Dr. Shamanthakamani Narendran M.D. (Pead), Ph.D. (Yoga Science) YOGA FOR HYPERTENSION & CORONARY ARTERY DISEASE
Hypertension Persistent – higher than normal blood pressure can damage internal organs if untreated.
Normally, blood is under pressure as the heart forces it around the circulation.
In hypertension, this pressure is above normal limits.
There are no symptoms at first, but despite this, over time it increases the risk of many serious disorders, such as stroke, heart disease and kidney failure.
There is no obvious cause; however, lifestyle and genetic factors may contribute, as do being overweight, drinking excessive amounts of alcohol, smoking and having a high-salt diet.
Most common in middle-aged and elderly people.
A stressful lifestyle may aggravate the condition.
A change of diet and lifestyle may be all that is necessary, but more severe cases may be treated with antihypertensive drugs.
High blood pressure can have for years without a single symptom. But silence isn't golden.
Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke.
Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries.
The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.
High blood pressure typically develops without signs or symptoms.
It affects nearly everyone eventually. If he/she don't have high blood pressure by 55 years of age, 90 percent chance of developing it at some point in life, according to the National Heart, Lung, and Blood Institute.
SYSTOLIC - 90 TO 140 mm/Hg DIASTOLIC - 60 TO 90 mm/Hg NORMAL BP Adult males (20-50 yrs)
Pulmonary hypertension begins when tiny arteries in the lungs, called pulmonary arteries and capillaries, become narrowed, blocked or destroyed.
This makes it harder for blood to flow through the lungs, which raises pressure within the pulmonary arteries.
As the pressure builds, the heart's lower right chamber (right ventricle) must work harder to pump blood through the lungs, eventually causing the heart muscle to weaken and sometimes fail completely.
Pulmonary hypertension is a serious illness that becomes progressively worse and is sometimes fatal.
Although it isn't curable, treatments are available that can help lessen symptoms and improve the quality of life.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Although a few people with early-stage high blood pressure may have fatigue, dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don't occur until high blood pressure has reached an advanced – possibly life-threatening – stage.
Signs and symptoms of pulmonary HTN are subtle in the early stages and may not be noticeable for months. As the disease progresses, it becomes worse.
Shortness of breath (dyspnea), either while exercising or at rest
Dizziness or fainting spells (syncope)
Chest pressure or pain
Swelling (edema) in ankles, legs and eventually in abdomen (ascites)
Bluish color lips and skin (cyanosis)
Racing pulse or heart palpitations
90-95% etiology is idiopathic. This type of HBP is essential HTN or primary HTN, tends to develop gradually over many years.
The other 5-10% of HBP cases caused by an underlying condition. This type of HBP, called secondary HTN, tends to appear suddenly and cause higher BP than does primary hypertension.
Various conditions can lead to secondary hypertension, including kidney abnormalities, tumors of the adrenal gland or certain congenital heart defects.
Certain medications –birth control pills, cold remedies, decongestants, OTC pain relievers and some prescription drugs also may cause secondary hypertension.
In a 2005 study, women who took an average of 500 mg or more of acetaminophen daily over several years were more likely to develop HBP than were women who didn't take any acetaminophen. It's not known if the same holds true for men.
Various illicit drugs, including cocaine and amphetamines, also can increase blood pressure.
STRESS AND HYPERTENSION EMOTIONAL CORTEX HYPOTHALAMUS SYMPATHETIC NERVES CONSTRICTS BLOOD VESSELS FORCEFUL CONTRACTION OF THE HEART Anger Fear Tension
Age - risk of HBP increases as one gets older. Through early middle age, HBP is more common in men. Women are more likely to develop HBP after menopause.
Race - HBP is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
Family history - HBP tends to run in families.
Excess weight - Greater body mass, the more blood need to supply oxygen and nutrients to the tissues. As the volume of blood circulated through the blood vessels increases, so does the pressure on artery walls.
Inactivity - People who are inactive tend to have higher heart rates. Lack of physical activity also increases the risk of being overweight.
Tobacco use - Chemicals in tobacco can damage the lining of the artery walls, which promotes narrowing of the arteries.
Sodium intake - Too much sodium in diet.
Low potassium intake – Potassium helps to balance the amount of sodium in the cells. If doesn’t consume or retain enough potassium, may accumulate too much sodium in the blood.
Excessive alcohol - Over time, heavy drinking can damage heart.
Stress - High levels of stress can lead to a temporary but dramatic increase in BP. If try to relax by eating more, using tobacco or drinking alcohol, may only fuel problems with HBP.
Certain chronic conditions may increase risk of HBP, including high cholesterol, diabetes, kidney disease and sleep apnea. Pregnancy - PIH.
In a 2006 study, adults who worked more than 40-50 hours a week – particularly sedentary, workers - were more likely to have HBP than were those who worked 40 hours or less a week. Researchers tied the higher risk for workers with longer hours to unhealthy eating, less exercise, more stress and less sleep.
Although HBP is most common in adults, children may be at risk, too. For some children, HBP is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits – such as an unhealthy diet and lack of exercise – contribute to HBP.
STRESS AND HYPERTENSION
Imbalance at ANS – Sympathetic dominance.
Increased secretion of catecholamines due to HPA Axis stimulation.
TESTS AND DIAGNOSIS
BP is measured with an inflatable arm cuff and a pressure-measuring gauge.
A BP reading, given in mm Hg, has two numbers.
The first, or upper, number measures the pressure in the arteries when the heart beats (systolic pressure).
The second, or lower, number
measures the pressure in the
arteries between beats
Normal BP – 115/75 mmHg to 120/80 mmHg
Pre-hypertension –systolic pressure ranging from 120-139 or a diastolic pressure from 80-89.
Stage 1 HTN – systolic pressure from 140-159 or diastolic pressure from 90-99.
Stage 2 HTN – most severe HTN, systolic pressure of 160 or higher or a diastolic pressure of 100 or higher.
Both numbers in a BP reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) – when diastolic pressure is normal but systolic pressure is high – is the most common type of high blood pressure among people older than 50.
Single HBP reading usually isn't enough for a diagnosis. Because BP normally varies throughout the day – and sometimes specifically during visits to the doctor – diagnosis is based on more than one reading taken on more than one occasion. Record BP at home and at work will provide additional information.
If any type of HBP, the doctor may recommend routine tests, such as urinalysis, blood tests and an ECG – measures heart's electrical activity.
Excessive pressure on the artery walls can damage vital organs.
The higher blood pressure and the longer it goes uncontrolled, the greater the damage.
Damage to arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack or other complications. An enlarged, bulging blood vessel (aneurysm) also is possible.
Heart failure. To pump blood against the higher pressure in vessels, the heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body's needs, which can lead to heart failure.
A blocked or ruptured blood vessel in brain can lead to stroke.
Weakened and narrowed blood vessels in the kidneys can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes can result in vision loss.
Metabolic syndrome – is a cluster of disorders of the body's metabolism – including elevated waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, HBP and high insulin levels.
Uncontrolled HBP also may affect the ability to think, remember and learn.
Cognitive impairment and dementia are more common in people who have HBP.
TREATMENTS & DRUGS
Treating HBP can help prevent serious – even life-threatening – complications.
Doctor also may suggest steps to control conditions that can contribute to HBP, such as diabetes and high cholesterol.
Blood pressure goals aren't the same for everyone. Although everyone should strive for blood pressure readings below 140/90, doctors recommend lower readings for people with certain conditions.
If the heart isn't pumping as well as it should (left ventricular dysfunction or heart failure) or may have severe chronic kidney disease 120/80 mm Hg or lower If presence of chronic kidney disease, diabetes or CAD or are at high risk of CAD 130/80 mm Hg or lower If he/she is a healthy adult 140/90 mm Hg or lower Blood pressure treatment goals
Changing the lifestyle can go a long way toward controlling HBP. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, doctor may recommend medication to lower the blood pressure, which category of medication doctor prescribes depends on the stage of HBP.
Doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one.
Sometimes finding the most effective medication or combination of drugs – is a matter of trial and error.
The heart is a powerful organ about the size of a clenched fist.
Located just to the left of center between the lungs.
It operates as two coordinated pumps that send blood around the body.
INTERNAL VIEW OF THE HEART
HEART BLOOD SUPPLY
The muscle wall or myocardium of the heart is constantly active and needs a generous supply of oxygen and energy from blood.
To provide this, the heart muscle has its own network of blood vessels known as coronary arteries.
These 2 arteries (right and left branch from the main artery) the aorta, just after it leaves the heart, divide over the heart’s surface and send smaller blood vessels into the heart muscle.
The pattern of the coronary veins, which collect wastes from the muscle tissue, is similar.
Most of the blood in these veins is collected by the coronary sinus, a large vein at the back of the heart that empties into the right atrium.
HEART ATTACK AND ANGINA INCREASING RAPIDLY IN LAST FIVE DECADES W H Y ??? MODERN LIFE STYLE CORONARY ARTERIAL DISEASE
Coronary arteries are the major blood vessels that supply the heart with blood, oxygen and nutrients.
When these arteries become damaged or diseased – usually due to a buildup of fatty deposits called plaques –coronary artery disease.
These deposits can slowly narrow the coronary arteries, causing the heart to receive less blood.
Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage, caused either by accumulated plaques or a ruptured plaque, can cause a heart attack.
Because coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack.
But there's plenty to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.
Myocardial Infarction / Heart Attack
Angina Pectoris Hardening of the arteries, and the presence of a thrombus, or clot, in a blood vessel are the most common causes of obstruction. Arteriosclerosis is responsible for most of the deaths resulting from heart attacks. Spasms of the coronary arteries can also result in a heart attack.
PLAGUE AND CHOLERA OF LAST CENTURY REPLACED BY HEART ATTACK AND CANCER IN THIS CENTURY HEART ATTACK -THE SECOND MAJOR KILLER AFTER ACCIDENTS CORONARY ARTERIAL DISEASE
SMOKING OBESITY DIABETES BLOOD LIPIDS HYPERTENSION NICOTINE ARTERIAL SPASM OVERLOAD ON CIRCULATION FAT DEPOSIT ON HEART OVERLOAD ON HEART DEPOSITS IN ARTERIES NARROWING EARLY AGING ATHEROSCLEROSIS SEDENTARY LIFESTYLE LEADS TO OBESITY STRESS CHOLESTEROL & LDL :HDL > 5 : 1
Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors,
C-reactive protein (CRP) – Liver product
Homocysteine – (amino acid) the body uses to make protein and to build and maintain tissue.
Fibrinogen – protein in the blood that plays a central role in blood clotting.
Lipoprotein (a) – substance forms when a LDL particle attaches to a specific protein.
Chest pain – coronary arteries narrow
Heart attack – cholesterol plaque ruptures, stimulating platelet clumping, complete blockage of heart artery may trigger a heart attack.
Heart failure – some areas of heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or damaged by a heart attack, heart may become too weak to pump enough blood to meet body's needs
Abnormal heart rhythm – Inadequate blood supply to the heart or damage to heart tissue
STRESS MANAGEMENT ANGER MANAGEMENT SCHOOLS
Difficulty in concentrating
In atherosclerosis, arteries are clogged by an accumulation of plaques – which are made up of cholesterol particles, fat, calcium, cellular waste and other substances.
NORMAL 20YRS FATTY STREAKS 40YRS ATHERO SCLEROSIS STAGES OF HARDENING & BLOCKAGE
Electrocardiography (EKG / ECG) Detects heart abnormalities, disease and damage by measuring the heart's rhythms and electrical impulses.
Echocardiography The image shows the motion pattern and structure of the four heart valves , revealing any potential leakage ( regurgitation ) or narrowing ( stenosis ). During this test, a Doppler ultrasound may be done to evaluate cardiac blood flow.
Stress Test/ Exercise tolerance test (ETT) / treadmill test It can assess the heart’s reaction under physical stress.
Flutter: Rapid, regular contraction of atria or ventricle reaching upto 250/300 beats per minute. Fibrillation: Rapid, random, irregular contraction reaching upto 350-400 beats per minute. Defibrillator is applied to the chest wall to help in cardioversion . Defibrillation is a technique used to counter the onset of ventricular fibrillation , a common cause of cardiac arrest. Defibrillation is part of an advanced cardiac life support . It applies a controlled electric shock.
Cardiac Arrest : Sudden stoppage of heart. Palpitation : Uncomfortable sensation in the chest associated with arrhythmia. This causes 1. Premature atrial contraction (PAC) 2. Premature ventricular contraction (PVC).
HYPERTENSION & CAD ÁDHIJA VYÁDHIS
YOGA AND HYPERTENSION IS EXCESSIVE SPEED STRESS IN MANOMAYA KOSA
BHAKTI PURE LOVE SURRENDER TO DIVINE VIOLENT EMOTIONS ANGER & IRRITABILITY TENSION AND FEAR JEALOUSY AND HATRED DEPRESSION REPLACED BY PARDON FAITH IN DIVINE ACCEPTANCE CONFIDENCE SOFT EMOTIONS
SURRENDER IS EXPANSION
YOGA FOR HYPERTENSION & CAD THE EXCESSIVE SPEED PERCOLATES AS IMBALANCES IN STRESS PRANAMAYA KOSA
PRANAYAMA SLOW DEEP BREATHING MASTERY OVER EXCESSIVE SPEED BALANCING OF PRANA REDUCED SYMPATHETIC TONE
THE EXCESSIVE SPEED MANIFESTS AS HYPER REACTIVE HABIT OF PERSISTANT HIGH BLOOD PRESSURE AT STRESS ANNAMAYA KOSA (CONSTRICTION OF BLOOD VESSELS) YOGA FOR HYPERTENSION & CAD
YOGA DEEP REST TO MIND BODY COMPLEX IRT QRT DRT CM CM QRT IRT DRT QRT RELAXATION CM CM
INTEGRATED YOGA MODULE FOR HYPERTENSION
Suksma Vyayama (strengthening the joints)
Loosening of wrists
Hands stretch breathing
Ankle stretch breathing
Straight leg raising
Quick relaxation technique (QRT)
Deep relaxation technique (DRT)
Candra Anuloma pranayama
Sitali/ Sitkari/ Sadanta
Meditation (Dhyana Dharana)
Kapalabhati (20-40 strokes/minute)
INTEGRATED YOGA MODULE FOR HEART DISEASES
Loosening of fingers
Instant relaxation technique (IRT)
Hands stretch breathing
Ankle stretch breathing
Straight leg raise breathing (alternating)
Side bending, each
Quick relaxation technique (QRT)
Deep relaxation technique (DRT)
Acute attack - chair breathing
Vamanadhouti + DRT – Once a week
Laghu Sankapraksalana + DRT - Daily
Millions of people in the world suffer from the diseases of the heart and blood vessels.
The heart, which is muscular pump, keeps the blood circulation of blood going.
But when there is a break down of this complicated mechanism, blood supply to a part of the body may be affected leading to what is known as heart attack.
But with yoga the cardiovascular diseases can be cured. Diseases that can be cured are:
Arteriosclerosis - hardening of arteries
Coronary Thrombosis - sudden blocking of one of the arteries.
Yoga helps to cope with this stress so that do not need to depend on smoking or eating unhealthy food.
It also helps to find a contentment from within.
Smoking should be completely stopped as it constricts the arteries.
For daily practice :
Keep yourself relaxed and free from anxiety , nervousness, tension and restlessness.
Meditation – has been scientifically proven to be beneficial for hypertensive people.
Ujjayi Pranayama - can be done while lying for about 3-4 minutes, if the blood pressure rises very high.
Nadi Shodak Pranayama - It can be done 10 times.
General considerations : Consultation with patient’s doctor is advisable because the limitation may differ substantially according to various heart diseases and their stages. Some heart abnormalities require no or little restraint.
Contraindications : No practices with internal breath retention. No physically demanding physical exercises exceeding trainee’s tolerance. Practices like Agnisara Dhauti or Shankha Prakshalana may be too risky even in persons with heart problems whose condition is fairly good.
Recommendations : Patients shortly after myocardial infarction are advised to practice Savasana, full yoga breath and later some easy Pavanmuktasanasa, in prone position.
General considerations : Severe hypertension should be medically treated on a long-term basis.
Contraindications : Long internal breath retention and inverted asanas, especially in older people, are usually not suitable. Shankha Prakshalana with drinking too much of salty water and too physically demanding exercise may be risky.
Recommendations : Relaxation, Ujjayi, Bhramari, and other practices.
General considerations : Hypotension, if it is not caused by some acute condition, such as internal bleeding, is usually not a serious medical problem.
Contraindications : People with hypotension should raise up very slowly after practising inverted asanas or after asanas in lying position to prevent dizziness.
Recommendations : Most vigorous Yoga practices such as Surya Namaskara, Dhanurasana, Bhunjangasana and activating pranayamas which increase blood pressure.
Recommended Asana :
Suryanamaskara (Sun salutation) - activates the whole body.
Pavanmuktasana (Relieving the flatus) - wind reliever, corrects malfunctioning of the abdomen. Make 4-6 rounds.
Uttanpadasana (Raising the legs) - Helps reduce fat.
Santulanasana - normalizes blood circulation.
Savasana (Corpse pose) - should be done twice or thrice daily as it normalizes the blood pressure.