You

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You Your Heart

• Dr B K Goyal
• MD, FAMS, FRCP, FACC, FSCAI (USA)
• Director
• Interventional Cardiology
• Bombay Hospital Medical Research Centre,
• Mumbai, India

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Heart Facts

• Is a muscle about the size of your fist
• Weighs approximately one pound
• Is located behind and slightly to the left of the
  breastbone
• Pumps about 5 liters of blood every minute
• Beats about 100,000 times in one day and about 35
  million times in a year.
• During an average lifetime, the human heart will
  beat more than 2.5 billion times.

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Blood Flow through Heart
Whenever the blood is pumped from one section of
the heart to another a valve closes behind it
preventing the blood from moving backwards.
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Cool pictures
JH
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Blood Supply To The Heart
2 coronary arteries branch from the main aorta
just above the aortic valve. No larger than
drinking straws, they divide and encircle the
heart to cover its surface with a lacy network
that reminded physicians of a slightly crooked
crown (coronary comes from the Latin coronarius,
belonging to a crown or wreath). They carry out
about 130 gallons of blood through the heart
muscle daily.
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DR. ANIL SHARMA
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• From 1960 to 2001, prevalence of Coronary Artery
  Disease (CAD) increased from
• 3 to 11 in urban India
• 2 to 4 in rural India
• Every 9 th person is suffering from CAD in urban
  INDIA

Indian Heart J 2001 53 282-292
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CVD/CAD Burden - INDIA

• Prevalence - Urban - 11, rural - 4
• Total Burden - 80 million / Yr.
• ACS- 20 million 80 lakhs are lt young(lt 40 years
  Age)
• 2 times increase in last 3 decades
• CVD mortality
• 1990- 23 of all deaths (15 lakhs)
• 2020- 34 of all deaths (30 lakhs)
• (Will be no.1 killer)

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Risk Factors

• Nonmodifiable

Modifiable

• Hereditary
• Sex (Gender)
• Age
• Race

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

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MODERN LIFE STYLE

• STRESS
• SMOKING
• DIETARY HABITS
• SEDENTARY LIFESTYLE

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Lifestyle Factors
Genes load the gun.Lifestyle pulls the trigger
Dr. Elliot Joslin
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STRESS
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WHAT IS STRESS?

• Stress is your mind and bodys response or
  reaction to a real or imagined threat, event or
  change.
• The threat, event or change are commonly called
  stressors. Stressors can be internal
  (thoughts, beliefs, attitudes or
  external (loss, tragedy, change).
• Expectations Performance Stress

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YOGA
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SMOKING
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The Result of Smoking
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The healthy eating concept
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DIET- AVOID
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DIET- ENCOURAGE
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• UNDERNOURISMENT and OVERNOURISHMENT are equally
  bad
• Avoid FAST FEAST
• A FAT or CHUBBY child should not be looked upon
  with pride

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SEDENTARY LIFESTYLE
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LOSE WEIGHT
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EXERCISE
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LIMIT ALCOHOL
There is evidence that heavy drinking of
alcoholmore than 34 oz of 100 proof whiskey,
18 oz of wine, or 3648 oz of beer each
dayraises the blood pressure.
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REDUCE SALT INTAKE
Reduce salt used in cooking, a little bit each
day until you no longer use any. Remember, if
you are being treated for heart failure, try to
keep your sodium intake below 2000 mg (approx. 1
teaspoon) per day.
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AAHAR VIHAR
VICHAR
TAKE HOME MESSAGE
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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
  passageway for the movement of blood. The
  resulting condition, called atherosclerosis often
  leads to eventual blockage of the coronary
  arteries and a heart attack.

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Signs and Symptoms

• None This is referred to as silent ischemia.
  Blood to your heart may be restricted due to CAD,
  but you dont feel any effects.
• Chest pain If your coronary arteries cant
  supply enough blood to meet the oxygen demands of
  your heart, the result may be chest pain called
  angina.
• Shortness of breath Some people may not be aware
  they have CAD until they develop symptoms of
  congestive heart failure- extreme fatigue with
  exertion, shortness of breath and swelling in
  their feet and ankles.
• Heart attack Results when an artery to your
  heart muscle becomes completely blocked and the
  party of your heart muscles fed by that artery
  dies.

None
Chest Pain
Signs Symptoms
Shortness Of Breath
Heart Attack
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Diagnosis
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ECG
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Other Tests Include...

• Blood tests used to evaluate kidney and thyroid
  function as well as to check cholesterol levels
  and the presence of anemia.
• Chest X-ray shows the size of your heart and
  whether there is fluid build up around the heart
  and lungs.
• Echocardiogram shows a graphic outline of the
  hearts movement. Ejection fraction (EF)
  determines how well your heart pumps with each
  beat.

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Treatment

• Many people are able to manage coronary artery
  disease with lifestyle changes and medications.
• Other people with severe coronary artery disease
  may need angioplasty or surgery.

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Treatment-ANGIOPLASTY

• A balloon catheter is passed through the guiding
  catheter to the area near the narrowing. A guide
  wire inside the balloon catheter is then advanced
  through the artery until the tip is beyond the
  narrowing.
• The angioplasty catheter is moved over the
  guide wire until the balloon is within the
  narrowed segment.
• Balloon is inflated, compressing the plaque
  against the artery wall
• Once plaque has been compressed and the artery
  has been sufficiently opened, the balloon
  catheter will be deflated and removed.

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Treatment-STENTING

• A stent is introduced into a blood vessel on a
  balloon catheter and advanced into the
  blocked area of the artery
• The balloon is then inflated and causes the
  stent to expand until it fits the inner wall of
  the vessel, conforming to contours as needed
• The balloon is then deflated and drawn back
• The stent stays in place permanently, holding
  the vessel open and improving the flow of blood.

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16th September 1977 Coronary Angioplasty

• In Zurich Switzerland, Gruentzig performed the
  first coronary angioplasty on an awake human

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ANGIOPLASTY - 1977
SINGLE VESSELSINGLE, DISCRETE LESIONGOOD LV
FUNCTIONTRANSFEMORAL(GROIN)
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LAD Lesion
Pre
During
Post
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• Bare Metal Stents
• A stent is a small round tube usually
• made of stainless steel,
• which is designed to support the wall
• of the coronary artery.

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Whats hot

• Drug Eluting Stents-2002

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ANGIOPLASTY - 2010
MULTIVESSEL DISEASECOMPLEX LESIONSIMPAIRED
LV FUNCTIONTRANSRADIAL (WRIST)
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Treatment-CABG

• Healthy blood vessel is removed from leg, arm or
  chest
• Blood vessel is used to create new blood flow
  path in your heart
• The bypass graft enables blood to reach your
  heart by flowing

around (bypassing) the blocked portion of the
diseased artery. The increased blood flow reduces
angina and the risk of heart attack.
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CABG VS. Angioplasty
My patient needs coronary revasculariztion
Should he/she have Coronary Artery Bypass
Surgery Or Angioplasty?
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TAKE HOME MESSAGE Life is a Matter of
Balance PREVENTIONDIET, EXERCISE
ANGIOPLASTY, SURGERY INTERVENTION
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THANK YOU
DR. B K Goyal