The document discusses the heart and cardiovascular disease. It describes the heart as a muscle the size of a fist that pumps blood over 100,000 times per day. Coronary artery disease occurs when these arteries become blocked, causing angina or heart attack. Risk factors include age, family history, hypertension, cholesterol levels, diabetes, obesity, smoking, and physical inactivity. Treatment may involve medications, angioplasty, or bypass surgery. Lifestyle changes like a healthy diet, exercise, not smoking, and managing conditions can help prevent cardiovascular disease.

1. Dr. Jain T. Kallarakkal
MD FCCP FRCP DM
St Mary’s Hospital, Thodupuzha

2.  Is a muscle the size of a clenched
fist
 Is located behind the breastbone
 Pumps about 100,000 times a day
 Pumps about 7,600 litres of blood
per day

3.  Occurs when the coronary arteries
that supply the heart muscle become
blocked.
 Partially blocked it causes angina.
 When fully blocked it causes a
myocardial infarction or a heart
attack!

7.  Chest pain (angina)
 Heaviness, tightness, pain,
burning, pressure or squeezing
◦ behind the breastbone or in the
arms, neck, or jaws
 Perhaps no pain

8. Shortness of breath
Sweating
Nausea
Light-headedness

9.  Lack of oxygen due to ischemia (lack of blood
supply)
 Narrowing of coronary arteries
 Heart responds with angina
 Finally, heart attack (myocardial infarction)
 Possible permanent damage

12.  Help during a cardiac arrest
 Give breaths and pump the heart
 Done by ordinary people
 Saves lives

14.  Unchangeable Risk Factors
 Changeable Risk Factors

15.  Age- the older you get, the greater the
chance.
 Sex- males have a greater rate even after
women pass menopause.
 Family history- if family members have
had CHD, there is a greater chance.

16.  Hypertension
 Serum cholesterol
 Obesity
 Diabetes Mellitus
 Physical Inactivity
 Cigarette Smoking
 Alcohol Intake

17. “Blood pressure
measures how
hard blood
pushes against
the blood vessel
walls.”

18.  Top number = pressure when heart
contracts (systolic)
 Bottom number = pressure when heart
relaxes (diastolic)
 Example: healthy BP = 120
80

20. Increase risk of stroke
Increase risk of heart
disease
Damage kidneys and
eyes
Cause impotence
Disrupt circulation

21.  Waxy fat substance in the blood
 Our body needs cholesterol to function
 Liver makes all the cholesterol it needs to
survive
 Other sources of cholesterol come from food
 Cholesterol is found in animal products such as
meat, eggs and whole milk dairy products
 If the level of cholesterol gets to high, it can stick
to artery walls and cause serious health
problems

23.  HDL is known as the good cholesterol.
 It helps carry some of the bad cholesterol out of the
body.
 It does not have the tendency to clog arteries.
 Levels should be >35.
 High levels of HDL >60 can actually negate one
other risk factor.

24.  LDL is known as bad cholesterol. It has a
tendency to increase risk of CHD.
 LDL’s are a major component of the
atherosclerotic plaque that clogs arteries.
 Levels should be <130

28.  Associated with
 diabetes mellitus
 hypertension
 cholesterol abnormality
 Body mass index
Weight (kg)
Height (m2)
20-25 : Ideal
> 28 : Overweight
> 30 : Obesity

29.  People who are obese have 2 to 6 times
the risk of developing hypertension.
 Location of the body fat is significant.

30. What arethenormal
values of bloodsugar?
Nondiabetic Stateof theBody
Stateof theBody
Fasting
Fasting
2hours after meal
2hours after meal
BloodGlucoseinmg/dl
BloodGlucoseinmg/dl
Less than110
Less than140
Diabetic
Greater thanor equal to126
Greater thanor equal to200
6

31.  2-4 fold risk for CHD
 Asymptomatic CHD ~ 30-40%
 Painless AMI, arrythmias, CCF, longer
hospital stay
 CHD- A major (60%) cause of mortality

32.  Increasing physical activity has been
shown to decrease blood pressure.
 Moderate to intense physical activity for
30-45 minutes on most days of the week
is recommended.

33.  Causes an increase in blood pressure
 Lowers the levels of HDL
 Within 1 year of quitting, CAD risk decreases,
within 2 years it reaches the level of a nonsmoker.

34.  Contributes to development of atherosclerosis
 Lowers levels of HDL
◦ causes deterioration of elasticity of vessels
◦ Responsible for 20% of all deaths from heart
disease
 Female smokers have a higher risk than male
smokers

35.  In small amounts it acts as a vasodilator.
 In large amounts it acts as a vasoconstrictor &
adds to the caloric intake
 The good & Bad affects of Alcohol are divided
with a very fine line!

40. High Carbohydrate intake
Very little physical exertion
Very little interest in sports
Higher incidence of diabetes and obesity

41. • Typical History
• Electrocardiography
• Serum Cardiac Markers
• Echocardiography
• Stress Testing
• Myocardial Perfusion Imaging
• Coronary Angiography

42.  Call for help
 Do not attribute it to “Gas”
 Reach a hospital as soon as possible
 Insist on an ECG
 Attempt Cardiopulmonary Resuscitation

43.  Drugs
 Angioplasty & Stent
 Coronary Artery Bypass Surgery

44.  Aspirin is an antiplatelet agent
 Aspirin should be given in a dose of 75-325
mg/day to all patients with ACS unless there is a
contraindication
 Clopidogrel is a potent antiplatelet agent
 Give 300 mg loading dose followed by 75
mg/day

47.  Eat a variety of fruits and vegetables every day.
( 5 servings - they are naturally low in fat and
high in vitamins and minerals)
 Eat a variety of grain products
 Choose nonfat or low-fat products.
 Use lean meats- choose chicken, fish, turkey
and lean cuts of beef and pork.
 Switch to fat-free milk- gradually reduce the fat
content of the milk you drink.

48.  Choose fats with 2 gms or less of saturated fats
per serving such as liquid and tub margarines,
canola oil and olive oil.
 Balance the # of calories you eat with the
number of calories you use each day.
 Maintain a level of physical activity that keeps
you fit and matches the # of calories you eat.

49.  Limit your intake of foods high in calories and
low in nutrition, including foods like soft drinks
and candy.
 Limit foods high in saturated fat, trans fat and
cholesterol.
 Eat less than 6 gms of salt a day.
 Have no more than one alcoholic drink a day.

50.  Adults aged 18-64 should accumulate at least
150 minutes of moderate-to-vigorous intensity
aerobic physical activity per week in bouts of
10 minutes or more
 Be active most days of the week
 Consult a healthcare professional
before starting an activity program

51.  Avoid Smoking
 Blood Pressure Control, BP < 140/90
 Physical Activity
 Lipid Control. Cholesterol < 200 Mg/Dl
 LDL < 130 Mg/Dl
 HDL > 35 Mg/Dl
 Diabetic Control
 Weight Reduction
 Aspirin in High Risk Groups
 Diet . Cholesterol Free Diet with plenty of fruits
vegetables and fibres

53.  Cardiovascular disease is the number
one killer.
 It is highly preventable and
controllable with diet and exercise.