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  2. 2. Atherosclerosis (arteriosclerotic vascular disease or ASVD)
  3. 3. Atherosclerosis It is a specific form of arteriosclerosis in which an artery wall thickens as a result of the accumulation of fatty materials like cholesterol and triglyceride
  4. 4. Causes of Atherosclerosis ▪ High blood Pressure, Smoking, High Cholesterol, ▪ Cholesterol invasion, ▪ Plaque Formation, ▪ Atherosclerosis and Plaque attacks
  5. 5. Plaques of Atherosclerosis causes ▪ Coronary artery disease
  6. 6. Cont… ▪ Cerebrovascular disease
  7. 7. Cont… ▪ Peripheral artery disease
  8. 8. Diagnosis Of Atherosclerosis Test to Diagnose- ▪ Electron Beam computed tomography ▪ Stress Test ▪ Angiography
  9. 9. Atherosclerosis Prevention In different Ages, ▪ Exercise, ▪ Diet, ▪ Risk Factors
  10. 10. Atherosclerosis Treatment ▪ Lifestyle changes ▪ Medication Using invasive technique, Doctor can open up blockages from atherosclerosis and go around them ▪ Angiography and stenting ▪ Bypass surgery
  11. 11. Cardiomyopathy DISEASES OF HEART WALLS
  12. 12. Cardiomyopathy ▪ Cardiomyopathy, or heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or rigid. As a result, the heart muscle's ability to pump blood is weakened, often causing heart failure and the backup of blood into the lungs or rest of the body. The disease can also cause abnormal heart rhythms. ▪ Usually, cardiomyopathy begins in the heart's lower chambers (the ventricles), but in severe cases can affect the upper chambers, or atria.
  13. 13. Type of cardiomyopathy ▪ Dilated cardiomyopathy ▪ What Is Dilated Cardiomyopathy? Dilated cardiomyopathy (DCM) is a condition in which the heart's ability to pump blood is decreased because the heart's main pumping chamber, the left ventricle, is enlarged and weakened. In some cases, it prevents the heart from relaxing and filling with blood as it should. Over time, it can affect the other heart chambers.
  14. 14. What Are the Symptoms of DCM? ▪ Many people with dilated cardiomyopathy have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which may progress and worsen as heart function worsens. ▪ Symptoms of DCM ▪ Weight gain. ▪ Dizziness ▪ Chest pain
  15. 15. What Is the Treatment for DCM? ▪ Treatment of dilated cardiomyopathy is aimed at decreasing the heart size and the substances in the bloodstream that enlarge the heart and ultimately lead to worsened symptoms: ▪ Medications: To manage heart failure, most people improve by taking drugs, such as a beta-blocker, ACE inhibitor an ARB, and/or diuretics. If you have an arrhythmia (irregular heart beat), your doctor may give you a medication to control your heart rate or lessen the occurrence of arrhythmias. Blood thinners may be used to prevent blood clots from occurring.
  16. 16. What Surgeries Are Used to Treat DCM? ▪ People with severe DCM may need one of the following surgeries: ▪ Cardiac resynchronization by biventricular pacemaker. For some people with DCM, stimulating both the right and left ventricles with this pacemaker improves the heart's ability to contract with more force, thereby improving symptoms and increasing the length of time you can exercise. This pacemaker also will help people with heart block or some bradycardias (slow heart rates).
  18. 18. ARTERIAL BLOOD PRESSURE  It is the pressure exerted by the circulating blood on the wall of arteries and it occurs due to the pumping action of Heart.  It is expressed in terms of Systolic pressure over Diastolic pressure and in normal healthy person it is found to be 120/80 mmHg  In healthy persons also variations in Blood Pressure occurs but those variations are under control of nervous and endocrine system.
  19. 19. HYPERTENSION  Primary or Essential Hypertension  Secondary Hypertension Systolic Pressure Diastolic Pressure Pre-Hypertension 120-140 mmHg 80-90 mmHg Stage I- Hypertension 140-160 mmHg 90-100 mmHg Stage II- Hypertension 160-180 mmHg 100-110 mmHg
  20. 20. ANTIHYPERTENSIVE DRUGS ▪ CLASSIFICATION I. ACE Inhibitors : ▪ Captopril, Lisinopril, Ramipril. II. Angiotensin Antagonist : ▪ Losartan III. Calcium Channel Blockers : ▪ Verapamil, Nitrendipine, Amlodipine IV. Diuretics : ▪ a. Thiazides Hydrochlorothiazide, chlorthalidone ▪ b. K+ Sparing Diuretics Spirinolactone, amiloride.
  21. 21. CONGENITAL HEART DISEASE (CHD): Congenital heart defects are the problem with the heart structure that are present at birth. These involve following defects: Interior walls of the heart Valves of the heart Arteries and veins of the heart Causes of congenital heart defects are as follows: Heredity Genetics defects Maternal problems
  22. 22. TYPES OF CONGENITAL HEART DEFECTS: Simple congenital heart defects e.g.: Hole in the interior walls of the heart (septal defects): Atrial septal defects Ventricle septal defects  Narrowed valves: Stenosis Atresia Regurgitation  Hypoplasia : Complex congenital heart defects  Tetralogy of fallot: combination of the following, Pulmonary valve stenosis A large ventricular septal defects An overriding aorta Right ventricular hypertrophy
  25. 25. TREATMENT FOR CONGENITAL HEART DEFECTS: The treatment of congenital heart defects depends on the type and severity of the defect. Other factor includes patient’s age, size and health. The congenital heart defects can be treated with: 1.Cardiac Catheterization. Catheter procedure involves a needle puncture in the skin where the catheter is inserted into a vein or a artery 2.Surgery. A patient may need open heart surgery if the defect can’t be fixed by catheter procedure The open heart surgery is done to: Close the hole in the heart with stitches or patch Repair or replace the heart valve Widen arteries or openings to heart valves 3. Heart transplant.
  26. 26. MEDICATION FOR CONGENITAL HEART DEFECTS: Medicines might be used to treat the complications, relieve symptoms or prevent problems. • Diuretics: lower the amount of extra fluid in the body. • Digoxin: increases the strength of heart contraction. • Vasodilators: widens blood vessels. • Antiarrhythmic: treat and prevent irregular heartbeats. • Aspirin or anticoagulant: thinners the blood, lowers the risk of blood clots in the heart or in blood vessels. • Angiotensin converting enzyme (ACE) inhibitors: blocks the enzyme that tighten the blood vessel, relaxes blood vessel and reduce the workload of heart • Beta blocker: lowers the blood pressure, slows the heartbeat.
  28. 28. ARRYTHMIA An Arrhythmia is an abnormal rhythm of the heart and is caused by problems with Hearts electrical impulse generation or conduction or both. The electrical impulses may occur too fast or too slow or irratically causing the heart to beat very fast or very slow . The normal rate of heart beat in a healthy person ranges between 60-80 beats per second
  29. 29. Types of Arrhythmias The arrhythmias are basically into two following categories depending upon there impact on rate of heartbeat. 1) Bradycardia :In which the rate of heart beat is very low i.e. less than 60pulse /min. 2) Tachycardia : In which the rate of heart beat is very high i.e. more than 100 pulse /min
  30. 30. Arrhythmias Originating in the Atria ▪ Atrial fibrillation It is irregular heart rhythm that causes the atria, the upper chambers of the heart, to contract abnormally. ▪ Atrial flutter The heart's electrical signals spread through the atria in a fast and regular—instead of irregular—rhythm. ▪ Supraventricular tachycardias (PSVT) A rapid heart rate, usually with a regular rhythm, originating from above the ventricles. ▪ Premature supraventricular contraction or premature atrial contraction (PAC) These are early extra beats that originate in the atria (upper chambers of the heart). They are harmless and do not require treatment.
  31. 31. Arrhythmias Originating in the Ventricles ▪ Ventricular Fibrillation An erratic, disorganized firing of impulses from the ventricles. The ventricles quiver and are unable to contract or pump blood to the body(they are serious and need immidiate treatment) ▪ Ventricular Tachycarida A rapid heart rhythm originating from the ventricles of the heart. The rapid rate prevents the heart from filling adequately with blood; therefore, less blood is able to pump through the body ▪ Premature ventricular contraction (PVC) These are among the most common arrhythmias and occur in people with and without heart disease.
  32. 32. Causes of Arrythmia ▪ Abnormal atomaticity. ▪ Impaired conduction. ▪ Combination of above two. ▪ Ischemia. ▪ Electrolyte and pH imbalance. ▪ Altering electrophysiological properties of cardiac fibres.
  33. 33. Cont… ▪ Wolff- Parkinson-White syndrome A fast heart rhythm caused by an extra, abnormal electrical pathway or connection between the atria and ventricles. The impulses travel through the extra pathways as well as the usual route. ▪ Sinus node dysfunction Slow heart rhythms due to an abnormal SA node. ▪ Heart block A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles. The level of the block or delay may occur in the AV node or HIS-Purkinje system. The heartbeat may be irregular and slow.
  34. 34. Tests ▪ Echocardiogram ▪ Coronary angiography ▪ Electrophysiologic studies ▪ 24-hour cardiac and event recorder monitoring ▪ Tilt table studies ▪ Implantable heart monitoring ▪ Exercise stress tests (treadmill tests)
  35. 35. Medications for Arrythmia ▪ Vaughan Williams and Singh in 1969 divided the antiarrythmatic drugs into four classes according to their actions on the heart cells Antiarrythmatic Drugs Class I Na+ channel blocker Class II Beta-Adrenergic blockers Propanolol,Esmolol,Sotalol Class III Prolong Repolaraization Amiodarone,Bretylium, Dofelitide,Ibulitide Class IV Ca channel blocker Verapamil,Diliatizem
  36. 36. Non-Surgical Treatments  Ablation: This procedure uses energy to eliminate the tissue in the heart that is causing the arrhythmia  Implantation of Permanent Pacemaker or Internal Cardioverter Defibrillator  Cardioversion for Atrial Fibrillation and Atrial Flutter: applying electrical shock to the chest to change an abnormal heartbeat into a normal one.
  37. 37. Surgical Treatment Options The CryoMaze Procedure this procedure creates electrical barriers in the upper chamber of the heart by applying an Argon-powered cold probe. By freezing the tissue to very cold temperatures, electrical activity is permanently blocked. Electrical barriers can be created in 60-90 seconds, minimizing the duration of the procedure. The CryoMaze procedure restores a regular coordinated heartbeat, abolishes atrial fibrillation, and restores coordinated pumping to the upper chambers of the heart.
  39. 39. WHAT IS CHF? ▪ Congestive Heart Failure(CHF) is a condition when the heart cannot pump enough blood to satisfy the needs of the body. ▪ Weakened chambers allow the blood to pool inside the heart and nearby veins . This triggers fluid retention , particularly in the lungs , legs and abdomen , CHF is also known as Chronic heart failure or Congestive cardiac failure. ▪ The major causes of heart failure include Coronary heart disease, Hypertension,cardiomyopathy and other heart diseases. ▪ CHF is more common in the elderly. The survival rate for people with CHF depends upon the severity of their conditions.
  40. 40. SYMPTOMS OF CHF ▪ Undue Breathlessness during activity. ▪ Breathlessness at rest or during light exercise. ▪ Muscular fatigue, tiredness. ▪ Swelling of ankles or legs. ▪ Swelling of abdomen. ▪ Unexplained coughing and wheezing.
  41. 41. VENTRICULAR FAILING ▪ SYSTOLIC DYSFUNCTION- The Ventricles are dilated and unable to develop sufficient wall tension to eject adequate quantity of blood. This occurs in ischaemic heart disease, valvular incompetency, dilated cardiomyopathy, myocarditis etc ▪ DIASTOLIC DYSFUNCTION- The ventricular wall is thickened and unable to relax properly during diastole; ventricular filling is impaired because of which output is low.
  42. 42. Causes for CHF Past heart attacks from coronary diseases lead to scarring in the heart muscle. Hypertension-the high pressure in the arteries means the heart must keep pumping more forcefully. It may not be able to keep it up. Heart valve disease may allow the blood to flow backwards or may obstruct the flow. Congenital heart diseases-Heart abnormalities may be present from birth such as defective valves or abnormal communications between heart chambers. Cardiomyopathy- Enlargement of ventricles. Thyroid diseases
  43. 43. DIAGNOSIS OF CHF ▪ X-rays ▪ Echocardiogram ▪ Exercise stress test ▪ Electrocardiogram ▪ Lung function test ▪ Angiography ▪ Blood test
  44. 44. MEDICAL TREATMENT FOR CHF • Angiotensin converting enzyme (ACE) inhibitors: lowers blood pressure, improve blood flow. • Angiotensin ll receptor blocker: provides several benefits of ACE inhibitor without potential side effects of persistent cough. • Beta blockers: lowers blood pressure and slow heart rate. • Digoxin: increases the strength of heart contraction. • Diuretics: prevent fluid from collecting in the body. • Aldosteron antagonist: block the activity of aldosteron and adrenal hormone that causes sodium retension.
  45. 45. SURGICAL TREATMENT ▪ Heart valve repair or replacement ▪ Coronary bypass surgery ▪ Heart transplant ▪ Myectomy
  46. 46. PREVENTION ▪ Regular exercise ▪ Treat high blood pressure ▪ Avoid alcohol and quit smoking ▪ Take medications as prescribed ▪ Monitor your weight ▪ Maintain fluid balance ▪ Monitor your symptoms
  47. 47. Angina Pectoris
  48. 48. Definition ▪ A recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. ▪ Intermittent crushing chest pain caused by reversible myocardial ischemia. ▪ A paroxysmal thoracic pain, with a failing of suffocation and impending death, due, most often, to anoxia of the myocardium and precipitated by effort or excitement.
  49. 49. Types of angina  Stable Most common Predictable and occurs after exertion. Symptoms usually last less than five minutes.  Unstable Less common Unpredictable and occurs during rest. Symptoms lasts longer
  50. 50. Causes ▪ Coronary Heart Disease ▪ Coronary Artery Spasm ▪ Inflammation or infection of the coronary arteries ▪ Injury to one or more coronary arteries ▪ Poor functioning of the tiny blood vessels of the heart
  51. 51. Risk factors ▪ High blood pressure (hypertension) ▪ High levels of cholesterol and other fats in the blood ▪ Diabetes ▪ Smoking ▪ Male gender ▪ Inactive (sedentary) lifestyle ▪ Family history of coronary heart disease ▪ Aging ▪ Regular use of stimulants, especially nicotine, cocaine, or amphetamines: Other stimulants include theophyllines, inhaled beta-agonists, caffeine, diet pills, and decongestants.
  52. 52. Symptoms ▪ An uncomfortable pressure, fullness, squeezing, or pain in center of the chest ▪ Tightness, burning, or a heavy weight. ▪ The pain may spread to the shoulders, neck, or arms. ▪ It may be located in the upper abdomen, back, or jaw. ▪ The pain may be of any intensity from mild to severe.
  53. 53. Other symptoms ▪ Shortness of breath ▪ Light headedness ▪ Fainting ▪ Anxiety or nervousness ▪ Sweating or cold, sweaty skin ▪ Nausea ▪ Rapid or irregular heart beat ▪ Pallor (pale skin) ▪ Feeling of impending doom
  54. 54. Medical treatment ▪ Depends on the severity of the symptoms and the underlying disease. ▪ Aspirin will probably be administered (unless the patient has already taken one) ▪ Oxygen will be administered through a face mask or a tube in the nose. ▪ Sublingual Nitroglycerin ▪ Medication for reducing Anxiety, Blood pressure, Heart rate. ▪ Fibrinolytic
  55. 55. Surgical treatment ▪Angioplasty ▪Coronary Artery Bypass Grafting ▪Transmyocardial Revascularization
  56. 56. Medication ▪ Nitrates ▪ Beta blockers ▪ Calcium channel blockers ▪ Aspirin ▪ Statins
  57. 57. Heart Valve diseases
  58. 58. What is heart valve disease? ▪ Valvular heart disease occurs when heart's valves do not work correctly. ▪ Valvular heart disease can be caused by valvular stenosis or valvular insufficiency.
  59. 59. Valvular stenosis ▪ The tissues forming the valve leaflets become stiffer, narrowing the valve opening and reducing the amount of blood that can flow through it. ▪ If the narrowing is mild, the overall functioning of the heart may not be reduced. ▪ However, the valve can become so narrow (stenotic) that heart function is reduced, and the rest of the body may not receive adequate blood flow.
  60. 60. Valvular insufficiency ▪ It occurs when the leaflets do not close completely, letting blood leak backward across the valve. ▪ This backward flow is referred to as “regurgitant flow.”
  61. 61. Causes of heart valve diseases Congenital valve disease ▪ It is an abnormality that develops before birth. ▪ It may be related to ▪ Improper valve size ▪ Malformed leaflets or ▪ An irregularity in the way the leaflets are attached. ▪ This most often affects the aortic or pulmonic valve.
  62. 62. Cont…. Bicuspid aortic valve disease ▪ A congenital valve disease that affects the aortic valve. ▪ Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stenotic - stiff valve leaflets that can not open or close properly leaky - not able close tightly
  63. 63. Acquired valve disease Normal aortic Valve It involves changes in the structure of valve or infection.
  64. 64. Infection ▪ Rheumatic fever: ▪ Inflammation of heart valve leaflets. ▪ Leaflets become rigid, scarred. ▪ One or more valve may become stenotic. ▪ Rheumatic fever is usually caused by an untreated streptococcal infection. ▪ The use of penicillin to treat strep throat can prevent this disease.
  65. 65. Infection (continued) ▪ b. Endocarditis ▪ Endocarditis is a major infection and can be life- threatening. It occurs when germs (especially bacteria) enter your blood stream and attach to the surface of your heart valves. •germs attack the heart valve, causing growths on the valve, holes in the valve or scarring of the valve tissue •may cause the valve to leak or become stenotic (narrowed)
  66. 66. Other causes of valve disease include ▪ Coronary artery disease ▪ Ceart attacks ▪ Cardiomyopathy (heart muscle disease) ▪ Cyphilis ▪ Cypertension ▪ Cortic aneurysms ▪ Connective tissue diseases ▪ Less commonly, tumors ▪ Come types of drugs and radiation
  67. 67. Changes in your valve structure can occur due to both acquired and congenital causes i. Stretching or Tearing of Chordae Tendineae or Papillary Muscles: ▪ This can be a result of: ▪ heart attack ▪ heart valve infection ▪ trauma Stretching or tearing of chordae tendineae or papillary muscles
  68. 68. Changes in your valve structure can occur due to both acquired and congenital causes iii. Fibro-calcific Degeneration ▪ Most commonly affects the aortic valve. ▪ Valve leaflets become fibrotic (thickened) and calcified (hardened), producing a narrowed valve opening. ▪ Risk factors are increased age, low body weight, high blood pressure.
  69. 69. Changes in your valve structure can occur due to both acquired and congenital causes iii. Dilation of the valve annulus ▪ a widening or stretching of the annulus causing leaflets to lack support and not closing tightly. ▪ Occurs due to: ▪ a heart attack (heart muscle injury) ▪ cardiomyopathy (weakened heart muscle) ▪ heart failure ▪ advanced stages of high blood pressure ▪ syphilis ▪ inherited disorders (such as Marfan syndrome) Dilatation of the valve annulus causes the valve to leak
  70. 70. Diagnosis ▪ Physical examination ▪ Echocardiogram (echo) ▪ Transesophageal echocardiogram (transesophageal echo or TEE) ▪ Cardiac catheterization (cardiac cath or angiogram) ▪ Electrocardiogram (EKG or ECG)
  71. 71. Treatment ▪ Minimally invasive aortic valve replacement surgery
  72. 72. THANK YOUstay healthy, stay fit…