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Myths & Facts Of Heart Dr. Vijay Dikshit (M.S., M.Ch, FICC) Chief Cardiac Surgeon Apollo Hospitals Hyderabad Normal Heart Diseases of Heart • Congenital (Birth defects) • Valve diseases • Coronary Artery Diseases NORMAL CORONARY ANATOMY Coronary Heart Disease (Plaque, Atherosclerosis) What Is Heart Attack? • Coronary artery becomes blocked - usually by a clot. • Blood flow is closed off and a heart attack begins. • If blockage continues, parts of the heart muscle start to die. • Heart may stop beating. Heart Attack Presentation Of CAD • No symptoms • Angina • Heart attack • Sudden death Myocardial Infarction or Heart Attack Symptoms: – Uncomfortable pressure – Fullness – Squeezing pain – Pain spreading to the shoulders – Neck and arms – Chest discomfort and light headedness – Anxiety / nervousness – sweating Cardiac Misconceptions • Heart disease is caused by ‘stress’ ‘worry’ or ‘overwork’ • If you’ve had a heart attack you are bound to die of heart disease • Rest restores the heart • Any excitement or shock could cause another heart attack Risk Factors Of Coronary Artery Diseases Major Minor – Diabetes – Obesity – High Blood Pressure – Inactivity – Abnormal Cholesterol – Diet – Family History – Gout – Smoking – Hormonal Disorders – STRESS Changeable Risk Factors • Hypertension • Serum cholesterol • Obesity • Diabetes Mellitus • Physical Inactivity • Cigarette Smoking • Alcohol Intake Non Modifiable Risk Factors • Age • Family History • Gender ECG • Normal ECG does not mean a normal heart • ECG indicates the condition of the heart at the time of recording. • ECG does not have any prognostic value TMT Coronary Angiography C.T Coronary Angiogram Prevention Of CAD • Diet • Cholesterol • Exercise • Smoking • Alcohol • Stress Diet and Prevention of CAD • High fiber low fat • Predominantly vegetarian food • Choose nonfat or low-fat products. • Use lean meats - choose chicken, fish, turkey • Switch to fat-free milk - gradually reduce the fat content of the milk you drink. 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. Types of Cholesterol Lipoproteins - 4 main classes • Chylomicrons • Very low density lipoproteins (VLDL) • Low Density Lipoprotein (LDL) • High Density Lipoprotein (HDL) The Facts About Fat • Certain fats are essential for good nutrition and health. • Fats provide essential fatty acids which the body can’t manufacture. • Act as insulators to maintain body temperature. • Improve the palatability of food and promote digestion. Cholesterol Level Desirable Border line High Risk Total Cholesterol < 200 200 – 240 > 240 LDL Cholesterol 100 100 – 150 > 150 HDL Cholesterol > 40 30 - 40 < 30 Triglyceride 150 150 - 200 > 200 Good Cholesterol • 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. Bad Cholesterol • 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 Exercise and CVD • 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. Cigarette Smoking • Causes an increase in blood pressure • Lowers the levels of HDL • Within 1 year of quitting, CAD risk decreases, within 2 years it reaches the level of a nonsmoker. Alcohol Consumption • In small amounts it acts as a vasodilator. • In large amounts it acts as a vasoconstrictor & adds to the caloric intake • The good & Bad affects of Alcohol are divided with a very fine line! Treatment • Drugs • Angioplasty & Stent • Coronary Artery Bypass Surgery Angioplasty & Stent (PTCA) Coronary Artery Bypass Surgery (CABG) – The most frequently performed major surgery. – Surgery reroutes or Bypasses blood around clogged arteries. Operating Room Robotic Surgery Conclusion • Coronary Artery Disease is highest among Indians. • It is highly preventable and controllable with diet and exercise. • With present treatment of Angioplasty & Coronary Bypass Surgery person can live long and fruitful life