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Dr Amar Prabhudesai
M.D.,D.M.
Consultant Interventional Cardiologist
Manipal Hospital
WHAT DO WE WANT
“?”
WE WANT
Long life – 120 years
No disease, sickness at all
Diabetes, high BP, joint pain, cancer etc –NOT at all
Lots of energy, stamina, joy, happiness
Enough money for needs
WHAT WE SEE
Average age 70-75
Fever, cold/cough, other sickness once a year -on average
By age 50 substantial numbers suffer diabetes, high BP, (or both), joint pains, stones, fibroids, chronic cold/cough, etc.
leading cause of death -worldwide
Coronary disease 7.2 million
Cancer 6.3
Cerebrovascular disease 4.6
Acute lower respiratory tract infections 3.9
Tuberculosis 3.0
COPD (chronic obstructive pulmonary disease) 2.9
Diarrhoea (including dysentery) 2.5
Malaria 2.1
AIDS 1.5
Hepatitis B 1.2
A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIATHE W.H.O FIGURES SAY THAT THERE ARE MORE THAN FOUR MILLION HEART PATIENTS IN INDIA.
INDIA HAS THE HIGHEST RATE OF HEART ATTACKS IN
THE WORLD.
A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIA
10 YRS. EARLIER IN INDIANS COMPARED TO WESTERNERS
THE INCIDENCE OF CORONARY ARTERY DISEASE IS AS FOLLOWS
URBAN RURAL
MALES 65/100 MALES 22.8/100
FEMALES 45/100 FEMALES 17.2/100
The Normal Artery
A healthy artery can do its job of pushing blood through out your body.
A normal artery is free of plaque formation
The artery wall is very thick and elastic
PlaquePlaque is the accumulation of fats
including cholesterol
Mild to Moderate plaque formation and damage to the walls of the artery
Progression of AtherosclerosisHealthyartery
Earlylesion
Vulnerableplaque
Stable plaque“Fibrofatty” stage
Lumen maintained
Intima thickens, atheromatous gruel
forms under cap
Lumen narrows
teenager 50 year old
Heart attack symptoms Shortness of breath
fatigue
nausea and heartburn
feeling of impending death.
Other important facts:
Most heart attacks occur between 4.00am end 10am due to higher adrenaline amounts released in the body during early morning hours.
25% of all heart attacks are “silent”- without chest pain.
Diabetics are at greater risk for “silent” heart attacks.
WHAT CAUSES HEART DISEASE? SMOKING
STRESS
HIGH CHOLESTEROL
DIABETES
HYPERTENSION
LACK OF EXERCISE
HEREDITY
GENDER
Having central obesity
Central obesity means carrying extra weight around the waist, as opposed to the hips
A waist measurement of more than 40 inches for Gentle men and more than 35 inches for women means you have central obesity
Type of polyunsaturated fat.
Consistently lowers serum triglycerides and may also have an effect on lowering blood pressure.
Found in oily fish such as salmon, tuna, and herring.
Is available as a supplement.
Example: Olive Oil
What about Omega 3 ?
Plasma cholesterol levels
WHAT IS THE WAY
FORWARD
“?”
World Health Orgenisation (WHO)
definition of health; “Health is a state
of complete physical, mental & social
well being and not merely an absence
of disease or infirmity.”
ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES
PRIMARY PREVENTION
STRESS REDUCTION
LIFE STYLE MODIFICATION
REGULAR CHECKUPS, CONTROL OF DM,HT, LIPIDS
SECONDARY PREVENTION
PROPHYLACTIC ASPIRIN
CHOLESTEROL LOWERING DRUGS
*Trans fatty acids also raise LDL-C and should be kept at a low intake.Note: Regarding total calories, balance energy intake and expenditure to maintain
desirable body weight.
<200 mg/dCholesterol
~15% of total caloriesProtein
20–30 g/dFiber
50%–60% of total caloriesCarbohydrate (esp. complex carbs)
25%–35% of total caloriesTotal fat
Up to 20% of total caloriesMonounsaturated fat
Up to 10% of total caloriesPolyunsaturated fat
<7% of total caloriesSaturated fat*
Recommended IntakeNutrient
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.
ATP III Dietary Recommendations
ATP=Adult Treatment Panel
FOOD CHART
BE CRAZY TAKE
REGULARLY
TAKE
SOMETIMES
AVOID BAN
Amla Roti Dosa Ice Cream Non-Veg
Sprouts (variety) Vegetables Utappam Sweets Deep fried
Mausambi Dals Cool Drink Liquor
Guava, apple Idli Chips Maggi
Badam, Akhrot Seasonal Fruits Pizza Biscuits Pan masala
Kishmish, Munakka,
Figs
Banana Lobia Cakes Smoking
Water Sendha Salt Kalachana Pastries
WGJ/BGJ/VCJ Popcorn Maida Items Kulcha
Coconut (small qty) ISABGOL Bhutta Sugar & Salt Kardhi
Ginger Dokhla Chocolates Fried rice
Onion Curd Milk More Oil Chowmeine
Muli(Morning) Cottage Cheese Rajma Preserved
Juices
Beetroot(Morning) Gachak (Winter) Kabuli Chane Medicines
Turnip(Morning) Groundnut(Winter) Namkins
Drumsticks(+Leaves) Black Pepper Tea & Coffee
Tender Coconut Pappad
Pista, Kaju Salads Chats
Totakura, Lettuce
K.Patta, Neem Supplements Rice
Pudina, Dhania Green tea Bread
Tomato, Cabbage Cinnamon Pan
Karela Tomato Sauce
Oats, Barley Butter, Jams
Olive Oil Paratha
Honey Manchurian
Fresh Grapes
Cucumber
Oxygen
Butter Milk
SoyabeanItem
- Soya Milk
- Tofu
- Mix in Atta 1:10
- Nutri nuggets
- Soya Sprouts
- Soya Oil
Dates ( Winter)
Bel ( Summer)
Mango Panna (Summer)
Nuts & Heart Diseases
• Myth – Nuts are bad for heart & they increase cholesterol
• Fact - WRONG : In fact it is a complete & healthy food
Free from cholesterol
Monounsaturated Fats (MuFA), Protein, CHO,
Minerals, Vitamins, Iron, Calcium & Fiber
20-40 gm/day of Nuts reduces cholesterol
• Caution – Contains calories, can trigycerides,
Avoid in obese patients
Fruits & Vegetables 5 servings of fruits & vegetables reduces heart attacks by 25-30%
A Comparison of Cooking Fats
77%
49%
25%
24%
20%
13%
28%
77%
69%
61%
62%
33%
9% 14%
18%
13%
15%
11%
10%
69%
Olive oil
Peanut oil
Corn oil(Mustard)
Soyabean oil
Sunflower oil
Saffower oil (Kardi)
Butter / Ghee(Coconut / Palm)
Monounsaturated Fatty Acids (MUFA)
Protects ‘good’ cholesterol (HDL) and reduces the level of ‘bad’ cholesterol (LDL)
reduces the risk of heart disease and diabetes
Polyunsaturated Fatty Acids (PUFA)
Reduces levels of both ‘good’ (HDL) and ‘bad’ (LDL cholesterol
Oxidises readily
Breaks down into potentially toxic substances during cooking
Saturated Fatty Acids (SFA)
Increases levels of ‘bad’ (LDL) cholesterol
increases the risk of cardiovascular disease
3%
Adults Need 30-60 Minutes of Moderate Activity Each Day
Moderate activity is one that requires as much energy as walking 2 miles in 30 minutes
Adults Need 30-60 Minutes of Moderate Activity Each Day
Moderate activity is one that requires as much energy as walking 2 miles in 30 minutes
Be Careful with Alcohol
One “drinking equivalent” equals:
12 ounce of beer
4 ounce of wine
1.5 ounce of 80 proof spirits(rum, gin, vodka, whiskey).
Men may be permitted 1-2 drinks per day and
women 1 drink per day to accrue health
benefits.
Statins and CAD Lots of evidence
Safe
Easily available
Need of the hour
ASPIRIN Diabetes
Age
Gender
Risk factors
Risk of heart attack
DR AMAR PRABHUDESAICONSULTANT INTERVENTIONAL CARDIOLOGIST
Common Procedures Coronary Angiography
Coronary Angioplasty
Peripheral Angiography
Peripheral Angioplasty
Permanent Pacemaker
Implantable Cardioveter Defibrillator (ICD)
Cardiac Resynchronization Therapy(CRT)
Balloon Valvotomy
IVC filters
Device Closures
ANGIOGRAPHY
CORONARY ANGIOGRAPHY
INDICATIONS FOR CAG
PROCEDURE TIME – 15 MIN
HOSPITAL STAY?
COST?
ADVANTAGES OF RADIAL EARLY DISCHARGE
LESS LOCAL COMPLICATIONS
DISADVANTAGES OF RADIAL ANATOMIC VARIANTS
RISK OF RADIAL ARTERY CLOSURE
HARDWARE LIMITATIONS
CORONARY ANGIOPLASTY
INDICATIONS SYMPTOMS
BLOCKAGE >70%
PROCEDURE TIME?
COST?
HOSPITAL STAY?
PRIMARY CORONARY ANGIOPLASTY
THROMBOLYSIS PRIMARY PCI
EASILY AVAILABLE
LESS COSTLY
LESS EFFECTIVE
RISK
FEW CENTRES
EXPENSIVE
MORE EFFECTIVE
RISK
RESCUE ANGIOPLASTY
PERIPHERAL ANGIOGRAPHY
INDICATIONS PAIN
ULCER- NON HEALING
IVC FILTER
CLOT IN THE LEGS
CANNOT TAKE BLOOD THINNERS
PULMONARY CLOT DESPITE BLOOD THINNERS
PERMANENT PACEMAKER
INDICATIONS SLOW HEART RATE
SYMPTOMS
PPI PROCEDURE TIME?
COST?
ICD FOR FAST HEART RATE
PRIMARY- ANYONE WITH A WEAK HEART
SECONDARY
COST?
CARDIAC RESYNCHRONISATION THERAPY
INDICATION WEAK HEART
HEART FAILURE SYMPTOMS
BALLOON VALVOTOMY
DEVICE CLOSURES HOLE IN THE HEART
CHILDREN & ADULTS
CAN SUBSTITUTE SURGERY IN SOME PATIENTS