Dr. Vijay Dikshit (M.S., M.Ch, FICC) Myths & Facts Of Heart Dr. Vijay Dikshit (M.S., M.Ch, FICC) Chief Cardiac Surgeon Apollo Hospitals Hyderabad

Normal Heart

Diseases of Heart Congenital (Birth defects) Valve diseases Coronary Artery Diseases

NORMAL CORONARY ANATOMY

Coronary Heart Disease (Plaque, Atherosclerosis)

What Is Heart Attack? Coronary artery becomes blocked - usually by a clot. Blood flow is closed off and a heart attack begins. If blockage continues, parts of the heart muscle start to die. Heart may stop beating. What causes heart disease? Two major conditions contribute Atherosclerosis it involves deposits of fatty substances cholesterol, cellular waste and calcium in the lining of an artery. It starts due to elevated levels of cholesterol, high blood pressure, and tobacco smoke.

Heart Attack

Presentation Of CAD No symptoms Angina Heart attack Sudden death

Myocardial Infarction or Heart Attack Symptoms: Uncomfortable pressure Fullness Squeezing pain Pain spreading to the shoulders Neck and arms Chest discomfort and light headedness Anxiety / nervousness sweating

Cardiac Misconceptions Heart disease is caused by ‘stress’ ‘worry’ or ‘overwork’ If you’ve had a heart attack you are bound to die of heart disease Rest restores the heart Any excitement or shock could cause another heart attack

Risk Factors Of Coronary Artery Diseases Major Diabetes High Blood Pressure Abnormal Cholesterol Family History Smoking STRESS Minor Obesity Inactivity Diet Gout Hormonal Disorders

Changeable Risk Factors Hypertension Serum cholesterol Obesity Diabetes Mellitus Physical Inactivity Cigarette Smoking Alcohol Intake Hypertension Serum Cholesterol: As cholesterol rises so does the risk of congestive heart disease, and obesity. It is unhealthy because excess weight puts more strain on your heart. It can raise blood pressure and blood cholesterol and lead to diabetes. Diabetes Mellitus, Physical Inactivity, and Cigarette Smoking along with Alcohol intake are the other changeable risk factors. A smoker’s risk of a heart attack is more than twice that of a non-smoker.

Non Modifiable Risk Factors Age Family History Gender

ECG Normal ECG does not mean a normal heart ECG indicates the condition of the heart at the time of recording. ECG does not have any prognostic value

TMT

Coronary Angiography

C.T Coronary Angiogram

Prevention Of CAD Diet Cholesterol Exercise Smoking Alcohol Stress

Diet and Prevention of CAD High fiber low fat Predominantly vegetarian food Choose nonfat or low-fat products. Use lean meats - choose chicken, fish, turkey Switch to fat-free milk - gradually reduce the fat content of the milk you drink.

Cholesterol Everybody needs cholesterol, it serves a vital function in the body. It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. Frequently measured to promote health and prevent disease. A major component of the plaque that clogs arteries. Cholesterol is a soft waxy substance found among the lipids in the bloodstream and in all of your body’s cells. Everybody needs cholesterol, it serves a vital function in the body. It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. We get cholesterol from two ways. Our bodies make it and the rest comes from animal products we eat. It is frequently measured to promote health and prevent disease. Desirable levels of total cholesterol levels should be at 200 or less. 240 is considered high but it will depend on the HDL and LDL levels if at this level there is a risk to your health. It is a major component of the plaque that clogs arteries. Cholesterol and other fats can’t dissolve in the blood. They have to be transported to and from cells by special carriers called lipoproteins.

Types of Cholesterol Lipoproteins - 4 main classes Chylomicrons Very low density lipoproteins (VLDL) Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL)

The Facts About Fat Certain fats are essential for good nutrition and health. Fats provide essential fatty acids which the body can’t manufacture. Act as insulators to maintain body temperature. Improve the palatability of food and promote digestion. The Facts About Fat – Certain fats are essential for good nutrition and health. Fats provided essential fatty acids which the body can’t manufacture, they act as insulators to maintain body temperature and they improve the palatability of food and promote digestion. Knowing which fats raise LDL cholesterol and which ones don’t is very important. Saturated fat, trans fatty acids, and dietary cholesterol raise blood cholesterol. Some studies suggest that using monounsaturated and polyunsaturated may lower cholesterol levels slightly.

Cholesterol Level Desirable Border line High Risk Total Cholesterol < 200 200 – 240 > 240 LDL Cholesterol 100 100 – 150 > 150 HDL Cholesterol > 40 30 - 40 < 30 Triglyceride 150 150 - 200 > 200

Good Cholesterol HDL is known as the good cholesterol. It helps carry some of the bad cholesterol out of the body. It does not have the tendency to clog arteries. Levels should be >35. High levels of HDL >60 can actually negate one other risk factor. HDL or high density lipoprotein is know as the good cholesterol, it helps to bind to some of the bad cholesterol and carry it out of the body. It does not have the tendency to clog arteries. The target level is greater than 35mg/dl. High levels of >60 can actually negate one other risk factor. Studies suggest that high levels of HDL cholesterol reduce your risk of a heart attack.

Bad Cholesterol LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. LDL’s are a major component of the atherosclerotic plaque that clogs arteries. Levels should be <130

Exercise and CVD Serves several functions in preventing and treating those at high risk. Reduces incidence of obesity. Increases HDL Lowers LDL and total cholesterol Helps control diabetes and hypertension Those at high risk should take part in a specially supervised program.

Cigarette Smoking Causes an increase in blood pressure Lowers the levels of HDL Within 1 year of quitting, CAD risk decreases, within 2 years it reaches the level of a nonsmoker.

Alcohol Consumption In small amounts it acts as a vasodilator. In large amounts it acts as a vasoconstrictor & adds to the caloric intake The good & Bad affects of Alcohol are divided with a very fine line! Alcohol Consumption: In small amounts alcohol acts as a vasodilator, this is good and usually occurs in 1-2 drinks. In large amounts it acts as a vasoconstrictor which is bad. The range this occurs is 3-4 drinks. This is a very fine line. Other risk factors that may contribute to a higher risk of heart disease is an individual’s response to stress, sex hormones, and the loss of natural estrogen as women age.

Treatment Drugs Angioplasty & Stent Coronary Artery Bypass Surgery

Angioplasty & Stent (PTCA)

Coronary Artery Bypass Surgery (CABG) The most frequently performed major surgery. Surgery reroutes or Bypasses blood around clogged arteries.

Operating Room

Robotic Surgery

Conclusion Coronary Artery Disease is highest among Indians. It is highly preventable and controllable with diet and exercise. With present treatment of Angioplasty & Coronary Bypass Surgery person can live long and fruitful life