Ischaemic Heart Diseases by Prof.Dr.R.R.deshpande,Pune,India

1/6/2015 Prof.Dr.R.R.Deshpande 1

Introduction to IHD

• Presented By –

• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic

Medicine & M.D. in Ayurvedic Physiology)

• www.ayurvedicfriend.com

• Mobile – 922 68 10 630

• [email protected]

http://www.ayurvedicfriend.com/

mailto:[email protected]


WE ALL WILL TALK

• For the Heart

• With our hearts

• From our hearts

• This is real Democracy !!


Preventive Cardiology

• To boost up Immunity or Vyadhikshamatva

• What is Immunity ? ( Ayurved )

1) Vyadhi bala virodhitvam ( To arrest the

progress of disease )

2) Vyadhi utpadaktava pratibandhakatva

( To prevent occurrence of disease )


Primary Prevention

• Heart is like synonym of Rhythm .For

Healthy Heart ---- keep the Rhythm in our

life style !

• Balanced Diet ,Regular Exercise,

Adequate sleep & Rest ,Yoga will

maintain the Rhythm of our life .


Primary Prevention 2

• Avoid risk factors & keep away from vices


To arrest disease progress


What to Prevent ? -- IHD

• IHD – Ischemic Heart Diseases

• Angina Pectoris & Myocardial Infarction

(M.I.)

• Ischemia – Inadequate blood supply

• Infarct ------ Complete stoppage of blood

supply


Angina Pectoris

• Angina means

• Heart muscles are crying due to

inadequate coronary blood supply to

myocardium.


Angina Pectoris 2

• Cardiac pain of short duration & relieved by rest or sublingual vasodilator (sorbitrate)

• Pain in mid or upper sternal region or may be felt over left side of chest.

• Pain is constricting, squeezing,pressing or crushing in character. Neck is frequently described as chocking in character. There may be tingling sensation in left arm.


Angina Pectoris 3

• Pain may radiate -- along both the

shoulder & upper arm ,more commonly on

left side.

• Pain usually starts after---- exercise –

walking uphill or upstairs ,after heavy

meals ,emotional upsets, exposure to cold

weather or even during sexual intercourse.


Angina -- Investigations

• Resting ECG most of the time is not

useful.

But REMEMBER –

• Chest Pain = Cardiac Pain ,unless

proved otherwise .


Angina – Investigations 2

• Resting ECG may be helpful to diagnose LVH in chronic HT & RVH in COPD.

• Rule out or confirm Angina by Treadmill or step Test ( ECG monitoring when patient do walking exercise on moving belt under supervision )


Who has Angina ? Guess


Stable Angina

Exercise Testing

N.A.N

2009


Types of ST seg Depression. 1) Horizontal or plain ST seg Depression.

This signifies myocardial ischemia.

2) Upward slopping ST seg Depression.

This is variant of Normal & significant only if,

point Depression > 2mm


1)Horizontality of ST seg -

-ST seg – Horizontal & Isoelectric

-This is early manifestation of ischemia.

2)Downward slopping of ST seg -

This indicates severe Ischaemia

– Also seen in Digitalis toxicity.


Exercise (stress) Test 1) ST Depression

2) Sometimes T Inversion


1) ST Depression

2) Sometimes T Inversion


Stress Test Positive- What Next?

• Stress test positive – ST depression –

indicates weakness of Heart !!

• How much is the Weakness ? ---

Advice 2 D echo of Heart ,which costs

only Rs.700 TO 1000 /-


Stable Angina

2 D Echo

N.A.N

2009


2 D Echo Test

• This test gives measurements of walls of

cardiac chambers & also functional

Capacity.

• In Chronic Hypertension mostly there is

Left Ventricular Hypertrophy ( LVH)

• Carefully note Ejection Fraction ( EF )

EF is < 50 --- It indicates Heart is weak !


Heart is Weak --- Why ?

• Heart is weak due to less blood supply

through Coronary Arteries .

• Advice Coronary Angiography ,which

costs only around Rs. 10,000/-/

• This gives idea about which Coronary has

block ? Where ? & How much ?


Angiography

N.A.N

2009


Angiography

• Coronary Arteries are affected as follows

• Anterior Descending branch of Left

Coronary Artery ----- 75 %

• Right Coronary Artery -------- 20 %

• Left Circumflex branch ------- 05 %

• This gives idea whether there is one

vessel disease or 2 vessel disease or 3

vessel disease ?


Angiography ---- What Next ?

• If one or two vessel disease or blocks are

below 50 % ---- Advice Angioplasty .

• If 3 vessel Disease or block is more than

70 % -------- Advice CABG ( Coronary

Artery Bypass Grafting = Bypass Surgery )


Angioplasty

• During angioplasty, your doctor inserts a

special balloon-tipped catheter into your artery

and guides it to the blockage.

• Depending on the specifics of the blockage, your

doctor may place a stent in your artery. The

stent is an expandable device that is mounted

on a balloon catheter. The stent and balloon

are advanced to the blockage area, and the

stent is expanded into place.

http://heart-disease.emedtv.com/angioplasty/angioplasty.html


Angioplasty

• A stent supports the artery and helps it

remain open for a longer time. After the

stent has been placed, the body will grow

tissue over the stent to help maintain its

position. The stent will not move around

inside your body.

• An angioplasty procedure usually takes

from one to three hours


Coronary Artery Bypass Grafting

( CABG )

• CHD is a condition in which a substance

called plaque ( plak) builds up inside the

coronary arteries.

• During CABG ,a healthy artery or vein

from the body is connected or grafted to

the blocked artery.

• The grafted artery or vein bypass the

blocked portion of the coronary artery.


Progress of Angina

1 ) Stable Angina

2 )Unstable Angina – Pain more severe,

lasts longer ,occurs at rest ,not completely

relieved by Nitroglycerines.

3 ) Myocardial Infarction


Prevent --- Progress of Angina

• R/o Diabetes Mellitus

• Not Known Diabetic --- Fasting & Post

Glucose Sugar

• Borderline Sugar Levels ---- Glucose

Tolerance Test or Modified Glucose

Tolerance Test.

• Known Diabetic ---- Fasting & Post

prandial Blood sugar, Glcosylated Hb


Diabetes & Heart

• Blood Vessels become fragile

• Silent Myocardial Infarction --- May be

no pain .Can occur in long standing

Diabetes ,Hypertension ,elderly or middle

post operative patients


Prevent progress of Angina

• Ageing ----- Arteriosclerosis ------- High

Cholesterol --------- Atherosclerosis ------

Hypertension -------- LVH ( Left Ventricular

Hypertrophy ) ------- Angina ------ M.I.


Prevent Progress of Angina

1 Cholesterol Less than

200 mg %

2 HDL ( Good Cholesterol ) Greater than

45 mg %

3 LDL ( Bad Cholesterol ) Less than

130 mg %

4 Triglycerides Less than

150 mg %


Prevent -- Progress of Angina

• Rule out causes of Secondary Hypertension

• 1 ) Serum Urea & Creatinine

• 2 ) Abdominal Sonography

• 3 ) T 3 ,T 4 ,TSH

• 4 ) Renal Angiography ( To r/o Renal Artery Stenosis )

• 5 ) 24 hour Urine – 17 Keto steroids ( Pheochromocytoma )


Diagnose M.I --- At the Earliest !!

• Typical retrosternal Pain of Angina ,but

unlike Angina it starts at rest ,persists

longer & is not relieved by coronary

dilators (Angised ).



• Patient is anxious & restless .

• Profuse sweating but limbs are cold.

• Sometimes nausea, vomiting,sensation for

urination or defecation



• Yes !! ECG will definitely help !!

• But ECG changes may not be that much clear within first few hours & then you must repeat ECG & also can take help of other Investigations -----

• Let us have a look on various ECG patterns related with Heart Attack ----


Myocardial Infarction

3 cardinal signs on ECG in AMI -

1)Elevation of ST segment.

2)Inverted T wave.

3)Deep & wide Q wave.


Events in chronological Order

1)on 1st day - ST elevated

- with upright tall T wave

- but No Q wave

2)Over Next 2 day -

T wave will slowly become Inverted, ST seg still raised.

3)Towards the end of 1st wk -

- ST seg returning to base Level, T wave deeply inverted

- Q wave starts appearing.

- T wave - Pointed, Inverted & symmetrical Limbs.


4)In 3rd week -

- Q wave fully developed.

- ST - Base

- T – wave flat & Returning to Normal.

5)By the end of 3 month -

-St seg & T wave – Return to Normal.

-Only Q wave remains permanent.

(of course if size of infarct is TOO small -Q wave may disappear)

-Q wave size is proportional to size of infarct.


Anterior M.I.

= S T Elevation in V1 – V4


Anterior M.I.

= T Inversion in

V1 – V4


Lateral M. I.

- S T Elevation in I, aVL, V4 – V6

- Hyper acute T waves in V4 & V5


Inferior M.I

i) Q in II, III aVF

ii) T Inversion in II, III, aVF


i) Anterior M. I. - V1 to V4

ii) Lateral M. I. - I, aVL, V5 – V6

iii) Antero Lateral - I, aVL,

V1 – V6.

iv) Antero-septal - V1 – V3

v) Interior M.I. - II, III, aVF

vi) Infero Lateral - I, II, III

aVL, aVF,

V5-V6.



Sr.

No

Chemical Markers Values Comment

1 Serum Myoglobin (Earliest

Indicator )

(10-46 microgram

per lit)

Rs.1250/-

2 CardiacTroponin T (Rises

earlier)

Positive or

Negative

Rs.900 /-

3 SGOT.

Peak at 18 to 36 hours &

come down in 3 to 4 days.

40 U/L Rise in 8 to 12

hours.



• CK ( Creatine Kinase ) ----

• Normal Value – 25 to 195 U/L

• Levels start rising within 6 hours of onset

of Infarction. Peak at 24 hours & come to

normal within 48 to 72 hours.

• Cost --- Rs.350/-



• CKMB

• Normal Value – 0.25 U/L

• Specific Marker of Myocardial Necrosis.

• CKMB – Twice the upper limit indicates AMI


Appeal to all

Ayurvedic Practioner Friends

• Always claim our success with Documentary proof of Objective Parameters .

• Do not only present subjective Expressions of Patients like feeling better ,Pain is less while exertion ,less breathlessness ,feeling energetic etc.etc.


Appeal – Show Results

as follows

Sr.

No

Objective

Parameter

Pre

Treatment

Post

Treatment

1 PP Blood Sugar 400 mg 170 mg

2 Cholesterol 400 mg 180 mg

3 Ejection Fraction

( 2 D Echo )

30 55

4 Coronary

Blockage

(Angiography )

90 % 40 %


Book for your G.P.( Rs. 85 /-)

• Description of 60

common diseases or

218 symptoms

• Causes,Investigations

& readymade

prescriptions



• For successful

diagnosis clinical

examination of all 9

Important systems

• Ayurvedic Srotas

Examination

• Clinical Interpretation

of all Lab

Investigations.




V C D for your G.P.( Rs 200/-)


THANKS 4 HEARING

MY PRESENTATION

• I hope that it is useful

• My best regards

• Professor

Dr.R.R.Deshpande (M.D)

Mobile –

922 68 10 630

Education

Ischaemic Heart Diseases by Prof.Dr.R.R.deshpande,Pune,India