? Prevention Of Heart
Attacks
PAIN
Is it good ?
or
Bad ?
SOME FACTS ABOUT CAD
• 25 -28 % of CAD die suddenly
• 55 % of all cardiac deaths occur within the 1st hour
• Among survivo...
A disease known is Half Cured
 Heart is most important organ in the body
 It is very sensitive, strong and hard
working
 It contracts for more than o...
 For pumping of blood to all parts of body,
Heart also needs oxygen and energy. It
gets energy and oxygen through,
“Coron...
Indian Scenario of Heart Attacks
(Coronary artery disease)
 CAD appears a decade earlier in
India, compared with develope...
Clinical Manifestations
Signs and Symptoms of CAD
 Sudden death may be the first clinical
manifestation of CAD in as many...
Risk Factors for CAD
Non-Modifiable risk factors of
CAD
 Age
 Sex
 Family History
 Genetic Factors
 Personality
Modif...
Smoking
SOME PEOPLE COMMIT “SUICIDE” BY
“DROWNING”, BUT MANY BY “SMOKING”
 Smoking is responsible for 25% of CAD deaths u...
Hypertension
Hypertension damages the blood
vessel walls and accelerates
atherosclerotic process resulting in
precipitatio...
ADVANTAGES OF LIFE STYLE MODIFICATIONS
Modification Recommendation Reduction in Systolic
Blood Pressure
• Weight reduction...
Blood Cholesterol
 Elevated blood lipids (Cholesterol & Triglycerides) are the
major risk factors for CAD
 Animal fats (...
Poly unsaturated fatty acids (PUFA)
 Usage of oils which are rich in „Linoleic,and Linolenic
fatty acids‟ like saffola, S...
Blood Lipids (mg/100ml of plasma)
Type of
cholesterol
Desirable
Border
line High
High Risk
Total
Cholesterol
<200 200-240 ...
Obesity
 The higher the body weight the greater is the risk
of CAD
 For every extra KG of fat, one tends to produce
20mg...
Diabetes Mellitus
 The risk of CAD is 2-3 times
higher in patients with Diabetes
 CAD is responsible in 30-50%
of deaths...
Genetic Factors
 A family history of CAD is
known to increase risk of
premature death.
 Probably the genetic
factors are...
Sedentary life style
 With increasing
industrialization,
modernization and
mechanization, sedentary
habits have become a ...
Lack of Physical Exercise
 Incidence of HTN is more in those who
lack physical exercise.
 Regular physical exercise incr...
Hormones
The „Estrogen‟ hormone in the
female is probably the most
important hormone which protects
the female from gettin...
Alcohol
 High alcohol intake defined as 75gms or more per
day is an independent risk factor for CAD
 Alcohol stimulates ...
Personality
 Type „A‟ persons‟ behaviour is
associated with competitive
drive, restlessness, hostility and
a sense of urg...
Stress
 It is well established that ambitious and
aggressive personalities are more prone for
CAD
 Stress can be physica...
Oral Contraceptive pills
Women using „Oral contraceptive pills‟
have higher blood pressure and the
risk of CAD seems to be...
Dietary Fiber
The cholesterol lowering effect of
certain types of dietary fiber is firmly
established, which in turn is us...
Anti-Oxidants and Micronutrients
 CAD is currently thought to be a result of
oxidative stress also i.e., the generation o...
Onion & Garlic
 In scientific studies large doses of
onion & garlic are noted to be
beneficial causing a decrease in
bloo...
Salt (Sodium Chloride)
 Excess salt is bad for the heart.
 Indians are in the habit of
consuming 10-15 gm of salt/day
in...
Water
Some scientific evidence suggests
that heart diseases are more
common in areas with soft water than
where the water ...
What to do in case of a heart attack.
 If you suspect that you are having “Heart
Attack“ Call for help at once.
 Lie dow...
How to prevent Heart Attack
 Stop smoking immediately.
 Stop Alcohol, gutka, jarda etc.
 Maintain an ideal body, weight...
Strategy of Prevention of CAD
 Population strategy
 High risk strategy
 Secondary prevention
Eat for a healthy heart. Don‟t eat your heart.
Conquer heart diseases through healthy life style
It is not work, but worry...
Good Planning
If you are planning for a Year sow rice.
If you are planning for a decade plant trees.
If you are planning f...
No one knows you better than yourself
No one can eat for you
No one can lose weight for you
No one can think for you
No on...
Framingham’s 10 yr Risk Score Calculation For CAD
Prevention of heart attacks
Prevention of heart attacks
Prevention of heart attacks
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Prevention of heart attacks

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Symptoms, Ways and means of Heart attack prevention -
Lifestyle modifications - Presentation by Dr MNRamakrishna

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Prevention of heart attacks

  1. 1. ? Prevention Of Heart Attacks
  2. 2. PAIN Is it good ? or Bad ?
  3. 3. SOME FACTS ABOUT CAD • 25 -28 % of CAD die suddenly • 55 % of all cardiac deaths occur within the 1st hour • Among survivors around 10% die in the 1st year and 5% thereafter every year.
  4. 4. A disease known is Half Cured
  5. 5.  Heart is most important organ in the body  It is very sensitive, strong and hard working  It contracts for more than one lakh times in a day and pumps blood to each and every organ in the body  A person dies if it stops for 3minutes  It is a muscular organ and supplies oxygen to each cell in the body through blood Right half of the Heart collects de- oxygenated (impure) blood from all parts of the body and pumps into the lungs for getting oxygen and removal of carbon- dioxide and other metabolic waste .Then the pure blood from lungs enters left side of the heart.
  6. 6.  For pumping of blood to all parts of body, Heart also needs oxygen and energy. It gets energy and oxygen through, “Coronary Arteries which are branches of Aorta”.  If due to some reason, Coronary Arteries get blocked, it results in “Heart Attack”  Usually as age advances, the blood vessel walls get thickened and become rigid, a condition called “Atherosclerosis”  At the same time, if cholesterol (Fat) in the blood is increased, it causes block in the blood flow. If this occurs in coronary blood vessels, it results in “Heart Attack”
  7. 7. Indian Scenario of Heart Attacks (Coronary artery disease)  CAD appears a decade earlier in India, compared with developed countries  Males are affected more than females  Hypertension and Diabetes accounts for about 40% of all cases  Heavy smoking is responsible aetiologically in a good number of patients
  8. 8. Clinical Manifestations Signs and Symptoms of CAD  Sudden death may be the first clinical manifestation of CAD in as many as one-fourth of the patients. In about 55% of all cardiac deaths mortality occurs within the 1st hour  Retrosternal (center of chest) stabbing pain  Radiation of pain to left shoulder and even up to tip of left little finger  Palpitation, fatigue, sweating all over the body and burning sensation in the stomach  Sudden breathlessness (previously never existed)  Toothache/ pain near the jaws  Nausea or Vomiting  Sometimes without any of the signs and symptoms (silent infarction). It is usually seen in Diabetics.
  9. 9. Risk Factors for CAD Non-Modifiable risk factors of CAD  Age  Sex  Family History  Genetic Factors  Personality Modifiable Risk Factors  Cigarette Smoking  High Blood Pressure  Elevated Serum cholesterol  Diabetes mellitus  Obesity  Sedentary habits  Stress  Lack of exercise
  10. 10. Smoking SOME PEOPLE COMMIT “SUICIDE” BY “DROWNING”, BUT MANY BY “SMOKING”  Smoking is responsible for 25% of CAD deaths under 65yrs of age in men. Cigarette seems to be particularly important in causing sudden death from CAD in men below 50yrs of age.  The main culprits in Tobacco, which harms Heart and blood vessels are NICOTINE and CARBON MONOXIDE  Nicotine stimulates the heart and increases demand of more oxygen to heart, and thus increases heart rate.  Carbon monoxide has 200 times more affinity towards hemoglobin and thus reduces oxygen supply to all tissues  Smoking increases the viscosity of blood and enhances the chances of blood clotting inside the vessels.
  11. 11. Hypertension Hypertension damages the blood vessel walls and accelerates atherosclerotic process resulting in precipitation of CAD Studies reveal that a reduction of BP by 2-3mm of Hg in general populations can produce large reduction in CVD complications
  12. 12. ADVANTAGES OF LIFE STYLE MODIFICATIONS Modification Recommendation Reduction in Systolic Blood Pressure • Weight reduction BMI 18.5-24.9 5-20mm of Hg/10 kg reduction • DASH eating plan Fruits, vegetables, low fat etc. 8-14mm of Hg. • Reduction in Na. 5-6 gms of sodium 2-8 mm of Hg. • Physical Activity Regular aerobic physical activity 4-9 mm of Hg. 30 mts /day • Limitation of Alcohol < 2drinks/day(30ml ethanal) 2-4 mm of Hg.
  13. 13. Blood Cholesterol  Elevated blood lipids (Cholesterol & Triglycerides) are the major risk factors for CAD  Animal fats (Meat, Milk Products, Egg etc.) except fish, contain saturated fatty acids which contain low density lipids will increase the thickness of blood vessel walls resulting in Hypertension and Coronary Artery Disease.  Vegetable oils(except palm oil & coconut oil) contain poly unsaturated fatty acids, have more „high density lipids‟ which protect the heart. The HDL fat acts as a „scavenger‟ in removing the LDL attached inside the blood vessel walls.  In typical Indian diet, which is cereal based, about 20gms of fat is obtained as „invisible fat‟. Therefore a daily in take of 20gms or 4 tea spoons of visible fat is sufficient. The ratio of saturated to PUFA should be roughly 0.8-1.0
  14. 14. Poly unsaturated fatty acids (PUFA)  Usage of oils which are rich in „Linoleic,and Linolenic fatty acids‟ like saffola, Sunflower, Soya Bean, Ground nut etc. will prevent occurrence of CAD.  The deficiency of PUFA enhances mechanism of blood clotting inside the blood vessel, which results in CAD/ Paralysis (CVA).  FISH is good for HEART. It is an abundant source of long chain n-3 PUFA, which reduces the blood levels of cholesterol and triglycerides and also decrease fibrinogen levels, inhibit platelet activity and clotting process.  Mustard and Soya oils are two common vegetable oils which contain alpha-linolenic acid. Use of any one oil along with other oils will be beneficial.  The n-3 PUFA is also good for brain & joints and have anti-cancer properties.
  15. 15. Blood Lipids (mg/100ml of plasma) Type of cholesterol Desirable Border line High High Risk Total Cholesterol <200 200-240 >240 LDL <130 130-160 >160 HDL >50** - <35 Triglycerides <150 150-500** >500 * In Indians CAD occurs even at cholesterol levels around 180mg/100ml of plasma ** Arbitrary Values Cholesterol : HDL should be less than 3.5
  16. 16. Obesity  The higher the body weight the greater is the risk of CAD  For every extra KG of fat, one tends to produce 20mg more cholesterol per day.  Higher abdominal fat (Fat around waist) is known to be a greater risk factor than accumulation of fat around hips.  It is hence necessary to maintain ideal body weight.  The simple formula to know the ideal body weight in KGs is height in centimeters minus 100.  The tendency for obesity seems to be inherited and over eating. Also it is clearly an important cause with low physical activity.
  17. 17. Diabetes Mellitus  The risk of CAD is 2-3 times higher in patients with Diabetes  CAD is responsible in 30-50% of deaths in Diabetes over the age of 40yrs  In Diabetes the blood lipids are increased and these contribute to premature or accelerated process of „Atherosclerosis‟.
  18. 18. Genetic Factors  A family history of CAD is known to increase risk of premature death.  Probably the genetic factors are most important determinants of an individual‟s “Total Cholesterol and HDL levels”.
  19. 19. Sedentary life style  With increasing industrialization, modernization and mechanization, sedentary habits have become a part and parcel of our life styles.  Sedentary habits decrease the energy expenditure and therefore contribute to over weight and rise in blood lipids
  20. 20. Lack of Physical Exercise  Incidence of HTN is more in those who lack physical exercise.  Regular physical exercise increases the concentration of HDL and decreases the body weight, blood glucose, blood lipids and blood pressure.  Walking briskly for 45 minutes a day can bring down the risk of HTN.
  21. 21. Hormones The „Estrogen‟ hormone in the female is probably the most important hormone which protects the female from getting CAD up to menopause. (After menopause, the hormone levels of estrogen fall, and chances of getting CAD will be same as male).
  22. 22. Alcohol  High alcohol intake defined as 75gms or more per day is an independent risk factor for CAD  Alcohol stimulates heart,and increase blood pressure transiently, and may precipitate CAD if other risk factors are also there.  Alcohol also stimulates „FAT‟ metabolism, increases obesity and results in Arteriosclerosis , Hypertension and CAD  The evidence that moderate alcohol intake leads to a reduction in the risk of CAD is “UNSUBSTANTIATED”  Though alcohol in small amounts (Large glass of beer, 35ml of whisky, 70ml of wine) increase HDL, it doesn‟t increase the protective fraction, the HDL2 of HDL  Alcohol weakens heart muscle resulting in Cardiomyopathy.
  23. 23. Personality  Type „A‟ persons‟ behaviour is associated with competitive drive, restlessness, hostility and a sense of urgency or impatience and are more prone for CAD.  Type „B‟ persons are easy going, less anxious, contented, calm and philosophical in nature and are less prone for CAD
  24. 24. Stress  It is well established that ambitious and aggressive personalities are more prone for CAD  Stress can be physical, social or emotional. Stress causes heart to beat faster, the blood pressure to go up, the muscles to become tense and the arteries to go into spasms. All these occur through release of a substance called “Adrenaline” Practice Yoga Yoga, the age-old Indian practice of mind and body control can play prominent role in the reduction of stress and indirectly prevents CAD. Yogic practices are ancient in India systematized by Pathanjali in 300 BC
  25. 25. Oral Contraceptive pills Women using „Oral contraceptive pills‟ have higher blood pressure and the risk of CAD seems to be increased and compounded by cigarette smoking
  26. 26. Dietary Fiber The cholesterol lowering effect of certain types of dietary fiber is firmly established, which in turn is useful in the prevention of CAD. The daily requirement of dietary fiber is 30- 40gm/day.
  27. 27. Anti-Oxidants and Micronutrients  CAD is currently thought to be a result of oxidative stress also i.e., the generation of excess of free radicals and peroxide in the tissues. Oxidized blood lipids are more “Atherogenic‟ than un-oxidized lipids.  Anti-oxidants and Micro-nutrients such as Vit C, Beta-Carotene, Vit-A, Vit-E and Selenium can remove peroxides and free radicals and there by reduce the oxidative stress in tissues.  Yellow and orange vegetables and fruits, green leafy vegetables, egg, milk, liver, kidney, fresh fruits, vegetable oils, cereals etc. are the main sources of Anti-Oxidant
  28. 28. Onion & Garlic  In scientific studies large doses of onion & garlic are noted to be beneficial causing a decrease in blood lipids and glucose and an increase in clot dissolution (Fibrinolytic).  The garlic and onions that are regularly included in Indians diets may also have beneficial effect.  One may as well eat garlic as part of daily diet rather than resort to garlic capsules.
  29. 29. Salt (Sodium Chloride)  Excess salt is bad for the heart.  Indians are in the habit of consuming 10-15 gm of salt/day in the form of added salt.  Probably 3gms of salt/day is both safe and adequate for healthy adults.  Reduction in salt in turn will reduce blood pressure and prevent CAD.
  30. 30. Water Some scientific evidence suggests that heart diseases are more common in areas with soft water than where the water is hard. Minerals such as calcium & magnesium and trace metals like chromium and vanadium present in hard water appear to be protective to heart.
  31. 31. What to do in case of a heart attack.  If you suspect that you are having “Heart Attack“ Call for help at once.  Lie down comfortably & loosen tight clothing  Chew an “Aspirin” tablet immediately. ( It can help prevent blood clot in your arteries. Chewing lets it act faster).  Inform your doctor.  Get some one to drive you to the hospital quickly or call an ambulance.  If you have the “Risk Factors like HTN, DM, Smoking etc, always keep “tab aspirin & tab Sorbitrate” handy.
  32. 32. How to prevent Heart Attack  Stop smoking immediately.  Stop Alcohol, gutka, jarda etc.  Maintain an ideal body, weight.  Exercise of at least 30min per day.  Reduce animal fats in your diet.  Restrict added “Salt” in your diet to only 5gms.  Control your stress. Yoga and meditation are good.  See that BP and DM are under control.
  33. 33. Strategy of Prevention of CAD  Population strategy  High risk strategy  Secondary prevention
  34. 34. Eat for a healthy heart. Don‟t eat your heart. Conquer heart diseases through healthy life style It is not work, but worry that kills Practice yoga and meditation for better health A little salt is divine .Too much is harmful Eat to live, Don‟t live to eat.
  35. 35. Good Planning If you are planning for a Year sow rice. If you are planning for a decade plant trees. If you are planning for a life time “EDUCATE PEOPLE”
  36. 36. No one knows you better than yourself No one can eat for you No one can lose weight for you No one can think for you No one can stop bad habits for you No one can develop good habits for you No one can take medication for you No one but YOU can change yourself SELF HELP
  37. 37. Framingham’s 10 yr Risk Score Calculation For CAD
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