Biological Basis of Behaviour

By- Shalini, Sandeep, Vidushi and Sakshi

Structure of the Cardiovascular System

The Cardiovascular System consists of the heart, blood vessels & the blood. Its primary function
is to transport nutrients & oxygen-rich blood to all parts of the body & to carry deoxygenated
blood back to the lungs.
Components of the Cardiovascular System
The Cardiovascular system is the system responsible for delivering blood to the different parts of
the body. It consists of the following organs and tissues:
Heart: A Muscular Pump -
The heart is a fist-sized organ in the chest that is responsible for pumping blood. The heart is
located in the chest cavity behind the breast-stone, in front of the windpipe, the esophagus and
the descending aorta, between the lungs and above the diaphragm. About ⅔ of the heart lies to
the left of the midline.
The heart is divided by septa (or partitions) into right and left halves, and each half is subdivided
into 2 chambers. Therefore, the heart has 4 chambers: 2 upper chambers (atria) and 2 lower
chambers (ventricles). These chambers are separated by valves to keep blood flowing in the
proper direction. The atria receive blood from various parts of the body and pass it into the
ventricles. The ventricles, in turn, pump the blood to the lungs and to the remainder of the body.
The right atrium is a thin walled chamber receiving blood from all tissues except the lungs, and
the right ventricle is the chamber from which the pulmonary artery carries blood to the lungs.
Blood flows from the right atrium to the right ventricle. The left atrium is slightly smaller than
the right atrium and has a thicker wall, and the left ventricle has walls 3 times as thick as those of
the right ventricles. Blood flows from the left atrium into the left ventricle. Blood is forced from
this chamber through the aorta to all parts of the body except the lungs. The valves control the
flow of the blood within the different chambers.
Blood follows the following path through the heart:

● Blood lacking oxygen returns from the body and enters the right atrium (upper right
chamber) via the inferior vena cava and superior vena cava veins.
● Blood flows through the tricuspid valve and enters the right ventricle (lower right
chamber).
● The right ventricle pumps the blood through the pulmonary valve and out of the heart via
the main pulmonary artery.
● The blood then flows through the left and right pulmonary arteries into the lungs.
● The blood returns to the heart and flows into the left atrium (upper left chamber) via four
pulmonary veins.
● Blood flows through the mitral valve and enters the left ventricle (lower left chamber).
 ● The left ventricle pumps the blood through the aortic valve into a large artery called the
“aorta”. This artery delivers blood to the rest of the body.

Blood Vessels -
The blood vessels consist of a closed system of tubes that transport blood to all parts of the body
and back to the heart. The blood vessels consist of Arteries, Capillaries and Veins.
Arteries: Tubes to Deliver Blood away from the Heart -
Arteries transport blood to body tissues under high pressure, which is exerted by the pumping
action of the heart. The heart forces blood into these elastic tubes, which recoil, sending blood in
the pulsating waves. The wall of an artery consists of 3 layers. The tunica intima, the innermost
layer, consists of an inner surface of smooth endothelium covered by a surface of elastic tissues.
The tunica media, or the middle coat, is thicker in arteries, particularly in large arteries, and
consists of large smooth muscle cells intermingled with elastic fibers. As the arteries become
smaller, the number of the elastic fibers decreases while the number of the smooth muscle fiber
increases. The tunica adventitia, the outermost layer, is composed of collagenous and elastic
fibers. It is the strongest of the three layers. It provides a limiting barrier, protecting the vessel
from over-expansion.
There are two main types of arteries:
1. Systemic Arteries: It takes oxygen-rich blood from the heart to the body. These include
the aorta and its branches.
2. Pulmonary Arteries: It takes oxygen-deprived blood from the right heart to the lungs to
get more oxygen.
The major arteries branch into smaller arteries, called arterioles. They act as control valves
through which blood is released into the capillaries, where the direct exchange of nutrients and
oxygen to tissues occurs.
Capillaries: Small Blood Vessels for Nutrients and Gas exchange -
Capillaries are microscopic blood vessels that receive oxygen-rich blood from arterioles. The
microscopic capillary tubules consist of a single layer of endothelium that is a continuation of the
innermost lining cells of arteries and veins. As the capillary converges, small venules are formed
whose function is to collect blood from the capillary beds (i.e., the networks of the capillaries).
The vast network of some 10 Billion microscopic capillaries functions together in order to
exchange fluids, nutrients & wastes between the blood & the tissues. A single capillary unit
consists of branching interconnecting networks of vessels, each averaging 0.5 to 1 millimeter in
length. The wall of the capillary is extremely thin and acts as a semipermeable membrane that
allows substances containing small molecules such as oxygen, carbon dioxide, water, fatty acids,
glucose & ketones, to pass through the membrane. Capillaries connect to veins which bring
blood back to the heart.
Veins: Tubes to deliver Blood back to the Heart -
Veins are the blood vessels that carry blood back to the heart. Veins tend to follow a course
parallel to that of arteries but are present in greater numbers. Their channels are larger than those
of arteries, and their walls are thinner. Venules collect blood from the capillaries and the blood
channels,known as sinusoids, and unite to form progressively larger veins that terminate as the
great veins, or venae cavae. In the extremities, there are superficial & deep veins; the superficial
lie just under the skin & drain the skin & superficial fascia (sheets of fibrous tissue), while the
deep veins accompany the principal arteries of the extremities and are similarly named. The
veins have valves that prevent blood from flowing backward.

FUNCTIONS OF BLOOD VESSELS AND HEART

The heart has four main chambers, which play crucial roles in the circulatory system. Here’s a
detailed breakdown:

1. Right Atrium: This is the upper right chamber of the heart. It receives deoxygenated blood
from the body through two large veins called the superior and inferior vena cavae. The right
atrium then contracts to push the blood into the right ventricle.

2. Right Ventricle: This is the lower right chamber. It receives the deoxygenated blood from the
right atrium and pumps it to the lungs via the pulmonary arteries. In the lungs, the blood
releases carbon dioxide and picks up oxygen.

3. Left Atrium: This is the upper left chamber. It receives oxygenated blood from the lungs
through the pulmonary veins. When the left atrium contracts, it sends the oxygen-rich blood into
the left ventricle.

4. Left Ventricle: This is the lower left chamber and is the strongest chamber of the heart. It
receives oxygenated blood from the left atrium and pumps it out to the rest of the body through
the aorta. The left ventricle has thick muscular walls to generate the high pressure needed to
circulate blood throughout the body.

The heart is connected to a network of veins and arteries that play essential roles in the
circulatory system. Here’s a detailed overview of the veins, arteries, and capillaries associated
with the heart:

1. Veins:
- Superior Vena Cava: This vein carries deoxygenated blood from the upper parts of the body
(head, neck, arms) back to the right atrium of the heart.
- Inferior Vena Cava: This vein brings deoxygenated blood from the lower parts of the body
(legs, abdomen) back to the right atrium.
- Pulmonary Veins: There are four pulmonary veins (two from each lung) that carry
oxygenated blood from the lungs back to the left atrium of the heart.
2. Arteries:
- Pulmonary Arteries: These carry deoxygenated blood from the right ventricle to the lungs for
oxygenation. The right pulmonary artery goes to the right lung, and the left pulmonary artery
goes to the left lung.
- Aorta: This is the largest artery in the body. It carries oxygenated blood from the left ventricle
to the rest of the body. The aorta branches into smaller arteries that supply blood to various
organs and tissues.

3. Capillaries:
- Capillaries are tiny blood vessels that connect the arteries and veins. They are where the
exchange of gasses, nutrients, and waste occurs. Oxygen and nutrients diffuse from the blood
in the capillaries into the tissues, while carbon dioxide and waste products move from the
tissues into the blood.

Central Nervous System (CNS) Regulation of the Cardiac

System
The central nervous system (CNS) plays a pivotal role in regulating the cardiac system, ensuring
that the heart pumps blood effectively to meet the body's needs. This regulation involves a
complex interplay of neural pathways, neurotransmitters, and hormones. It is primarily achieved
through the autonomic nervous system (ANS), a division of the peripheral nervous system.

Neural Control & Regulation

1) Key CNS Structures Involved

(a) Medulla Oblongata:

- Houses the cardiovascular control center.
- Regulates heart rate, blood pressure, and blood vessel tone.
- Receives input from sensory receptors.
- Sends signals to the heart and blood vessels via the autonomic nervous system.
(b) Hypothalamus:
- Regulates the release of hormones affecting heart rate and blood pressure.
- It helps regulate not just heart rate but also emotions, stress responses, and
hormonal secretions.

(c) Cerebral Cortex:

- Involved in higher-order cognitive functions.

- Can influence cardiac activity through emotional stress or anxiety.
2) Neural Pathways and Neurotransmitters

The autonomic nervous system (ANS), divided into the sympathetic and parasympathetic
branches, plays a significant role in cardiac regulation.

i) The sympathetic nervous system increases heart rate, blood pressure, and cardiac output in
response to stress or exercise. It gets activated during an emergency situation and releases
norepinephrine and epinephrine, which bind to receptors on the heart and blood vessels.

ii) The parasympathetic nervous system decreases heart rate and cardiac output in response to
rest or relaxation. It releases acetylcholine, which binds to receptors on the heart and slows its
activity.

Functioning of ANS

During Emergency

The brain processes the incoming information about an emergency situation and sends a signal to
the medulla which is located in the lower part of the brain. The medulla has a group of neurons
called the cardiovascular center from which a nerve arises and goes directly to the heart and
secretes a neurotransmitter called Epinephrine.

The Epinephrine increases the heart rate during an emergency situation. When the heart rate
increases, the blood flow also increases and muscles will demand more blood because it will
need more oxygen to produce energy. The nerve that secretes epinephrine into the heart is a part
of the sympathetic nervous system and increases the heartbeat to 150 beats per minute during an
extreme condition.

During relaxation/resting state

The brain sends a signal to relax and brings the heart rate down by secreting the neurotransmitter
called acetylcholine into the heart on the nodal tissues. The acetylcholine stimulates the nodal
tissues to relax the heart and bring down the heart rate. The nerve that secretes acetylcholine into
the heart is a part of the parasympathetic nervous system and brings down the heartbeat to 70-75
beats per minute.
 Hormonal Control & Regulation

Adrenal Medulla : Adrenal medulla, a gland which sits over the kidneys secretes two hormones
called epinephrine and norepinephrine which are also called adrenaline and noradrenaline
respectively.
- The Epinephrine (neurotransmitter) takes an immediate action and has an instant effect
on the heart rate; the Epinephrine (hormone) is directly released into the blood flow and
doesn’t have an immediate effect on the heart but it will have a long lasting effect. This
hormone stays in the blood for some time. So even after the emergency gets over, the
heart will continue to beat faster because of this hormone. Thus, Epinephrine &
Norepinephrine are secreted during an emergency situation and are called Fight or Flight
hormones.

Thyroid Hormones: The thyroid gland secretes thyroxine which increases the heart's metabolic
rate (Basal metabolic rate). When the metabolism is increased, the heart rate and the cardiac
output is also increased.

3) Feedback Mechanisms in Cardiac Regulation

Feedback mechanisms are biological processes that help maintain a stable internal environment,
or homeostasis. In the context of cardiac regulation, these mechanisms ensure that the heart rate
and blood pressure remain within a normal range, despite changes in the body's demands.

Baroreceptor Reflex:

● Senses changes in blood pressure.

● Adjusts heart rate and blood vessel tone.
● Helps maintain blood pressure.
Baroreceptor Reflexes : Helps in maintaining blood pressure by sensing changes in blood
pressure and adjusting the heart rate and blood vessel tone accordingly. These specialized nerve
endings are located in the walls of the carotid arteries (in the neck) and the aortic arch (near the
heart). They are sensitive to changes in blood pressure.

Signal Transmission: When blood pressure rises, the baroreceptors fire more rapidly. These
signals are sent to the medulla oblongata, a part of the brainstem that controls many vital
functions, including heart rate and blood vessel tone.

Response: In response to the increased baroreceptor firing, the medulla oblongata sends signals
to the heart and blood vessels to decrease blood pressure.

Chemoreceptor Reflex:

● Senses changes in blood oxygen and carbon dioxide levels.

● Adjusts heart rate and blood vessel tone.
● Helps maintain blood oxygen levels.

Chemoreceptor Reflex: Helps maintain blood oxygen and carbon dioxide levels. It involves
specialized nerve cells called chemoreceptors that are located in the carotid bodies and aortic
bodies.

Chemoreceptors are sensitive to changes in blood oxygen and carbon dioxide levels.

Signal Transmission: When blood oxygen levels decrease or carbon dioxide levels increase, the
chemoreceptors send signals to the medulla oblongata.

Response: In response to these signals, the medulla oblongata increases heart rate and blood
vessel tone to improve blood flow and oxygen delivery to the tissues.

Both reflexes are crucial for maintaining cardiovascular homeostasis.

Role of vagus nerve : The vagus nerve regulates the heart by slowing the heart rate through
parasympathetic control. It releases acetylcholine, which acts on the heart's SA and AV nodes
to reduce heart rate and electrical signal conduction. This nerve also plays a key role in heart
rate variability and helps maintain blood pressure through the baroreceptor reflex, contributing
to overall cardiovascular balance and relaxation.

Conclusion: The CNS plays a vital role in regulating the cardiac system by integrating
information from various sensory receptors and coordinating the activities of the autonomic
nervous system, neurotransmitters, and hormones. This regulation is essential for maintaining
cardiovascular homeostasis and ensuring that the body's needs are met.

4) Effects on Behaviour

1. Sympathetic Nervous System (SNS) and Stress Responses : The SNS is activated in
response to stress, fear, or excitement, releasing hormones like adrenaline. This speeds up the
heart rate and increases blood pressure, preparing the body for action, commonly referred to as
the "fight or flight" response.

Behavioral Effects: During this state, people tend to become more alert, anxious, or agitated.
Overactivation of this system due to chronic stress can lead to anxiety disorders or stress-related
behaviors such as restlessness, irritability, and hypervigilance. Over time, this can also affect
mental health due to the constant physiological pressure on the body.

2. Parasympathetic Nervous System (PNS) and Relaxation : The PNS acts in opposition to
the SNS, slowing the heart rate and lowering blood pressure when the body is relaxed or after a
stressful event. This is known as the "rest and digest" response.

Behavioral Effects: When the PNS dominates, individuals tend to feel more calm, relaxed, and
focused. The heart rate slows down, promoting behaviors like mindfulness, patience, and
emotional regulation. People with a well-functioning PNS are typically better able to recover
from stress and maintain emotional balance.

3. Emotional and Behavioral Impact: The emotions directly affect heart rhythms, and
disturbances in these rhythms can reinforce certain emotional states. For example, anxiety and
fear can lead to irregular heartbeats, and in turn, irregular heartbeats can exacerbate feelings of
anxiety. This heart-brain loop can cause a person to remain stuck in a cycle of heightened
emotional and physical arousal, leading to behaviors like avoidance, hyperactivity, or social
withdrawal.

4. Heart-Brain Connection: The heart sends signals back to the brain through afferent (sensory)
pathways. These signals affect cognition (thinking) and emotions. For example, heart rate
variability (HRV)—the variation in time between heartbeats—can influence emotional and
cognitive responses. High HRV is linked to better focus and emotional control, while low HRV
can lead to stress and poor cognitive performance

Cardiovascular Diseases
Cardiovascular Disease
Cardiovascular diseases (CVDs) affect your heart and blood vessels. Almost half of all adults in
the U.S. have at least one form of heart disease. You may make lifestyle changes to manage
cardiovascular disease or your healthcare provider may prescribe medications. The sooner you
detect cardiovascular disease, the easier it is to treat.
What is cardiovascular disease?
Cardiovascular disease is a group of diseases affecting your heart and blood vessels. These
diseases can affect one or many parts of your heart and/or blood vessels. A person may be
symptomatic (physically experiencing the disease) or asymptomatic (not feeling anything at
all).Cardiovascular diseases are conditions that affect your heart and blood vessels. Without
appropriate treatment, heart disease can lead to heart attacks or strokes. You can make lifestyle
changes or take medications to manage cardiovascular disease. Earlier diagnosis can help with
effective treatment. Many people live a full and active life with cardiovascular disease.

Cardiovascular disease includes heart or blood vessel issues, including:

● Narrowing of the blood vessels in your heart, other organs or throughout your body.
● Heart and blood vessel problems present at birth.
● Heart valves that aren’t working right.
● Irregular heart rhythms.

How common is cardiovascular disease?

Cardiovascular disease is the leading cause of death worldwide and in the U.S.

Almost half of adults in the U.S. have some form of cardiovascular disease. It affects people of
all ages, sexes, ethnicities and socioeconomic levels. One in three women and people assigned
female at birth dies from cardiovascular disease.

Signs and Symptoms

What are the symptoms of cardiovascular disease?
Cardiovascular disease symptoms can vary depending on the cause. Older adults and people
assigned female at birth may have more subtle symptoms. However, they can still have serious
cardiovascular disease.

Symptoms of heart issues

● Chest pain (angina).
● Chest pressure, heaviness or discomfort, sometimes described as a “belt around the
chest” or a “weight on the chest.”
● Shortness of breath (dyspnea).
● Dizziness or fainting.
● Fatigue or exhaustion.
● Symptoms of blockages in blood vessels throughout your body
● Pain or cramps in your legs when you walk.
 ● Leg sores that aren’t healing.
● Cool or red skin on your legs.
● Swelling in your legs.
● Numbness in your face or a limb. This may be on only one side of your body.
● Difficulty with talking, seeing or walking.

Causes of CVD

The exact cause of CVD isn't clear, but there are lots of things that can increase your risk of
getting it. These are called "risk factors".The more risk factors you have, the greater your
chances of developing CVD. Part of this check involves assessing your individual CVD risk and
advising you how to reduce it if necessary.

1. High blood pressure: High blood pressure (hypertension) is one of the most
important risk factors for CVD. If your blood pressure is too high, it can damage your
blood vessels.
2. Smoking: Smoking and other tobacco use is also a significant risk factor for CVD. The
harmful substances in tobacco can damage and narrow your blood vessels.
3. High cholesterol: Cholesterol is a fatty substance found in the blood. If you have
high cholesterol, it can cause your blood vessels to narrow and increase your risk of
developing a blood clot.
4. Diabetes:Diabetes is a lifelong condition that causes your blood sugar level to become
too high.High blood sugar levels can damage the blood vessels, making them more
likely to become narrowed.Many people with type 2 diabetes are also overweight or
obese, which is also a risk factor for CVD.
5. Inactivity:If you don't exercise regularly, it's more likely that you'll have high blood
pressure, high cholesterol levels and be overweight. All of these are risk factors for
CVD.Exercising regularly will help keep your heart healthy. When combined with a
healthy diet, exercise can also help you maintain a healthy weight.
6. Being overweight or obese:Being overweight or obese increases your risk of
developing diabetes and high blood pressure, both of which are risk factors for CVD.
You're at an increased risk of CVD if:

● your body mass index (BMI) is 25 or above – use the BMI healthy weight
calculator to work out your BMI
● you're a man with a waist measurement of 94cm (about 37 inches) or more, or a
woman with a waist measurement of 80cm (about 31.5 inches) or more
 7. Family history of CVD: If you have a family history of CVD, your risk of developing
it is also increased. You're considered to have a family history of CVD if either: your
father or brother were diagnosed with CVD before they were 55 .your mother or sister
were diagnosed with CVD before they were 65 .Tell your doctor or nurse if you have a
family history of CVD. They may suggest checking your blood pressure and cholesterol
level.
8. Ethnic background:In the UK people of south Asian and Black African or African
Caribbean background have an increased risk of getting CVD. This is because people
from these backgrounds are more likely to have other risk factors for CVD, such as high
blood pressure or type 2 diabetes.
9. Other risk factors: Other factors that affect your risk of developing CVD include:
○ age – CVD is most common in people over 50 and your risk of developing it
increases as you get older
○ gender – men are more likely to develop CVD at an earlier age than women
○ diet – an unhealthy diet can lead to high cholesterol and high blood pressure
○ alcohol – excessive alcohol consumption can also increase your cholesterol and
blood pressure levels, and contribute to weight gain

What conditions are cardiovascular diseases?

There are many different types of cardiovascular diseases, including but not limited to:

1. Arrhythmia: Problem with your heart’s electrical conduction system, which can lead to
abnormal heart rhythms or heart rates.

2. Coronary artery disease: Problem with your heart’s blood vessels, such as blockage.

3. Heart failure: Problem with heart pumping/relaxing functions, leading to fluid buildup
and shortness of breath.

4. Heart Attack:A heart attack, or myocardial infarction, happens when the blood supply to
part of the heart muscle is suddenly blocked, usually by a blood clot. The affected part of
the heart is deprived of oxygen, and without prompt treatment, it can suffer permanent
damage.

5. Stroke: Stroke Occurs when the blood supply to part of the brain is interrupted or
reduced, depriving brain tissue of oxygen and nutrients. This can happen due to a blood
clot or a blood vessel.
 6. Hypertension (High Blood Pressure): Next, we have Hypertension or high blood
pressure . This is often called the "silent killer" because it usually has no symptoms but
can lead to serious problems like heart attack, stroke, and heart failure over time.
OTHER CONDITIONS
● Aortic disease (including aortic aneurysm) – a disease that causes the aorta to widen
or tear.
● Cardiomyopathies – diseases of the heart muscle.
● Congenital heart disease – problems with the heart or blood vessels that exist at birth.
● Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which
can break loose and travel to the heart and lungs.
● Heart valve disease – a disease of the heart valves that keep blood flowing through the
heart.
● Pericardial disease (pericarditis) – inflammation of the thin tissue sac that surrounds
the heart.
● Rheumatic heart disease (RHD) – Rheumatic heart disease is damage to the heart
muscle and heart valves from rheumatic fever, caused by streptococcal bacteria.
● Vascular disease (blood vessel disease) – any condition that affects your circulatory
system.
● Peripheral vascular disease (including peripheral arterial disease) – a disease of
blood vessels supplying the arms and legs.
● Cerebrovascular disease – a disease of the blood vessels supplying the brain.
● Chagas disease – discovered more than 100 years ago, Chagas disease can cause
irreversible damage to the heart and other organs.

Causes
What causes cardiovascular disease?
The causes of cardiovascular disease can vary depending on the specific type. For example,
atherosclerosis (plaque buildup in your arteries) causes coronary artery disease and peripheral
artery disease. Coronary artery disease, scarring of your heart muscle, genetic problems or
medications can cause arrhythmias. Aging, infections and rheumatic disease can cause valve
diseases.
What are cardiovascular disease risk factors?
You may be more likely to develop cardiovascular disease if you have risk factors such as:

● High blood pressure (hypertension).

● High cholesterol (hyperlipidemia).
● Tobacco use (including vaping).
● Type 2 diabetes.
● Family history of heart disease.
● Lack of physical activity.
● Having excess weight or obesity.
● Diet high in sodium, sugar and fat.
● Overuse of alcohol.
● Misuse of prescription or recreational drugs.
● Preeclampsia or toxaemia.
● Gestational diabetes.
● Chronic inflammatory or autoimmune conditions.
● Chronic kidney disease

Diagnosis and Tests

How is cardiovascular disease diagnosed?
Your healthcare provider will perform a physical exam and ask questions about your symptoms,
personal health and family health history. They may also order tests to help diagnose
cardiovascular disease.

What tests might I have for cardiovascular disease?

Some common tests to diagnose cardiovascular disease include:

● Blood work measures substances that indicate cardiovascular health, such as

cholesterol, blood sugar levels and specific proteins. A provider can use a blood test to
check for blood clotting issues as well.
● Ankle brachial index (ABI) compares the blood pressure in your ankles and arms to
diagnose peripheral artery disease.
● Electrocardiogram (EKG) records your heart’s electrical activity.
● Ambulatory monitoring uses wearable devices that track your heart rhythm and rates.
● Echocardiogram uses sound waves to create an image of your heartbeat and blood flow.
● Ultrasound uses sound waves to check blood flow in your legs or neck.
● Cardiac computerized tomography (CT) uses X-rays and computer processing to create
3D images of your heart and blood vessels.
● Cardiac magnetic resonance imaging (MRI) uses magnets and radio waves to create
highly detailed images of your heart.
● MR angiogram or CT angiogram uses an MRI or CT, respectively, to see blood vessels
in your legs, head and neck.
 ● Stress tests analyze how physical activity affects your heart in a controlled setting, using
exercise or medications, to determine how your heart responds. This type of test can
involve EKGs and/or imaging tests.
● Cardiac catheterization uses a catheter (thin, hollow tube) to measure pressure and
blood flow in your heart.

Management and Treatment

How is cardiovascular disease treated?
Treatment plans can vary depending on your symptoms and the type of cardiovascular disease
you have. Cardiovascular disease treatment may include:

1. Lifestyle changes: Examples include changing your diet, increasing your aerobic
activity and quitting smoking or tobacco products (including vaping).
2. Medications: Your healthcare provider may prescribe medications to help manage
cardiovascular disease. Medication type will depend on what kind of cardiovascular
disease you have.
3. Procedures or surgeries: If medications aren’t enough, your healthcare provider may
use certain procedures or surgeries to treat your cardiovascular disease. Examples
include stents in your heart or leg arteries, minimally invasive heart surgery, open-heart
surgery, ablations or cardioversion.
4. Cardiac rehabilitation:You may need a monitored exercise program to help your heart
get stronger.
5. Active surveillance: You may need careful monitoring over time without medications or
procedures/surgeries.

Prevention
How can I prevent cardiovascular disease?
You can't prevent some types of cardiovascular disease, such as congenital heart disease. But
lifestyle changes can reduce your risk of many types of cardiovascular disease.

You can reduce your cardiovascular risks by:

● Avoiding all tobacco products.

● Managing other health conditions, such as Type 2 diabetes, high cholesterol or high
blood pressure.
● Achieving and maintaining a healthy weight.
● Eating a diet low in saturated fat and sodium.
● Exercising at least 30 to 60 minutes per day on most days.
● Reducing and managing stress.
Outlook / Prognosis
What is the outlook for people with cardiovascular disease?
Many people enjoy a high quality of life and can manage their cardiovascular disease with the
help of their healthcare team. Your chances for a positive outcome are higher if you engage in
your healthcare and follow your provider’s treatment plan. It’s important to take medications
exactly as prescribed.

Does cardiovascular disease increase my risk of other conditions?

Untreated cardiovascular disease can lead to serious complications.

If you have cardiovascular disease, you may have a higher risk of:

● Heart attack.
● Stroke.
● Acute limb ischemia (sudden blockage in your leg arteries).
● Aortic dissection.
● Sudden cardiac death.
● Living With

What are the risk factors for cardiovascular disease?

The most important behavioural risk factors of heart disease and stroke are unhealthy diet,
physical inactivity, tobacco use and harmful use of alcohol. Amongst environmental risk factors,
air pollution is an important factor. The effects of behavioural risk factors may show up in
individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight
and obesity. These “intermediate risks factors” can be measured in primary care facilities and
indicate an increased risk of heart attack, stroke, heart failure and other complications.

Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular
physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of
cardiovascular disease. Health policies that create conducive environments for making healthy
choices affordable and available, as well as improving air quality and reducing pollution, are
essential for motivating people to adopt and sustain healthy behaviours.

There are also a number of underlying determinants of CVDs. These are a reflection of the
major forces driving social, economic and cultural change – globalization, urbanization and
population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.

In addition, drug treatment of hypertension, diabetes and high blood lipids are necessary to
reduce cardiovascular risk and prevent heart attacks and strokes among people with these
conditions.
Key facts
● Cardiovascular diseases (CVDs) are the leading cause of death globally.
● An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global
deaths. Of these deaths, 85% were due to heart attack and stroke.
● Over three quarters of CVD deaths take place in low- and middle-income countries.
● Out of the 17 million premature deaths (under the age of 70) due to noncommunicable
diseases in 2019, 38% were caused by CVDs.
● Most cardiovascular diseases can be prevented by addressing behavioural and
environmental risk factors such as tobacco use, unhealthy diet and obesity, physical
inactivity, harmful use of alcohol and air pollution.
● It is important to detect cardiovascular disease as early as possible so that management
with counselling and medicines can begin.

What are common symptoms of cardiovascular diseases?

Symptoms of heart attacks and strokes
Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or
stroke may be the first sign of underlying disease. Symptoms of a heart attack include:

pain or discomfort in the centre of the chest; and/or

pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.
In addition the person may experience difficulty in breathing or shortness of breath; nausea or
vomiting; light-headedness or faintness; a cold sweat; and turning pale. Women are more likely
than men to have shortness of breath, nausea, vomiting, and back or jaw pain.

The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often
on one side of the body. Other symptoms include sudden onset of:

● numbness of the face, arm, or leg, especially on one side of the body;
● confusion, difficulty speaking or understanding speech;
● difficulty seeing with one or both eyes;
● difficulty walking, dizziness and/or loss of balance or coordination;
● severe headache with no known cause; and/or
● fainting or unconsciousness.
● People experiencing these symptoms should seek medical care immediately.

Why are cardiovascular diseases a development issue in low- and middle-income

countries?
At least three-quarters of the world's deaths from CVDs occur in low- and middle-income
countries. People living in low- and middle-income countries often do not have the benefit of
primary health care programmes for early detection and treatment of people with risk factors for
CVDs. People in low- and middle-income countries who suffer from CVDs and other
noncommunicable diseases have less access to effective and equitable health care services
which respond to their needs. As a result, for many people in these countries detection is often
late in the course of the disease and people die at a younger age from CVDs and other
noncommunicable diseases, often in their most productive years.

The poorest people in low- and middle-income countries are most affected. At the household
level, evidence is emerging that CVDs and other noncommunicable diseases contribute to
poverty due to catastrophic health spending and high out-of-pocket expenditure. At the
macro-economic level, CVDs place a heavy burden on the economies of low- and
middle-income countries.

How can the burden of cardiovascular diseases be reduced?

The key to cardiovascular disease reduction lies in the inclusion of cardiovascular disease
management interventions in universal health coverage packages, although in a high number of
countries health systems require significant investment and reorientation to effectively manage
CVDs.

Evidence from 18 countries has shown that hypertension programmes can be implemented
efficiently and cost-effectively at the primary care level which will ultimately result in reduced
coronary heart disease and stroke. Patients with cardiovascular disease should have access to
appropriate technology and medication. Basic medicines that should be available include:

● aspirin;
● beta-blockers;
● angiotensin-converting enzyme inhibitors; and
● statins.
An acute event such as a heart attack or stroke should be promptly managed.

Sometimes, surgical operations are required to treat CVDs. They include:

● coronary artery bypass;

● balloon angioplasty (where a small balloon-like device is threaded through an artery to
open the blockage);
● valve repair and replacement;
● heart transplantation; and
● artificial heart operations.
● Medical devices are required to treat some CVDs. Such devices include pacemakers,
prosthetic valves, and patches for closing holes in the heart.
● XD

Conclusion
Large parts of the world today are at moderate or high levels of risk for CVD, and cumulative
behavioral, biological, and social risks will increase the global impact of chronic diseases in the
future. CVDs (mainly IHD and stroke) are, and will remain for decades, the major causes of
death in the world. This chapter has presented evidence on the determinants of CVD,
establishing a rationale for intervention approaches that will be discussed later in this report.
The breadth of determinants that contribute to CVD points to the need for lifelong and
multisectoral approaches. Because unhealthful diet, tobacco use, and decreased physical activity
levels are among the major drivers of the CVD epidemic, prevention through promoting
healthful diet and lifestyle should remain one of the cornerstones of global CVD reduction
efforts. This does not exclude the importance of the potential to reduce CVD burden through
better health care delivery, including better integration and development of chronic disease care
models. Together, these approaches have the potential to address the burden of disease and
overlapping determinants that are common in most emerging economies.
Prevention efforts need to start early in life and continue through the life course. A new and far
greater emphasis on early childhood development is warranted, including greater attention to
chronic disease risk in maternal and child health programs. However, trends in major risks will
continue to influence incidence for many decades even if childhood prevention is rapidly
implemented. Therefore, concerted and combined primary and secondary prevention efforts are
also needed to reduce death rates in middle age and beyond.
Finally, although the epidemiological data described in this chapter provide a clear rationale for
the proximal risk factors and broader determinants that need to be targeted in prevention efforts
as well as compelling evidence that if these factors can be reduced, the burden of CVD will
decrease. However, the epidemiological data does not detail how specifically to design and
implement programs that will effectively achieve these goals, nor does it provide sufficient
guidance on how to tailor such interventions to work in disparate settings with different cultural,
structural, and epidemiological backdrops. The complex, interrelated determinants of global
CVD and the variation in both risk profiles and capacity among low and middle income
countries means that prevention efforts will only be effective if they are adapted to account for
the specific needs of the settings in which they will be applied. To achieve this, additional
surveillance and implementation research in all global regions, but especially in low and middle
income countries, is required. These important issues are the subject of the remaining chapters of
this report.