2. C ARDIOVASCULAR DISEASE Definition:  CVD or Heart disease is class of disease that involves the heart & blood vessels(arteries & veins)  CVD includes dysfunctional conditions of the heart, arteries & veins that supply oxygen to vital life- sustaining areas of the body like brain, the heart itself or other vital organs. If oxygen doesn’t arrive the tissue or organ will die.

3. Prevalence:-  CVD disease remain biggest cause of death worldwide though over the last two decades, cardio, vascular mortality rates have declined in many high incomes countries but have increased at fast rate in low & middle countries.  The prevalence of CAD in urban areas in India is 4-fold higher then the overall US rates.  Those in the high socio-economic group are the first ones to adopt an adverse life style such as high saturated fatty acid diet, sedentary life style & cigarette smoking.

4.  The percentage of premature death from CVD range from 4% in high income countries to 42% in low income countries..  More than 17million people died from CVD in 2008 in the world.

5. T YPES OF CARDIOVASCULAR DISEASE Coronary Heart Disease :- Refers to the failure of the coronary circulation to supply adequate circulation to cardiac muscle & surrounding tissue. Cardiomyopathy :- “ Heart muscle disease” Extrinsic Cardiomyopathies :- Cardiomyopathies where the primary pathology is outside the myocardium.

6. Most cardiomyopathies are extrinsic, because by for the most common of a cardiomyopathy is ischemia. Alcoholic cardiomyopathy Coronary artery disease Congenital heart disease Ischemic cardiomyopathy Valvular Cardiomyopathy

7. INTRINSIC CARDIOMYOPATHIES Dilated Cardiomyopathy:- (DCM) Hypertrophic Cardiomyopathy:- (HCM) Arrhythmogenic Right Ventricular Cardiomyopathy:- (ARVC) Restrictive Cardiomyopathy:- (RCM)

8. SIX MAIN TYPES OF CVD Ischemic Heart Disease. Cerebrovascular Disease. Heart Failure. Peripheral Vascular Disease. Hypertensive Heart Disease. Inflammatory Heart Disease.  Endocarditis.  Myocarditis. Valvular Heart Disease. Coronary Artery Disease.

9. RISK FACTOR The CVD is caused by multiple Risk Factor. These are:- Age Gender Family history Cigarette smoking Obesity Diabetes Hypertension Lack of Physical activity. High Saturated fat, High cholesterol Diet Alcoholic beverage consumption

10. CHOLESTEROL AND LIPOPROTEIN PROFILE CLASSIFICATION CHOLESTEROL READINGCLASSI FICATION Total Cholesterol (mg/dl) < 200 200-239 >240 LDL Cholesterol (mg/dl) < 100 100-129 130-159 160-189 >190 HDL Cholesterol (mg/dl) >60 <40 Triglycerides(mg/dl) < 150 150-199 200-499 >500 Desirable Borderline high risk High Risk Optimal Near Optimal Borderline High Risk High Risk Very High Risk Optimal Low Normal Borderline High Risk High risk Very High risk

11. SIGN & SYMPTOMS Angina (Chest Pain). Shortness of Breath (Dyspnea). Pain or Discomfort:- Pain or Discomfort in the arm & shoulder & jaw, neck or feeling weak, light headache. Syncope (Fainting). Reduced ability to exercise. Arrhythmias. Myocardial Infarction (MI). Ischemic stroke

12. C ONT ……..

14. DILATED CARDIOMYOPATHY(DCM) Definition:- o Dilated cardiomyopathy is a disease of the Heart Muscle, Primarily affecting Heart’s main Pumping chambers (ventricle). The ventricle become enlarged & can’t pump blood to body with as much force as a healthy heart can. Dilated cardiomyopathy is a common cause of Heart failure.

15. CAUSES OF DILATED CARDIOMYOPATHY The causes of dilated cardiomyopathy can’t be determined Such cases are called “ Idiopathic.” Birth Defects Infections Drug and alcohol abuse Certain cancer medications Family history of DCM Inflammation of heart muscle from immune system disorder Poor nutrition Inflammation Hereditary

16. SIGN & SYMPTOMS These include:- Arrhythmias which means irregular, fast or slow Heart rates. Syncope (Fainting) Dyspnea (Shortness of breath) When You are active or lying down. Swelling (edema) in your legs, ankles & feet swelling or your abdomen ( ascites) Lack of appetite. Light headache, dizziness or fainting Pale skin Vague chest pain

17. Sudden cardiac arrest (Heart stop beating) effectively.

18. CORONARY ARTERY DISEASE  Coronary artery disease is the narrowing or blockage of the coronary arteries usually caused by atherosclerosis. Atherosclerosis (sometimes called hardening or clogging of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries.  These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone & function.

19. RISK FACTORS Gender (Male) Advanced age Family history of heart disease Modifiable Risk Factors :- Cigarette smoking High blood Cholesterol Physical Inactivity Uncontrolled stress or anger Diet high in saturated fat & cholesterol Alcohol

20. SIGN & SYMPTOMS  Angina  Shortness of breath  Palpitations (irregular heart beats)  Dizziness  Myocardial Infarction (Heart attack)

21. HOW TO CVD’S TREATED? (1) Relieve symptoms (2) Reduce the Risk Factors is an effort to slow stop or reverse the build up of plaque. (3) Prevent complication of CVD (4) Life style changes. a) Fallow a healthy diet b) Therapeutic lifestyle changes Be physically active Maintain healthy weight Quit smoking Reduce stress Medicine

22. DIETARY MANAGEMENT Principle of Diet:- Low calorie, Low fat, particularly low saturated fat, low cholesterol, high in PUFA, Low carbohydrates & normal protein, minerals & vitamins are suggested. High fibre diet is also recommended.

23. General Guidelines for Coronary Heart Disease Calories :- Sufficient to maintain body weight for height Total fat :- 15-30% of arteries Cholesterol:- <300 mg/day SFA :- <10% of total calories PUFA:- <8% of total calories Linoleic acid:- 3-7% of total calories Alpha Linolenic acid:- <1% of total calories Proteins:- 10-15% of total calories Carbohydrates:- 55-60% with emphasis on complex carbohydrates Sugar:- <10% of total calories Salt :- 5-7 g/day Dietary Fibre:- 40g/day

24. Foods to be takenFoods to be restricted Amla, bitter-guard,Pickles, chips, canned food Bottle-guard, brinjalSpices & condiments such as ketchup, sauce Cabbage, colocasiaCheese, peanut, cakes, pastries Cucumber, grapesSalted butter, frozen peas, bread Guava, honeyShellfish & dry fish Whole cerealsRegular baking powder Pumpkin, ladyfingerSodium bi-sulphite (aginomoto)

25. THANK YOU THANK YOU