Cardiovascular disease

“ Americans are also becoming more overweight and less active-two key factors that increase the risk of heart disease. Most disturbing, for the first time in decades, Americans are losing ground against some cardiovascular diseases. The rate of stroke has risen slightly, the prevalence of heart failure has increased, and the decline in the death rate for those with coronary heart disease has slowed. ”

“ Despite our knowledge of the importance of exercise and a proper diet to maintaining a healthy heart, studies indicate that both physical inactivity and obesity are on the rise throughout our country. Today, more than 58 million Americans have one or more types of cardiovascular disease (CVD) , and each year nearly 1 million Americans die from CVD—more than from the next 7 leading causes of death combined. Furthermore, rates of coronary heart disease deaths and the prevalence of some risk factors remain disproportionately high in minority and low-income populations. ”

“ More than 700,000 men and women die each year of heart disease, making it the leading cause of death in our country. Annually, about 1.5 million Americans suffer heart attacks, one-third of which are fatal. Collectively, diseases of the heart and blood vessels claim about 960,000 American lives annually. These statistics only hint at the individual and collective tragedy brought on by heart disease and stroke and underscore the need for us to do everything possible to combat cardiovascular diseases. ”

“ Although most causes of heart disease observed early in the 20th century are still present today, the treatment and cures of the disease are now dramatically altered.
Today, heart disease is one health threat that Americans can conquer. Extraordinary scientific advances, together with increased public awareness, have forged one of this century's greatest medical achievements, saving untold lives through improved prevention and treatment. However, as long as cardiovascular diseases and stroke threaten the lives of Americans, we must continue in our diligent efforts to fight these diseases. ”

“ While we have made significant progress in the treatment of this group of diseases, they still take an appallingly high toll on our people. Cardiovascular diseases still account for more than 50 percent of the deaths in America; coronary heart disease is the primary cause of death. ”

“ Widespread application of research and clinical advances stemming from this effort is having substantial and salutary effects on cardiovascular disease mortality rates, which have declined by 34 percent since 1950. These mortality-rate decreases extend across the whole spectrum of cardiovascular diseases and, in most categories, have accelerated during recent years. ”

“ The steps to a healthy heart include preventing and controlling factors that can lead to heart disease—smoking, high blood pressure, high blood cholesterol, physical inactivity, obesity, and diabetes. By avoiding tobacco, limiting consumption of alcohol, exercising regularly, eating a nutritious diet, and maintaining a healthy weight, Americans can substantially reduce their risk of developing cardiovascular disease. ”

“ Today, Americans are enjoying the rewards of the progress humanity has made in understanding and treating cardiovascular disease. Advances in diagnosis make it possible to see the heart beat without the use of invasive procedures. ”

“ Americans are increasingly aware of the crucial role lifestyles play in affecting their risk of these diseases. By recognizing the importance of proper nutrition, reduced smoking, exercise, and prevention of high blood pressure, our citizens are making a major contribution to the fight against heart disease. The role of prevention in cardiovascular diseases is especially vital because the initial symptoms are so frequently lethal or permanently disabling. ”

“ Often called the silent killer because it usually exhibits no symptoms, high blood pressure is an insidious condition that may lead to heart attack, stroke or kidney damage. Along with cigarette smoking and elevated blood cholesterol, it is one of three major risk factors for cardiovascular diseases.
High blood pressure can be detected quickly and painlessly by use of an inflatable arm cuff and stethoscope. All Americans should take advantage of the high blood pressure screening activities in their communities, their work places and their public health facilities. ”

“ It has been shown that high-fat hyperlipidemia, obesity, hypertension, atherosclerosis, coronary heart disease, myocardial infarction, cerebral thrombosis and a series of cardiovascular and cerebrovascular diseases are associated with abnormal lipid metabolism. ”

“ Many individuals and organizations have contributed to the past four decades of progress against cardiovascular diseases. However, two organizations-the federally funded National Heart, Lung, and Blood Institute and the privately supported American Heart Association-have been in the forefront of this national effort. ”

“ This chronic myocardial degeneration is often a part of the general arteriosclerosis, and is an important factor in what is termed cardiovascular-renal disease. In simple chronic renal diseases the heart first normally hypertrophies to overcome the increased blood tension and increased resistance. ”

“ But you will remember that we have found that cardiac dilatation may be present in every kind of cardio-vascular degeneration; that the arteries are naturally enlarged and thickened after middle life, and that we refused to call these changes morbid. Clearly, therefore, a purely anatomical diagnosis of this sort is insufficient. If you are asked what the prognosis is of fatty degeneration of the heart, you answer that you must first be told whether syphilitic or gouty disease of the coronary arteries, or strain, or alcoholism, or phosphorus-poisoning or anæmia is the cause of it. ”

“ Thus it happens that in metabolic disorders, from excessive or unwholesome eating and drinking, the heart, vessels and kidneys are kept under incessant strain; and, like other organs working under strain in the gouty subject, they are the readiest to suffer—first from disorders of many kinds, and ultimately, unless reform be enforced, from cardio-vascular degeneration and chronic Bright's disease. ”

“ The great majority presented distinct thickening of the arterial walls. As I suggested in our study of the etiology, these pathological changes appear to be the result of malnutrition of structures (the myocardium, valves and arteries) worked at high pressure; and in addition to the local disturbance of metabolism in the cardiac and arterial walls, which are fed with gouty blood, there is the damaging effect on them of similar disease of the vasa vasorum and vasa cordis or coronaries. ”

“ The combination of (1) hypertrophied heart, (2) increased blood pressure, (3) palpable arteries, and (4) ringing, accentuated second sound at the aortic cartilage is, in reality, the picture of advanced arteriosclerosis. If the individual is in good condition much may be done by judicious [211] advice and treatment to ward off complications and prolong life with a considerable degree of comfort. But we should not wait until such signs are found before making a diagnosis and instituting treatment. As in all forms of chronic disease the early diagnosis is all important. ”

“ The stress and strain of our daily life has, as one of its consequences, early arterial degeneration. There can be no doubt that arterial disease in the comparatively young is more frequent than it was twenty-five years ago, and that the mortality from diseases directly dependent on arteriosclerotic changes is increasing. ”

“ Sooner or later, however, the nutrition of the heart, especially in atheromatous conditions, becomes impaired, and the lack of a proper blood supply to the heart muscle causes myocardial disturbance, either a chronic myocarditis or fatty degeneration. If there is no atheromatous condition of the coronary arteries, and arterial disease is not a cause of the valvular lesion, compensation may be broken by some sudden extra strain put on the heart, either muscular or by some acute sickness or a necessary anesthetic and operation. ”

“ In addition to extrinsic dangers, particularly those of Bright's disease, cerebral thrombosis and hæmorrhage, and bronchitis, failure of the heart is liable to supervene and prove fatal from the gravest of all intrinsic causes, namely, coronary degeneration. As this increases, the myocardium is steadily more and more impoverished ”

“ But digitalis is indicated whenever the heart shows itself unequal to the work it has to perform. This formula includes the vast majority of cardiac cases. The drug is contra-indicated in all cases where the heart is already beating too slowly; in aortic incompetence—where the prolongation of diastole increases the amount of the blood that regurgitates through the incompetent valve; in chronic Bright’s disease and in fatty degeneration of the heart—since nothing can cause fat to become contractile. ”

“ Excessive use of alcohol, while tending to promote hypertension by the disturbances that it causes, may give, by causing a weak heart muscle, a permanent low blood pressure. A single large dose of alcohol always lowers the blood pressure.
Arteriosclerosis frequently reaches a stage when the blood pressure is low, and with atheroma of the arteries of the arms a true blood pressure is difficult to obtain. Addison's disease, or any other organic lesion of the suprarenals, will lower the pressure, while stimulation of the suprarenals increases the pressure. ”

“ Lead, tobacco, and according to some, tea and coffee, are to be classed as causal factors in the production of arteriosclerosis. Certain it is that all these substances have a tendency to raise the arterial pressure, but whether the drug itself causes first a degeneration, and later a hypertension results, or vice versa, is not yet positively known. We have just mentioned that lead particularly has a marked effect in producing arterial lesions. Other drugs as adrenalin, barium chloride, physostigmin, etc., while producing experimental arteriosclerosis, hardly could produce the disease in man. ”

“ Alcoholic heart occurs both in men and women; tobacco heart is extraordinarily common in our own profession, and common in clergymen and in retired members of the public services; tea-, coffee-, and cocoa- poisoning I have met with principally in students.
4. There can be no question but that by far the most prolific causes of cardio-vascular disorder and disease after 40 are disturbances of metabolism, including gout—at any rate amongst the middle and upper classes in this country. ”

“ Just what causes the increase in blood pressure sometimes to over 270 mm. of Hg, is not definitely known. It seems most probable that it is some poison elaborated by the diseased kidneys and absorbed into the general circulation. There it acts primarily on the musculature of the arterioles causing tonic contraction and an increase of work on the part of the heart to force the blood through narrowed channels. One fact is certain. We see patients in coma due to renal disease with [170] blood pressure much over 200 mm of Hg. ”

“ An almost constant feature of chronic heart disease is a condition of dulness, sluggishness, and in many cases, curiously enough, a tendency to lay on fat, so that although the patient is unfit to work, he appears to enjoy excellent general health to which a period is only put by sudden death. ”

“ The arterial tissue is no exception to this rule, and we have already shown that certain changes normally take place as the individual grows older, changes which are arteriosclerotic in type and are quite like those caused in younger people by many of the etiologic factors of the disease.
We are absolutely dependent upon the integrity of our hearts and blood vessels for the maintenance of activity and span of life. Respiration may cease and be carried on artificially for many hours while the heart continues to beat. ”