1. 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

2. Normal Heart

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

4. NORMAL CORONARY ANATOMY

5. Coronary Heart Disease (Plaque, Atherosclerosis)

6. 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.

7. Heart Attack

8. Presentation Of CAD
No symptoms
Angina
Heart attack
Sudden death

9. 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

10. 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

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

12. 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.

13. Non Modifiable Risk Factors
Age
Family History
Gender

14. 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

15. TMT

16. Coronary Angiography

17. C.T Coronary Angiogram

18. Prevention Of CAD
Diet
Cholesterol
Exercise
Smoking
Alcohol
Stress

19. 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.

20. 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 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.

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

22. 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.

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

24. 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.

25. 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

26. 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.

27. 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.

28. 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.

29. Treatment
Drugs
Angioplasty & Stent
Coronary Artery Bypass Surgery

30. Angioplasty & Stent (PTCA)

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

32. Operating Room

33. Robotic Surgery

34. 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