Dr Amar Prabhudesai

M.D.,D.M.

Consultant Interventional Cardiologist

Manipal Hospital

WHAT DO WE WANT

“?”

WE WANT

Long life – 120 years

No disease, sickness at all

Diabetes, high BP, joint pain, cancer etc –NOT at all

Lots of energy, stamina, joy, happiness

Enough money for needs

WHAT WE SEE

Average age 70-75

Fever, cold/cough, other sickness once a year -on average

By age 50 substantial numbers suffer diabetes, high BP, (or both), joint pains, stones, fibroids, chronic cold/cough, etc.

leading cause of death -worldwide

Coronary disease 7.2 million

Cancer 6.3

Cerebrovascular disease 4.6

Acute lower respiratory tract infections 3.9

Tuberculosis 3.0

COPD (chronic obstructive pulmonary disease) 2.9

Diarrhoea (including dysentery) 2.5

Malaria 2.1

AIDS 1.5

Hepatitis B 1.2

A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIATHE W.H.O FIGURES SAY THAT THERE ARE MORE THAN FOUR MILLION HEART PATIENTS IN INDIA.

INDIA HAS THE HIGHEST RATE OF HEART ATTACKS IN

THE WORLD.

A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIA

10 YRS. EARLIER IN INDIANS COMPARED TO WESTERNERS

THE INCIDENCE OF CORONARY ARTERY DISEASE IS AS FOLLOWS

URBAN RURAL

MALES 65/100 MALES 22.8/100

FEMALES 45/100 FEMALES 17.2/100

The Normal Artery

A healthy artery can do its job of pushing blood through out your body.

A normal artery is free of plaque formation

The artery wall is very thick and elastic

PlaquePlaque is the accumulation of fats

including cholesterol

Mild to Moderate plaque formation and damage to the walls of the artery

Progression of AtherosclerosisHealthyartery

Earlylesion

Vulnerableplaque

Stable plaque“Fibrofatty” stage

Lumen maintained

Intima thickens, atheromatous gruel

forms under cap

Lumen narrows

teenager 50 year old

Heart attack symptoms Shortness of breath

fatigue

nausea and heartburn

feeling of impending death.

Other important facts:

Most heart attacks occur between 4.00am end 10am due to higher adrenaline amounts released in the body during early morning hours.

25% of all heart attacks are “silent”- without chest pain.

Diabetics are at greater risk for “silent” heart attacks.

WHAT CAUSES HEART DISEASE? SMOKING

STRESS

HIGH CHOLESTEROL

DIABETES

HYPERTENSION

LACK OF EXERCISE

HEREDITY

GENDER

Having central obesity

Central obesity means carrying extra weight around the waist, as opposed to the hips

A waist measurement of more than 40 inches for Gentle men and more than 35 inches for women means you have central obesity

Type of polyunsaturated fat.

Consistently lowers serum triglycerides and may also have an effect on lowering blood pressure.

Found in oily fish such as salmon, tuna, and herring.

Is available as a supplement.

Example: Olive Oil

What about Omega 3 ?

Plasma cholesterol levels

WHAT IS THE WAY

FORWARD

“?”

World Health Orgenisation (WHO)

definition of health; “Health is a state

of complete physical, mental & social

well being and not merely an absence

of disease or infirmity.”

ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASES

PRIMARY PREVENTION

STRESS REDUCTION

LIFE STYLE MODIFICATION

REGULAR CHECKUPS, CONTROL OF DM,HT, LIPIDS

SECONDARY PREVENTION

PROPHYLACTIC ASPIRIN

CHOLESTEROL LOWERING DRUGS

*Trans fatty acids also raise LDL-C and should be kept at a low intake.Note: Regarding total calories, balance energy intake and expenditure to maintain

desirable body weight.

<200 mg/dCholesterol

~15% of total caloriesProtein

20–30 g/dFiber

50%–60% of total caloriesCarbohydrate (esp. complex carbs)

25%–35% of total caloriesTotal fat

Up to 20% of total caloriesMonounsaturated fat

Up to 10% of total caloriesPolyunsaturated fat

<7% of total caloriesSaturated fat*

Recommended IntakeNutrient

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.

ATP III Dietary Recommendations

ATP=Adult Treatment Panel

FOOD CHART

BE CRAZY TAKE

REGULARLY

TAKE

SOMETIMES

AVOID BAN

Amla Roti Dosa Ice Cream Non-Veg

Sprouts (variety) Vegetables Utappam Sweets Deep fried

Mausambi Dals Cool Drink Liquor

Guava, apple Idli Chips Maggi

Badam, Akhrot Seasonal Fruits Pizza Biscuits Pan masala

Kishmish, Munakka,

Figs

Banana Lobia Cakes Smoking

Water Sendha Salt Kalachana Pastries

WGJ/BGJ/VCJ Popcorn Maida Items Kulcha

Coconut (small qty) ISABGOL Bhutta Sugar & Salt Kardhi

Ginger Dokhla Chocolates Fried rice

Onion Curd Milk More Oil Chowmeine

Muli(Morning) Cottage Cheese Rajma Preserved

Juices

Beetroot(Morning) Gachak (Winter) Kabuli Chane Medicines

Turnip(Morning) Groundnut(Winter) Namkins

Drumsticks(+Leaves) Black Pepper Tea & Coffee

Tender Coconut Pappad

Pista, Kaju Salads Chats

Totakura, Lettuce

K.Patta, Neem Supplements Rice

Pudina, Dhania Green tea Bread

Tomato, Cabbage Cinnamon Pan

Karela Tomato Sauce

Oats, Barley Butter, Jams

Olive Oil Paratha

Honey Manchurian

Fresh Grapes

Cucumber

Oxygen

Butter Milk

SoyabeanItem

- Soya Milk

- Tofu

- Mix in Atta 1:10

- Nutri nuggets

- Soya Sprouts

- Soya Oil

Dates ( Winter)

Bel ( Summer)

Mango Panna (Summer)

Nuts & Heart Diseases

• Myth – Nuts are bad for heart & they increase cholesterol

• Fact - WRONG : In fact it is a complete & healthy food

Free from cholesterol

Monounsaturated Fats (MuFA), Protein, CHO,

Minerals, Vitamins, Iron, Calcium & Fiber

20-40 gm/day of Nuts reduces cholesterol

• Caution – Contains calories, can trigycerides,

Avoid in obese patients

Fruits & Vegetables 5 servings of fruits & vegetables reduces heart attacks by 25-30%

A Comparison of Cooking Fats

77%

49%

25%

24%

20%

13%

28%

77%

69%

61%

62%

33%

9% 14%

18%

13%

15%

11%

10%

69%

Olive oil

Peanut oil

Corn oil(Mustard)

Soyabean oil

Sunflower oil

Saffower oil (Kardi)

Butter / Ghee(Coconut / Palm)

Monounsaturated Fatty Acids (MUFA)

Protects ‘good’ cholesterol (HDL) and reduces the level of ‘bad’ cholesterol (LDL)

reduces the risk of heart disease and diabetes

Polyunsaturated Fatty Acids (PUFA)

Reduces levels of both ‘good’ (HDL) and ‘bad’ (LDL cholesterol

Oxidises readily

Breaks down into potentially toxic substances during cooking

Saturated Fatty Acids (SFA)

Increases levels of ‘bad’ (LDL) cholesterol

increases the risk of cardiovascular disease

3%

Adults Need 30-60 Minutes of Moderate Activity Each Day

Moderate activity is one that requires as much energy as walking 2 miles in 30 minutes

Adults Need 30-60 Minutes of Moderate Activity Each Day

Moderate activity is one that requires as much energy as walking 2 miles in 30 minutes

Be Careful with Alcohol

One “drinking equivalent” equals:

12 ounce of beer

4 ounce of wine

1.5 ounce of 80 proof spirits(rum, gin, vodka, whiskey).

Men may be permitted 1-2 drinks per day and

women 1 drink per day to accrue health

benefits.

Statins and CAD Lots of evidence

Safe

Easily available

Need of the hour

ASPIRIN Diabetes

Age

Gender

Risk factors

Risk of heart attack

DR AMAR PRABHUDESAICONSULTANT INTERVENTIONAL CARDIOLOGIST

Common Procedures Coronary Angiography

Coronary Angioplasty

Peripheral Angiography

Peripheral Angioplasty

Permanent Pacemaker

Implantable Cardioveter Defibrillator (ICD)

Cardiac Resynchronization Therapy(CRT)

Balloon Valvotomy

IVC filters

Device Closures

ANGIOGRAPHY

CORONARY ANGIOGRAPHY

INDICATIONS FOR CAG

PROCEDURE TIME – 15 MIN

HOSPITAL STAY?

COST?

ADVANTAGES OF RADIAL EARLY DISCHARGE

LESS LOCAL COMPLICATIONS

DISADVANTAGES OF RADIAL ANATOMIC VARIANTS

RISK OF RADIAL ARTERY CLOSURE

HARDWARE LIMITATIONS

CORONARY ANGIOPLASTY

INDICATIONS SYMPTOMS

BLOCKAGE >70%

PROCEDURE TIME?

COST?

HOSPITAL STAY?

PRIMARY CORONARY ANGIOPLASTY

THROMBOLYSIS PRIMARY PCI

EASILY AVAILABLE

LESS COSTLY

LESS EFFECTIVE

RISK

FEW CENTRES

EXPENSIVE

MORE EFFECTIVE

RISK

RESCUE ANGIOPLASTY

PERIPHERAL ANGIOGRAPHY

INDICATIONS PAIN

ULCER- NON HEALING

IVC FILTER

CLOT IN THE LEGS

CANNOT TAKE BLOOD THINNERS

PULMONARY CLOT DESPITE BLOOD THINNERS

PERMANENT PACEMAKER

INDICATIONS SLOW HEART RATE

SYMPTOMS

PPI PROCEDURE TIME?

COST?

ICD FOR FAST HEART RATE

PRIMARY- ANYONE WITH A WEAK HEART

SECONDARY

COST?

CARDIAC RESYNCHRONISATION THERAPY

INDICATION WEAK HEART

HEART FAILURE SYMPTOMS

BALLOON VALVOTOMY

DEVICE CLOSURES HOLE IN THE HEART

CHILDREN & ADULTS

CAN SUBSTITUTE SURGERY IN SOME PATIENTS