PREVENTION OF EARLY HEART DISEASES

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PREVENTION OF EARLY HEART DISEASES
DR. PRAVEEN CHANDRA SENIOR CONSULTANT DIRECTOR
CARDIAC CATH LAB MAX HEART VASCULAR INSTITUTE
NEW DELHI
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• STRUCTURE FUNCTION OF HEART

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STRUCTURE OF THE HEART
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STRUCTURE OF THE HEART
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BLOOD SUPPLY
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Prevention of Early Heart Diseases

• Diet for a Healthy Heart
• Basic Aid in Heart Emergencies
• Stress Busters for a Healthy Heart
• Early Detection and Prevention

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• DIET FOR
• A
• HEALTHY HEART

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DIETARY PRUDENCE
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Types 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

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Glycemic 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

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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

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Benefits 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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What 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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Nuts
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Healthy 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

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Summary

• 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

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• BASIC AID
• IN
• HEART EMERGENCIES

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Types 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)

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Suspect a Cardiac Emergency when

• Symptoms last for more than a few minutes
• Medical history of cardiac disease
• Presence of several risk factors

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The Chain of Survival
ECC Guidelines, Circulation. 2000102I-22
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The Chain of Survival

• Consists of Four Links
• Early access
• Early CPR
• Early defibrillation
• Early advanced care

ECC Guidelines, Circulation. 2000102I-22
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Procedure of Defibrillation
If rapid defibrillation is unsuccessful, then the
Basic Life Support is resumed along with Drug
therapy
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Advanced 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..
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Do not interrupt resuscitation for more than 10
seconds, except to defibrillate
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After Successful Resuscitation

• Transfer to Coronary Care Unit
• Monitor Vital Signs
• Explain to the relatives about what has happened

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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

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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
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TREATMENT
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WHAT IS THE BEST TREATMENT OF HEART ATTACK ?
IMMEDIATE ANGIOGRAPHY ANGIOPLASTY WITHIN 2-6
HRS OF ONSET OF PAIN
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THE CONCEPT OF GOLDEN HOUR
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Golden 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.
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GOLDEN 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

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USUAL 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

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IMPACT 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

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A Stitch in Time Saves Nine !!!
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How 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

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24 Hour Emergency
4055 4055
Max Health Care
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The institution
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The institution
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APEX CORONARY CARE
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BALLOON ANGIOPLASTY
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IMMEDIATE ANGIOPLASTY
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Primary 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

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ADVANCED OPTIONS

• FOR HEART FAILURE
• TO PREVENT SUDDEN CARDIAC DEATH AFTER HEART ATTACK

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IMPLANTABLE DEFIBRILLATOR
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• STRESS BUSTERS FOR
• A
• HEALTHY HEART

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STRESS MANAGEMENT

• REGULAR EXERCISE
• REST AND SLEEP
• RELAXATION
• FAMILY AND SOCIAL SUPPORT
• YOGA AND MEDITATION

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• EARLY DETECTION
• PREVENTION

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SURVIVAL BENEFITS

• 99 survival when CAD is detected at asymptomatic
  stage or at stage of angina
• 20 mortality with acute heart attack

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Early detection of CAD

• A
• BREAKTHROUGH!

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HOW TO PREVENT HEART ATTACK

• REGULAR 5 YEARLY CHECK AFTER THE AGE OF 35
• EVERY YEAR IN DIABETICS
• PREVENTIVE MEASURES

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CANDIDATES FOR SCREENING

• PEOPLE WITH RISK FACTORS
• SENSITIVE POPULATION-AIR CREW
• EQUIVOCAL TMT WITH SOME /INTERMEDIATE PROBABILITY
  OF CAD

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Atherosclerosisa 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
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TMT
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ECHOCARDIOGRAM
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STRESS THALLIUM
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THE GOLD STANDARD
ANGIOGRAPHY
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The ultimate cure Prevention

• CHANGES IN HABITS LIFE STYLE
• AWARENESS ABOUT DISEASE
• EARLY DETECTION IN ASYMPTOMATIC

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How To Prevent CAD

• Identification of Risk Factors
• Aggressive management of risk factors
• Early detection and management

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Risk factors for CAD
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WHO 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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• Will regular exercise help?

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Yoga good for stress !
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To Conclude
HEART DISEASE is the Second Biggest Killer of
Mankind
Prevention , early diagnosis and treatment is the
key to survival.
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THANK YOU