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Helena Taskinen

Occupational Health and

the Heart

by:Dr.bahrami

Helena Taskinen

Introduction

• Heart disease and stroke cause majority of deaths in world

• Major risk factor:– family history,

– HTN,DM,lipid abnormalities

– smoking

Other factors:

Stress,

Exposure to occupational or environmental toxic agent

Helena Taskinen

Introduction

• US 1%-3% of deaths from CVD are work related

• Note: Preventable

• Toxic CVD is usually result of chronic low level exposure

• Problems in establishing

• CVD is common even in absence of toxic exposures.

• Cardiovascular toxic substances interact with other RF

Helena Taskinen

Agents can be grouped by main or

major effects on the C.V.S

Coronary artery disease

Dysrhythmias

Cardiomyopathy

Hypertension

Helena Taskinen

Helena Taskinen

Coronary artery disease

Air pollution Carbon disulfide Carbon monoxide

Helena Taskinen

CAD - Carbon monoxide

Exposure: forklift operators,

foundry workers, miners,

mechanic, firefighters.

Cigarette smoking

Helena Taskinen

Patogenesis

• most widely distributed of all industrial toxic

• greatest number of intoxications and deaths.

• Excessive CO :

• reduce maximal exercise capacity,

• aggravate angina,

• intermittent claudication,

• chronic OLD ;

• arrhythmias.

• Increases platelet stickiness

Helena Taskinen

Pathogenesis & Clinical findings

• Binds to Hb more avidly than O2 (200x oxygen’s affinity)

(only finding specific for CO is elevation carboxy Hb)

• Acute:

– Headache(first symptom), nausea, dizziness, fatigue, coma

• MI or sudden death

• Chronic:

– aggravate angina pectoris,

– cardiac arrhythmia,

– cardiomyopathy.

Helena Taskinen

Helena Taskinen

Helena Taskinen

Helena Taskinen

CAD : Organic Nitrates

(nitroglycerin, ethylene glycol dinitrate)

• In 1950s, an epidemic of sudden death in young

munitions workers who hand-packed cartridges of

explosives

• Exposure :

Explosive manufacturing,

construction work involving blasting,

pharmaceutical manufacturing of nitrate

Helena Taskinen

CAD : Organic Nitrates

(nitroglycerin, ethylene glycol dinitrate)• With prolonged exposure(1- 4 years), compensatory

vasoconstriction develops (by sympathetic, rennin-

angiotensin or both)

• When exposure to nitrates is stopped, compensatory

vasoconstriction becomes unopposed, coronary

vasospasm

• Withdrawal : HTN, angina ,MI, sudden death

Helena Taskinen

Helena Taskinen

Pathogenesis & Clinical findings

• Chest pain during nitrate withdrawal termed : Monday morning angina

2-3 days after last day of nitrate exposure.

• Prevention

• Nitrates extremely volatile and absorbed readily through lungs and skin.

workers who handle dynamite advised to wear cotton gloves.

• Natural rubber gloves not used.

• levels of nitrates in workplace environment must controlled by

- adequate ventilation and during periods of hot weather.

• excessive exposure :

• Progressively decreasing BP

• increasing heart rate during workday

Helena Taskinen

Coronary artery disease

Carbon disulfide (CS2)

• Solvent for rubber,

• Viscose rayon

• CCL4 and ammonium salts

• Microelectronics industry

(degreasing)

Helena Taskinen

Pathogenesis

RR of 2 to 5x for death from CAD

direct role in atherogenesis in vessels

Disturbances of lipid metabolism and

thyroid function (LDL , hypothyrodism)

(risk factor atherosclerosis)

Helena Taskinen

Clinical findings

• Acute: polyneuropathy, encephalopathy:fatigue, headaches,

dizziness, disorientation, paresthesias, psychosis, delirium

• Chronic: hypertension, angina, MI (5-10years)

• Early sign: eye sign abnormal ocular microcirculation ,

(micro aneurysms, hemorrhages) such as

diabetic retinopathy

• Disturbed color vision, Presenile dementia, stroke, and

sudden death

Helena Taskinen

Examination

History : CVS &CNS disease, hypertension,…

Examination:

CVS,CNS,

Ocular fundoscopy

Helena Taskinen

Dysrhythmias

Arsenic

Chlorofluorocarbon propellants

Hydrocarbon solvents ( trichloroethane

and trichloroethylene)

Organophosphate and carbamate

insecticides

Helena Taskinen

Dysrhythmias

• Chlorofluorocarbons (Freon® etc)

Refrigeration, air conditioning, propellants

Cleaning slide (surgical pathology laboratory)

• Exposure to solvents and propellants

- cardiac arrhythmia, syncope with resulting

accident at work, or sudden death

Helena Taskinen

Pathogenesis &

Clinical findings

May sensitize myocardium to catechol effects

• Low level of exposure:

– Sensitize, arrhythmia (VT,VF), death

• Higher level:

– Depress sinus node activity, brardycardia, arrest

• Symptom:

– Dizziness, headache, nausea, syncope

Helena Taskinen

Cardiomyopathy

• Lead, arsenic

• Cobalt: used to stabilize beer foam

• Cardiomyopathy reported in beer

drinkers several months afterward

Helena Taskinen

Hypertension

• Lead:

– Probable mechanism is via renal injury

– May also increase vascular tone and resistance

• Cadmium:

– Possibly associated with HTN;

noted to occur at levels below nephrotoxic dose

Helena Taskinen

Occupational Stress

• Managers

Helena Taskinen

Cardiovascular effects on work

Some figures on heart disease in US:

• 1.5 million MI each year

• Nearly 200,000 CABG per year

• Over 80% of workers are generally able to

return to work after initial MI or CABG

Helena Taskinen

Job

CharacteristicsHuman

Capabilities

Job & Ability

fitness for work

Helena Taskinen

Fitness-for-work

• Many safety-sensitive jobs (fire, police) have qualification

requirements based on exercise testing or physical fitness

standards

Helena Taskinen

Fitness-for-work

• Pace maker: Electromagnetic field

Helena Taskinen

Retern-to-work

• Worker with CAD with cautious:

CO,

Solvent,

Heat or Cold,

physical activity

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Job demand Human capacity

معافیت پزشکی

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