Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Protect Your Heart And Save You Life By


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Protect Your Heart And Save You Life By

  2. 2. Prof. Nandu Bhide Consultant Cardiac Surgeon D Y Patil University, Nerul Wanless Hospital, Miraj Aston university Birmingham UK
  3. 3. Coronary obstruction <ul><li>Can be prevented or reversed </li></ul><ul><li>The correct lifestyle is the answer. </li></ul>
  4. 4. Interventions <ul><li>Angioplasty </li></ul><ul><li>Bypass Surgery </li></ul>
  5. 5. Angioplasty <ul><li>Tube passed via a peripheral artery to reach the lesion. </li></ul><ul><li>The tube has a balloon at the end. </li></ul><ul><li>At the site of the lesion the balloon is inflated. </li></ul><ul><li>Stent placed in the hope to prevent collapse. </li></ul>
  6. 6. Bypass Surgery <ul><li>The lesion untouched. </li></ul><ul><li>Conduit from before to beyond the lesion. </li></ul><ul><li>Conduit is own tissue. </li></ul>
  7. 7. Role of medicines in lifestyle disease. <ul><li>Medicines neither prevent nor cure. </li></ul><ul><li>Role is supportive till the obstruction is reversed. </li></ul><ul><li>A lot of side effects. </li></ul>
  8. 8. Lifestyle modification <ul><li>The only and right answer to the problem. </li></ul>
  9. 9. The right lifestyle <ul><li>FOR </li></ul><ul><li>EVERYONE. </li></ul>
  10. 10. Intervention <ul><li>In only half the patients. </li></ul><ul><li>If the lesion is at a critical site </li></ul><ul><li>And is more than 70% </li></ul>
  11. 11. Choice of therapy <ul><li>Medicines are just supportive. </li></ul><ul><li>Unproven therapies are dangerous </li></ul><ul><li>Right lifestyle is the answer. </li></ul><ul><li>All need right lifestyle. </li></ul><ul><li>But if intervention is needed then??????????????????????????????????????????????????????????????????????????????????????????? </li></ul>
  12. 12. Attractive Therapy= Angioplasty <ul><li>No Anesthesia </li></ul><ul><li>Short hospital stay </li></ul><ul><li>Less pain </li></ul><ul><li>But is it safe???????????? </li></ul><ul><li>Is it effective in long term??????????????????????????????????????????????????????????? </li></ul>
  13. 13. Angioplasty [PCI] <ul><li>Is the current use of PCI in multi vessel disease actually evidence based?  </li></ul><ul><li>Are the limitations and risks of PCI explained to patients? </li></ul><ul><li>Does it represent value for money? </li></ul><ul><li>Do numerous/repeat PCI make economic or medical sense?  </li></ul>
  14. 14. Angioplasty <ul><li>Many previous &quot;innovations&quot; have been touted to be the solution to problems of restenosis. These have included direct atherectomy, laser atherectomy, rotablater, brachytherapy which have all been touted previously as the grand solution to restenosis. However the hype for each has subsided over time.All these have been shown to be ineffective. It is difficult to fool nature in the reparative process of placing foreign materials in small vessels.  </li></ul>
  15. 15. Angioplasty <ul><li>You insert a foreign substance in the human body in PCI. This is nothing but to give a new disease in exchange of old one. </li></ul>
  16. 16. Angioplasty <ul><li>Blood thinners compulsory after stent implantation. </li></ul><ul><li>Patient has other organs too that may require surgery in future. </li></ul><ul><li>Then either you stop the blood thinners and die of heart attack or </li></ul><ul><li>Bleed to death. </li></ul>
  17. 17. Angioplasty <ul><li>Immediate Risk of sub acute myocardial infarction after PCI is 37%. </li></ul><ul><li>Magnetic resonance imaging defined a mean loss of 5% of left ventricular muscle mass therefore function. </li></ul>
  18. 18. Angioplasty <ul><li>700% more chances of re-stenosis. </li></ul><ul><li>150% more chances of death </li></ul><ul><li>Late thrombosis </li></ul><ul><li>More adverse events related to heart and brain due to angioplasty </li></ul>
  19. 19. Angioplasty- Cost <ul><li>Two studies have been carried out to compare the costs of angioplasty and bypass surgery. </li></ul><ul><li>One was NHS- UK other one was by joint study by researchers in reputed US and British Universities in New York and London. </li></ul>
  20. 20. Angioplasty- Cost <ul><li>Both conclude that the real cost of angioplasty is way higher than bypass. </li></ul><ul><li>If you add the high death rate of angioplasty high incidence of heart attack after angioplasty, the cost becomes phenomenally high for angioplasty. </li></ul>
  21. 21. Bypass Surgery <ul><li>Patients own tissues used to re-vascularize. </li></ul><ul><li>Cost effective. </li></ul><ul><li>Long term solution. </li></ul><ul><li>Complete re-vascularization. </li></ul><ul><li>Takes care of Future lesions. </li></ul><ul><li>Time tested. performed as it was on day one. More than five decades around. </li></ul>
  22. 22. The evil <ul><li>Clinical trials manipulated to sell stents. </li></ul><ul><li>The cardiologist is the gatekeeper, and this may produce a conflict of interest in terms of self-referral;  </li></ul><ul><li>The disingenuous presentation and inappropriate application of results of randomized trials in highly select and atypical groups to the whole population; and  </li></ul><ul><li>The result of what happens when evidence-based medicine is challenged by a multibillion dollar industry.  </li></ul>
  23. 23. Chuen-Neng Lee, MD NUS Singapore <ul><li>There are many unanswered questions concerning drug-eluting stents: </li></ul><ul><li>Will the drugs stay on the stents forever?  </li></ul><ul><li>What happens when the drugs run out?  </li></ul><ul><li>What will be the effect of the coatings on the arterial walls?  </li></ul><ul><li>Will the drugs weaken the fibrous cap of vulnerable plaques nearby?  </li></ul><ul><li>Is there a risk of creating a new disease by placing the drugs inside the artery? </li></ul>
  24. 24. Editorial from the Mayo Clinic proceeding <ul><li>: &quot;Medical therapy has been forgotten options in the current mechanistic age of cardiology, in which, therapeutic results are more often measured by percentage stenosis rather than by clinical outcomes or long-term survival.&quot; </li></ul>
  25. 25. David P. Taggart, University of Oxford, Oxford, United Kingdom <ul><li>Bypass surgery is the best treatment for the coronary patients but the patient needs to know. Unfortunately the patient is not informed about this fact by many of us and therefore denied the chance of best treatment. </li></ul><ul><li>continued ----  </li></ul>
  26. 26. David P. Taggart, University of Oxford, Oxford, United Kingdom <ul><li>Therefore it is our duty to educate the public so that they become aware of the facts. </li></ul><ul><li>This is the only way Out to save the patients from evil. </li></ul>
  27. 27. Spencer King at the end of the RITA II trials <ul><li>&quot;We must be honest with ourselves as well as our patients if there is no evidence to support improvement in prognosis. The patients need to hear and understand that. In advocating use of drug-eluting stents, there could be situations where patients are not fully informed about the prognosis in terms of life span, myocardial infarction or potential long-term complications.” </li></ul>
  28. 28. Conclusion <ul><li>Right lifestyle is the answer. </li></ul><ul><li>Half the patients need only lifestyle modification. </li></ul><ul><li>Those with critical lesion need intervention. </li></ul><ul><li>Angioplasty is dangerous, ineffective and costly affair. </li></ul><ul><li>Bypass surgery is the right intervention. </li></ul>
  29. 29. Thank you.
  30. 30. 0-98-6957-5897 SMS ONLY