2. You &Your Heart Dr B K Goyal MD, FAMS, FRCP, FACC, FSCAI (USA) Director Interventional Cardiology Bombay Hospital & Medical Research Centre, Mumbai, India

3. Heart 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.

4. 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 Heart

5. Cool pictures JH

6. 2 coronary arteries branch from the main aorta just above 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

8. DR. ANIL SHARMA

10. 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 INDIA Indian Heart J 2001: 53 : 282-292

11. CVD/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)

12. Risk Factors Nonmodifiable Hereditary Sex (Gender) Age Race Modifiable Stress and anger Smoking Physical inactivity Obesity High blood cholesterol Diabetes High blood pressure

13. MODERN LIFE STYLE  STRESS  SMOKING  DIETARY HABITS  SEDENTARY LIFESTYLE

14. “Genes load the gun. Lifestyle pulls the trigger” Dr. Elliot Joslin Lifestyle Factors

15. STRESS

16. WHAT IS STRESS? lStress is your mind and body’s response or reaction to a real or imagined threat, event or change. lThe threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change). lExpectations – Performance = Stress

17. YOGA

18. SMOKING

19. The Result of Smoking

20. The healthy eating concept

21. DIET- AVOID

22. DIET- ENCOURAGE

23.  UNDERNOURISMENT and OVERNOURISHMENT are equally bad  Avoid FAST & FEAST  A FAT or CHUBBY child should not be looked upon with pride

25. SEDENTARY LIFESTYLE

26. LOSE WEIGHT

27. EXERCISE

29. 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

30. 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

31. AAHAR AAHAR VIHAR VIHAR VICHAR VICHAR TAKE HOME MESSAGE

32. Coronary 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”.

33. Signs 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. Signs & Symptoms None Chest Pain Shortness Of Breath Heart Attack

34. Diagnosis StressTestmeasuresblood supply to heart Coronary CoronaryAngiography specificshowscoronaries Narrowing in Sites of ECGmeasureselectrical impulses

35. ECG

36. 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.

37.  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.

38. 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.

39. 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.

41. 16 th September 1977 Coronary Angioplasty In Zurich Switzerland, Gruentzig performed the first coronary angioplasty on an awake human

42. ANGIOPLASTY - 1977 SINGLE VESSEL SINGLE, DISCRETE LESION GOOD LV FUNCTION TRANSFEMORAL(GROIN)

43. Pre During Post LAD Lesion

44. 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.

45. What’s hot … Drug Eluting Stents-2002

46. ANGIOPLASTY - 2010 MULTIVESSEL DISEASE COMPLEX LESIONS IMPAIRED LV FUNCTION TRANSRADIAL (WRIST)

47. 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.

48. CABG VS. Angioplasty My patient needs coronary revasculariztion Should he/she have Coronary Artery Bypass Surgery Or Angioplasty?

49. TAKE HOME MESSAGE Life is a Matter of “Balance” PREVENTION DIET, EXERCISE ANGIOPLASTY, SURGERY INTERVENTION

50. DR. B K Goyal THANK YOU