Heart diseaseHeart diseaseprevention and treatmentprevention and treatment

Dr Jamshed J DalalDr Jamshed J Dalal

Kokilaben Dhirubhai Ambani Kokilaben Dhirubhai Ambani HospitalHospital

Treatment of Treatment of Coronary Artery DiseaseCoronary Artery Disease

Early DiagnosisEarly Diagnosis

Early Recognisation of Risk Factor Early Recognisation of Risk Factor

& Modification of Risk Factor& Modification of Risk Factor

Early TreatmentEarly Treatment

- Medical Management- Medical Management

- Coronary Angioplasty- Coronary Angioplasty Bypass Surgery (CABG)Bypass Surgery (CABG)

Family History and IHDFamily History and IHD

Genetic factorsGenetic factors Environmental factorsEnvironmental factors Psychological social factorsPsychological social factors

WHAT IS CHOLESTEROL ?

Management of Hypercholesterolemia :Management of Hypercholesterolemia :

1)1) EducationEducation

2) 2) DietDiet

3) 3) ExerciseExercise

4)4) Drug therapyDrug therapy

PINCH TEST

Diabetes Mellitus and heart Diabetes Mellitus and heart diseasedisease

Diabetes is well established risk Diabetes is well established risk factorfactor

Increases risk Two to four timesIncreases risk Two to four times

Metabolic syndrome-Metabolic syndrome- big stomach, high big stomach, high trigycerides, high BP, diabetes.trigycerides, high BP, diabetes.

Type A - PersonalityType A - Personality

AmbitiousAmbitious

AggressiveAggressive

Very ActiveVery Active UnsatisfiedUnsatisfied Non-adjustableNon-adjustable

A

Diagnosis of CAD

Gold Standard

ECG

ECHO

Stress Test

Coronary AngiographyCoronary Angiography

RoutesRoutes

1. Femoral artery approach1. Femoral artery approach

2.2. Radial artery approachRadial artery approach

Procedure TimeProcedure Time

10 minutes10 minutes

OPD – Day Care ProcedureOPD – Day Care Procedure

4-5 hrs Hospitalisation4-5 hrs Hospitalisation

CT angiographyCT angiography

ANGIOPLASTYANGIOPLASTY

Arm or legArm or leg One hour procedureOne hour procedure 24 to 48 hr stay24 to 48 hr stay No anesthesiaNo anesthesia Back to work immediatelyBack to work immediately

Medicated stentsMedicated stents

Special drug coating on the stent which Special drug coating on the stent which gets liberated at the site of blockage and gets liberated at the site of blockage and reduces the chance of recurrence.The reduces the chance of recurrence.The drug is liberated over six weeks. Reduces drug is liberated over six weeks. Reduces reblockage chances to only 5-6%reblockage chances to only 5-6%

TREATMENTTREATMENT

Non drugNon drug MedicalMedical AngioplastyAngioplasty Bypass surgeryBypass surgery

Medical ManagementMedical Management

AspirinAspirin

-blocker-blocker

Ace InhibitorsAce Inhibitors

Lipid Lower AgentsLipid Lower Agents

StatinsStatins

BYPASS SURGERYBYPASS SURGERY

More traumatic, needs general anesthesiaMore traumatic, needs general anesthesia Useful when there are too many blocksUseful when there are too many blocks One month to recoverOne month to recover Long lasting if arterial grafts used - Long lasting if arterial grafts used - total total

arterial graftingarterial grafting Beating Heart Surgery Bypass surgeryBeating Heart Surgery Bypass surgery

is done without stopping the heart – no is done without stopping the heart – no heart lung machineheart lung machine

WHERE

YOU

EAT

Type A – Personality : Type A – Personality : TreatmentTreatment

StretchesStretches

RelaxationRelaxation

MeditationMeditation

Yogic BehaviorYogic Behavior

PsychotherapyPsychotherapy

20minutes

ControlStress-yoga

ControlObesity

ControlDiabetes

ControlFats

ControlBlood Pressure

Relaxation

Avoid SmokingRegularExercise

Prevention of Coronary Artery DiseasePrevention of Coronary Artery DiseasePrevention of Coronary Artery DiseasePrevention of Coronary Artery Disease

Prevention is better, Prevention is better, cheaper, andcheaper, and

easier, than treatment easier, than treatment & remember there is & remember there is

no real cureno real cure