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6: Other Environmental Impacts

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    Clinical Perspectives

    • As mentioned previously, the following sections include information on clinical perspectives

    Cardiovascular System

    • Arteries – take blood away from heart

      • Always under high pressure

      • More elastic tissue, less smooth muscle – able to change size and diameter

      • Blood is oxygenated

    • Veins – return blood back to heart

      • Under low pressure

      • Thinner walls than arteries, less elasticity, valves prevent blood backflow

      • Rely on gravity, inertia and force of skeletal muscle contractions

    • Arterioles – provide blood to organs

      • Mostly smooth muscle

      • Lower pressure, thinner walls

    • Venules – smallest veins

      • Receive blood from capillaries

    • Capillaries – exchange gasses between vessels

      • Thin walls (1-cell thickness)

    • Heart 

      • Left of midline, between 2nd rib and 5th intercostal space

      • Posterior to sternum

      • < 1lb

      • Beats 100,000 times/day

      • Transports 8,000 liters blood/day

    • Aorta

      • Main artery extending from left ventricle into abdomen (left side of body) 

      • Aortic valve can be surgically replaced

    • Pulse – expansion and recoil of an artery with each heartbeat

    • Blood pressure

      • Systolic measurement – pressure when heart is beating

        • Contraction in cardiac muscle

        • Blood pushed to next chamber

      • Diastolic measurement – between beats

        • Cardiac muscle relaxes

        • Chamber fills with blood

    • What is the difference between blood pressure and heart rate?

      • Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels

      • Heart rate is a measurement of the number of times the heart beats per minute

    • Hypertension – high blood pressure (140/90 mmHg or higher)

    • Hypotension – low blood pressure

      • Circulatory shock – acute hypotension (acute = severe and sudden onset, hypotension = low blood pressure); blood loss

    • With high blood pressure, the heart works harder to pump blood to organs, which can lead to hardening of arteries

    • Influences?

      • Stress, smoking, alcohol, poor diet, sedentary lifestyle, genetics

    • Normal range: 120/80 mmHg

    • Cholesterol – waxy substance used to build cells, vitamins, hormones

      • Body makes all the cholesterol it needs

      • Too much cholesterol combines with other substances in blood, forming plaque

    • High density lipoprotein (HDL) – “good cholesterol”

      • Carries cholesterol back to liver to be removed from body

      • Doesn’t completely eliminate LDL (⅓ - ¼ of cholesterol)

    • Low density lipoprotein (LDL) – “bad cholesterol”

      • Leads to buildup of plaque

    • Triglycerides – type of fat that store excess energy

      • High triglyceride and cholesterol levels increases risk of heart attack and stroke

    • Artery walls thicken due to accumulation of plaque buildup

      • Myocardial infarction – results from plaque buildup (formation of thrombus, also known as a blood clot)

      • Common in U.S. soldiers killed in WWII, Korean War, Vietnam War (77.3% of autopsies) – higher rates of tobacco, advent of processed foods

    • Stressors:

      • High blood pressure

      • Hardening of arteries

      • Congestive heart failure

      • Myocardial infarction (heart attack)

        • Heart tissue that is denied oxygen dies

      • Stroke

      • Angina pectoris (chest pain)

    • “Stroke”

    • Loss of blood supply to the brain

    • Risk factors:

      • High cholesterol

      • Diabetes

      • Hypertension

      • Heart disease

      • Smoking

    • Bypass

      • Healthy arteries are used to create new pathways around blockages

      • Significant recovery time; must saw through sternum and ribs

      • Quadruple bypass – 4 major coronary arteries

    • Stent

      • Springy, lattice-shaped tubes used to prop open clogged arteries

      • Drug-coated

      • Faster recovery time, but not always as much relief as surgery

    • Some evidence suggests that Neanderthals or Denisovans transmitted a HPV (Human papillomavirus) strain to humans

      • Lack of skeletal evidence, but DNA evidence

    • STIs have been well-observed, cross-culturally, and even appear in cuneiform tablets from Mesopotamia

      • Variation in beliefs about STIs and sexual health

      • In some cases, pervasive beliefs that STIs were a punishment for immorality

    • STI spread:

      • War and colonization

      • Poor hygiene and sanitation

      • Sex work (violence/lack of protection for workers)

    • The severity of syphilis (bacterial infection) seems to have decreased over time, as milder strains emerged

      • The categorization of syphilis as an STI was debated because only one subspecies is transmitted sexually

      • Sex workers required to register and undergo examinations or get sent to prison for failure to comply

        • London Lock Hospital – 1747, first to treat STIs, primarily syphilis

    • Many STIs are asymptomatic (especially viral diseases)

      • Those who are symptomatic are more likely to seek treatment and less likely to develop complications from lack of treatment than those who are asymptomatic

    • Gender disparities

      • Open vaginal anatomy and short urethra makes some people more susceptible

      • AMAB can be asymptomatic for some diseases

    • Social, behavioral, and economic factors

      • Secrecy, medical access, education, poverty, drug use, violence

      • Presence of other STIs increases HIV risk

    • Substance abuse

    • STIs that can be treated with antibiotics:

      • Chlamydia, gonorrhea, syphilis

    • Vaccines – some types of HPV (Human papillomavirus), hepatitis B (liver infection

    • Pelvic inflammatory disease

      • Infection of uterine tubes, most often caused by untreated STIs (chlamydia, especially)

      • One of the leading causes of infertility

    • HPV Vaccination Recommendations, CDC. (2021). https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html

    • Most common STI in the U.S. (CDC, 2021)

      • More than half of all sexually active individuals get exposed to some type of HPV at some point in their lives

    • Some types may cause warts on genitalia

      • Warts treated by drugs, laser surgery, freezing – not a cure

    • Some types clear up on their own

    • Some are asymptomatic (regardless of severity)

    • Increased risk of cancer (especially cervical cancer, where nearly all cases are caused by HPV)

    • Vaccines for prevention against strains that cause majority of cervical cancer

      • 3 shots over 6 month period, ages 11-12

      • Up to age 26…there may be options for people between 27-45

    • Cervical cancer cases have dropped 88% since HPV vaccines were implemented in 2006 (CDC, 2021)!

    • Human immunodeficiency virus

      • AIDS is the condition caused by HIV (Acquired Immune Deficiency Syndrome)

      • Fatigue, fever, chills, night sweats, swollen lymph nodes, diarrhea, weight loss

      • Asymptomatic stage may last years

      • Opportunistic infections include: tuberculosis, encephalitis, meningitis, and fungal infections (yeast infections)

    • Originated in southwestern Cameroon forests

      • HIV-1 first infected humans around 1908 (subtype O)

    • Spread in Kinshasa in 1920s

      • Large number of laborers drawn to the city

      • Extensive railway network in the region

      • Injectable drugs used to treat STIs (before disposable syringes were implemented)

    • Subtype C spread to India

    • Subtype B spread to Haiti and then to the U.S.

      • In 1960s, after Democratic Republic of the Congo became independent from Belgium, migration in and out from French-speaking Haitians that moved to DRC for work in medical, legal professions, and other industries

      • In Haiti, spread in plasmapheresis center where people donated blood

      • Entered U.S. around 1969, and it took a while to see the effects of the disease

    • National AIDS Memorial Quilt

    • Reading recommendation: Correcting the record: Gaetan Dugas, stigma, and the Patient Zero narrative by Emilio Davis

    • See Ch. 8 for information on PrEP and PEP

    6: Other Environmental Impacts is shared under a not declared license and was authored, remixed, and/or curated by LibreTexts.

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