HEART

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HEART
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HEART

• Hollow, muscular organ.
• 300 grams.
• 4 chambers.
• found in chest between lungs .
• surrounded by membrane called Pericardium.
• Pericardial space is fluid-filled to nourish and
  protect the heart.

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HEART ANATOMY

• The heart is a complex muscular pump that
  maintains blood pressure and flow through the
  lungs and the rest of the body.
• The heart pumps about 100,000 times and moves
  7200 liters of blood every day.

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• Deoxygenated blood returns to the heart via the
  superior and inferior vena cava, enters the right
  atrium, passes into the right ventricle, and from
  here it is ejected to the pulmonary artery.
• Oxygenated blood returning from the lungs enters
  the left atrium via the pulmonary veins, passes
  into the left ventricle, and is then ejected to
  the aorta.

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Blood Vessels
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Functions of the Heart

• Generates blood pressure.
• The role of the heart is to pump oxygen-rich
  blood to every living cell in the body and
  deoxygenated blood to the liver.
• Routes blood
• Heart separates pulmonary and systemic
  circulation.

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Functions of the Heart

• The heart pumps the blood, which carries all the
  vital materials which help our bodies function
  and removes the waste products that we do not
  need. 
• Heart failure is the inability of the heart to
  provide enough blood flow to maintain normal
  metabolism

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QUIZ

• The right ventricle is the chamber of the heart
  that pumps blood for the pulmonary circulation.
  Based on this information, blood from the right
  ventricle is on its way to the -----
• Which of the following is also known as the
  mitral valve?
• How much does your heart weigh?

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•  Which of these are a part of your circulatory
  system?
• Arteries, veins
• capillaries
• all of the above
•  Where in your body is your heart located?
• Blood transported by the pulmonary veins returns
  to the
•  The bulk of the heart consists of
• Blood vessels that carry blood away from the
  heart are called

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What is Heart Disease?

• Coronary heart disease- arteries that
• supply the heart with blood and oxygen
• are narrowed by a build-up of plaque,
• and less blood gets through.

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Angina-pain or pressure that occurs because blood
flow and oxygen to the heart is reduced. Is a
symptom of heart disease. Heart Attack-blood
flow to part of the heart is completely blocked
and cells begin to die from lack of oxygen.
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Coronary Artery Disease

• Coronary artery disease is one of the most common
  and serious effects of aging. Fatty deposits
  build up in blood vessel walls and narrow the
  passage way for the movement of blood. The
  resulting condition, called atherosclerosis often
  leads to blockage of the coronary arteries and a
  heart attack.

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ATHEROSCLEROSIS

• Atherosclerosis is in which the walls of the
  blood vessels become thickened and hardened by
  "plaques." The plaques are composed of
  cholesterol and other lipids, inflammatory cells,
  and calcium deposits.

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Development of Atherosclerotic Plaques
Fatty streak
Normal
Lipid-rich plaque
Foam cells
Fibrous cap
Lipid core
Thrombus
Ross R. Nature. 1993362801-809.
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Atherosclerotic Plaque Rupture and Thrombus
Formation
Growth of thrombus
Intraluminal thrombus
Blood Flow
Lipid pool
Intraplaque thrombus
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ATHEROSCLEROSIS SIGNS AND SYMPTOMS

• Heart
• Brain
• Legs, pelvis, or arms
• Kidneys.

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Symptoms of Atherosclerosis in the Heart

• Chest pain or chest discomfort (angina).
• Pain in one or both arms, the left shoulder,
  neck, jaw, or back.
• Shortness of breath.
• Dizziness.
• Faster heartbeats.
• Nausea .
• Abnormal heartbeats.
• Feeling very tired.

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Symptoms in the Brain

• Sudden numbness or weakness of face, arm, or leg,
  especially on one side of the body.
• Sudden confusion or trouble speaking or
  understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, or loss of
  balance or coordination.
• Sudden severe headache with no known cause.

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Symptoms in the Legs, Pelvis, or Arms

• Ache, or cramping in the muscles that occurs
  during exercise but improves with rest.
• Cold or numb feeling in the feet or toes,
  especially at night.

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Atherosclerosis Symptoms and the Kidneys

• Headache
• Dizziness
• Blurred vision
• Nausea.

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Causes

• High blood cholesterol
• High blood pressure
• Smoking
• Obesity
• Lack of physical activity
• Improper dietary pattern.

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Risk Factors

• Uncontrollable

Controllable

• Sex
• Hereditary
• Race
• Age

• High blood pressure
• High blood cholesterol
• Smoking
• Physical activity
• Obesity
• Diabetes
• Stress and anger

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DIAGNOSIS

• Blood Tests
• Blood tests that may be ordered as part of making
  anatherosclerosis diagnosis include
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• A fasting glucose test that checks your blood
  sugar level to screen for diabetes.
•  
• A fasting lipid panel to check your cholesterol an
  dtriglyceride levels.

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ELECTROCARDIOGRAM

• An electrocardiogram (ECG or EKG) is a test that
  records your heart's electrical activity and can
  show certain problems, such as abnormal
  heartbeats or damage to the heart.
•  

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CHEST X-RAY

• A chest x-ray provides a picture of the lungs,
  heart, large arteries, ribs, and the diaphragm.

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Stress Tests

• During stress testing, a patient exercises or is
  given medicine to make the heart work harder and
  beat faster while tests are performed. In an
  exercise stress test, your heart, breathing,
  and blood pressure are monitored while you
  exercise using a treadmill or a stationary
  bicycle.

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NUCLEAR HEART SCAN

• A nuclear heart scan (also known as a thallium
  stress test) shows areas of the heart that lack
  blood flow and are damaged.
• It also can reveal problems with the heart's
  pumping action. A small amount
  of radioactive material is
  injected into a vein,
  usually in the arm.

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ULTRASOUND

• An ultrasound is a test that uses sound waves to
  create a picture. The picture is more detailed
  than an x-ray image.

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ECHOCARDIOGRAM

• An echocardiogram is an exam of the heart using
  sound waves to create a moving picture of the
  organ.
• An echocardiogram provides information about the
  size and shape of your heart and how well your
  heart chambers and valves are functioning

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CT SCAN

• CT, scan provides computer-generated images of
  the heart, brain, or other areas of interest.
  Some specialized types of CT scans can also be
  used to diagnose

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What is Stroke?

• A stroke occurs when a blood vessel carrying
• oxygen and nutrients to the brain is either
• blocked by a clot or bursts.
• Part of the brain does not get the oxygen it
  needs so it starts to die.

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Causes

• If blood flow is stopped for longer than a few
  seconds, the brain cannot get blood and oxygen.
  Brain cells can die, causing permanent damage.

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STROKE RISK FACTORS

• High blood pressure is the number one risk factor
  for strokes.
• Diabetes
• Family history of stroke
• High cholesterol
• Increasing age, especially after age 55
• Race (black people are more likely to die of a
  stroke)
• People who have heart disease or poor blood flow
  in their legs caused by narrowed arteries are
  also more likely to have a stroke.

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• The chance of stroke is higher in people who live
  an unhealthy lifestyle by
• Being overweight or obese.
• Drinking heavily.
• Eating too much fat or salt.
• Smoking.
• Taking cocaine and other illegal drugs.

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Symptoms

• Starts suddenly and may be severe.
• Occurs when you are lying flat.
• Wakes you up from sleep.
• Gets worse when you change positions or when you
  bend, strain, or cough
• Dizziness or abnormal feeling of movement .
• Lack of control over the bladder or bowels.
• Loss of balance.
• Loss of coordination.

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• Change in alertness (including sleepiness, unconsc
  iousness, and coma)
• Changes in hearing
• Changes in taste
• Changes that affect touch and the ability to feel
  pain, pressure, or different temperatures
• Clumsiness
• Confusion or loss of memory
• Difficulty swallowing
• Difficulty writing or reading

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DIETARY MANAGEMENT

• ENERGY- A hypo caloric diet should be given.
• FAT- Total fat in the diet be reduced to provide
  less than 20 of energy for patients with higher
  level of serum cholesterol.
• Saturated FA- less than 10.
• PUSFA- less than 10 .
• MUSFA-rest of energy.

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• CHOLESTROL- Less than 200 mg/day
• PROTEIN- Normal protein should be given.
• Animal protein should be avoided as they are rich
  source of saturated fats.
• CARBOHYDRATES- give complex starches rather than
  simple sugar in a diet.
• Therefore use of foods containing water soluble
  fiber such as whole pulses, legumes, beans, oats,
  fruits, and vegetables.

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• MINERALS AND VITAMINS- These are to be provided
  in normal amount in a diet.
• As the fat of milk, butter, cream, and fatty
  meats are to be avoided.
• The diet tend to be in low in vitamin a
  especially retinol.
• Deep yellow, orange, green vegetables should be
  include in the diet.
• SODIUM- Reduction of dietary sodium to be
  moderate intake between 1.5 to 3 gm per day

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QUIZ

• Another name for raised lesions seen in
  atherosclerosis?
• Type of stroke?
• People with a stroke always have numbness,
  dizziness and weakness on one side.
•  Atherosclerosis can affect several parts of the
  body and increase your risk of future problems.
• The most common form of heart disease is coronary
  artery disease caused by atherosclerosis.

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HEART FAILURE

• It  is a condition in which the heart can't pump
  enough blood to meet the body's needs. 
• Some times heart can't fill with enough blood. 
• Some time the heart can't pump blood to the rest
  of the body with enough force. 

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TWO TYPES OF HEART FAILURE

• Right side Heart failure .
• Lift side Heart failure .

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RIGHT SIDE HEART FAILURE

• heart failure occurs if the heart can't pump
  enough blood to the lungs to pick up oxygen. 

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LEFT-SIDE HEART FAILURE

• Left-side heart failure occurs if the heart can't
  pump enough oxygen-rich blood to the rest of the
  body.

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CAUSING SYMPTOMS

• Shortness of breath when you exert yourself or
  when you lie down.
• Fatigue and weakness.
• Swelling (oedema) in your legs, ankles and feet
• Rapid or irregular heartbeat.
• Reduced ability to exercise.
• cough.
• Swelling of your abdomen.
• Sudden weight gain from fluid retention.
• Lack of appetite and nausea.
• Difficulty concentrating or decreased alertness.

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DIETARY TREATMENT

• ENERGY- The amount of calories should be 1200-
  1500 kcals per day.
• PROTEIN - the normal intake of protein i.e 1g/kg
  body weight.
• SODIUM- 2-m3 gm per day is recommended.

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DIET AND FEEDING PATERN

• To provide adequate nutrition number of feeds
  should be increased i.e 5 to 6 a day.
• Fixed meal timing and with adequate rest after
  meal is important.
• Food rich in fat saturated fat and cholesterol
  should be avoided.
• More fiber should be given.
• Processed food and canned food should be avoided.

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• FAT-
• FLUID- in sever oedema the intake of fluid is
  restricted to match the out put.