1. Ischemic Heart Disease.ppt — Presentation Transcript
• 1. ISCHEMIC HEART DISEASE
• 2. DEFINITION Ischemic heart disease: Any of a group of acute or chronic
cardiac disabilities resulting from insufficient supply of oxygenated blood to the
heart. Inadequate circulation of blood to the myocardium, usually as a result of
coronary artery disease
• 3. INTRODUCTION Ischaemic Heart Disease (IHD), otherwise known as
Coronary Artery Disease, is a condition that affects the supply of blood to the
heart. The blood vessels are narrowed or blocked due to the deposition of
cholesterol plaques on their walls. This reduces the supply of oxygen and
nutrients to the heart musculature, which is essential for proper functioning of the
heart.
• 4. This may eventually result in a portion of the heart being suddenly deprived of
its blood supply leading to the death of that area of heart tissue, resulting in a
heart attack. As the heart is the pump that supplies oxygenated blood to the
various vital organs, any defect in the heart immediately affects the supply of
oxygen to the vital organs like the brain, kidneys etc. This leads to the death of
tissue within these organs and their eventual failure or death. Ischaemic Heart
Disease is the most common cause of death in several countries around the world.
• 5. CAUSE AND PATHOGENESIS A multitude of factors are responsible for the
development of IHD. The major risk factors are smoking, diabetes mellitusand
cholesterol levels. Those with Hypercholesterolaemia (elevated blood levels of
cholesterol) have a much higher tendency to develop the disease. There is also the
theory that Hypertension is a risk factor in the development of IHD, Genetic and
hereditary factors may also be responsible for the disease.
• 6. Males are more prone to IHD. However, in post-menopausal women, the risk is
almost similar to that of men. Stress is also thought to be a risk factor, though
there has been a great deal of debate on this factor of late. The disease process
occurs when an atheromatous plaque forms in the coronary vessels, leading to
narrowing of the vessel walls and obstructing blood flow to the musculature of the
heart. Complete blockage results in deficient oxygenation and nutrient supply to
the heart tissues, leading to damage, death and necrosis of the tissue, which is
known as Myocardial Infarction (heart attack).
• 7. Risks for this condition include Personal or family history of heart attack,
angina, unstable angina, atherosclerosis, or other coronary artery diseases High
blood pressure Smoking Diabetes High fat diet High cholesterol Obesity
• 8. SIGNS AND SYMPTOMS Quite often, the first sign of Ischaemic Heart
Disease may be the severe chest pain of Myocardial Infarction, which may be
fatal. The warning symptoms occur in a large number of patients in the form of

2. Angina Pectoris. The main symptom of Angina is pain over the central chest that
may sometimes radiate down the left arm, to the jaw or to the back. The
characteristic feature of the pain is that it is usually aggravated by exercise and
relieved by rest, though variant forms may occur.
• 9. The pain is also relieved by the use of nitrates kept under the tongue. The pain
is usually described as a sense of compression or tightness in the middle of the
chest, and may last for five to twenty minutes. The pain may be accompanied by
sweating. The presence of anginal episodes is virtually diagnostic of IHD.
• 10. Other signs that can be observed on clinical examination is the presence of
Tendon Xanthomas, thickening of the Achilles Tendon and Arcus Lipidus in
young patients, all of which may indicate a hereditary Hyperlipdaemia. The
patient should also be examined for anaemia, obesity, diabetes, thyroid and
peripheral vascular disease.
• 11. SYMPTOMS Chest pain Under the chest bone May move (radiate) to the
neck, jaw, back, shoulder, arm May feel tight, pressure, crushing, squeezing May
or may not be relieved by rest or nitroglycerin Sensation of feeling the heart beat
(palpitations) Irregular or rapid pulse Shortness of breath, especially with activity
• 12. Shortness of breath that occurs after lying down for a while Cough Fatigue,
weakness, faintness Decreased alertness or concentration Decreased urine output
Excessive urination at night Overall swelling Breathing difficulty when lying
down
• 13. INVESTIGATIONS AND DIAGNOSIS Electrocardiography (ECG) may be
normal in several patients at rest between attacks of Angina. During the episodes
of pain there may be depression of the ST segment and a T wave inversion in
several leads, indicating Ischaemia. In cases of Infarction (heart attack), there will
be ST segment elevation in the ECG, which may gradually evolve.
• 14. An Echocardiogram may help in showing any functional abnormalities in the
various cardiac chambers and in assessing the pumping efficiency of the heart. An
exercise testing (Treadmill Test-TMT) is often indicated in patients who have
symptoms but have normal ECG patterns. Nowadays, TMT is being indicated in
all high-risk categories beyond the age of 35 irrespective of symptoms.
• 15. Myocardial perfusion scanning with radioactive thallium may also be helpful
in the diagnosis. Coronary Angiogram provides accurate information about the
actual site and extent of the stenosis (narrowing) and helps in deciding the method
of therapy required.
• 16.
• 17. TESTS Physical examination – leg swelling, enlarged liver, crackles in the
lungs, extra heart sounds, or an elevated pressure in the neck vein.
Echocardiogram Ventriculogram performed during a cardiac catheterization

3. Gated SPECT MRI of chest ECG Biopsy of the heart is needed in rare cases to
rule out other disorders.
• 18. Lab tests that may be used to rule out other disorders and to assess the
condition of the heart include: CBC Coronary risk profile Blood chemistries
Cardiac biochemical markers (CK-MB, troponin)
• 19. TREATMENT AND PROGNOSIS Drug therapy with Nitrates, which dilate
the diseased coronary arteries, administered sublingually are very effective in
relieving the pain in a few minutes. Drugs such as Isosorbide Dinitrate and
Isosorbide Mononitrate belong to the category of Nitrates. These drugs are also
used as a prophylactic to prevent the pain from occurring.
• 20. Beta-blockers like Propranolol are also highly effective in relieving pain by
reducing myocardial oxygen demand, mainly by decreasing the heart rate.
Calcium channel antagonists produce vasodilatation and relieve the symptoms by
reducing the excitability and conductivity of cardiac muscle and by reducing
blood pressure. For patients with hypercholesterolaemia, drugs may be used to
lower cholesterol levels.
• 21. SURGICAL TREATMENT Surgical therapy is indicated when medical
treatment has failed to relieve symptoms or when the Angiogram shows
significant disease in the blood vessels. Coronary Angioplasty - dilating the
blocked vessel by inflating a balloon inside the vessel and Coronary Artery
Bypass Grafting (CABG) - replacing the blocked area of the vessel using a graft
from the patient, may be done to relieve the blockage.
• 22. A number of studies have shown that heart failure symptoms can be improved
with a special type of pacemaker. It paces both the right and left sides of heart.
This is referred to as biventricular pacing or cardiac resynchronization therapy. A
heart transplant may be recommended for patients who have failed all the
standard treatments and still have very severe symptoms. Recently, implantable,
artificial heart pumps have been developed. At this point, very, very few patients
will be able to undergo either of these advanced treatments.
• 23. The indications for bypass surgery are increasingly becoming limited. This is
due to the growing realization that except in selected cases, bypass surgery only
helps to improve the quality of life and relieve symptoms. It does not significantly
increase life expectancy. The current trends are to focus on medical treatment and
techniques like angioplasty.
• 24. With proper treatment, most patients will be able to lead normal and healthy
lives. Treatment also involves advice regarding regular exercise, avoiding
smoking, diet control and life style modification. Good control of diabetes and
hypertension significantly improves the outlook.
• 25. PREVENTION Risk factors like a fatty diet, smoking, sedentary lifestyle and
stress should be avoided, as they are the main areas of focus in prevention.

4. Avoiding foods rich in saturated fats is vital to reduce lipid levels in the blood and
to prevent arteriosclerosis. Adequate regular exercise is also essential. Diabetes
Mellitus and hypertension should be kept under good control with proper
treatment.
• 26.
• 27. YOGA PRACTICES YOGA IS BALANCE (SAMATVAM) I A Y T
CORRECTS IMBALANCES AIMS : STRESS REDUCTION RELIEF OF PAIN
MEDICATION REDUCTION
• 28. INTEGRATED YOGA MODULE FOR HEART DISEASES Loosening
Exercises Loosening of fingers Shoulder rotation Drill walking Instant relaxation
technique (IRT) Breathing practices Hands stretch breathing Ankle stretch
breathing Rabbit breathing Straight leg raise breathing (alternating) Side bending,
each Quick relaxation technique (QRT)
• 29. Yogasanas Standing Ardhakati cakrasana Garudasana Bhujangasana
Vakrasana Gomukhasana Deep relaxation technique (DRT) Pranayama Nadisuddi
pranayama Sitali pranayama Bhramari pranayama Meditation Nadanusandhana
OM-Dhyana (meditation) Acute attack - chair breathing Vamanadhouti + DRT –
Once a week Laghu Sankapraksalana + DRT - Daily
• 30. SPECIFIC PRACTICE 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.
• 31. Yoga helps one to cope with this stress so that he/she do not need to depend
on smoking or eating unhealthy food. It also helps one to find contentment from
within. Smoking should be completely stopped as it constricts the arteries.
• 32. 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.
• 33. 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

5. shortly after myocardial infarction are advised to practice Savasana, full yoga
breath and later some easy Pavanmuktasanasa, in prone position.
• 34. 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. Shavasana
(Corpse pose) - should be done twice or thrice daily as it normalizes the blood
pressure.
• 35. Thank You