You &Your Heart Dr B K Goyal MD, FAMS, FRCP, FACC, FSCAI (USA) Director Interventional...

You &Your HeartYou &Your HeartYou &Your HeartYou &Your Heart

Dr B K GoyalMD, FAMS, FRCP, FACC, FSCAI (USA)

Director

Interventional Cardiology

Bombay Hospital & Medical Research Centre,

Mumbai, India

Dr B K GoyalMD, FAMS, FRCP, FACC, FSCAI (USA)

Director

Interventional Cardiology

Bombay Hospital & Medical Research Centre,

Mumbai, India

Heart FactsHeart FactsHeart FactsHeart Facts

Is a muscle about the size of your fist

Weighs approximately one pound

Is located behind and slightly to the left of the breastbone

Pumps about 5 liters of blood every minute

Beats about 100,000 times in one day and about 35 million times in a year.

During an average lifetime, the human heart will beat more than 2.5 billion times.

Is a muscle about the size of your fist

Weighs approximately one pound

Is located behind and slightly to the left of the breastbone

Pumps about 5 liters of blood every minute

Beats about 100,000 times in one day and about 35 million times in a year.

During an average lifetime, the human heart will beat more than 2.5 billion times.

Whenever the blood is pumped from one section of the heart to another a valve closes behind it preventing the blood from moving backwards.

Blood Flow through HeartBlood Flow through Heart

Cool picturesCool picturesCool picturesCool pictures

JH

2 coronary arteries branch from the main aorta justabove the aortic valve.

“No larger than drinking straws, they divide and encircle the heart to cover its surface with a lacy network that reminded physicians of a slightly crooked crown (coronary comes from the Latin coronarius, belonging to a crown or wreath).

They carry out about 130 gallons of blood through the heart muscle daily.”

Blood Supply To The Heart

DR. ANIL SHARMA

From 1960 to 2001, prevalence of Coronary Artery Disease (CAD) increased from –

3% to 11% in urban India

2% to 4% in rural India

Every 9 th person is suffering from CAD in urban INDIAIndian Heart J 2001: 53 : 282-292

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Year

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CVD/CAD Burden - INDIACVD/CAD Burden - INDIACVD/CAD Burden - INDIACVD/CAD Burden - INDIA

Prevalence - Urban - 11%, rural - 4%

Total Burden - 80 million / Yr.

ACS- 20 million {80 lakhs are < young(< 40 years Age)}

2 times increase in last 3 decades

CVD mortality

1990-23% of all deaths (15 lakhs)

2020- 34% of all deaths (30 lakhs)

(Will be no.1 killer)

Prevalence - Urban - 11%, rural - 4%

Total Burden - 80 million / Yr.

ACS- 20 million {80 lakhs are < young(< 40 years Age)}

2 times increase in last 3 decades

CVD mortality

1990-23% of all deaths (15 lakhs)

2020- 34% of all deaths (30 lakhs)

(Will be no.1 killer)

Risk FactorsRisk FactorsRisk FactorsRisk Factors

NonmodifiableNonmodifiable

•Hereditary

•Sex (Gender)

•Age

•Race

ModifiableModifiable

•Stress and anger

•Smoking

•Physical inactivity

•Obesity

•High blood cholesterol

•Diabetes

•High blood pressure

MODERN LIFE STYLEMODERN LIFE STYLE

STRESS

SMOKING

DIETARY HABITS

SEDENTARY LIFESTYLE

““Genes load the gun.Genes load the gun.Lifestyle pulls the trigger”Lifestyle pulls the trigger”

Dr. Elliot Joslin

Lifestyle Factors

STRESSSTRESSSTRESSSTRESS

WHAT IS STRESS?WHAT IS STRESS?WHAT IS STRESS?WHAT IS STRESS?

Stress is your mind and body’s response or reaction to a real or imagined threat, event or change.

The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change).

Expectations – Performance = Stress

Stress is your mind and body’s response or reaction to a real or imagined threat, event or change.

The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change).

Expectations – Performance = Stress

YOGAYOGAYOGAYOGA

SMOKINGSMOKINGSMOKINGSMOKING

The Result of SmokingThe Result of SmokingThe Result of SmokingThe Result of Smoking

The healthy eating concept

DIET- AVOID

DIET- ENCOURAGE

UNDERNOURISMENT and OVERNOURISHMENT are equally bad

Avoid FAST & FEAST

A FAT or CHUBBY child should not be looked upon with pride

UNDERNOURISMENT and OVERNOURISHMENT are equally bad

Avoid FAST & FEAST

A FAT or CHUBBY child should not be looked upon with pride

SEDENTARY LIFESTYLE SEDENTARY LIFESTYLE SEDENTARY LIFESTYLE SEDENTARY LIFESTYLE

LOSE WEIGHT

EXERCISE

There is evidence that heavy drinking of alcohol—more than 3–4 oz of 100 % proof whiskey, 18 oz of wine, or 36–48 oz of beer each day—raises the blood pressure.

LIMIT ALCOHOL

Reduce salt used in cooking, a little bit each day until you no longer use any.

Remember, if you are being treated for heart failure, try to keep your sodium intake below 2000 mg (approx. 1 teaspoon) per day.

REDUCE SALT INTAKE

AAHAR AAHAR

VIHARVIHAR

VICHARVICHAR

TAKE HOME MESSAGE TAKE HOME MESSAGE

Coronary Artery DiseaseCoronary Artery DiseaseCoronary Artery DiseaseCoronary Artery Disease Coronary artery disease is one of the most common and

serious effects of aging. Fatty deposits build up in blood vessel walls and narrow the passageway for the movement of blood. The resulting condition, called atherosclerosis often leads to eventual blockage of the coronary arteries and a “heart attack”.

Coronary artery disease is one of the most common and serious effects of aging. Fatty deposits build up in blood vessel walls and narrow the passageway for the movement of blood. The resulting condition, called atherosclerosis often leads to eventual blockage of the coronary arteries and a “heart attack”.

Signs and SymptomsSigns and SymptomsSigns and SymptomsSigns and Symptoms None: This is referred to as silent ischemia. Blood to your heart may be restricted due to CAD, but you don’t feel any effects.

Chest pain: If your coronary arteries can’t supply enough blood to meet the oxygen demands of your heart, the result may be chest pain called angina.

Shortness of breath: Some people may not be aware they have CAD until they develop symptoms of congestive heart failure- extreme fatigue with exertion, shortness of breath and swelling in their feet and ankles.

Heart attack: Results when an artery to your heart muscle becomes completely blocked and the party of your heart muscles fed by that artery dies.

None: This is referred to as silent ischemia. Blood to your heart may be restricted due to CAD, but you don’t feel any effects.

Chest pain: If your coronary arteries can’t supply enough blood to meet the oxygen demands of your heart, the result may be chest pain called angina.

Shortness of breath: Some people may not be aware they have CAD until they develop symptoms of congestive heart failure- extreme fatigue with exertion, shortness of breath and swelling in their feet and ankles.

Heart attack: Results when an artery to your heart muscle becomes completely blocked and the party of your heart muscles fed by that artery dies.

Signs & Symptoms

NoneChestPain

ShortnessOf Breath

HeartAttack

DiagnosisDiagnosisDiagnosisDiagnosis

StressStressTestTest

measures

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CoronaryCoronaryAngiographyAngiography

spec

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spec

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showsshows

coro

nar

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coro

nar

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Narrowing inNarrowing in

Sites of

Sites of

ECGECG

measures

measures

elec

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impulses

impulses

ECGECGECGECG

•Blood tests: used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia.

•Chest X-ray: shows the size of your heart and whether there is fluid build up around the heart and lungs.

•Echocardiogram: shows a graphic outline of the heart’s movement. Ejection fraction (EF): determines how well your heart pumps with each beat.

Many people are able to manage coronary artery disease with lifestyle changes and medications.

Other people with severe coronary artery disease may need angioplasty or surgery.

Many people are able to manage coronary artery disease with lifestyle changes and medications.

Other people with severe coronary artery disease may need angioplasty or surgery.

Treatment-ANGIOPLASTY• A balloon catheter is passed through the guiding catheter to the

area near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing.

• The angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment.

• Balloon is inflated, compressing the plaque against the artery wall

• Once plaque has been compressed and the artery has been sufficiently opened, the balloon catheter will be deflated and removed.

Treatment-STENTING

• A stent is introduced into a blood vessel on a balloon catheter and advanced into the blocked area of the artery

• The balloon is then inflated and causes the stent to expand until it fits the inner wall of the vessel, conforming to contours as needed

• The balloon is then deflated and drawn back

• The stent stays in place permanently, holding the vessel open and improving the flow of blood.

1616thth September 1977 September 1977 Coronary Angioplasty Coronary Angioplasty1616thth September 1977 September 1977 Coronary Angioplasty Coronary Angioplasty

In Zurich Switzerland, Gruentzig performed the first coronary angioplasty on an awake human

In Zurich Switzerland, Gruentzig performed the first coronary angioplasty on an awake human

ANGIOPLASTY - 1977ANGIOPLASTY - 1977 ANGIOPLASTY - 1977ANGIOPLASTY - 1977

SINGLE VESSELSINGLE VESSEL

SINGLE, DISCRETE LESIONSINGLE, DISCRETE LESION

GOOD LV FUNCTIONGOOD LV FUNCTION

TRANSFEMORAL(GROIN)TRANSFEMORAL(GROIN)

Pre During Post

LAD Lesion

Bare Metal Stents A stent is a small round tube usually

made of stainless steel,

which is designed to support the wall

of the coronary artery.

Bare Metal Stents A stent is a small round tube usually

made of stainless steel,

which is designed to support the wall

of the coronary artery.

What’s hotWhat’s hot……What’s hotWhat’s hot……

Drug Eluting Stents-2002

Drug Eluting Stents-2002

ANGIOPLASTY - 2010ANGIOPLASTY - 2010ANGIOPLASTY - 2010ANGIOPLASTY - 2010

MULTIVESSEL DISEASEMULTIVESSEL DISEASE

COMPLEX LESIONSCOMPLEX LESIONS

IMPAIRED LV FUNCTIONIMPAIRED LV FUNCTION

TRANSRADIAL (WRIST)TRANSRADIAL (WRIST)

Treatment-CABG

• Healthy blood vessel is removed from leg, arm or chest

• Blood vessel is used to create new blood flow path in your heart

• The “bypass graft” enables blood to reach your heart by flowing

around (bypassing) the blocked portion of the diseased artery. The increased blood flow reduces angina and the risk of heart attack.

CABG VS. AngioplastyCABG VS. AngioplastyCABG VS. AngioplastyCABG VS. Angioplasty

My patient needs coronary revasculariztion

Should he/she have

Coronary Artery Bypass Surgery Or

Angioplasty?

TAKE HOME MESSAGE TAKE HOME MESSAGE Life is a Matter of “Balance”Life is a Matter of “Balance”

PREVENTIONPREVENTIONDIET, EXERCISEDIET, EXERCISE

ANGIOPLASTY, SURGERY

INTERVENTION

DR. B K Goyal

THANK YOU THANK YOU