymphatic system and our immune response mechanisms as it carries white blood cells (WBCs) to the site of infection or injury.
Blood is also instrumental in the maintenance of proper concentrations of ions in the tissues as well as transport of various hormones and other specific substances to different tissues. It also removes carbon dioxide, hydrogen ions, and other waste products from the tissues.
As the conduits for these important substances in
the blood, it makes sense that cardiovascular disease processes will affect that anatomy—the vessels. It is important to remember, though, that blood vessels are not just "pipes." They are dynamic living tissue, constantly rebuilding and adapting to their internal environment.
An important take-home point is that when a patient suffers from CVD, vital exchange processes can be inhibited, and that includes delivery of all vital oxygen and nutrients to the cells of the body and the removal of toxic waste from the cells.
The Walls of Our Blood Vessels Have Three Layers:
Tunica externa/adventitia: This is the outermost layer of the vessel and consists of connective tissue and smaller blood vessels.
Tunica media: The middle layer is the thickest layer, and it contains more muscular and contractile tissues (elastic fibers, connective tissues, and smooth mm cells).
Tunica intima: The innermost and thinnest layer,
comprised of a single layer of endothelium supported by a subendothelial layer. This is the layer first affected by changes and plaque buildup.
Note, capillaries consist of only a single layer of epithelium and associated connective tissue. These are the smallest of vessels and where the exchange of oxygen, carbon dioxide, nutrients, and waste products occurs.
66An important take-home point is that when a patient suffers from CVD\ vital exchange processes can be inhibited(, and that includes delivery of all vital oxygen and nutrients to the cells of the body and the removal of
toxic waste from the cells.33
Physical Signs
If your CA role in the office includes performing part of the physical exam, then you may very well see and document some of the outward physical clues that CVD could be present. Some of these will be gleaned from simple observation, while others may be part of taking the vital signs, such as blood pressure and respiration.
Observation:
Visceral body fat: The anthropomorphic "shape" of a patient may give us clues regarding his or her metabolism. Many of us have heard of the "apple" body shape, which is when most of the fat positions itself around the middle/gut area of the patient. Studies have shown that this type of distribution is more apt to also have such fat around internal organs, so they are at a higher risk for CVD and vascular changes.
Edema (swelling): If you notice edema in the legs or hands, it can be a sign that capillaries are leaking fluid that is building up in surroundingtissues. Edema can be a sign of a variety of underlying conditions, some very serious, that the DC may need to further assess and then provide care along with the patient's MD.
Blood pressure (BP): A high BP is the most common problem we think about with cardiac health. However, low blood pressure can also be a problem, particularly for the elderly. CAs should not "diagnose" HBP with a patient, as that is assessed by the doctor and accomplished over several consecutive readings and visits. The CA's role is simply to take
the pressure and record it in the chart. Of course, if patients ask what their pressure is, it is fine to tell them their numbers. If you ever get readings in the "hypertensive crisis" range, be sure to call the doctor in immediately and call 911. As a reminder of our ranges, we've included the following chart.
Blood Pressure Systolic Diastolic Category mm Hg (upper #) mm Hg (lower#) Normal less than 120 and less than 80 Prehypertension 120-139 80-89 High Blood Pressure 140-159 90-99 (Hypertension) Stage 1 High Blood Pressure 160 or higher 100 or higher (Hypertension) Stage 2 Hypertensive Crisis Higher than 180 Higher than 110 (Emergency care needed)
Respiration: The way a patient breathes can also give us a global picture of what is happening internally. Note the respirations the same time you take the pulse. If a patient is breathing rapidly, it could be paired with tachycardia (rapid heart rate) and be a sign that they are trying to get more oxygen.
Lifestyle Factors
The American Heart Association tracks seven key health factors/behaviors that increase the risk for heart disease and stroke. The following seven factors are viewed as having a significant impact:
• Smoking
• Lack of physical activity
• Lack of healthy diet
• Overweight/obesity
• Uncontrolled cholesterol
• High blood pressure
• Blood sugar handling issues/diabetes
If you want to learn more about these, the AHA has statistics and more information in a document on their website.
The take-home message here is that many CVD factors can be reduced greatly by lifestyle changes that are within the patient's control. As a matter of fact, the Lansing Journal's 2004 interheart study, which included over 30,000 people, concluded that 90% of all heart disease could be prevented by changing lifestyle. Those figures should feel very empowering for our patients.
Inflammation
The concept of inflammation within the body as a key causation of cardiovascular disease is important here and the subject of all cutting-edge research on the topic. It is closely related to the concept of oxidative stress. There is extensive and growing evidence that inflammation participates centrally in all stages of cardiovascular disease, from initial lesions to the end-stage thrombotic complications (clots/emboli). The progression from initial changes in the intimal layers of our vasculature to complex plaque and ultimate plaque rupture is a dynamic one, and we are starting to see these changes earlier in life in conjunction with the lack of exercise and unhealthy eating in our society. One in six American teenagers already has pathologic intimal thickening in their coronary arteries.
UThere is extensive and growing evidence that inflammation participates centrally in all stages of cardiovascular disease, from initial lesions to the end-stage thrombotic complications (clots/emboli).33
We could spend hours discussing the topic of inflammation, but an important message on this regard is that a patient's lifestyle is paramount in preventing inflammation and combatting it. Removing bad habits such as smoking, ensuring optimum nutrition, maintaining healthy blood sugar levels, exercise, reducing stress, and maintaining a healthy weight are all factors.
Education Fosters Understanding
An understanding of anatomy and clinical applicability helps CAs better communicate with patients and provide care more safely. Online training programs in particular make high-quality training affordable and convenient and can be taken anytime of day. At CCCAonline.com learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfills the training requirements needed for the national examination.
DCs will often pay for their employees to train. Full price for this training is an affordable $339 for the entire 24-hour program. CCCAonline.com also has a special discount available for you! If you are receiv-
ing this article through The American Chiropractor magazine, use AMCHIRO as your discount code. When you enter this code during the registration process, it will automatically provide a $15 discount off the regular price of the program. This is the program that gives back to the profession.
Learners can expect text, images/schematics, dynamic video lectures, and robust customized, experiential interactivities in a thorough 19-module program. An extensive note-packet of nearly 200 pages is also included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an e-mail at [email protected].
practice graduate Laurie in Mueller, San director Diego, BA, at Palmer DC, California. CFMP, She College served was from in the 2000 private postto 2010; served as the ACC postgraduate subcommittee chair for six years; peer-reviewed for the Research
Agenda Conference; and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, and its subsidiary, CCCAonline.com. She is a clinician, educator, and expert in online educational pedagogy.
