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Cardiology
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HEART ATTACKHEART ATTACK
VINEET MALIKVINEET MALIKCONSULTANT INTERVENTIONAL CARDIOLOGYCONSULTANT INTERVENTIONAL CARDIOLOGY
BL KAPUR MEMORIAL HOSPITALBL KAPUR MEMORIAL HOSPITAL
NEW DELHINEW DELHI
• Leading cause of Death in 21st Century
• 50% of People who die of heart attacks do not
have any preceeding Symptom
• Atherosclerosis begins in childhood and
advances throughout life
• Women are relatively protected till menopause
CORONARY ARTERY DISEASE
MagnitudeOne in ten adult men
&One in nine women aged 45
to 65 years&
One in three both men and women after age of 65
Suffer from CAD!
ESTIMATED CAD LOADESTIMATED CAD LOAD
• TOTAL POPULATION OF INDIA > 100 CRORE
• ESTIMATED ADULT POPULATION (above 40 years)
~ 60 CRORE
• ESTIMATED CAD SUFFERERS ~ 6 CRORE
FURTHER 20 CRORE ARE AT RISK IN NEXT DECADE
THE HUMAN HEARTTHE HUMAN HEART
How The Fat Deposits In Your Blood Vessels
ncreased deposition of ‘bad cholesterol’I
This is known as atherosclerosis
Normal blood vessel
Deposition of ‘bad cholesterol’
The Blockage Of Coronary Arteries
The Heart Attack-Myocardial Infarction-The Damaged Heart
THE HEART PAINTHE HEART PAIN
Associated symptomsAssociated symptoms
DyspneaDyspnea
Diaphoresis Diaphoresis
Weakness Weakness
NauseaNausea
Vomiting Vomiting
Diarrhea Diarrhea
Impending DoomImpending Doom
E C G
THE CONCEPT OF THE CONCEPT OF GOLDEN HOURGOLDEN HOUR
•MAXIMUM DAMAGE TO HEART MUSCLE
•MAXIMUM EFFICACY OF TREATMENT SEEN
•SURVIVAL IS BEST IF CLOT BUSTER DRUGS
GIVEN WITHIN THIS PERIOD
TIME IS MUSCLE AND MUSCLE IS TIME
REASONS FOR DELAYREASONS FOR DELAY
• DISBELIEF THAT THE SYMPTOMS ARE DISBELIEF THAT THE SYMPTOMS ARE
FROM HEARTFROM HEART
• DON’T WANT TO PANIC AND BE AN DON’T WANT TO PANIC AND BE AN
INCONVENIENCE TO THE FAMILYINCONVENIENCE TO THE FAMILY
• FINANCIAL CONSTRAINS FINANCIAL CONSTRAINS
• WHOM TO CONTACT AND WHERE TO WHOM TO CONTACT AND WHERE TO
CONTACT AT THIS HOURCONTACT AT THIS HOUR
IMMEDIATE MEASURESIMMEDIATE MEASURESDISPIRINDISPIRINAVOID EXERTIONAVOID EXERTIONINFORM FRIENDS OR FAMILYINFORM FRIENDS OR FAMILYCALL FOR AMBULANCECALL FOR AMBULANCE
CLOT BUSTER CLOT BUSTER OR OR
ANGIOPLASTYANGIOPLASTY
HEART COMMANDHEART COMMAND
INTENSIVE CAREINTENSIVE CARE
RECOVERY AFTER RECOVERY AFTER HEART ATTACKHEART ATTACK
ACTIVITY4 – 5 DAYS BED REST IN HOSPITAL
HALF NORMAL ACTIVITIES AT HOME FOR 1 WEEK
NORMAL ACTIVITIES FROM 3RD WEEK
RISK STRATIFICATION
SECONDARY PREVENTION
TMT
RISK STRATIFICATIONRISK STRATIFICATION
ECHO
RISK STRATIFICATIONRISK STRATIFICATION
THE GOLD STANDARD
ANGIOGRAPHY
ACCESS FOR ACCESS FOR PROCEDUREPROCEDURE
ANGIOGRAPHY
WHAT AFTER ANGIOGRAPHY?WHAT AFTER ANGIOGRAPHY?
MEDICAL MANAGEMENT
ANGIOPLASTY
BYPASS SURGERY
CORONARYCORONARY
ANGIOPLASTYANGIOPLASTY
BALLOONINGBALLOONING
BALLOON PLASTYBALLOON PLASTY
STENTINGSTENTING
BALLOON THERAPYBALLOON THERAPY
CORONARY ANGIOPLASTYCORONARY ANGIOPLASTY
BALLOONINGBALLOONING
STENT DEPLOYMENTSTENT DEPLOYMENT
RESULT OF ANGIOPLASTYRESULT OF ANGIOPLASTY
RECOVERY FROM RECOVERY FROM ANGIOPLASTYANGIOPLASTY
• BED REST FOR 1 DAY IN ICUBED REST FOR 1 DAY IN ICU
• START WALKING ON 2START WALKING ON 2NDND DAY IN HOSPITAL DAY IN HOSPITAL
• HALF NORMAL ACTIVITIES IN NEXT 4 DAYS HALF NORMAL ACTIVITIES IN NEXT 4 DAYS
AT HOMEAT HOME
• FULL ACTIVITIES FROM NEXT WEEK BACK FULL ACTIVITIES FROM NEXT WEEK BACK
TO WORKTO WORK
• FULL HEALTHY DIET FROM DAY 2FULL HEALTHY DIET FROM DAY 2
Bypass Surgery
Bypass Surgery
BYPASS SURGERYBYPASS SURGERY
Bypass Surgery
BYPASS SURGERY ON A BYPASS SURGERY ON A BEATING HEARTBEATING HEART
ROBOTIC HEART SURGERYROBOTIC HEART SURGERY
THE ULTIMATE CURETHE ULTIMATE CURE
PREVENTIONPREVENTION
CORONARY ARTERY DISEASECORONARY ARTERY DISEASECORONARY ARTERY DISEASECORONARY ARTERY DISEASE
RISK FACTORS
Family History
Stress
Lipoprotein ‘a’
Obesity
Smoking
Age / Sex
NIDDM
Hypertension
High TG, Low HDL , High LDL
Multiplier effect
The Major Risk Factors For CAD
Traditional Risk Factors
No Risk Factor?
Newer ToolsIMTFMDABI
PWVCal Score
Coronary Artery Disease
(Clinical Disease)
Endothelial Dysfunction
Atherosclerotic Plaque
(sub-clinical)
Atherosclerosis‘a long smoldering process!’
WHO IS OBESE?• BMI (Weight in kg/Height in
meters^2)– 19 to 25 Normal – 25 to 30 Over Weight– 30 to 35 Obese– > 35 Morbidly Obese
• Waist circumference– <35 inch (women)– <40 inch (men)
• Waist / hip ratio– < 0.85 – Apple vs pear
BALANCED DIET
Major portion from carbohydrates & proteins Less fat
Vegetables & fruits – 4-5 servings per day
High fibre diet Plenty of liquids (water & juices)
EAT LESS VS EAT MORE
• DIETATRY PRUDENCE
• AVOID SMOKING
• REGULAR EXERCISE
• STRESS MANAGEMENT –RELAXATION
–REST AND SLEEP
–FAMILY AND SOCIAL SUPPORT
–YOGA AND MEDITATION
LIVING WITH A HEALTHY LIVING WITH A HEALTHY HEARTHEART
THANK YOUTHANK YOU
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