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hypertension and diabetes - risk factors for Myocardial infarction


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hypertension and diabetes - risk factors for Myocardial infarction

  2. 2. HYPERTENSION  What is Hypertension?  High pressure in the blood vessels  NOT excessive emotional tension  > 140/90 mm Hg - confirmed on multiple occasions
  3. 3. How is the blood pressure measured?  Patient to be seated comfortably with his arm on a table in a relaxed posture.  Single reading is not sufficient.  Best with a mercury type of apparatus.  White coat Hypertension.
  4. 4. What causes hypertension?  Primary Hypertension - 95%  High intake of salt.  Age, Black race, Genetic (30%),  Obesity  Secondary Hypertension - 5%  Due to kidney, Aortic, Adrenal diseases.
  5. 5. How do alcohol, coffee, and smoking influence blood pressure?  Smoking rises BP by 5-10 mm.  Alcohol rises BP on the long run.  Caffeine also rises BP.
  6. 6. What do patients feel with high blood pressure?  No symptoms for many years (silent killer)  May present with fatal complications.  Hence periodic BP check up is essential.  Some may have giddiness, SOB, Headache, Blurred vision.  May come with kidney failure, HA, vision loss on THE FIRST VISIT ITSELF.
  7. 7. Complications of Hypertension  Enlarged heart.  Kidney failure.  Brain damage.  Changes in the eye (retina) - Leaking of blood in the retina. - Swelling of the eye nerve.
  8. 8. Lifestyle modifications Diet Restricting salt Reducing wt. Exercise Quitting alcohol Quitting Smoking
  9. 9. Obesity  Problem of sleep Apnoea syndrome  Increased incidence of BP On reduction of wt -  BP reduces  BP drugs act well  Insulin also acts well
  10. 10. Regular exercise  Jogging, Bicycle riding, Swimming for 30 to 45 minutes daily - lowers BP by 5-15 mm.  The more you exercise (up to a point), the more you lower the blood pressure.
  11. 11. What are the goals of anti- hypertensive treatment?  Treat hypertension early, before it damages critical organs.  Goal – 130/80 mm of Hg.  Even lower if patient has Diabetes or Kidney failure.
  12. 12. Treatment of hypertension  Not possible to control BP in a single day or a few days.  For a good control of BP, it may take even a month.  May require one or more drugs most of the times.  Initially he has to make frequent visits to doctor for assessment of BP control and titration of dose.
  13. 13. Treatment of hypertension  Once hypertension is detected in a patient, he or she would require treatment life long.  There is no need for taking food before taking these medicines.  Once the BP is under control with the medicines he has to continue the medicines and stopping drugs would again increase the BP.
  14. 14. HEART ATTACK
  15. 15. What is a heart attack?  Known as a Myocardial Infarction  Sudden blockage blood vessel  Death of heart muscle  Causes chest pain and pressure  Muscle continues to die for 6-8 hours  Heart muscle is replaced by scar tissue
  16. 16. What causes a heart attack?  Atherosclerosis - Deposition of cholesterol in the walls of vessels  Hardening of the arterial walls and narrowing of the inner channels  Cannot deliver enough blood  Atherosclerosis can remain silent for years or decades  Atherosclerosis can begin as early as the teenage years
  17. 17. What causes a heart attack?  symptoms appear when the blood vessels are critically narrowed  Aggravating factors:  Smoking  High blood pressure  Diabetes  Elevated cholesterol  Family history of heart attack
  18. 18. Angina  Chest pain  Coronary arteries are narrowed by more than 50 to 70 %  Arteries cannot increase the supply of blood to the heart muscle during exertion  Diabetics – no pain occurs but just shortness of breath
  19. 19. Angina  Angina is like a pressure, heaviness, squeezing, or aching across the chest  This pain may travel to the neck, jaw, arms, back, or even the teeth  May be accompanied by shortness of breath, nausea, vomiting or a cold sweat  Angina lasts for 1 to 15 minutes  Relieved by rest or by placing a Nitroglycerine tablet under the tongue.  Can even occur at rest.
  20. 20. Angina  Too often patients attribute heart attack symptoms to "indigestion," "fatigue," or “stress” and consequently delay seeking prompt medical attention.  Early diagnosis and treatment saves lives, and delays in reaching medical assistance can be fatal. A delay in treatment can lead to permanently reduced function of the heart due to more extensive damage to the heart muscle.
  21. 21. What are the complications of a heart attack?  Heart failure  Ventricular fibrillation
  22. 22. How is a heart attack treated?  Medications to prevent formation of blood clots  Medications to prevent growth of blood clots  PTCA with or without stenting to open blocked coronary arteries  Clot-dissolving medications to open blocked arteries  Oxygen to increase the supply of oxygen to the heart's muscle  Medications to prevent abnormal heart rate
  23. 23. DIABETES  What is Diabetes Mellitus?  Defects in INSULIN secretion or action  Diabetes means "sweet urine."  Elevated levels of blood glucose lead to spillage of glucose into the urine
  24. 24. INSULIN  Released from Pancreas in response to elevated glucose (sugar) levels  Normally Insulin controls blood sugar  If deficient, glucose levels increase  It’s a chronic condition - lasts for life  Hence treatment is life long
  25. 25. What causes Diabetes?  Body cells cannot use glucose in the absence of Insulin.  Cells are starved of glucose energy  There is starvation in the midst of plenty  Unutilized glucose is wastefully excreted in the urine
  26. 26. What is the impact of Diabetes?  Blindness  Kidney failure  Nerve damage  Accelerating the hardening and narrowing of the arteries  That leads to strokes, coronary heart diseases
  27. 27. What are the different types of Diabetes?  Type I – no insulin – young  Damage of pancreas due to infections  Due to genetic factors  Type II – Inadequate insulin  Normally in adults, rarely in teen age  Risk factor – obesity
  28. 28. What are the symptoms of Diabetes?  Increased urine output  Increase in appetite  Increase in thirst  Urinary Infections  Skin Infections  Weakness  Coma
  29. 29. How is Diabetes diagnosed?  The Fasting sugar test is the preferred way to diagnose diabetes  No need to do GTT  Normally fasting sugar levels are less than 110mg/dl  If more than 126mg/dl, it is diagnostic of Diabetes
  30. 30. Goal of Diabetes treatment  To keep the blood sugar levels between 70 to 120mg/dl before each meal.  To keep the level under 140 mg/dl at 2 hours after eating
  31. 31. What are the complications of Diabetes?  Ketoacidosis  Electrolyte imbalance  Hypoglycemia  Heart disease  Eye problems  Strokes  Kidney failure
  32. 32. What are the complications of Diabetes?  Cataract  Glaucoma  Neurological problems  Weight loss  Loose motions  Depression.
  33. 33. What can be done to slow Diabetes complications?  Aggressive and intensive control of elevated levels of blood sugar  Means achieving fasting glucose levels between 70-120 mg/dl;  Glucose levels of less than 140 mg/dl after meals.
  34. 34. If treated well  In intensively treated patients  Diabetic eye disease decreased by 76%  Kidney disease decreased by 54%  Nerve disease decreased by 60%.
  35. 35. How is Diabetes treated?  Life style modification, weight reduction  Diet  Exercise  Oral drugs  Insulin
  36. 36. THANK YOU