Prevention of heart attacks
Symptoms, Ways and means of Heart attack prevention - Lifestyle modifications - Presentation by Dr MNRamakrishna
Published on: Mar 4, 2016
Transcripts - Prevention of heart attacks
? Prevention Of Heart
Is it good ?
SOME FACTS ABOUT CAD
• 25 -28 % of CAD die suddenly
• 55 % of all cardiac deaths occur within the 1st hour
• Among survivors around 10% die in the 1st year and 5%
thereafter every year.
A disease known is Half Cured
Heart is most important organ in the body
It is very sensitive, strong and hard
It contracts for more than one lakh times in
a day and pumps blood to each and every
organ in the body
A person dies if it stops for 3minutes
It is a muscular organ and supplies oxygen
to each cell in the body through blood
Right half of the Heart collects de-
oxygenated (impure) blood from all parts of
the body and pumps into the lungs for
getting oxygen and removal of carbon-
dioxide and other metabolic waste .Then the
pure blood from lungs enters left side of the
For pumping of blood to all parts of body,
Heart also needs oxygen and energy. It
gets energy and oxygen through,
“Coronary Arteries which are branches of
If due to some reason, Coronary Arteries
get blocked, it results in “Heart Attack”
Usually as age advances, the blood
vessel walls get thickened and become
rigid, a condition called “Atherosclerosis”
At the same time, if cholesterol (Fat) in
the blood is increased, it causes block in
the blood flow. If this occurs in coronary
blood vessels, it results in “Heart Attack”
Indian Scenario of Heart Attacks
(Coronary artery disease)
CAD appears a decade earlier in
India, compared with developed
Males are affected more than
Hypertension and Diabetes
accounts for about 40% of all
Heavy smoking is responsible
aetiologically in a good number
Signs and Symptoms of CAD
Sudden death may be the first clinical
manifestation of CAD in as many as one-fourth
of the patients. In about 55% of all cardiac
deaths mortality occurs within the 1st hour
Retrosternal (center of chest) stabbing pain
Radiation of pain to left shoulder and even up to
tip of left little finger
Palpitation, fatigue, sweating all over the body
and burning sensation in the stomach
Sudden breathlessness (previously never
Toothache/ pain near the jaws
Nausea or Vomiting
Sometimes without any of the signs and
symptoms (silent infarction). It is usually seen in
Risk Factors for CAD
Non-Modifiable risk factors of
Modifiable Risk Factors
High Blood Pressure
Elevated Serum cholesterol
Lack of exercise
SOME PEOPLE COMMIT “SUICIDE” BY
“DROWNING”, BUT MANY BY “SMOKING”
Smoking is responsible for 25% of CAD deaths under
65yrs of age in men. Cigarette seems to be
particularly important in causing sudden death from
CAD in men below 50yrs of age.
The main culprits in Tobacco, which harms Heart and
blood vessels are
Nicotine stimulates the heart and increases demand
of more oxygen to heart, and thus increases heart
Carbon monoxide has 200 times more affinity towards
hemoglobin and thus reduces oxygen supply to all
Smoking increases the viscosity of blood and
enhances the chances of blood clotting inside the
Hypertension damages the blood
vessel walls and accelerates
atherosclerotic process resulting in
precipitation of CAD
Studies reveal that a reduction of
BP by 2-3mm of Hg in general
populations can produce large
reduction in CVD complications
ADVANTAGES OF LIFE STYLE MODIFICATIONS
Modification Recommendation Reduction in Systolic
• Weight reduction BMI 18.5-24.9 5-20mm of Hg/10 kg
• DASH eating plan Fruits, vegetables, low fat etc. 8-14mm of Hg.
• Reduction in Na. 5-6 gms of sodium 2-8 mm of Hg.
• Physical Activity Regular aerobic physical activity 4-9 mm of Hg.
30 mts /day
• Limitation of Alcohol < 2drinks/day(30ml ethanal) 2-4 mm of Hg.
Elevated blood lipids (Cholesterol & Triglycerides) are the
major risk factors for CAD
Animal fats (Meat, Milk Products, Egg etc.) except fish,
contain saturated fatty acids which contain low density lipids
will increase the thickness of blood vessel walls resulting in
Hypertension and Coronary Artery Disease.
Vegetable oils(except palm oil & coconut oil) contain poly
unsaturated fatty acids, have more „high density lipids‟
which protect the heart. The HDL fat acts as a „scavenger‟
in removing the LDL attached inside the blood vessel walls.
In typical Indian diet, which is cereal based, about 20gms of
fat is obtained as „invisible fat‟. Therefore a daily in take of
20gms or 4 tea spoons of visible fat is sufficient. The ratio of
saturated to PUFA should be roughly 0.8-1.0
Poly unsaturated fatty acids (PUFA)
Usage of oils which are rich in „Linoleic,and Linolenic
fatty acids‟ like saffola, Sunflower, Soya Bean,
Ground nut etc. will prevent occurrence of CAD.
The deficiency of PUFA enhances mechanism of
blood clotting inside the blood vessel, which results in
CAD/ Paralysis (CVA).
FISH is good for HEART. It is an abundant source of
long chain n-3 PUFA, which reduces the blood levels
of cholesterol and triglycerides and also decrease
fibrinogen levels, inhibit platelet activity and clotting
Mustard and Soya oils are two common vegetable
oils which contain alpha-linolenic acid. Use of any one
oil along with other oils will be beneficial.
The n-3 PUFA is also good for brain & joints and have
Blood Lipids (mg/100ml of plasma)
<200 200-240 >240
LDL <130 130-160 >160
HDL >50** - <35
Triglycerides <150 150-500** >500
* In Indians CAD occurs even at
cholesterol levels around 180mg/100ml
** Arbitrary Values
Cholesterol : HDL should be less than 3.5
The higher the body weight the greater is the risk
For every extra KG of fat, one tends to produce
20mg more cholesterol per day.
Higher abdominal fat (Fat around waist) is known
to be a greater risk factor than accumulation of fat
It is hence necessary to maintain ideal body
The simple formula to know the ideal body weight
in KGs is height in centimeters minus 100.
The tendency for obesity seems to be inherited
and over eating. Also it is clearly an important
cause with low physical activity.
The risk of CAD is 2-3 times
higher in patients with Diabetes
CAD is responsible in 30-50%
of deaths in Diabetes over the
age of 40yrs
In Diabetes the blood lipids are
increased and these contribute
to premature or accelerated
process of „Atherosclerosis‟.
A family history of CAD is
known to increase risk of
Probably the genetic
factors are most important
determinants of an
Cholesterol and HDL
Sedentary life style
habits have become a part
and parcel of our life styles.
Sedentary habits decrease
the energy expenditure and
therefore contribute to over
weight and rise in blood
Lack of Physical Exercise
Incidence of HTN is more in those who
lack physical exercise.
Regular physical exercise increases
the concentration of HDL and
decreases the body weight, blood
glucose, blood lipids and blood
Walking briskly for 45 minutes a day
can bring down the risk of HTN.
The „Estrogen‟ hormone in the
female is probably the most
important hormone which protects
the female from getting CAD up to
menopause. (After menopause, the
hormone levels of estrogen fall, and
chances of getting CAD will be same
High alcohol intake defined as 75gms or more per
day is an independent risk factor for CAD
Alcohol stimulates heart,and increase blood pressure
transiently, and may precipitate CAD if other risk
factors are also there.
Alcohol also stimulates „FAT‟ metabolism, increases
obesity and results in Arteriosclerosis , Hypertension
The evidence that moderate alcohol intake leads to a
reduction in the risk of CAD is “UNSUBSTANTIATED”
Though alcohol in small amounts (Large glass of
beer, 35ml of whisky, 70ml of wine) increase HDL, it
doesn‟t increase the protective fraction, the HDL2 of
Alcohol weakens heart muscle resulting in
Type „A‟ persons‟ behaviour is
associated with competitive
drive, restlessness, hostility and
a sense of urgency or
impatience and are more prone
Type „B‟ persons are easy
going, less anxious, contented,
calm and philosophical in nature
and are less prone for CAD
It is well established that ambitious and
aggressive personalities are more prone for
Stress can be physical, social or emotional.
Stress causes heart to beat faster, the blood
pressure to go up, the muscles to become
tense and the arteries to go into spasms. All
these occur through release of a substance
Yoga, the age-old Indian practice of mind and
body control can play prominent role in the
reduction of stress and indirectly prevents
CAD. Yogic practices are ancient in India
systematized by Pathanjali in 300 BC
Oral Contraceptive pills
Women using „Oral contraceptive pills‟
have higher blood pressure and the
risk of CAD seems to be increased
and compounded by cigarette
The cholesterol lowering effect of
certain types of dietary fiber is firmly
established, which in turn is useful
in the prevention of CAD. The daily
requirement of dietary fiber is 30-
Anti-Oxidants and Micronutrients
CAD is currently thought to be a result of
oxidative stress also i.e., the generation of
excess of free radicals and peroxide in
the tissues. Oxidized blood lipids are
more “Atherogenic‟ than un-oxidized
Anti-oxidants and Micro-nutrients such as
Vit C, Beta-Carotene, Vit-A, Vit-E and
Selenium can remove peroxides and free
radicals and there by reduce the oxidative
stress in tissues.
Yellow and orange vegetables and fruits,
green leafy vegetables, egg, milk, liver,
kidney, fresh fruits, vegetable oils, cereals
etc. are the main sources of Anti-Oxidant
Onion & Garlic
In scientific studies large doses of
onion & garlic are noted to be
beneficial causing a decrease in
blood lipids and glucose and an
increase in clot dissolution
The garlic and onions that are
regularly included in Indians diets
may also have beneficial effect.
One may as well eat garlic as part of
daily diet rather than resort to garlic
Salt (Sodium Chloride)
Excess salt is bad for the heart.
Indians are in the habit of
consuming 10-15 gm of salt/day
in the form of added salt.
Probably 3gms of salt/day is both
safe and adequate for healthy
Reduction in salt in turn will
reduce blood pressure and
Some scientific evidence suggests
that heart diseases are more
common in areas with soft water than
where the water is hard. Minerals
such as calcium & magnesium and
trace metals like chromium and
vanadium present in hard water
appear to be protective to heart.
What to do in case of a heart attack.
If you suspect that you are having “Heart
Attack“ Call for help at once.
Lie down comfortably & loosen tight clothing
Chew an “Aspirin” tablet immediately. ( It can
help prevent blood clot in your arteries.
Chewing lets it act faster).
Inform your doctor.
Get some one to drive you to the hospital
quickly or call an ambulance.
If you have the “Risk Factors like HTN, DM,
Smoking etc, always keep “tab aspirin & tab
How to prevent Heart Attack
Stop smoking immediately.
Stop Alcohol, gutka, jarda etc.
Maintain an ideal body, weight.
Exercise of at least 30min per day.
Reduce animal fats in your diet.
Restrict added “Salt” in your diet to only 5gms.
Control your stress. Yoga and meditation are good.
See that BP and DM are under control.
Strategy of Prevention of CAD
High risk strategy
Eat for a healthy heart. Don‟t eat your heart.
Conquer heart diseases through healthy life style
It is not work, but worry that kills
Practice yoga and meditation for better health
A little salt is divine .Too much is harmful
Eat to live, Don‟t live to eat.
If you are planning for a Year sow rice.
If you are planning for a decade plant trees.
If you are planning for a life time “EDUCATE PEOPLE”
No one knows you better than yourself
No one can eat for you
No one can lose weight for you
No one can think for you
No one can stop bad habits for you
No one can develop good habits for you
No one can take medication for you
No one but YOU can change yourself
Framingham’s 10 yr Risk Score Calculation For CAD