Title: PREVENTION OF EARLY HEART DISEASES
1PREVENTION OF EARLY HEART DISEASES
DR. PRAVEEN CHANDRA SENIOR CONSULTANT DIRECTOR
CARDIAC CATH LAB MAX HEART VASCULAR INSTITUTE
NEW DELHI
2- STRUCTURE FUNCTION OF HEART
3STRUCTURE OF THE HEART
4STRUCTURE OF THE HEART
5BLOOD SUPPLY
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7Prevention of Early Heart Diseases
- Diet for a Healthy Heart
- Basic Aid in Heart Emergencies
- Stress Busters for a Healthy Heart
- Early Detection and Prevention
8 9DIETARY PRUDENCE
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13Types of Carbohydrates
- Less processed or whole grain carbs contain
fiber and numerous nutrients - White, refined, and processed carbs contain very
little fiber and are enriched
14Glycemic index of foods
- High GI foods (GI over 100)
- White and whole wheat breads, white potatoes,
most cold cereals, white rice, cakes, cream of
wheat - Intermediate (GI of 75-100)
- Sucrose (table sugar), bananas, instant and quick
oatmeal, bran cereals, shredded wheat, brown rice
rice - Low GI foods (GI
- Barley, old fashioned oats, dried beans, lentils,
soybeans, pasta, yogurt, most fruits,
sweet-potatoes, breads with intact whole grains
15 High GI diets-risk of CAD,DM
- High glycemic index diets associated with
increased risk of CAD - Nurses Health Study
FASEB J 199812!260 - High glycemic index diet combined with low cereal
fiber intake increases risk of type 2 diabetes in
both men and women - Nurses Health Study,
JAMA 199727772- 28 - Health Professionals
Follow-up Study, Diabetes Care
19974545-550 550
16Benefits of a low glycemic index diet
- Decreases
- Insulin resistance
- Triglycerides
- Insulin levels
- Blood sugars
- Body fat
- Increases
- Nutrient density
- Fiber
- HDL
- Athletic performance
JAMA May 20022872414-2423 Diabetes Care May
200225822-828
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19What about eggs?
- One egg a day not associated with increased risk
of CVD - Nurses Health Study
- Eggs are a good source of nutrients
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21Nuts
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25Healthy Heart Diet
- Quality and Moderation
- Nutrient Dense and Fiber Rich
- Emphasis on Fruits, Vegetables, Whole Grains,
Low-fat Dairy, Lean Meats, Monounsaturated Fats
and Omega 3s - Whole Diet
- 80-90 healthier choices
26Summary
- Genetic phenotype influences response to diet.
No one diet fits all. - A LF, high carb diet worsens the lipid profile
for those with metabolic syndrome, insulin
resistance, and diabetes - Not all fats are bad, not all carbohydrates are
created equal - Play it safe A Mediterranean diet with low GI
carbohydrates benefits most
27- BASIC AID
- IN
- HEART EMERGENCIES
28Types of Cardiac Emergencies
- Arrhythmias (eg., VF, VT)
- Myocardial Infarction
- Unstable Angina
- Congestive Cardiac Failure
- Acute pulmonary Oedema following a heart attack
- Dissection of aorta
- Valvular heart disease (MS, AS)
29Suspect a Cardiac Emergency when
- Symptoms last for more than a few minutes
- Medical history of cardiac disease
- Presence of several risk factors
30The Chain of Survival
ECC Guidelines, Circulation. 2000102I-22
31The Chain of Survival
- Consists of Four Links
- Early access
- Early CPR
- Early defibrillation
- Early advanced care
ECC Guidelines, Circulation. 2000102I-22
32Procedure of Defibrillation
If rapid defibrillation is unsuccessful, then the
Basic Life Support is resumed along with Drug
therapy
33Advanced Cardiac Life Support
- IV access and Endotracheal intubation
- Look for reversible causes of cardiac arrest and
treat - Hypoxia
- Hypovolemia
- Hypo/hyperkalaemia
- Tension pneumothorax
- Cardiac tamponade
- Toxic/ therapeutic disturbance
- Thromboembolic/ mechanical obstruction
Contd..
34Do not interrupt resuscitation for more than 10
seconds, except to defibrillate
35After Successful Resuscitation
- Transfer to Coronary Care Unit
- Monitor Vital Signs
- Explain to the relatives about what has happened
36 Warning Signs of a Heart attack
- Steady, squeezing pressure or burning pain in the
centre of the chest that lasts two minutes or
more - Pain that radiates from the centre of the chest
down one (usually left) or both arms and to
shoulders, neck, jaw or back - Dizziness, light-headedness or fainting
- Nausea or vomiting
- A sense of anxiety or impending doom
37 Warning Signs of a Heart attack
- If a Cardiac arrest occurs outside a hospital
- 25-30 chances of survival if CPR administered
promptly - 5 survival chances if CPR is not administered
Cardiac emergencies Ch 27 Yale University
School of Medicine Heart Book
38TREATMENT
39WHAT IS THE BEST TREATMENT OF HEART ATTACK ?
IMMEDIATE ANGIOGRAPHY ANGIOPLASTY WITHIN 2-6
HRS OF ONSET OF PAIN
40THE CONCEPT OF GOLDEN HOUR
41Golden Hour
Term used in emergency medicine which refers to
the first sixty minutes after an accident or the
onset of acute illness. The victim's chances of
survival are greatest if he or she can be
transported to a hospital within the Golden Hour.
42GOLDEN HOUR
- MAXIMUM DAMAGE TO HEART MUSCLE
- MAXIMUM EFFICACY OF TREATMENT SEEN
- SURVIVAL IS BEST IF CLOT BUSTER DRUGS GIVEN
WITHIN THIS PERIOD - TIME IS MUSCLE AND MUSCLE IS TIME
43USUAL REASONS OF DELAY
- DISBELIEF THAT THE SYMPTOMS ARE FROM HEART
- DONT WANT TO PANIC AND BE AN
INCONVENIENCE TO THE FAMILY - WHOM TO CONTACT AND WHERE TO CONTACT AT THIS HOUR
44IMPACT OF SAVE HEART
- MORTALITY RATE FOR ACUTE HEART ATTACK HAS REDUCED
FROM OVER 20 TO LESS THAN 5 - INCREASED LONGIVITY
- BETTER QUALITY OF LIFE
- AIM IS TO REDUCE MORTALITY TO
45A Stitch in Time Saves Nine !!!
46How to Suspect Heart Attack What to Do if Heart
Attack Occurs
- Immediate Rest Lie Down
- Call / inform Family Dont Hesitate
- Call Nearest Doctor / Hospital with ECG Facility
- Dont Waste Time
- Emergency 4055 4055
4724 Hour Emergency
4055 4055
Max Health Care
48The institution
49The institution
50APEX CORONARY CARE
51BALLOON ANGIOPLASTY
52IMMEDIATE ANGIOPLASTY
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55Primary PTCA at Max
- Primary PCI - 328 out of 5550 PTCAs till date
- Thrombolysis 18 patients
- 2B3A use 90
- IABP 11
- Cardiogenic Shock 10
- Door to needle time 45 min
- Mortality 2
56ADVANCED OPTIONS
- FOR HEART FAILURE
- TO PREVENT SUDDEN CARDIAC DEATH AFTER HEART ATTACK
57IMPLANTABLE DEFIBRILLATOR
58- STRESS BUSTERS FOR
- A
- HEALTHY HEART
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68STRESS MANAGEMENT
- REGULAR EXERCISE
- REST AND SLEEP
- RELAXATION
- FAMILY AND SOCIAL SUPPORT
- YOGA AND MEDITATION
69- EARLY DETECTION
-
- PREVENTION
70SURVIVAL BENEFITS
- 99 survival when CAD is detected at asymptomatic
stage or at stage of angina - 20 mortality with acute heart attack
-
71Early detection of CAD
72HOW TO PREVENT HEART ATTACK
- REGULAR 5 YEARLY CHECK AFTER THE AGE OF 35
- EVERY YEAR IN DIABETICS
- PREVENTIVE MEASURES
73CANDIDATES FOR SCREENING
- PEOPLE WITH RISK FACTORS
- SENSITIVE POPULATION-AIR CREW
- EQUIVOCAL TMT WITH SOME /INTERMEDIATE PROBABILITY
OF CAD
74Atherosclerosisa long smoldering process!
Traditional Risk Factors
Endothelial Dysfunction
Coronary Artery Disease (Clinical Disease)
Atherosclerotic Plaque (sub-clinical)
No Risk Factor?
Stress test TMT Stress ECHO SPECT CT
Angio CORONARY Angio
75TMT
76ECHOCARDIOGRAM
77STRESS THALLIUM
78THE GOLD STANDARD
ANGIOGRAPHY
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82The ultimate cure Prevention
- CHANGES IN HABITS LIFE STYLE
- AWARENESS ABOUT DISEASE
- EARLY DETECTION IN ASYMPTOMATIC
83How To Prevent CAD
- Identification of Risk Factors
- Aggressive management of risk factors
- Early detection and management
84Risk factors for CAD
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87WHO IS OBESE?
- BMI (Weight in kg/Height in
- meters2)
- 19 to 25 Normal
- 25 to 30 Over Weight
- 30 to 35 Obese
- 35 Morbidly Obese
- Waist circumference
- Waist / hip ratio
- Apple vs pear
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89- Will regular exercise help?
90Yoga good for stress !
91 To Conclude
HEART DISEASE is the Second Biggest Killer of
Mankind
Prevention , early diagnosis and treatment is the
key to survival.
92THANK YOU