Prevention and Treatment of the Heart diseases

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Prevention and Treatment of the Heart diseases

  1. 1. ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES DR.MANOJ .J. PRADHAN CARDIAC SURGEON ATHENA HEARTCARE
  2. 3. <ul><li>1 PERSON DIES EVERY 33 SECONDS </li></ul><ul><li>DUE TO A HEART ATTACK IN INDIA! </li></ul>
  3. 4. A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIA <ul><li>CORONARY ARTERY DISEASE OCCURS ABOUT 10 YRS. EARLIER IN INDIANS COMPARED TO WESTERNERS </li></ul><ul><li>THE INCIDENCE OF CORONARY ARTERY DISEASE IS AS FOLLOWS </li></ul><ul><li>URBAN RURAL </li></ul><ul><li>MALES 65/100 MALES 22.8/100 </li></ul><ul><li>FEMALES 45/100 FEMALES 17.2/100 </li></ul>
  4. 5. A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIA <ul><li>THUS IF YOU LIVE IN CITIES AND TOWNS,YOU HAVE A THREE TIMES HIGHER CHANCE OF SUFFERING A HEART ATTACK. </li></ul><ul><li>THE W.H.O FIGURES SAY THAT THERE ARE MORE THAN FOUR MILLION HEART PATIENTS IN INDIA. </li></ul><ul><li>INDIA HAS THE HIGHEST RATE OF HEART ATTACKS IN THE WORLD. </li></ul>
  5. 6. INDIAN STATISTICS ABOUT CVD <ul><li>Current projections suggest that by the year 2020,India will have the largest cardiovascular disease burden in the world </li></ul><ul><li>One–fifth of deaths in India are from coronary vascular disease.By the year 2020,it will account for one- third of all deaths,and many of these will be young deaths. </li></ul>
  6. 7. HEART DISEASE IN WOMEN <ul><li>10% of women between 45-64yrs. , and 25% of those over 65 yrs. Are now living with heart disease. </li></ul><ul><li>Nearly 13% women over 45 yrs. have had a heart attack! </li></ul><ul><li>Women who smoke may suffer a heart attack 19 years earlier. </li></ul>
  7. 8. HEART DISEASE IN INDIANS <ul><li>Why are we seeing this sudden increase in heart disease? </li></ul><ul><li> NOT AN OVERDIAGNOSIS! </li></ul><ul><ul><li>Lifestyle changes:more western outlook. </li></ul></ul><ul><ul><li>But we continue to work a 6 day week. </li></ul></ul><ul><ul><li>Result oriented society:in the past,it was important to do your job well and enjoy doing it. Nowadays, the result is more important not the means. </li></ul></ul>
  8. 9. HEART DISEASE IN INDIANS <ul><li>Traditionally we have a higher carbohydrate intake. </li></ul><ul><li>Very little physical exertion due to lack of space & facilities,lack of an exercise culture & little interest in sports. </li></ul><ul><li>Higher incidence of obesity , diabetes, heart disease. </li></ul><ul><li>Hereditary ? </li></ul>
  9. 10. A FEW FACTS ABOUT HEART DISEASE <ul><li>ANGINA IS CHEST PAIN THAT OCCURS SECONDARY TO BLOCKAGES IN THE CORONARY ARTERIES. </li></ul><ul><li>ANGINA OCCURS WHEN THE HEART MUSCLE IS STARVED OF OXYGEN AND ENERGY. </li></ul><ul><li>VERY SEVERE AND SUDDEN BLOCKAGES IN THE CORONARY ARTERIES MAY PRODUCE A HEART ATTACK. </li></ul><ul><li>TREATMENT OF CORONARY ARTERY DISEASE IS ALL ABOUT AVOIDING THAT HEART ATTACK! </li></ul>
  10. 11. Angina <ul><li>Angina is a specific type of pain in the chest caused by inadequate blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). </li></ul>
  11. 13. What Is a Heart Attack? <ul><li>A heart attack is a condition in which damage to an area of heart muscle occurs because of inadequate oxygen supply to the region. Cardiac arrest is a condition in which the heart stops or is otherwise unable to pump enough blood to supply vital organs. Cardiopulmonary arrest is a sudden cessation of both breathing and effective heart function. </li></ul>
  12. 15. Heart attack symptoms <ul><li>Symptoms of a heart attack may be widely varied, from the classic &quot;elephant on the chest&quot; feeling of crushing pain, to the </li></ul><ul><li>nausea and heartburn mistaken for indigestion. In some patients, the symptoms may only be sudden fatigue or an oppressive </li></ul><ul><li>feeling of impending death. </li></ul>
  13. 16. Jaw pain and heart attacks <ul><li>Pain from a heart attack may sometimes radiate to the jaw and teeth. Chest pain is a major symptom of heart attack, but other </li></ul><ul><li>symptoms such as weakness, shortness of breath, nausea, or vomiting may also occur. </li></ul>Pain from a heart attack may sometimes radiate to the jaw and teeth. Chest pain is a major symptom of heart attack, but other symptoms such as weakness, shortness of breath, nausea, or vomiting may also occur.
  14. 19. Other important facts: <ul><li>Most heart attacks occur between 4.00am end 10am due to higher adrenaline amounts released in the body during early morning hours. </li></ul><ul><li>25% of all heart attacks are “silent”- without chest pain. </li></ul><ul><li>Diabetics are at greater risk for “silent” heart attacks. </li></ul>
  15. 20. SIGNS OF A HEART ATTACK <ul><ul><ul><li>CHEST PAIN,BACK PAIN , JAW PAIN. </li></ul></ul></ul><ul><ul><ul><li>SWEATING,VOMITING </li></ul></ul></ul><ul><ul><ul><li>VAGUE FEELING OF UNEASINESS </li></ul></ul></ul><ul><ul><ul><li>ACIDITY! </li></ul></ul></ul><ul><ul><ul><li>GIDDINESS,BREATHLESSNESS </li></ul></ul></ul><ul><ul><ul><li>UNCONSCIOUSNESS </li></ul></ul></ul><ul><ul><ul><li>DEATH </li></ul></ul></ul>
  16. 21. TREATMENT OF A HEART ATTACK <ul><li>TAKE THE PATIENT TO A HOSPITAL ASAP! </li></ul><ul><li>GIVE HIM/HER A TABLET OF ISORDIL/SORBITRATE TO KEEP UNDER THE TONGUE. </li></ul><ul><li>IF HE/SHE IS NOT VOMITING , GIVE ONE TABLET OF DISPIRIN. </li></ul><ul><li>INSIST THAT AN ECG BE TAKEN! </li></ul>
  17. 22. TREATMENT OF A HEART ATTACK <ul><li>ADMISSION TO AN ICU. </li></ul><ul><li>ADMINISTRATION OF A CLOT BUSTER-STREPTOKINASE,UROKINASE. </li></ul><ul><li>IF NOT HELPFUL-ANGIOGRAPHY FOLLOWED BY PRIMARY ANGIOPLASTY. </li></ul>
  18. 23. Lives saved per 1000 65 --- within 1 hr 27 --- 2-3 hr 25 --- 4-6 hr 8 --- 7-12 hr
  19. 24. WHAT CAUSES HEART DISEASE? <ul><li>STRESS </li></ul><ul><li>DIET </li></ul><ul><li>HIGH CHOLESTEROL </li></ul><ul><li>DIABETES </li></ul><ul><li>HEREDITY </li></ul>
  20. 25. WHAT ARE THE PREVENTABLE CAUSES? <ul><li>LIFESTYLE </li></ul><ul><li>OBESITY </li></ul><ul><li>TOBACCO IN ANY FORM </li></ul><ul><li>DIETARY EXCESS </li></ul><ul><li>LACK OF EXERCISE </li></ul><ul><li>ALCOHOL </li></ul>
  21. 26. RISK FACTORS FOR YOUNG PATIENTS TO DEVELOP MI <ul><li>SMOKING –74.8% </li></ul><ul><li>HYPERTENSION –18.8% </li></ul><ul><li>HYPERCHOLESTEROLAEMIA –18% </li></ul><ul><li>OBESITY –18% </li></ul><ul><li>DIABETES MELLITUS –16.4% </li></ul><ul><li>FAMILY HISTORY OF PREVIOUS MI –13.2% </li></ul>
  22. 27. CARDIOVASCULAR RISK FACTORS <ul><li>Smoking - The risk of heart disease for smokers is more than twice that of non-smokers. </li></ul><ul><li>High Blood Pressure - If you have high blood pressure, it is important to work with your doctor to lower it. </li></ul><ul><li>Other Risk Factors </li></ul><ul><ul><li>High fat/high cholesterol diet </li></ul></ul><ul><ul><li>Family history of coronary artery disease </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Lack of exercise </li></ul></ul><ul><ul><li>Obesity (being overweight) </li></ul></ul><ul><ul><li>Stress </li></ul></ul>
  23. 29. LIFESTYLE <ul><li>WHAT’S WRONG IN OUR LIVES TODAY? </li></ul><ul><li>ABSOLUTELY EVERYTHING’S CHANGED! </li></ul><ul><li>TIME IS AT PREMIUM! </li></ul><ul><li>MONEY AND SUCCESS IS EVERYTHING! </li></ul>
  24. 30. LIFESTYLE <ul><li>EXTENDED WORKING HOURS </li></ul><ul><li>NO TIME FOR RELAXATION </li></ul><ul><li>NO EXERCISE </li></ul><ul><li>STRESS!!! </li></ul>
  25. 31. STRESS <ul><li>WHAT IS STRESS? </li></ul><ul><li>IT IS THE FIGHT OR FLIGHT RESPONSE IN THE HUMAN BODY! </li></ul><ul><li>MOST OF THE TIME WE FIGHT! </li></ul><ul><li>THIS CAUSES MENTAL AND PHYSICAL STRESS. </li></ul>
  26. 32. STRESS <ul><li>MENTAL STRESS CAUSES AN EXTRA LOAD ON THE HEART- INCREASE IN HEART RATE AND BLOOD PRESSURE! </li></ul><ul><li>PROLONGED& SUSTAINED MENTAL STRESS CAUSES A HARDENING OF ALL ARTERIES IN THE BODY CAUSING HIGH BLOOD PRESSURE. </li></ul>
  27. 33. EMOTIONS AND YOUR HEART <ul><li>POSITIVE REACTIONS - HAPPINESS,WINNING,CONTENTMENT. </li></ul><ul><li>NEGATIVE REACTIONS- </li></ul><ul><li>TENSION,ANGER, </li></ul><ul><li>FRUSTRATIONS,DEJECTION. </li></ul><ul><li>NEGATIVE REACTIONS CAUSE STRESS & HARM THE HEART! </li></ul>
  28. 34. BAD EFFECTS OF STRESS! <ul><li>HIGH BLOOD PRESSURE </li></ul><ul><li>DIABETES </li></ul><ul><li>HEART DISEASE </li></ul><ul><li>PERIPHERAL ARTERIAL DISEASE </li></ul><ul><li>STROKE </li></ul>
  29. 35. How serious is HT? Can it be fatal? Absolutely. High BP contributes directly or indirectly to about one million deaths each year and accounts for more doctor visits and prescriptions than any other medical problem. If left untreated, high BP causes the walls of the small arteries to thicken (which reduces the flow), and weaken (which increases the chance of rupture). If this continues long enough, the result can be a heart attack, stroke, kidney damage or potentially life threatening problems
  30. 36. CHOLESTEROL-SOME MISCONCEPTIONS <ul><li>YOU DON’T HAVE TO BE FAT/OVERWEIGHT TO HAVE HIGH CHOLESTEROL! </li></ul><ul><li>YOUR CHOLESTEROL LEVEL IS NOT ONLY RELATED TO THE AMOUNT OF FATS YOU EAT! </li></ul><ul><li>CHOLESTEROL IS MADE BY OUR BODY EVEN IF YOU STOP EATING FATTY SUBSTANCES. </li></ul><ul><li>ALL CHOLESTEROL IN BLOOD IS NOT BAD! </li></ul>
  31. 37. ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES <ul><li>PRIMARY PREVENTION </li></ul><ul><ul><ul><li>STRESS REDUCTION </li></ul></ul></ul><ul><ul><ul><li>LIFE STYLE MODIFICATION </li></ul></ul></ul><ul><ul><ul><li>REGULAR CHECKUPS </li></ul></ul></ul><ul><li>SECONDARY PREVENTION </li></ul><ul><ul><ul><li>PROPHYLACTIC ASPIRIN </li></ul></ul></ul><ul><ul><ul><li>CHOLESTEROL LOWERING DRUGS </li></ul></ul></ul>
  32. 38. ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES <ul><li>REGULAR CHECK-UPS </li></ul><ul><ul><ul><li>YEARLY EXERCISE ECG ( STRESS TEST) FOR ALL ABOVE 35/40 YRS. </li></ul></ul></ul><ul><ul><ul><li>YEARLY LIPID PROFILE TESTING </li></ul></ul></ul><ul><ul><ul><li>SCREENING FOR DIABETES. </li></ul></ul></ul>
  33. 39. DIAGNOSIS OF HEART DISEASE <ul><li>ECG, STRESS TEST ECHOCARDIOGRAM. </li></ul><ul><li>ANGIOGRAPHY </li></ul><ul><li>THALLIUM TEST </li></ul>
  34. 40. TREATMENT OPTIONS FOR CORONARY ARTERY DISEASE
  35. 45. TREATMENT OF HEART DISEASE-OPTIONS <ul><li>DRUGS </li></ul><ul><li>ANGIOPLASTY </li></ul><ul><li>ANGIOPLASTY WITH STENTS </li></ul><ul><li>CORONARY BYPASS GRAFTING </li></ul>
  36. 46. COST OF TREATMENT <ul><li>HEART ATTACK- Rs. 10000-25000 </li></ul><ul><li>ANGIOGRAPHY- Rs. 12000-15000 </li></ul><ul><li>ANGIOPLASTY- Rs. 70,000+cost of stent. </li></ul><ul><li>COST OF A STENT – Rs.60000-1,50,000 </li></ul><ul><li>BYPASS SURGERY- Rs.1,25,000 – 2,00,000 </li></ul><ul><li>* This is the cost of treatment without complications in standard institutes in Pune. </li></ul>
  37. 47. <ul><li>PREVENTION IS ALWAYS BETTER (CHEAPER) THAN CURE! </li></ul>
  38. 49. PREVENTION <ul><li>MEDICATIONS </li></ul><ul><li>STOP TOBACCO IMMEDIATELY, COMPLETELY AND PERMANENTLY. </li></ul><ul><li>CHOOSE YOUR FOOD WISELY- eat less fat and sugar.Cut down on meat,diary products,cakes, sweets and ghee. You are allowed to eat poultry,fish,fruits,vegetable and salads. </li></ul><ul><li>CHANGE YOUR COOKING MEDIUM TO OIL </li></ul><ul><li>HAVE A BALANCED DIET. </li></ul>
  39. 50. PREVENTION <ul><li>DIET </li></ul><ul><li>BALANCED DIET- </li></ul><ul><li>CARBOHYDRATES( WHEAT, RICE) </li></ul><ul><li>PROTEINS( PULSES, SOYA, ANIMAL PROTEIN) </li></ul><ul><li>FATS – UNSATURATED, SATURATED. </li></ul><ul><li>VITAMINS, MINERALS </li></ul><ul><li>WATER. </li></ul>
  40. 51. PREVENTION OF HEART DISEASE <ul><li>WATCH YOUR WEIGHT – being over weight can lead to high blood pressure,diabetes and heart disease </li></ul><ul><li>GO EASY ON ALCOHOL. </li></ul><ul><li>TAKE REGULAR EXERCISES- such as brisk walking ,running, swimming,and cycling.Not only does it improve your circulation and help in weight control,but is also protects your heart. </li></ul>
  41. 52. EXERCISE <ul><li>WALKING IS THE BEST AND THE CHEAPEST FORM OF EXERCISE. </li></ul><ul><li>A BRISK UNINTERRUPTED WALK FOR 25-30 MINS DAILY IS NECESSARY FOR BENEFICIAL EFFECTS ON THE HEART. </li></ul><ul><li>TAKING YOUR DOG FOR A WALK IS GOOD ONLY FOR THE DOG! </li></ul>
  42. 53. PREVENTION OF HEART DISEASE <ul><li>REDUCE STRESS! </li></ul><ul><li>DO NOT SET UNREALISTIC TARGETS! </li></ul><ul><li>DO NOT CARRY YOUR WORK HOME. </li></ul><ul><li>TAKE YOUR LEAVE , DON’T ENCASH IT! IF YOU DO , USE THE MONEY TO PAY FOR YOUR BYPASS! </li></ul>
  43. 54. YOGA / MEDITATION.
  44. 55. PREVENTION <ul><li>REMEMBER! </li></ul><ul><li>YOU HAVE ONLY ONE HEART, AND IT IS UPTO YOU TO LOOK AFTER IT WELL. </li></ul><ul><li>ALL WORK , NO PLAY , TOBACCO AND STRESS MAKE “ JACK” AN ILL MAN! </li></ul>
  45. 56. <ul><li>DO NOT RUN THROUGH LIFE SO FAST THAT YOU FORGET NOT ONLY WHERE YOU HAVE BEEN , BUT ALSO WHERE YOU ARE GOING. </li></ul>PREVENTION
  46. 57. LIFE IS NOT A RACE , BUT A JOURNEY TO BE SAVORED EACH STEP OF THE WAY
  47. 58. THANK YOU
  48. 59. TREATMENT OF HEART DISEASE <ul><li>ANGIOPLASTY </li></ul><ul><li>NONOPERATIVE METHOD OF TREATING BLOCKS IN YOUR ARTERIES. </li></ul><ul><li>NOT EVERYONE CAN HAVE THIS PROCEDURE. </li></ul><ul><li>FAILURE RATES ARE HIGH IN SOME CASES </li></ul><ul><li>LASTS FOR UPTO 3 YRS. </li></ul>
  49. 61. TREATMENT OF HEART DISEASES <ul><li>ANGIOPLASTY WITH STENT </li></ul><ul><li>NONOPERATIVE METHOD </li></ul><ul><li>RESULTS BETTER THAN ANGIOLPASTY ALONE. </li></ul><ul><li>CAN LAST UPTO 5-6 YRS. </li></ul><ul><li>SUDDEN BLOCKAGES OF STENT CAN OCCUR. </li></ul><ul><li>EXPENSIVE. </li></ul>
  50. 63. TREATMENT OF HEART DISEASES <ul><li>CORONARY ARTERY BYPASS GRAFTING </li></ul><ul><li>CAN BE DONE IN ALL PATIENTS. </li></ul><ul><li>CAN LAST UPTO 10-15 YRS. </li></ul><ul><li>MOST COST EFFECTIVE PROCEDURE. </li></ul><ul><li>RECOVERY FASTER IN PATIENTS DONE ON A BEATING HEART. </li></ul>
  51. 65. VEIN GRAFT TO RIGHT CORONARY ARTERY
  52. 66. VEIN GRAFT TO RIGHT CORONARY ARTERY
  53. 67. VEIN GRAFT TO RIGHT CORONARY ARTERY
  54. 69. COMPOSITE MAMMARY GRAFTS
  55. 70. THE HEART LUNG MACHINE
  56. 71. NEW TRENDS IN CORONARY BYPASS GRAFTING
  57. 72. NEW TRENDS IN CORONARY ARTERY BYPASS GRAFTING <ul><li>OCTOPUS </li></ul><ul><li>IS IT THE INVENTION TO REVOLUTIONIZE CABG ? </li></ul>
  58. 73. NEW TRENDS IN CORONARY BYPASS GRAFTING <ul><li>OFF PUMP CABG – BEATING HEART SURGERY </li></ul><ul><ul><li>DOES NOT NEED THE HEART LUNG MACHINE </li></ul></ul><ul><ul><li>THE HEART CONTINUES TO BEAT WHILE THE ANASTOMOSIS ARE PERFORMED. </li></ul></ul><ul><ul><li>NEEDS THE USE OF A STABILISER TO REDUCE MOTION WHILE SUTURING. </li></ul></ul>
  59. 75. HEART SURGERY IN THE 21ST CENTURY
  60. 76. ENDOSCOPIC RADIAL ARTERY HARVESTING
  61. 77. WATCH BAND INCISION FOR RADIAL HARVEST
  62. 78. TOTALLY ENDOSCOPIC CORONARY BYPASS GRAFTING
  63. 79. ROBOTIC CORONARY BYPASS SURGERY
  64. 80. ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES
  65. 81. ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES
  66. 82. A HAPPY MAN HAS A HAPPY HEART!

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