The document provides information about the anatomy and physiology of the heart, as well as various heart diseases. It describes the internal and external structures of the heart, how the heart pumps blood through the body, and how the heart gets its own blood supply. It then covers topics like the symptoms, signs, and investigations of general heart disease. It discusses specific conditions like coronary artery disease, myocardial infarction, hypertensive heart disease, valvular heart disease, heart failure, congenital heart diseases, heart rhythm disorders, and infectious endocarditis.

2. ANATOMY OF HEART Chapter 01

3. The Heart The heart is located in the center of the thorax and contracts 72 times per minute pumping blood throughout the body

4. The Beating Heart

5. Heart - Front View The external structures of the heart include the ventricles, the atria, aorta, pulmonary arteries and the pulmonary veins

6. Heart - Section The interior of the heart is composed of the myocardium, four heart valves, four cardiac chambers, and associated vessels

7. Not From Within Heart can not get blood for its own need from within the chambers of heart, but has to depend on the coronaries from outside

8. Left Coronary Artery Left coronary artery is the largest of the blood vessels supplying the heart, especially the left ventricle and the left atrium

9. Right Coronary Artery Right coronary artery is the 2 nd largest of the blood vessels supplying the heart especially the right ventricle and right atrium

10. Anterior Heart Arteries The important branch of the left coronary artery is the left anterior inter-ventricular artery which supplies the anterior surface

11. Posterior Heart Arteries Another important branch of left coronary artery is the Deep Circumflex Artery which supplies the posterior surface

12. SYMPTOMS OF HEART DISEASE Chapter 02

13. Chest Pain Pain in the center of the chest is very characteristic of diseases of the heart especially those due to coronary artery disease

14. Non Cardiac Chest Pain Even though chest pain as a presenting symptoms of heart attack is quite characteristic, it is not unique to heart disease

15. Breathlessness on Exertion Breathlessness especially on exertion and on lying down occurs in heart disease. Patient may also wake up at night with breathlessness

16. Palpitation Palpitation is another important symptom of heart disease. It may occur during exertion or while at rest

17. Hemoptysis Spitting blood or blood stained sputum, even though more likely to be due to a respiratory disease may also occur in heart disease

18. Bluish coloration Otherwise called cyanosis, of the lips and tongue is likely to occur in some congenital heart diseases and also in heart failures

19. Peripheral Cyanosis Bluish coloration may also occur in heart disease due to the reduced circulation of the peripheral tissues like fingers and toes

20. Leg Swelling Leg swelling due to accumulation of fluid in the subcutaneous tissues is likely to occur in heart failure

21. SIGNS OF HEART DISEASE Chapter 03

22. Examination of Pulse The right radial artery pulse is palpated in the forearm for at least one minute and studied in detail for the rate and the rhythm

23. The Blood Pressure The BP is recorded in the right arm using a sphygmomanometer applied to the upper arm and K sounds auscultated at elbow Coming up – an Animation of BP measurement

24. Measurement of BP

25. Jugular Venous Pressure The pressure inside the right atrium is reflected in the root of the neck as the jugular venous pressure which is measured and studied Coming up a Video of JVP measurement

26. Measurement of Jugular venous Pressure

27. Palpation of Heart Precordium of the chest is palpated for position of the apex beat, left parasternal heave and presence of any thrills

28. Areas for Auscultation These are the aortic area, the pulmonary area, the second aortic area, the tricuspid Area and the mitral area

29. Auscultation of Heart Sounds The heart is auscultated for the intensity and quality of the heart sounds and any additional heart sounds Coming up a Video of Auscultation of Heart

30. Auscultation of The Heart - Video

31. Auscultation of Heart Murmurs The heart is then auscultated carefully for the presence of any heart murmurs either in the systole, diastole

32. INVESTIGATIONS IN HEART DISEASE Chapter 04

33. Electrocardiogram (ECG) It is a test that measures the electrical activity of the heart, the rate, rhythm and presence of any ischemia

34. ECG ECG is used extensively in the diagnosis of heart disease, from congenital disease to myocardial infarction and myocarditis

35. Holter Monitoring The patient wears a monitor that records electrical activity of their heart (similarly to the recording of an ECG) for 24 hours

36. X-Ray Chest PA view Chest X-Ray PA view brings into focus the heart and the lungs and the chambers and any enlargement of the heart Coming up a Video of Echocardiography

37. Echocardiography

38. Coronary Angiography The narrowing of the coronary vessels can be demonstrated using this radiological technique

39. CORONARY ARTERY HEART DISEASES - ANGINA Chapter 05

40. Definition of Angina Angina is a temporary chest pain, pressure or discomfort due to insufficient blood supply to heart, during exertion

41. Angina – The Cry of Heart When heart does not get enough blood through coronaries during exertion, it cries for more oxygen, causing the pain

42. Site of Chest Pain The chest pain in angina is felt in the center of the chest, and is described by an open or closed fist showing the site

43. Chest Pain Radiation In angina, chest pain usually radiates to the left shoulder, left upper limb and along its inside border and up to the left hand

44. Other Sites of Radiation In another patient the chest pain may radiate to the neck, jaw, upper abdomen, right shoulders and or the right arms

45. Severity Of Pain The severity of the chest pain is such that the patient can no longer exert and therefore stops, gasping with pain

46. Character Of The Pain It is described as either a firm pressure, chest discomfort, crushing or burning or tightness of chest

47. Other Symptoms Patients may complain about anxiety, dizziness, cold sweating, breathlessness or even presence of a stomach upset

48. Duration of Chest Pain The pain usually lasts for only 2-3 minutes and is relieved when the patient takes rest or puts medicines under the tongue

49. It is a Vicious Cycle Initially pain occurs during moderate activity but later it occurs during mild activity, then during normal daily activities

50. Coronary Atherosclerosis The basic abnormality in of angina is the narrowing of the coronary arteries by progressive atherosclerosis

51. Plaque Formation Accumulation of lipids in the walls of the artery leads to the formation of an inward elevation called the plaque

52. Treatment of Angina The treatment of Angina is by using drugs which dilate the coronary arteries like nitroglycerine and vasodilators

53. Nitroglycerine Nitroglycerine is taken by the patient immediately after chest pain by placing it under the tongue for quick absorption

54. CORONARY ARTERY DISEASE - UNSTABLE ANGINA Chapter 07

55. No permanent damage In angina there is no permanent damage to the myocardium as would occur in patients with Myocardial Infarction

56. Coronary Angioplasty Here the narrowed coronary artery causing the CAD is opened up using a catheter passed through the vessel

57. Coronary Artery Stent A stent is a rust proof wire mesh placed inside the coronary artery, which costs anything above Rs 50,000 per piece

58. Stent Insertion A guide wire is advanced across the blocked section of the coronary artery and a balloon is positioned beside the blockage

59. The Result The outcome is relief from chest pain and improved exercise capacity. In 2/3 rd of patients, the procedure is successful Coming up an Animation of Angioplasty

60. Angioplasty

61. Coronary Bypass Surgery Bypass surgery is the alternative option indicated when one or more coronary arteries are seriously blocked

62. Bypass Surgery In Bypass surgery, the site of coronary obstruction is bypassed by means of a vein or artery from the patient himself

63. Saphenous Vein Graft Here the saphenous vein is harvested from the patient’s own legs and used as a conduit for bypass

64. Internal Mammary Graft Internal mammary artery graft is used alternatively in selected cases producing a longer term of benefit of up to 10 years

65. Beating Heart Surgery Here stabilization devices are used to reduces the motion of target vessels and the bypass under taken with out Heart-Lung machine Coming up a Video of Beating Heart Surgery

66. Beating Heart Surgery Coming up a Video of Robot Assisted Bypass Surgery

67. Robot Assisted Surgery

68. MYOCARDIAL INFARCTION Chapter 08

69. Heart Attack A heart attack or acute myocardial infarction (MI) occurs when one of the coronary arteries is blocked

70. Total Occlusion In angina there is only up to 70-80% occlusion; but in Acute Myocardial Infarction, there is 100% occlusion

71. Myocardial Infarction The area of myocardium which is totally deprived of blood supply becomes a non contracting scar tissue Coming up an animation of Thrombus Formation

72. Thrombus Formation

73. Who Gets Heart Attack? Any body can get a heart attack above the age of 30 years, irrespective of the sex, race and country of origin

74. Females and Heart Attack Females are generally protected from heart attack because of estrogen in their body during menstruating age Coming up an Animation about Risk Factors of MI

75. Risk Factors for MI

76. Sudden Death Importance of Myocardial Infarction, is that it can cause sudden, unexpected death, even in very young people Coming up a Animation about Complications of MI

77. Complications of MI Coming up a Video of Cardio Pulmonary Resuscitation

78. Cardiopulmonary Resuscitation Coming up an Animation of Automated Defibrillation

79. Automated Defibrillation

80. ECG wave tracings in MI Various phases of MI can be seen in ECG wave tracings during the acute phase, fully evolved phase, resolution phase and chronic phase

81. ST Elevation MI ST elevation Myocardial Infarction is the most important type of Myocardial infarction leading to sudden cardiac arrest and death

82. Thrombolytic Therapy If the patient can be brought sufficiently early to the hospital, the blood clot can be dissolved using certain drugs like streptokinase Coming up a Video of Emergency Ambulance Service

83. Call the Ambulance

84. Non ST Elevation MI Here the patient has no ST elevation in the ECG. But at the same time there is death of the myocardial tissue which is not easily reversible Coming up an Animation about Final Outcome

85. Final Outcome

86. HYPERTENSIVE HEART DISEASE Chapter 09

87. Definition Hypertension is defined as sustained and abnormal elevation of arterial blood pressure of at least 140 mmHg systolic and 90 mmHg diastolic

88. Importance If left untreated hypertensive patients can end up with several complications in the due course of the illness

89. Complications of HTN Hypertension is a very important predisposing cause of heart disease, kidney disease, as well as stroke

90. What is blood pressure? It is the pressure exerted on the lateral walls of the blood vessels by the blood from within the vessel

91. Why We Need Blood Pressure? Blood pressure is needed to push the blood along the blood vessels to reach the various tissues of the body

92. Essential Hypertension In Primary or Essential Hypertension both the systolic as well as diastolic blood pressures are elevated to almost an equal extend

93. Sodium in Food Sodium is an element that the human body needs to function properly and especially to regulate the blood pressure and blood volume

94. Sodium and Hypertension For individuals who are sodium-sensitive, an increased intake of sodium through food may contribute to high blood pressure

95. The values Persons with BP in the normal ranges are normal. Those having BP in the borderline are called pre-hypertensives

96. Normal Blood Pressure The normal blood pressure is 120/70 to 140/90. It is advisable to maintain a BP in or around 130/80 mmHg under any circumstances

97. Isolated Systolic Hypertension In some patients with hypertension especially old people, only the systolic Blood Pressure is found to be elevated

98. White Coat Hypertension In these cases high blood pressure is seen only when recorded by the doctor in the clinic or hospital surroundings

99. Symptoms Most patients with hypertension have no specific symptoms. Others may complain about dizziness, vertigo or epistaxis

100. Headache and Hypertension Headache is seen only in patients with more severe hypertension. In these patients it is localized to the back of the head

101. The Silent Killer Hypertension is considered as a silent killer because even in the absence of symptoms it can cause heart attack or stroke Coming up an Animation of Effects of Hypertension

102. Effects of Hypertension

103. Hypertension and Heart The heart muscles thicken to make up for increased blood pressure. It is the left ventricle which gets the brunt of the enlargement

104. Left Ventricular Hypertrophy The left ventricle is markedly thickened in this patient with severe hypertension that was remaining untreated for many years Coming up an Animation of Effect of HTN on Heart

105. The Effect On The Heart

106. Hemiplegia Occlusion of the middle cerebral artery results in sudden paralysis of upper and lower limbs called as a stroke or hemiplegia

107. Intracerebral Hemorrhage Perhaps a more important and dangerous complication of hypertension is bleeding in to the brain, causing unconsciousness

108. Treatment of High BP Maintaining the blood pressure within the normal ranges for months and years is perhaps more difficult

109. Advice to High BP patients Every patient with hypertension is advised to check BP regularly so that sudden increase may not occur

110. Regular Exercise By doing regular exercise the tone of the muscles in the walls of the arteries remain reduced and thus BP is lowered

111. Low Salt Intake Low salt intake is an essential component of management of hypertension irrespective of the degree of BP rise

112. Pappads, Pickles, Fried, Dried Pappads, pickles, fried items and dried fish contain large quantities of salt. Hence all hypertensive's should avoid these

113. Beta Blockers Atenelol is one such drugs used in the treatment of hypertension especially in the early stages

114. Calcium Channel Blockers Nifedipine is a calcium channel blocker used for the control of mild to moderate hypertension

115. ACEIs and ARBs Angiotensin Converting Enzyme inhibitors and Angiotension Receptor Blockers are the other drugs

116. VALVULAR HEART DISEASES Chapter 10

117. The Heart Valves The valves of the heart open and close to control the flow of blood entering or leaving the heart

118. The Four Valves There are four valves in the heart: namely the aortic, the mitral, tricuspid, and the pulmonary valve

119. The Heart Valves The valves are designed to control the direction of blood flow through the heart. Their opening and closing produce the heart sounds

120. Mitral stenosis It is a heart valve disorder that narrows the mitral valve opening reducing the amount of blood that flows through it

121. Mitral Regurgitation Mitral valve may develop damage due to rheumatic fever and become leaky resulting in blood regurgitating into the left atrium

122. Aortic Stenosis Aortic valve gets constricted due to valve damage preventing blood from flowing into the aorta

123. Aortic Regurgitation The aortic valve, when affected by disease cannot prevent back flow of blood in to the left ventricle

124. HEART FAILURE Chapter 11 Coming up an Animation about Heart Failure

125. Heart Failure

126. Pulmonary Edema As the heart fails, pressure in the vein going through the lungs starts to rise. fluid is pushed into the air spaces (alveoli)

127. Pulmonary Edema in X- Ray Pulmonary edema can be seen in the X-Ray chest as a fluffy non-homogenous opacities of both hila of lungs Coming up an Animation of Ventricular Assist Device

128. Left Ventricular Assist Device Coming up a Video of Heart Transplantation

129. Heart Transplantation Coming up an Animation of Total Artificial Heart

130. Total Artificial Heart

131. CONGENITAL ACYANOTIC HEART DISEASES Chapter 12

132. Atrial Septal Defect It is a congenital heart defect where the wall between the right and left atrium has a hole and blood flows between the two atria

133. Ventricular Septal Defect Ventricular septal defect is an abnormal opening in the wall that separates the right and left ventricles

134. Patent Ductus Arteriosus Here there is an abnormal communication between the aorta and the pulmonary artery which is normally present in infants

135. CONGENITAL CYANOTIC HEART DISEASES Chapter 13

136. Tetralogy of Fallot It is a birth defect of the heart consisting of 4 abnormalities that results in insufficiently oxygenated blood pumped to the body

137. Transposition of the great vessels Here the position of the two major vessels that carry blood away from the heart - the aorta and the pulmonary artery - is switched (transposed)

138. DISORDERS OF HEART RHYTHM Chapter 14

139. Sinus Bradycardia It is a cardiac rhythm characterized by a slowness of the heartbeat, usually at a rate under 60 beats per minute

140. Ventricular tachycardia It is a rapid resting heart rate initiated within the ventricles, typically at 160 - 240 beats per minute

141. Sick Sinus Syndrome It is a collection of heart rhythm disorders that include alternating slow and fast heart rhythms

142. Cardiac Pacemaker A pacemaker is a small, battery-operated electronic device inserted under the skin to help the heart beat regularly at an appropriate rate

143. DISEASES OF ENDOCARDIUM Chapter 15

144. Infective Endocarditis It involves the heart valves and is most commonly found in people who have underlying heart disease

145. Infective Endocarditis Sources of the infection may be due to transient bacteremia, which is common during minor surgical procedures

146. Surgical Procedures These are commonly done dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures

147. Vegetations The infection can cause growths called as vegetations on the heart valves, the lining of the heart, or the lining of the blood vessels.

148. Embolism These growths may be dislodged and send clots to the brain, lungs, kidneys, or spleen resulting in what is called an embolism Coming up an Animation of Cerebral Embolism

149. Cerebral Embolism

150. DISEASES OF MYOCARDIUM Chapter 16

151. Myocarditis It is acute inflammation of the muscle of heart due to infections especially of viral etiology like Coxachie B

152. Cardiomyopathy It is a disease affecting the muscle of the heart resulting in thickness and loss of function. It is of three varieties

153. Hypertrophic Cardiomyopathy It is a condition in which there is primary thickening of the muscle of the heart in the inter-ventricular septum resulting in an obstruction

154. Dilated Cardiomyopathy Here the thickening of the myocardium results in dilation and  functioning of the chambers of heart especially the ventricles

155. DISEASES OF PERICARDIUM Chapter 17

156. Pericardium It is a thin double-layered sac which encloses the heart. Fluid contained within the layers lubricates constantly rubbing surfaces

157. Pericarditis It is caused by inflammation of the pericardium, the sac-like covering of the heart and resulting in pain

158. Pericardial Effusion It is a collection of fluid in excess of the normal quantity, in the pericardium, producing compression of the heart

159. Cardiac Tamponade It is a compression of the heart caused by blood or fluid accumulation in the space between the layers of the pericardium of heart

160. Summary Heart Diseases are many Coronary Artery Disease is important Hypertensive Heart Disease too Valvular Heart Disease is still common Congenital Heart Disease is rare Investigations help us in diagnosis Early Treatment is advisable Prevention is better than cure

161. MAY YOUR HEARTS WORK FOR EVER