Heart Attack

HEART ATTACKHEART ATTACK

VINEET MALIKVINEET MALIKCONSULTANT INTERVENTIONAL CARDIOLOGYCONSULTANT INTERVENTIONAL CARDIOLOGY

BL KAPUR MEMORIAL HOSPITALBL KAPUR MEMORIAL HOSPITAL

NEW DELHINEW DELHI

• Leading cause of Death in 21st Century

• 50% of People who die of heart attacks do not

have any preceeding Symptom

• Atherosclerosis begins in childhood and

advances throughout life

• Women are relatively protected till menopause

CORONARY ARTERY DISEASE

MagnitudeOne in ten adult men

&One in nine women aged 45

to 65 years&

One in three both men and women after age of 65

Suffer from CAD!

ESTIMATED CAD LOADESTIMATED CAD LOAD

• TOTAL POPULATION OF INDIA > 100 CRORE

• ESTIMATED ADULT POPULATION (above 40 years)

~ 60 CRORE

• ESTIMATED CAD SUFFERERS ~ 6 CRORE

FURTHER 20 CRORE ARE AT RISK IN NEXT DECADE

THE HUMAN HEARTTHE HUMAN HEART

How The Fat Deposits In Your Blood Vessels

ncreased deposition of ‘bad cholesterol’I

This is known as atherosclerosis

Normal blood vessel

Deposition of ‘bad cholesterol’

The Blockage Of Coronary Arteries

The Heart Attack-Myocardial Infarction-The Damaged Heart

THE HEART PAINTHE HEART PAIN

Associated symptomsAssociated symptoms

DyspneaDyspnea

Diaphoresis Diaphoresis

Weakness Weakness

NauseaNausea

Vomiting Vomiting

Diarrhea Diarrhea

Impending DoomImpending Doom

E C G

THE CONCEPT OF THE CONCEPT OF GOLDEN HOURGOLDEN HOUR

•MAXIMUM DAMAGE TO HEART MUSCLE

•MAXIMUM EFFICACY OF TREATMENT SEEN

•SURVIVAL IS BEST IF CLOT BUSTER DRUGS

GIVEN WITHIN THIS PERIOD

TIME IS MUSCLE AND MUSCLE IS TIME

REASONS FOR DELAYREASONS FOR DELAY

• DISBELIEF THAT THE SYMPTOMS ARE DISBELIEF THAT THE SYMPTOMS ARE

FROM HEARTFROM HEART

• DON’T WANT TO PANIC AND BE AN DON’T WANT TO PANIC AND BE AN

INCONVENIENCE TO THE FAMILYINCONVENIENCE TO THE FAMILY

• FINANCIAL CONSTRAINS FINANCIAL CONSTRAINS

• WHOM TO CONTACT AND WHERE TO WHOM TO CONTACT AND WHERE TO

CONTACT AT THIS HOURCONTACT AT THIS HOUR

IMMEDIATE MEASURESIMMEDIATE MEASURESDISPIRINDISPIRINAVOID EXERTIONAVOID EXERTIONINFORM FRIENDS OR FAMILYINFORM FRIENDS OR FAMILYCALL FOR AMBULANCECALL FOR AMBULANCE

CLOT BUSTER CLOT BUSTER OR OR

ANGIOPLASTYANGIOPLASTY

HEART COMMANDHEART COMMAND

INTENSIVE CAREINTENSIVE CARE

RECOVERY AFTER RECOVERY AFTER HEART ATTACKHEART ATTACK

ACTIVITY4 – 5 DAYS BED REST IN HOSPITAL

HALF NORMAL ACTIVITIES AT HOME FOR 1 WEEK

NORMAL ACTIVITIES FROM 3RD WEEK

RISK STRATIFICATION

SECONDARY PREVENTION

TMT

RISK STRATIFICATIONRISK STRATIFICATION

ECHO

RISK STRATIFICATIONRISK STRATIFICATION

THE GOLD STANDARD

ANGIOGRAPHY

ACCESS FOR ACCESS FOR PROCEDUREPROCEDURE

ANGIOGRAPHY

WHAT AFTER ANGIOGRAPHY?WHAT AFTER ANGIOGRAPHY?

MEDICAL MANAGEMENT

ANGIOPLASTY

BYPASS SURGERY

CORONARYCORONARY

ANGIOPLASTYANGIOPLASTY

BALLOONINGBALLOONING

BALLOON PLASTYBALLOON PLASTY

STENTINGSTENTING

BALLOON THERAPYBALLOON THERAPY

CORONARY ANGIOPLASTYCORONARY ANGIOPLASTY

BALLOONINGBALLOONING

STENT DEPLOYMENTSTENT DEPLOYMENT

RESULT OF ANGIOPLASTYRESULT OF ANGIOPLASTY

RECOVERY FROM RECOVERY FROM ANGIOPLASTYANGIOPLASTY

• BED REST FOR 1 DAY IN ICUBED REST FOR 1 DAY IN ICU

• START WALKING ON 2START WALKING ON 2NDND DAY IN HOSPITAL DAY IN HOSPITAL

• HALF NORMAL ACTIVITIES IN NEXT 4 DAYS HALF NORMAL ACTIVITIES IN NEXT 4 DAYS

AT HOMEAT HOME

• FULL ACTIVITIES FROM NEXT WEEK BACK FULL ACTIVITIES FROM NEXT WEEK BACK

TO WORKTO WORK

• FULL HEALTHY DIET FROM DAY 2FULL HEALTHY DIET FROM DAY 2

Bypass Surgery

Bypass Surgery

BYPASS SURGERYBYPASS SURGERY

Bypass Surgery

BYPASS SURGERY ON A BYPASS SURGERY ON A BEATING HEARTBEATING HEART

ROBOTIC HEART SURGERYROBOTIC HEART SURGERY

THE ULTIMATE CURETHE ULTIMATE CURE

PREVENTIONPREVENTION

CORONARY ARTERY DISEASECORONARY ARTERY DISEASECORONARY ARTERY DISEASECORONARY ARTERY DISEASE

RISK FACTORS

Family History

Stress

Lipoprotein ‘a’

Obesity

Smoking

Age / Sex

NIDDM

Hypertension

High TG, Low HDL , High LDL

Multiplier effect

The Major Risk Factors For CAD

Traditional Risk Factors

No Risk Factor?

Newer ToolsIMTFMDABI

PWVCal Score

Coronary Artery Disease

(Clinical Disease)

Endothelial Dysfunction

Atherosclerotic Plaque

(sub-clinical)

Atherosclerosis‘a long smoldering process!’

WHO IS OBESE?• BMI (Weight in kg/Height in

meters^2)– 19 to 25 Normal – 25 to 30 Over Weight– 30 to 35 Obese– > 35 Morbidly Obese

• Waist circumference– <35 inch (women)– <40 inch (men)

• Waist / hip ratio– < 0.85 – Apple vs pear

BALANCED DIET

Major portion from carbohydrates & proteins Less fat

Vegetables & fruits – 4-5 servings per day

High fibre diet Plenty of liquids (water & juices)

EAT LESS VS EAT MORE

• DIETATRY PRUDENCE

• AVOID SMOKING

• REGULAR EXERCISE

• STRESS MANAGEMENT –RELAXATION

–REST AND SLEEP

–FAMILY AND SOCIAL SUPPORT

–YOGA AND MEDITATION

LIVING WITH A HEALTHY LIVING WITH A HEALTHY HEARTHEART

THANK YOUTHANK YOU