4. Myocardial Infarction
Most commonly due to occlusion (blockage) of a
coronary artery following the rupture of a vulnerable
atherosclerotic plaque
5. Artherosclerosis
Gumpalan Kolestrol,
lemak dan sel-sel darah
putih di dalam dinding
salur darah,
menyebabkan
penyempitan salur darah
Jika dibiarkan tidak
dirawat, akan
menyebabkan kematian
sel-sel jantung
6. Myocardial Infarction
Typical symptoms of acute
myocardial infarction
include sudden chest pain
(typically radiating to the
left arm or left side of the
neck), shortness of breath,
nausea, vomiting,
palpitations, sweating, and
anxiety (often described as
a sense of impending
doom)
Symptoms more then 20
minutes
7. Myocardial Infarction
Women may experience
fewer typical symptoms
than men, most
commonly shortness of
breath, weakness, a
feeling of indigestion,
and fatigue.[2]
8. Myocardial Infarction
] A sizeable proportion of
myocardial infarctions
(22–64%)[3] are "silent",
that is without chest
pain or other symptoms
Common - Elderly,
Diabetes Mellitus
10. 10
Stress
Continuous stress can promote and
accelerate the development of high
BP
Anxiety and stress:
cause narrowing of artery
Increase BP
Cause hypertension
Stress:
Releases hormones (catecholamines?)
Causes increased LDL
11. Age
Dominant influence
Death rates increase with
each passing decade
As Clinically evident in
middle age or later
Between ages 40 – 60,
MI incidence 5 times
12. Sex
Males more prone than
females
Atherosc and sequelae
uncommon in pre
menopausal females
After menopause incidence
increases
Decreased natural
estrogen levels
Estrogen improves
endothelial function thus
playing a protective role
14. Hyperlipidaemia
Major modifiable risk
factor
Specifically
Hypercholesterolemia
Elevated levels sufficient to
stimulate development of
AS in absence of other risk
factors
LDL transports cholesterol
to peripheral tissues
Increased LDL = increased
risk
15. HDL mobilizes cholesterol
from developing and existing
atheroma and transports it to
liver for excretion in bile
increased HDL = lower risk
increased: after exercise,
moderate consumption of
alcohol
decreased: in obesity &
smoking
LDL- Bad cholesterol
HDL –Good cholesterol
16. 16
Cholesterol
Plants do not contain cholesterol
but contain beta-sitosterol, which
competes with cholesterol for
absorption
Cholesterol is found only in
animal food sources, and is
associated with animal fat
Review
17. 17
Oxidants vs. Antioxidants: Tocotrienols
1. Oxidants promote the oxidation of
lipids, proteins and nucleic acids
2. Antioxidants prevent the oxidation of
lipids, proteins and nucleic acids
3. Antioxidants include vitamins C and E
Vitamin E is grouped as tocotrienols
Tocotrienols prevent breast cancer
Tocotrienols act as statin
20. 20
Breakfast
Review
Pengat pisang is bananas + santan + water + coconut sugar +pandan + cloves
Lompat tikam is pulut + pandan + coconut + sira
Nasi lemak is a balanced meal
21. 21
TFA in infant milk formulas
TFA = trans FA
Trans monoene level in
animal fat = 5 – 8%
Should we reduce trans
monoene level in infant
milk formulas?
Susu ibu adalah susu yang
paling baik untuk bayi
Manusia!
22. 22
FA, hypercholesterolemia & CVD risk
Myristic acid (C14:0)
Medium chain FA
Forms medium chain triglycerides
(MCT)
Found in santan, palm kernel oil
Coconut milk (santan) and
palm kernel oil (minyak kelapa
sawit) are rich in myristic acid
23. 23
Fruits do not contain cholesterol; they contain fibre &
antioxidants (vit. C & flavinoids)
Review
24. 24
Vegetables do not contain cholesterol; they
contain folic acid
Review
High folic acid lowers homocysteine in blood
High homocysteine (hyperhomocysteinaemia) is associated with CHD
25. 25
Milk, milkshakes and burgers contain high fat and
high cholesterol
Review
Burgers contain 22% fat
Egg banjo is fried in chicken fat
Milkshake is full cream
milk + egg + glucose +
cooking oil + water
Goat’s milk is low fatSkimmed milk is low fat
but fortified with vitamins
26. 26
Eggs have high phospholipids and high
cholesterol
Review
Maggi mee is egg noodles and high in cholesterol
Mi kuning is egg noodles and also rich in cholesterol
27. 27
Soy- & tofu-based foods have high
phospholipids but no cholesterol
Review
Soy sauce (kicap) is soy
bean + Aspergillus niger +
artificial sugar + MSG
Artificial sugar has been
linked to cancer
28. 28
Seafood has high cholesterol
Review
Seafood with high cholesterol include: cuttlefish, prawn, shrimp, lobster, crab
Sambal sotong … causes hypertension!
29. 29
Breakfast food is high fat, high
carbohydrate, variable cholesterol
Review
Bread & potatoes are low-fatSoft margarine is higher in PUFA and lower in
trans FA than hard margarine
30. 30
Glutinous rice (pulut) is high gluten, high
carbohydrate
Review
Pulut hitam has bran left on and is high in riboflavin
Pulut manis (wajik) is pulut rice + coconut sugar (gula melaka/ gula keret) + sugar
Nasi dagang rice is pulut rice with bran left on (high in riboflavin) + santan
All pulut rice are rich sources of gluten and carbohydrate, and are fattening
31. 31
Frying adds oil to food;
fried foods are fattening
Review
Fritters (cucur) are oily as they absorb frying oil
32. 32
Meat is high fat, high cholesterol
Review
Meat is dense, many muscle cells, highly
nucleated, source of uric acid from DNA
breakdown. High meat intake leads to gout
which often accompanies CHD
Beef soup is a rich source of
saturated FA and cholesterol
33. 33
Chicken has high saturated FA in the fat
under the skin and high cholesterol
Review
Chicken is safe if skin is removed and steamed to remove all traces of fat
Chicken curry is chicken + santan + water + curry powder + chicken cube
(chicken fat + MSG + salt)
34. 34
Fish has high PUFA and low cholesterol
Review
Sardine curry is sardine + chili + santan
Sardine sambal is sardine + chili
Fish ball is fish + starch +salt
Fried fish is very oily.
Pencicah ikan bakar is
chili + water + vinegar +
salt
Lemak ikan & fish curry is fish + santan +
fresh chili or curry powder
Dried fish causes GI cancer
35. 35
Malaysian 1999 Dietary Guidelines
Total dietary fat 20 – 30%
PUFA as LA (18:2, n-6) 4 – 7%
n-3 FA (ALA + EPA + DHA) 0.4 – 1.2% kcal
n-6:n-3 FA ratio 5 – 10:1
MUFA (eg, olive oil) Maximise
TFA (esp. t18-1 in hydrogenated oils) Minimise
Myristic acid (14:0) in santan & palm kernel oil Minimise
Hypercholesterolemic patients 6 – 7% LA
Dietary cholesterol
<300 mg/day
(1 egg yolk alternate day)
Use Palm olein-PUFA vegetable oil blends
38. Hypertension
Major risk factor at all
ages
Both systolic and
diastolic levels are
important
BP more than 169/95
mm of Hg has 5 fold
greater risk of IHD than
of 140/90 mm of Hg
Antihypertensives
reduce the risk of IHD
42. Diabetes mellitus
Induces
hypercholesterolemia –
increased predisposition
to AS
Risk of MI twice in
diabetics when
compared to non
diabetics
100 – fold increased risk
of atherosclerosis
induced gangrene of
lower extremities
51. Aneurysm formation
due to atrophy of tunica media
1. circumscribed dilation of an artery or a
cardiac chamber, a direct communication
with the lumen, usually due to an acquired
or congenital weakness of the wall of the
artery or chamber.
