HYPERTENSIONHYPERTENSIONHEART ATTACKHEART ATTACKDIABETESDIABETES

HYPERTENSIONHYPERTENSION

What is Hypertension?What is Hypertension?

High pressure in the blood High pressure in the blood vesselsvessels

NOTNOT excessive emotional tension excessive emotional tension > > 140/90140/90 mm Hg - mm Hg - confirmed on confirmed on

multiple occasionsmultiple occasions

How is the blood pressure How is the blood pressure measured?measured?

Patient to be seated Patient to be seated comfortably with his arm on a comfortably with his arm on a table in a relaxed posture.table in a relaxed posture.

Single reading is not sufficient.Single reading is not sufficient. Best with a mercury type of Best with a mercury type of

apparatus.apparatus. White coat Hypertension.White coat Hypertension.

What causes What causes hypertension?hypertension?

Primary HypertensionPrimary Hypertension - 95%- 95% High intake of salt.High intake of salt. Age, Black race, Genetic (30%), Age, Black race, Genetic (30%), ObesityObesity

Secondary HypertensionSecondary Hypertension - 5%- 5% Due to kidney, Aortic, Adrenal Due to kidney, Aortic, Adrenal

diseases.diseases.

How do alcohol, coffee, and How do alcohol, coffee, and smoking influence blood smoking influence blood pressure?pressure?

Smoking rises BP by 5-10 mm.Smoking rises BP by 5-10 mm. Alcohol rises BP on the long run.Alcohol rises BP on the long run. Caffeine also rises BP.Caffeine also rises BP.

What do patients feel with high What do patients feel with high blood pressure?blood pressure?

No symptoms for many years (silent No symptoms for many years (silent killer)killer)

May present with fatal complications.May present with fatal complications. Hence periodic BP check up is essential.Hence periodic BP check up is essential. Some may have giddiness, SOB, Some may have giddiness, SOB,

Headache, Blurred vision.Headache, Blurred vision. May come with kidney failure, HA, May come with kidney failure, HA,

vision loss on THE FIRST VISIT ITSELF.vision loss on THE FIRST VISIT ITSELF.

Complications of Complications of HypertensionHypertension

Enlarged heart. Enlarged heart. Kidney failure.Kidney failure. Brain damage. Brain damage. Changes in the eye (retina) Changes in the eye (retina)

- Leaking of blood in the - Leaking of blood in the

retina. retina.

- Swelling of the eye nerve. - Swelling of the eye nerve.

Lifestyle modificationsLifestyle modifications

DietDiet

Restricting saltRestricting salt

Reducing wt.Reducing wt.

ExerciseExercise

Quitting alcoholQuitting alcohol

Quitting SmokingQuitting Smoking

ObesityObesity

Problem of sleep Apnoea syndromeProblem of sleep Apnoea syndrome Increased incidence of BPIncreased incidence of BP

On reduction of wt - On reduction of wt - BP reducesBP reduces BP drugs act wellBP drugs act well Insulin also acts wellInsulin also acts well

Regular exerciseRegular exercise

Jogging, Bicycle riding, Swimming Jogging, Bicycle riding, Swimming for 30 to 45 minutes daily - lowers for 30 to 45 minutes daily - lowers BP by 5-15 mm.BP by 5-15 mm.

The more you exercise (up to a The more you exercise (up to a point), the more you lower the point), the more you lower the blood pressure. blood pressure.

What are the goals of anti-What are the goals of anti-hypertensive treatment?hypertensive treatment?

Treat hypertension early, before Treat hypertension early, before it damages critical organs. it damages critical organs.

Goal – 130/80 mm of Hg.Goal – 130/80 mm of Hg. Even lower if patient has Even lower if patient has

Diabetes or Kidney failure.Diabetes or Kidney failure.

Treatment of Treatment of hypertension hypertension Not possible to control BP in a Not possible to control BP in a

single day or a few days.single day or a few days. For a good control of BP, it may For a good control of BP, it may

take even a month.take even a month. May require one or more drugs May require one or more drugs

most of the times.most of the times. Initially he has to make frequent Initially he has to make frequent

visits to doctor for assessment of visits to doctor for assessment of BP control and titration of dose.BP control and titration of dose.

Treatment of Treatment of hypertensionhypertension

Once hypertension is detected in a Once hypertension is detected in a patient, he or she would require patient, he or she would require treatment life long. treatment life long.

There is no need for taking food There is no need for taking food before taking these medicines. before taking these medicines.

Once the BP is under control with Once the BP is under control with the medicines he has to continue the medicines he has to continue the medicines and stopping drugs the medicines and stopping drugs would again increase the BP. would again increase the BP.

HEART HEART ATTACKATTACK

What is a heart attack?What is a heart attack?

Known as a Myocardial InfarctionKnown as a Myocardial Infarction Sudden blockage blood vesselSudden blockage blood vessel Death of heart muscle Death of heart muscle Causes chest pain and pressure Causes chest pain and pressure Muscle continues to die for 6-8 Muscle continues to die for 6-8

hours hours Heart muscle is replaced by scar Heart muscle is replaced by scar

tissue tissue

What causes a heart What causes a heart attack?attack? Atherosclerosis - Deposition of Atherosclerosis - Deposition of

cholesterol in the walls of vesselscholesterol in the walls of vessels Hardening of the arterial walls and Hardening of the arterial walls and

narrowing of the inner channelsnarrowing of the inner channels Cannot deliver enough blood Cannot deliver enough blood Atherosclerosis can remain silent for Atherosclerosis can remain silent for

years or decades years or decades Atherosclerosis can begin as early as Atherosclerosis can begin as early as

the teenage years the teenage years

What causes a heart What causes a heart attack?attack?

symptoms appear when the blood symptoms appear when the blood vessels are critically narrowedvessels are critically narrowed

Aggravating factors:Aggravating factors: Smoking Smoking High blood pressureHigh blood pressure DiabetesDiabetes Elevated cholesterolElevated cholesterol Family history of heart attackFamily history of heart attack

AnginaAngina

Chest pain Chest pain Coronary arteries are narrowed by Coronary arteries are narrowed by

more than 50 to 70 %more than 50 to 70 % Arteries cannot increase the Arteries cannot increase the

supply of blood to the heart supply of blood to the heart muscle during exertion muscle during exertion

Diabetics – no pain occurs but just Diabetics – no pain occurs but just shortness of breath shortness of breath

AnginaAngina

Angina is like a pressure, heaviness, Angina is like a pressure, heaviness, squeezing, or aching across the chestsqueezing, or aching across the chest

This pain may travel to the neck, jaw, This pain may travel to the neck, jaw, arms, back, or even the teetharms, back, or even the teeth

May be accompanied by shortness of May be accompanied by shortness of breath, nausea, vomiting or a cold sweatbreath, nausea, vomiting or a cold sweat

Angina lasts for 1 to 15 minutes Angina lasts for 1 to 15 minutes Relieved by rest or by placing a Relieved by rest or by placing a

Nitroglycerine tablet under the tongue.Nitroglycerine tablet under the tongue. Can even occur at rest.Can even occur at rest.

AnginaAngina

Too often patients attribute heart attack Too often patients attribute heart attack symptoms to "indigestion," "fatigue," or symptoms to "indigestion," "fatigue," or “stress” and consequently delay seeking “stress” and consequently delay seeking prompt medical attention. prompt medical attention.

Early diagnosis and treatment saves lives, Early diagnosis and treatment saves lives, and delays in reaching medical assistance and delays in reaching medical assistance can be can be fatalfatal. A . A delaydelay in treatment can in treatment can lead to lead to permanently reduced function permanently reduced function of the heartof the heart due to more extensive due to more extensive damage to the heart muscle. damage to the heart muscle.

What are the complications of What are the complications of a heart attack?a heart attack?

Heart failureHeart failure

Ventricular fibrillationVentricular fibrillation

How is a heart attack How is a heart attack treated?treated? Medications to prevent formation of blood Medications to prevent formation of blood

clots clots Medications to prevent growth of blood clots Medications to prevent growth of blood clots PTCA with or without stenting to open blocked PTCA with or without stenting to open blocked

coronary arteriescoronary arteries Clot-dissolving medications to open blocked Clot-dissolving medications to open blocked

arteries arteries Oxygen to increase the supply of oxygen to Oxygen to increase the supply of oxygen to

the heart's musclethe heart's muscle Medications to prevent abnormal heart rateMedications to prevent abnormal heart rate

DIABETESDIABETES

What is Diabetes Mellitus?What is Diabetes Mellitus?

Defects in INSULIN secretion or Defects in INSULIN secretion or actionaction

Diabetes means "sweet urine." Diabetes means "sweet urine." Elevated levels of blood glucose Elevated levels of blood glucose

lead to spillage of glucose into the lead to spillage of glucose into the urine urine

INSULININSULIN

Released from Pancreas in response Released from Pancreas in response to elevated glucose (sugar) levelsto elevated glucose (sugar) levels

Normally Insulin controls blood Normally Insulin controls blood sugarsugar

If deficient, glucose levels increaseIf deficient, glucose levels increase It’s a chronic condition - lasts for lifeIt’s a chronic condition - lasts for life Hence treatment is life longHence treatment is life long

What causes Diabetes?What causes Diabetes?

Body cells cannot use glucose in Body cells cannot use glucose in the absence of Insulin. the absence of Insulin.

Cells are starved of glucose Cells are starved of glucose energyenergy

There is starvation in the midst of There is starvation in the midst of plentyplenty

Unutilized glucose is wastefully Unutilized glucose is wastefully excreted in the urineexcreted in the urine

What is the impact of What is the impact of Diabetes?Diabetes?

BlindnessBlindness Kidney failureKidney failure Nerve damage Nerve damage Accelerating the hardening and Accelerating the hardening and

narrowing of the arteries narrowing of the arteries That leads to strokes, coronary That leads to strokes, coronary

heart diseases heart diseases

What are the different What are the different types of Diabetes?types of Diabetes?

Type I – no insulin – youngType I – no insulin – young Damage of pancreas due to infectionsDamage of pancreas due to infections Due to genetic factorsDue to genetic factors

Type II – Inadequate insulin Type II – Inadequate insulin Normally in adults, rarely in teen age Normally in adults, rarely in teen age Risk factor – obesity Risk factor – obesity

What are the symptoms What are the symptoms of Diabetes?of Diabetes?

Increased urine outputIncreased urine output Increase in appetiteIncrease in appetite Increase in thirstIncrease in thirst Urinary InfectionsUrinary Infections Skin InfectionsSkin Infections WeaknessWeakness Coma Coma

How is Diabetes How is Diabetes diagnosed?diagnosed?

The Fasting sugar test is the The Fasting sugar test is the preferred way to diagnose preferred way to diagnose diabetes diabetes

No need to do GTT No need to do GTT Normally fasting sugar levels are Normally fasting sugar levels are

less than 110mg/dlless than 110mg/dl If more than 126mg/dl, it is If more than 126mg/dl, it is

diagnostic of Diabetesdiagnostic of Diabetes

Goal of Diabetes Goal of Diabetes treatment treatment

To keep the blood sugar levels To keep the blood sugar levels between 70 to 120mg/dl before between 70 to 120mg/dl before each meal.each meal.

To keep the level under 140 To keep the level under 140 mg/dl at 2 hours after eating mg/dl at 2 hours after eating

What are the What are the complications of complications of Diabetes?Diabetes?

KetoacidosisKetoacidosis Electrolyte imbalanceElectrolyte imbalance HypoglycemiaHypoglycemia Heart diseaseHeart disease Eye problemsEye problems StrokesStrokes Kidney failureKidney failure

What are the What are the complications of complications of Diabetes?Diabetes?

CataractCataract GlaucomaGlaucoma Neurological problemsNeurological problems Weight lossWeight loss Loose motionsLoose motions Depression.Depression.

What can be done to slow What can be done to slow Diabetes complications?Diabetes complications?

Aggressive and intensive control Aggressive and intensive control of elevated levels of blood sugar of elevated levels of blood sugar

Means achieving fasting glucose Means achieving fasting glucose levels between 70-120 mg/dl; levels between 70-120 mg/dl;

Glucose levels of less than 140 Glucose levels of less than 140 mg/dl after meals. mg/dl after meals.

If treated wellIf treated well

In intensively treated patientsIn intensively treated patients

Diabetic eye disease decreased Diabetic eye disease decreased by by

76%76% Kidney disease decreased by 54%Kidney disease decreased by 54% Nerve disease decreased by 60%. Nerve disease decreased by 60%.

How is Diabetes treated?How is Diabetes treated?

Life style modification, weight Life style modification, weight reductionreduction

DietDiet ExerciseExercise Oral drugsOral drugs Insulin Insulin

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