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Wednesday 15 October 2008
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Heart attack
Author by : Bhavesh shah
HEART ATTACK
Prevention of Heart Disease
What is Heart Disease?
Slide 2 Slide 2
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• Heart : The most hard-working muscle of our body – pumps 4-5 litres 
of blood every minute during rest
• Supplies nutrients and oxygen rich blood to all body parts, including itself
• Heart : The most hard-working muscle of our body – pumps 4-5 litres of blood every minute during rest
• Supplies nutrients and oxygen rich blood to all body parts, including itself
What is Atherosclerosis
what is coronary artery disease?
• Over time, fatty deposits called 
plaque build up within the artery walls. The artery becomes narrow. This is atherosclerosis
• When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called coronary artery disease, or coronary heart disease
Myth : fat deposits at old age!
It starts from 2 years of age
Are Other organs Affected?
What are the symptoms of Coronary artery disease?
What are the symptoms of Coronary artery disease?
• No symptoms for long period
• Chest pain for short period on exertion also known as Angina or minor heart attack
• Myocardial Infarction or major heart attack-Severe chest pain, death of heart muscle, heart failure, irregular heart beats
• Sudden Death
How Big is the Problem ?
• No. 1 killer disease worldwide
– 12 Million deaths annually
• During last 30 years large declines in developed countries -rising health awareness and government programmes
• Alarming increase in developing countries especially
• Get the disease at much younger age
– 5-10 years earlier than other communities
• Disease follows more severe and malignant course
– 3 times higher rate of second heart attack and two times higher mortality than whites
What Increases Risk?
You can’t help it !
• Age:
Men > 45;
Women > 55
• Sex
• Race
• Family History
You can !!
• High Cholesterol
• Smoking
• High Blood Pressure
• Diabetes
• Obesity
• Alcohol
• Physical Inactivity
Cholesterol ( A type of fat)
• Everybody needs cholesterol, it serves a vital function in the body.
• It circulates in the blood.
• Too much cholesterol
can deposit in the
arteries in the form of
plaque and block them
• No symptoms till heart
attack
Where does it come from ?
• Two sources of cholesterol: Food & made in your body
• Food sources: All foods containing animal fat and meat products
Good vs. BAD Cholesterol
• LDL cholesterol is known as bad cholesterol. It has a tendency to increase risk of heart disease
• LDL cholesterol is a major component of the plaque that clogs arteries
• HDL cholesterol is known as the good cholesterol. Higher in women, increases with exercise
• HDL cholesterol helps carry some of the bad cholesterol out of arteries.
Obesity
• People who are overweight (10-30 % more than their normal body weight)
• Obese have 2 to 6 times the risk of developing heart disease
• Normal Waist-Hip Ratio
<>
<>
• Pears or apples?
Pears and Apples
Apple- shaped are at a higher risk
Pear-shaped paunch store fat on the hips and thighs, just below the surface of the skin.
Apple-shaped paunch store body fat around the abdomen and chest, surrounding internal organs
Cigarette Smoking
• Increases blood pressure
• Decreases HDL
• Damages arteries and blood cells
• Increases heart attacks
• Cigarette smoke contains more than 4,000 chemicals, and 200 of these chemicals are poisonous
Alcohol Consumption
• In small amounts it is beneficial: 1-2 drinks
• In large amounts it adds fat and calories & raises BP!
• 4 drinks per day. You end up with gastroenterologist instead of cardiologist
• This is a very fine line! Finer for women as they are at higher risk
Diabetes
• At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of heart attack or stroke
• A diabetic is more likely to die of a heart attack than a non-diabetic
• ~80% Diabetics die from heart disease
• Risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had a heart attack.
Interactions of Risk Factors
Risk operates across a continuum - no clearcut line
(Blood Pressure; Cholesterol; overweight; Smoking)
The risk is multiplicative when many risk factors co-
exist; risk factors often cluster together
Majority of events arise in individuals with modest
elevations of many risk factors than from marked
elevation of a single risk factor
Creative strategies do not work !
• Never had a test or retest
• Never been to Doctor !
I hate them
• Never take medicines!
• My BP is normal, so stopped meds!
• Miracle men and Miracle Medicines! So many of them
• I am my own doctor! No fees too
Preventing Heart Disease
Rule #1 Look before your eat
• Eat a variety of fruits and vegetables every day. (5 servings - they are naturally low in fat and high in vitamins and minerals and anti oxidants). Eat colored vegetables and fruits
• Eat a variety of grain products
• Choose nonfat or low-fat products.
• Use less fat meats- chicken, fish and lean cuts
- Switch to fat-free milk—toned/skimmed milk
Dietary Guidelines
• Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks, candy, junk food
• Limit foods high in saturated fat, trans- fat and cholesterol
• Eat less than 6 gms of salt a day
• Have no more than1-2 alcoholic drink a day if you are a regular drinker
Limit / Avoid
• Foods rich in Cholesterol and Saturated fats
– Egg Yolk
– Fatty meat & organ meat( Liver)
– Butter chicken / Batter fried fish !
– Milk fat – Desi Ghee, Butter, Cheese, Malai, Rabri, Khurchan, Doda, Ice Cream, full cream milk,
– Hidden Fat like Bakery biscuits, Patties (!), Cakes, Pastries,
Cooking Oils: The mystery of PUFA / MUFA
• Saturated Fats : Increase Cholesterol – Avoid
– Coconut oil, Palm oil, Vanaspati ghee
• Monounsaturated Fats (MUFA): Heart healthy
– Olive oil, Groundnut oil, Canola oil, Mustard oil
• Polyunsaturated Fats (PUFA): Heart healthy
– Sunflower oil, Soybean oil
• Omega-3-Fatty acids Fish oil : Heart Healthy
Rotate the oils or Mixture of oils
Preventing Heart Disease
Rule #2 Exercise
• Maintain a level of physical activity that keeps you fit and matches the calories you eat
• Serves several functions in preventing and treating those at high risk
• Reduces incidence of obesity
• Increases HDL
• Lowers LDL and total cholesterol
• Helps control diabetes and hypertension
Exercise, Exercise, Exercise
• Mortality is halved in retired men who walk more than two miles every day
• Regular exercise can halve the risk of heart disease, particularly in men who walk briskly
• Someone who is inactive has as great a risk of having heart disease as someone who smokes, has high blood pressure or has high cholesterol
• Exercise significantly reduces the chances of diabetes and stroke
• With regular exercise, blood pressure in those with hypertension is reduced by as much as 20mms Hg
Rule # 3 Stop Smoking NOW!
• The risk of heart attack starts decreasing within 24 hours of quitting smoking, within 1 year of quitting, CHD risk decreases significantly, within 2 years it reaches the level of a nonsmoker
• Smell and taste improve within days
• Within three months of quitting, the smokers' cough disappears in most people
Benefits much beyond Heart Disease
Rule # 4 Know your Number!
Desirable numbers
• Total cholesterol <>
• LDL <>
• HDL > 40
• triglycerides <>
• Get the levels tested routinely and keep them under control
• The only thing worse than finding out that you have one of these conditions is…….NOT finding out that you have it!!
Benefits of reducing cholesterol
10% reduction of blood cholesterol produces 20-30% decline in CHD deaths
All Adults >20 yrs must get tested- if normal test again after 5 years, if elevated, work towards normalizing the levels with lifestyle modification and drugs as needed
Controlling Blood Pressure
• Adults should have their blood pressure checked at least once every two years, as there are no symptoms to tell if you have high blood pressure
• Optimal levels : 120 /80 mm Hg
• If high
– Modify your lifestyle – Diet, Weight, Exercise, Salt restriction
– Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood pressure becomes normal
Controlling Blood Sugar
• All adults should have their blood sugar checked regularly, as there are no early symptoms of diabetes
• Normal blood sugar:
• Fasting <>
• If high
– Modify your lifestyle – Diet, Weight, Exercise
– Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood sugar becomes normal
If you or someone in your family already diagnosed with heart disease
• Don’t get disheartened – science has made significant progress
• Just monitor risk factors much more aggressively
– Eat healthy
– Walk regularly
– Watch your weight
– Quit smoking immediately
– Keep your weight under control
– In addition to improving your heart – health these measures are sure to enhance your appearance !!
• Adhere to you medicines & listen to your doctor
Don’t wait for a heart attack to take an action !
Don’t wait for a second life we are not cats!
Heart disease is often avoidable. Following a heart-healthy lifestyle doesn't have to be complicated, and it doesn't mean you need to live a life of self-deprivation. Instead, find ways to incorporate heart-healthy habits into your lifestyle — and you may well enjoy a healthier life for years to come.
Heart Care Tips :
Q What are the five thumb rules for a layman to take care of his heart?
A. 1. Diet – Less of carbohydrate, more of protein, less oil.
2. Exercise – half an hour’s walk, at least five days a week. Avoid lifts and avoid sitting for a long time.
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar.
Q Is eating non-veg food (fish) good for the heart?
A. No
Q. It’s still a grave shock to hear that some apparently healthy person get a cardiac arrest. How do we understand it in perspective?
A. This is called silent attack. That is why, we recommend everyone past the age of 30 to undergo routine health check-ups.
Q Are heart diseases hereditary?
A. Yes
Q What are the ways in which the heart is stressed? What practices do you suggest to de-stress?
A. Change your attitude towards life. Do not look for perfection in everything in life.
A. Walking is better than jogging since jogging leads to early fatigue and injury to joints.
A. Mother Theresa, who was my patient.
A. Extremely rare.
Q Does cholesterol accumulate right from an early age (I’m currently only 22) or do you have to worry about it only after you are above 30 years of age?
A. Cholesterol accumulates from childhood.
Q How do irregular eating habits affect the heart?
A. You tend to eat junk food when the habits are irregular and your body’s enzyme releases for digestion gets confused.
Q Can a healthy person without a medical history have a heart attack due to stress?
A. Extremely rare
Q How can I control cholesterol content without using medicines?
A. Control diet, walk and eat walnut.
A. Yoga helps
A. Best food is fruits, worst are oils.
A. Stent doesn’t get displaced. It can get blocked. You could prevent it by controlling sugar, cholesterol and taking medication to prevent clots.
Q Do negative emotions like depression or anger always cause heart disease?
A. Not always. On the other hand, positive emotions help recovery of the heart.
Q I have read about music therapy for the heart and the mind. What is your opinion on this?
A. Guess, it helps.
A. All oils are bad. The so-called best oil company has the largest marketing budget.
A. Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.
A. It was extremely difficult because of the media attention. As far as the medical treatment is concerned, she was like any other child with a complex heart problem.
A. Help the person into a sleeping position, put an Aspirin tablet under the tongue with a Sorbitrate tablet if available, and rush him to coronary care unit since the maximum casualty takes place within the first hour.
Q How do you differentiate between pain caused by a heart attack and that cause due to gastric trouble ?
A. Extremely difficult without ECG.
Q Can drinking less water lead to heart problems ?
A. No. However, drinking plenty of water in normal people helps preserve good health.
Q Is it true that diabetic women seem to have 3 to 7 times greater risk of developing heart diseases than non-diabetic women? Is it the same with high BP patients as well ?
A. Women are protected by the hormones till the age of 45. After that, their risk increases like men and in general, the result of treatment on heart patients who are women is slightly poorer than men.
Q What are some of the precautions during pregnancy to avoid heart problems in the new born ?
A. Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.
Q What is the right time to check the BP in any person?
A. Past the age of 30 and earlier, if you have symptoms.
Q Is it possible for a person for a person to have BP outside the normal range of 120/80 and yet to be perfectly healthy ?
A. Yes
Q Are there any symptoms for heart problems, which we need to be aware of ?
A. Shortness of breath on exertion, and chest pain.
Q If a person has had a heart attack, how frequently is regular heart check-up recommend?
A. Once in 6 months.
Q Marriages within close relatives can lead to heart problems for the child. Is it true?
A. Yes, co-sanguinity leads to congenital abnormalities and you may not have a software engineer as a child.
Q Many of us have an irregular daily routine and many a time we have to stay in office till late nights. Does this affect our heart? What precautions would you recommend?
A. When you are young, nature protects you against all these irregularities. However, as you grow older, respect the biological clock.
Q How can we find out about blockage of arteries, beforehand?
A. Routine cardiac evaluation by blood test, ECGs, TMTs, Stress Thallium Scan,
Q Does a recurring pain in the left arm signify any heart related ailment?
A. Usually, you get chest discomfort or shortness of breath, months or years before the heart attack. So, when in doubt, go for a heart check-up, which should not take more than a couple of hours.
Q Will taking anti-hypertensive drugs cause some other complications (short/long term) ?
A. Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.
Q Will consuming more coffee/tea lead to heart attacks?
A. No
Q What are the chances of lean people developing heart complications? Are they at less risk?
A. Obese people are at a higher risk. Lean people also develop heart attacks, but primarily because of genetic predisposition.
Q Is it true that after open-heart surgery, patients lose memory-recall to some extent?
A. No. Especially after bypass grafting on a beating heart, incidence of neurological problems have come down significantly.
Q Are Asthma patients more prone to heart disease?
A. No
Q How would you define junk food?
A. Fried food like Kentucky, McDonalds, Samosas, and even Masala Dosas.
Q You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food ?
A. Every race is vulnerable to some disease and unfortunately Indians are vulnerable for the most expensive disease.
Q Does consuming bananas help reduce hypertension?
A. No
Q Is there any cure for chronic palpitations?
A. The patient should be investigated and if there is a cause for palpitation like an electrical abnormality of the heart, this can be rectified by a procedure called radio-frequency-ablation.
Q How would you rate the health facilities currently available in
A. There are institutions, which are as good or even better than the one in the
Q If there is a small hole in the heart, what are the possible ways of curing it? Is operation the only solution?
A. Small holes in children less than 6 months of age usually closes. But the decision not to operate should be taken by the specialists who are experts in treating children with heart problems.
Q Are emotions really controlled by heart?
A. No. The heart is just a slave of the brain and it is the brain, which controls the emotions.
Q If a person does not do any physical exercise, he is bound to have shortness of breath on exertion; say climbing stairs. Is this an indication of heart disease?
A. No. But if one has difficulty in breathing on mild exertion, it is better to go for a heart check-up.
Q Can a person help himself during a heart attack?
A. Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary-care-unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up
A. No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.
Q Sometimes, due to the hectic schedule, we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
A. Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.
Q Is there a relation between heart problems and blood sugar?
A. Yes. A strong relationship is there since diabetics are more vulnerable to heart attacks than non-diabetics.
Q Do bypass surgeries reduce the risk of future heart attacks ?
A. It significantly reduces the risk of heart attack.
Q What are the things one needs to take care of after a heart operation?
A. Diet, exercise, drugs on time. Control Cholesterol, BP and weight.
Q Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?
A. No.
Q Can you brief us about angina attack? How major it is?
A. Angina is the pain, which comes on exertion and goes away with rest and medication. One has to be investigated in detail to plan treatment.
Q What are the modern anti-hypertensive drugs?
A. There are hundreds of drugs and your doctor will chose the right combination for your problem. But my suggestion is to avoid the drugs and go for natural ways of controlling blood pressure by walk, diet to reduce weight and changing attitudes towards lifestyle.
Q Does dispirin or similar headache pills increase the risk of heart attacks?
A. No
Q If there is about 85 percent blockage in the arteries, can the person be treated without surgery? If not, what other remedies and the power of your heart muscles
A. It depends on collateral or natural bypass, the quality of other arteries and the power of your heart muscles. It’s impossible to give an opinion without seeing the angiography film.
Q There is a feeling that bypass is unnecessarily being performed in some cases. When is bypass really needed?
A. When you have blockages affecting major arteries, bypass is the best option. I am sure, conscientious doctors will not perform an operation when it is not required.
Q Is it true that mechanical valves can fail any moment?
A. No. If you take medication to prevent clot formation and maintain the INR at accepted levels, the valve cannot get blocked. However, like any mechanical gadget, it can fail and fortunately, such incidences are extremely low.
Q Can you brief me on pulmonary stenosys problems? What are the complications involved and what care needs to be taken?
A. In this condition, the pulmonary valve is narrower at birth and putting a balloon across the valve and dilating it can easily correct it.
Q Why is it the rate of heart attacks more in men than in women?
A Nature protects women till the age of 45.
Q How can one keep the heart in a good condition?
A Eat a healthy diet, avoid junk food, exercise every day, do not smoke and, go for a health checkup if you are past the age of 30 for at least once in two years. And WORK VERY HARD.
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