Prof. V.K.Gupta HOD CTVS Department Dr.RML Hospital & PGIMER

Transcription

1 Prof. V.K.Gupta HOD CTVS Department Dr.RML Hospital & PGIMER

2 The Heart

3 Video3

4 Coronary Arteries to heart

5 Coronary Artery Disease Occurs when the coronary arteries that supply the heart muscle get blocked. Partially blocked; it causes angina. Fully blocked; it causes a myocardial infarction or a heart attack! Healthy artery Fibrofatty stage Early lesion Vulnerable plaque Stable plaque Lumen maintained Intima thickens, atheromatous gruel forms under cap Lumen narrows

6 Normal Coronary arteries

7 Blocked Coronary Arteries

8 Blocked Coronary Arteries

9 Prevention of Coronary Artery Disease is Important Coronary Artery disease is the commonest killer in the world including India. It will kill almost 20 million people by 2015 More than 1/4 th of CAD patients live in Indian subcontinent

10 Selected Deaths by cause in WHO regions for 2002 Total Deaths 1) Cardiovascular diseases a) Coronary Artery disease b) Rheumatic Heart disease c) Congenital heart abnormalities 2) Tuberculosis 3) Trachea/bronchus/lung cancers 4) Road traffic accidents 5) Esophageal cancer 57,029,000 16,733,000(29.34%) 7,208,000(12.64%) 327,000(0.50%) 281,751(0.49%) 1,566,000(2.74%) 1,243,000(2.17%) 1,192,000(2.09%) 446,000(0.78%)

11 Be cautious! CHD affects Indians with greater frequency and at a younger age than counterparts in developed countries.

12 Why should we take care of our health? Firstly because we have only one body! Unlike machine, once its broken down, we can still fix it. But our body? Once its broken down, then we are ruined for life Secondly, it affects the people around us.

13 Learn from the mistakes of others. You can't live long enough to make them all yourself. --Eleanor Roosevelt

14 What are common Symptoms of Coronary artery Disease? Chest pain or heaviness, especially on exertion uncomfortable pressure, fullness, squeezing pain, pain spreading to the shoulders, neck and arms Shortness of breath, especially on exertion Anxiety/nervousness Pallor Irregular heart rate

15 People at risk

16 What Causes Cardiovascular Disease? High cholesterol High blood pressure Diabetes Cigarette smoking Older age Male sex Family history of early heart disease Obesity Poor diet Inactivity

17 Balance "Studies show that up to 80 percent of coronary heart disease, 90 percent of diabetes and about one third of cancers can be avoided through a change in lifestyle, Uton Muchtar Rafei, Regional Director of the World Health Organization

18 Lifestyle modifications Regular physical activity Smoking cessation Dietary modification Weight reduction Stress reduction

19 Regular physical activity

20 Regular physical activity Regular aerobic exercise can lower systolic BP by an average of 4 mmhg and diastolic BP by an average of 2.5 mmhg. Aim for 30 minutes of moderate-intensity physical activity on most, if not all, days of the week. The daily dose can be accumulated in shorter bouts (e.g. three 10-minute walks). Moderate-intensity physical activity (e.g. brisk walking, low-paced swimming, cycling, gentle aerobics)

21 Exercise and CAD 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 Those at high risk should take part in a specially supervised program.

22 Myths Related to Exercise You have to be athletic to exercise. All exercises give you the same benefits. Exercising makes you tired. Meaningful exercise takes too much time. The older you are, the less exercise you need.

23 Smoking cessation Smoking cessation markedly reduces overall cardiovascular risk. Risk of myocardial infarction (Heart attack) is 2 6 times higher and the risk of stroke is 3 times higher in people who smoke than in non-smokers. Complete cessation. No exposure to environmental tobacco smoke.

24 Smoking Cessation You lose one minute of life for every minute that you smoke A lifetime smoker loses 7 years of life Stop smoking at age 30, add 5 years of life Make a commitment Join an organized program Bupropion and nicotine substitutes help (use them longterm) Substitute exercise

25 Dietary modification

26 Cholesterol Everybody needs cholesterol, it serves a vital function in the body. It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. Frequently measured to promote health and prevent disease. A major component of the plaque that clogs arteries.

27 Types of Cholesterol Lipoproteins- 4 main classes Chylomicrons Very low density lipoproteins (VLDL) Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL)

28 Good vs. BAD LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. LDL s are a major component of the atherosclerotic plaque that clogs arteries. Levels should be <130

29 Good vs. BAD HDL is known as the good cholesterol. It helps carry some of the bad cholesterol out of the body. It does not have the tendency to clog arteries. Levels should be >35. High levels of HDL >60 can actually negate one other risk factor.

30 Know Your Numbers OK Very Good Total cholesterol: <200 <150 LDL (bad) cholesterol: <130 <100 HDL (good) cholesterol: >40/50 >60 Blood pressure: <140/90 <120/80 Fasting blood sugar: <126 <100

31 The Fat Facts Saturated fats- basically means the fat is saturated with hydrogen, they are solid at room temperature. Examples are lard and butter. they increase levels of LDL, decrease HDL and increase total cholesterol. Polyunsaturated fats- Unsaturated fats which are liquid at room temperature and in the refrigerator. good for us. help the body get rid of newly formed cholesterol. Monounsaturated fats- They are liquid at room temperature but start to solidify in the refrigerator. decrease total cholesterol and lower LDL levels.

32 The Fat Facts Trans fatty acids- They are unsaturated fats but they tend to raise total and bad cholesterol. Where do you find them? In fast-food restaurants Commercial baked goods. Examples: doughnuts, potato chips, cupcakes.

33 Dietary modification Limit salt intake to 4 g/day choose foods processed without salt, foods labelled no added salt or low salt. avoid high-salt processed foods, salty snacks. Consume of a variety of fruits, vegetables, grains, lowfat or nonfat dairy products, fish, legumes, poultry, and lean meats. Reduce saturated fats, cholesterol, and trans-fatty acids by substituting grains and unsaturated fatty acids from fish, vegetables, legumes, and nuts.

34 Weight reduction Every 1% reduction in body weight lowers systolic BP by an average of 1 mmhg. Weight loss of 10 kg can reduce systolic BP by 6 10 mmhg.

35 Obesity Targets are: waist circumference < 94 cm (males); < 80 cm (females). BMI(Weight/Height 2 ) < 23 kg/m2 Location of the body fat is significant. Pears or apples?

36 Obesity and Dieting Facts 3500 cal = 1 pound weight 1 mile = 100 cal Δ 100 cal/day = 10 pound/year

37 Why are portion sizes important? 10 Years Ago Today 210 Calories 610 Calories Calorie Difference: 400 Calories How to burn* 400 calories: Walk 2 hr 20 Minutes *Based on 130 pound person

38 Golden rules Walk, bike, or swim for 30 minutes most days; Consume fish, whole grains/legumes, fruits, vegetables, and nuts; Always eat small portion sizes; Limit salt intake to 4 g/day Avoid trans fats, sugared beverages, and highly processed foods; Do not smoke.

39 Treatment of CAD

40 CABG

41 CABG

42 Conclusion Our genes have not changed for the past years, but we have changed from a caveman to a modern man. Changes that have come are more comforts, more eating, less physical activity more stress all leading too obesity and diabetes so the answer to all this is lifestyle modification Increase your physical activity, walking, exercise. If you are using the lift from tomorrow take a staircase, if your company is close by don t use the vehicle go by walk other things - saying no to fast food, calorie rich food like pizzas, chocolates, soft drinks and modern day addictions like tv serials and computer games and saying yes to -walking, exercises and lot of physical activity So friends from tomorrow no going by lift, take a staircase, and say yes to health

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