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Compiled & Published as a Public Education Service by
Dr. R. SRINIVAS, M.D., D.M.
SRINIVASA HEART CENTRE
HANAMKONDA, WARANGAL, A.P.
FACTS YOU ALWAYS WANTED TO KNOW
Structure of the Human Heart. - Gross structure of the Human heart. - The Human circulatory system. - Coronary arteries. - Conduction system of the heart.
This book is dedicated to all those to whom “HEART” matters.
2) 3) 4) 5) 6) 7) 8) 9)
Functioning of the Human Heart. Symptoms of Heart Disease. Tests done to detect Heart Disease. Risk factors for Heart disease. Types of Heart Disease. Cardiopulmonary Resuscitation. Methods of Treating Heart Disease. Prevention of Heart Disease.
1. STRUCTURE OF THE HUMAN HEART
GROSS STRUCTURE :
✤ ✤ ✤ The Heart is a major organ of the human circulatory system. The heart lies in the chest cavity with a major portion on the left side. The average weight of the human heart : Males : 325 ± 75 gms Females : 275± 75 gms. ✤ The heart has 3 layers : Pericardium : This is the outer protective cover which has 2 layers. (Serous pericardium & parietal pericardium). The Pericardium is a thin fibrous baglike structure within which the heart lies. The two layers of the pericardium are separated by a small amount of lubricating fluid - pericardial fluid. This allows movement of the heart during contraction and relaxation to occur without disturbance of the surrounding lungs. ✤ ✤ ✤ ✤ ✤ ✤ The Pericardial cavity normally contains over 10-20 ml of pericardial fluid. The middle one is the Myocardium and the inner layer is the Endocardium. The Heart has four chambers. The 2 upper chambers - left atrium & right atrium. The 2 lower chambers : Left ventricle & Right ventricle. The upper chambers - left atrium & right atrium are separated by the Interatrial Septum and the lower chambers - left ventricle and right ventricle are separated by the Interventricular Septum. These prevent mixing of blood from both sides. The heart has four valves: The mitral valve: Situated between the left atrium & left ventricle.
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Tricuspid valve: Situated between the right atrium & right ventricle. Aortic Valve : This is situated between the left ventricle and the aorta. Pulmonary Valve: This is situated between the right ventricle and the pulmonary artery.
THE STRUCTURE OF THE HUMAN HEART
Pulmonary veins Pulmonary artery Pulmonary valve Interatrial septum Aortic valve Mitral valve Tricuspid valve Interventricular septum Inferior venacava Left atrium Right atrium Left ventricle Right ventricle
THE HUMAN CIRCULATORY SYSTEM
THE CORONARY ARTERIES
The Major Blood Vessels : The Aorta is a major artery which arises from the left ventricle. The branches of the Aorta supply pure blood containing oxygen & nutrients to different parts of the body - head, upper limbs, abdominal organs including kidneys & lower limbs. ✤ The impure blood containing Co2 & waste material from all parts of the body reaches the right side of the heart - Rt.Atrium through the major veins - Superior venacavae from the upper body and inferior venacavae from the lower body. The impure blood from the Right Atrium passes in to the right ventricle and reaches the lungs through the Pulmonary Artery. In the lungs, this gets oxygenated or purified and the oxygenated or pure blood reaches the left side of the heart (left Atrium) through the pulmonary veins.
Right atrial branch of Right coronary artery Right coronary artery
Aorta Left main coronary artery Left circumflex artery Left anterior descending artery
Aorta Left main coronary artery Left anterior descending artery Septal Branch
Left circumflex artery Right coronary artery Obtuse marginals
Posterior descending artery
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The coronary arteries supply blood to the different portions of heart muscle. The coronary arteries arise from the Aorta. The Left main coronary artery arises from the aorta and divides into Left anterior descending artery and Left circumflex artery. The branches of the left anterior descending artery are the Diagonals and Septals. The branches of the left circumflex artery are the Obtuse marginals. The right coronary artery gives rise to the posterior descending artery and posterolateral branches. The diameter of the coronary arteries varies from 2-3.5 mm.
CONDUCTION SYSTEM OF THE HEART
Sino atrial node
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Atrio ventricular node Common bundle
The conduction system of the Human Heart is similar to the electrical circuit. Symptoms of rhythm disturbance of Heart : Palpitations : Undue awareness of one's own heart beat. Syncope : Momentary loss of consciousness. Patients with rhythm disturbances may present with palpitations, syncope or heart failure. The cardiac impulse passes through different structures of the conduction system of the heart as shown in the diagram. The cardiac impulse originates in the sinoatrial node which is called the pacemaker of the Heart. The normal heart rate and rhythm are maintained by the conduction system of the heart. Abnormalities of heart rate and rhythm are called Arrhythmias. Arrhythmias may be due to abnormal formation of cardiac impulse or abnormal Impulse conduction through the structures of the conduction system. Sometimes, abnormal impulse conduction may be through Accessory pathways.
Arrhythmias may be Tachyarrhythmias (where heart rate is very high) or Bradyarrhythmias (Heart rate is low). Arrhythmias are diagnosed by the resting ECG, 24 hrs Holter (24 hrs ECG monitoring), event recorder and Electrophysiological studies. Drugs which are used to treat arrhythmias are called antiarrhythmic drugs. Certain arrhythmias which may present as an emergency and do not respond to drugs or presenting with low blood pressure or heart failure are treated with direct current electrical shock, using defibrillator. The energy delivered may vary from 1 joule to 360 joules. Radiofrequency ablation therapy is a type of treatment for certain arrhythmias which do not respond to drugs. In this method of treatment, the focus of origin of rhythm disturbance in the heart muscles is destroyed by delivering electrical energy. Some rhythm disturbances like 'Heart Block' where the heart rate is very low are treated by placement of permanent pacemaker in the chest. Patients who have already undergone permanent pacemaker placement should undergo periodic check-up. Implantable cardioverter - defibrillator placement is done in patients who already experienced a life - threatening rhythm disturbance like ventricular tachycardia or in preventing sudden death in those who are at high risk.
2. FUNCTIONING OF THE HUMAN HEART
To body From body
To lungs To lungs From lungs From lungs Right atrium Left atrium
Left ventricle From body To body
The basic function of the heart is to act like a pump, pumping blood from the left ventricle to the entire body, supplying oxygen and nutrients to the various organs. The impure or venous blood flows back to the right side of the heart and goes to the lungs from the right ventricle. In the lungs, the impure blood is purified or oxygenated and enters the left atrium and left ventricle.
Do you know ?
✤ The Heart beats around 70 times a minute. If the heart rate is above 100 it is called Tachycardia and if is below 60 it is called Bradycardia. The Heart functions by Cardiac cycle. The cardiac cycle has two phases - Systole and Diastole. Systole - contraction of the heart muscle. Diastole - relaxation of the heart muscle. ✤ ✤ ✤ The duration of the cardiac cycle is 0.8 sec. The amount of blood released with each contraction is around 70-80 ml. The amount of blood pumped by the heart per minute 70 ml X 72 = 5050ml. - i.e. cardiac output is around 5 liters per minute or per hour 5 X 60 = 300 liters, or per day = 300X24=7200 liters. Blood constitutes 8% of the body weight (i.e. around 5.6 liters). The normal blood flow through coronary arteries is 70-90ml/ 100gms/min. The heart muscle uses 8-10ml/100gms/min. of oxygen. The above values change during various body conditions and
3. SYMPTOMS OF HEART DISEASE
It is important to have a knowledge of common symptoms of heart disease. This will help in knowing the need to consult a doctor. 1. Chest Pain 2. Breathlessness 3. Loss of consciousness 4. Palpitations 5. Swelling of the body.
1. CHEST PAIN
The causes of chest pain are many. Out of these, heart disease is a serious cause of chest pain. Hence, any person suffering from chest pain should have a preliminary consultation by a doctor. What is Angina? Angina is central chest discomfort, tightness or heaviness occurring on exertion and relieved by rest. It may be associated with pain in one or both arms or lower jaw pain, or tightness of throat. ✤ ✤ Localised chest pain may not be related to heart disease. Sometimes chest pain related to heart disease may be confused with symptoms due to hyperacidity, abdominal pain due to stones in gallbladder or muscular pain. Angina results from reduction in blood flow to heart muscle (Myocardial Ischemia) due to blockages in the coronary arteries. Any chest pain which results following exertion, i.e. on walking, climbing stairs or slopes, lifting heavy weights is suggestive of ANGINA & this should alert you to consult a doctor immediately.
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Angina is a symptom of Ischemic Heart Disease.
What is Heart Attack? Heart Attack or Myocardial Infarction results from total stoppage of blood flow to a portion of heart muscle due to total blockage of a coronary artery.
4. TESTS DONE TO DETECT HEART DISEASE
Based on the symptoms complained by the patient, his age, associated risk factors like Diabetes, Hypertension, smoking, hypercholesterolemia and family history of heart disease, a preliminary examination of the heart is done. This involves examination of the pulse, blood pressure and examination of the
✤ ✤ ✤ Breathlessness on exertion may be a sign of heart disease. Breathlessness occurring at midnight or waking from sleep should alert one to consult a doctor. Apar t from diseases of the lungs, sudden onset of breathlessness may be a sign of heart disease.
3. LOSS OF CONSCIOUSNESS
✤ Momentary loss of consciousness may be due to irregularity in heart beat - (Arrhythmias) or diseases of the heart valves like aortic stenosis. Neurological problems like fits or Transient Ischemic Attack (TIA - i.e. reduction in blood flow to brain) should also be considered in those presenting with history of unconsciousness. heart. The heart sounds are heard using the STETHOSCOPE. The blood pressure is noted using the blood pressure apparatus or
Undue awareness of one's own heart beat is palpitation. Apart from situations of anxiety, palpitations may be a symptom of irregularity in heart beat.
Swelling of legs or body may be a symptom of Heart failure, apart from diseases of the liver, kidneys, or blockage of the large veins in the leg.
Sphygmomanometer. Biochemical Investigations : Fasting lipid profile : This involves testing of levels of cholesterol and its different fractions in the blood in a fasting state.
ECG reflects the effect of different diseases on the heart.
Chest X-ray : Apart from detecting lung problems and rib cage abnormalities, chest X-ray gives indirect information about heart size and effect of
Electrocardiogram : This determines the electrical activity of the heart. ✤ ✤ ✤ A Normal ECG will not rule out heart disease. In the absence of heart disease, sometimes Nonspecific changes may appear in the ECG. An initial ECG is done in any person who complains of chest pain.
various diseases on the heart. ✤ Two-Dimensional Echocardiogram - Colour Doppler: This helps us in knowing the heart structure, function and blood flow within the heart. ✤ Echocardiogram helps in detecting various diseases like birth defects in the heart,
diseases of the heart valves and abnormal heart function due to heart attack. Treadmill test or Exercise test (TMT) : This test is done in those complaining of chest pain to rule out heart disease. This test gives indirect information about heart disease
heart valves, cardiac catheterisation is a test done for confirmation & to know the need for surgery.
5. RISK FACTORS FOR HEART DISEASE
Persons with risk factors are usually at high risk of developing heart disease. Hence, those with risk factors should undergo a periodic heart check-up to rule out silent disease. Risk Factors for Heart Disease : 1. 2. 3. 4. 5. Diabetes Mellitus Hypertension Smoking Hypercholesterolemia Family history of heart disease.
1) DIABETES MELLITUS PRODUCES HEART DISEASE IN MANY WAYS.
Patients with Diabetes are at risk of having silent heart disease. Hence, routine heart-check is a must in very diabetic. Long standing diabetes may lead to heart failure due to disease of the heart muscle. Diabetes increases the chances of producing blockages in the coronary arteries leading to heart attack. Patients with diabetes may have silent heart attacks and hence even in the absence of symptoms of heart disease, all Diabetics should undergo a periodic checkup of the heart.
due to the effect of exercise on the heart. In case of an abnormal TMT, coronary angiography is usually recommended. ✤ Information given by tests like Dobutamine stress Echo or stress Thallium which are done in some patients is of more value than treadmill test.
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24 hours ECG recording or Holter monitor : This helps in recording of ECG during the entire day while the person does his usual activities. This helps in detecting disturbances of the heart rate and rhythm. Arteriography or Angiography & Cardiac catheterisation Coronary Angiography : Is a test which is done to know the site, severity of blockages in the coronary arteries which supply blood to the heart. Commonly this is done through the arteries in the thigh or sometimes through the artery in the hand. ✤ In those with birth defects of the heart and diseases of the
2) HYPERTENSION Facts you always wanted to know
What is Blood Pressure ? Blood Pressure is the pressure exerted by the blood on the walls of the arteries. Your Doctor always indicates your B.P. by a set
of two numbers. Eg:- 120/80 mmHg What are these numbers ?
and other organs done by HTN for as long as 10 to 20 years. This is the reason why it is called a “silent killer”.
The upper one denotes the pressure on the arteries when the heart is contracting. This is called “systolic pressure” The lower one is the pressure on the arteries when the heart is relaxed. This is called “diastolic pressure”.
Smoking or use of tobacco in any form is injurious to health in general and heart in particular. Apart from heart disease, smokers are at risk of developing diseases of the lungs, digestive system and urinary system(bladder cancer). “Second-hand smoking” or Passive Smoking is also equally injurious to the body. Smoking increases the risk of heart disease by the increase in oxidation products in the body which are harmful. Nicotine in tobacco and carbon monoxide which is released on smoking injure the endothelium-which is the inner lining of blood vessel. This increases the chance of producing blockages in the blood vessels supplying the heart and thereby leading to heart attack. Stopping smoking reduces the chance of developing heart disease.
After repeated Blood Pressure measurement with an instrument — Blood Pressure Apparatus or Sphygmomanometer your doctor has diagnosed that you are suffering from High Blood Pressure — Hypertension.
Hypertension is very common. It is often without any symptoms. A few cases may Have Headache, Tinnitus(ringing in the ears) Giddiness and fainting. HTN is readily detectable Usually easily treatable
It is necessary to continue treatment regularly as per doctor’s advice. If left untreated, Hypertension can lead to: Heart Diseases Brain Diseases Kidney Diseases Eye problems Why HTN is called a “silent killer” ? Majority of patients with HTN have no specific symptoms. Therefore, a person does not realise the damage to the heart
4) HYPERCHOLESTEROLEMIA What is Cholesterol ?
Cholesterol is a waxy, fat-like substance that is present in every cell in the body. Some cholesterol is needed for our body to function. Our liver produces enough cholesterol for the body. However certain foods provide additional amount of cholesterol, which may be more than our body needs.
While some cholesterol in the blood is essential to our health, too much can be harmful. IF THE CHOLESTEROL LEVEL IS TOO HIGH, IT MAY INCREASE OUR RISK OF HEART DISEASE. There are many reasons for a high cholesterol level : These include diet, family history, obesity, diseases such as diabetes, thyroid gland abnormalities. Are there different kinds of cholesterol ? Yes. Different types of cholesterol and fats have different effects. The most commonly known types are:LDL Cholesterol :Low-density lipoprotein or LDL Cholesterol is known as “the bad cholesterol.” Excess LDL builds up in our arteries and may lead to heart disease. The higher the level of LDL, the higher the risk for heart disease. LOWERING ELEVATED LDL CHOLESTEROL CAN PREVENT HEART ATTACKS AND SAVE LIVES. HDL CHOLESTEROL - High - density Lipoprotein, or HDL cholesterol has earned the nickname “the good cholesterol.” That is because it is believed to remove cholesterol from the blood. High levels of HDL in the blood may help to reduce our risk of coronary heart disease. Low HDL levels can increase our risk of heart disease. Triglycerides : Triglycerides are another type of fat in our blood stream. People with a high blood triglyceride may also have a high LDL. Those with a high triglyceride Level in addition to an elevated LDL cholesterol level may be at an increased risk of coronary heart disease. What is high cholesterol ?
The definition of high cholesterol can vary depending on other risk factors. Discuss with your doctor what is considered high for you. Detection and treatment of high blood cholesterol in adults is based on guidelines incorporated in the National Cholesterol Education Program-developed by the National Institute of Health (NIH), USA.
5) FAMILY HISTORY OF HEART DISEASE :
Family members (1st degree relatives) of those persons who had unexplained death at a young age or history of heart attack should also undergo heart check-up.
Physical inactivity and obesity also increase the chance of developing heart disease.
6. TYPES OF HEART DISEASE
1. 2. Congenital Heart Disease:- Diseases present by birth. Rheumatic Heart Diseases are those which affect the heart valves following Acute Rheumatic Fever leading to disease of the heart valves. Ischemic Heart Disease:- Results from reduction in blood supply to the heart muscle. Cardiomyopathy:- Is a disease of the heart muscle. Pericardial disease is a disease of the pericardium which is the protective cover around the heart. Arrhythmias are disorders of heart rate and rhythm due to disease of the conducting system of the heart.
CONGENITAL HEART DISEASE
These are defects in the heart which result due to abnormalities in development of heart in the fetal stage. Holes in the Heart : Abnormalities of Development of septum between Atria leads to Atrial septal Defect & between the ventricles leads to Ventricular Septal Defect.
3. 4. 5. 6.
If the communication between the Aorta and Pulmonary artery ie Ductus Arteriosus which normally closes in the fetal stage or immediately after birth, dees not close it leads to a disease called Patent Ductus Arteriosus. Some Complex congenital Heart diseases where there is an abnormality of the major blood ressels of the heart and heart valves are really serious. Symptoms of babies with Congenital Heart Disease:Frequent respiratory infections. Difficulty in taking breast feeds. Delayed milestones or abnormalities in physical development. Some babies with complex congenital heart disease present with bluish discoloration of the lips, tongue, fingers and toes due to mixing of blood from both sides of the heart. Congenital Heart Diseases are usually suspected on routine
1. 2. 3. 4.
examination by children specialists.
in Mitral Regurgitation there is leakage of blood acroos the Mitral Valve.
RHEUMATIC HEART DISEASE
This is a very common heart disease in our country. This usually affects the heart valves and initially may present as Acute rheumatic fever.
ISCHEMIC HEART DISEASE OR CORONARY ARTERY DISEASE
The non-stop function of the heart is facilitated by blood supply to heart muscle through coronary arteries.
Acute Rheumatic Fever :✤ ✤
Usually affects children between 5 and 15 years. Children with Acute Rheumatic fever usually have joint pains, fever and sore-throat. Acute rheumatic fever results from throat infection due to bacteria of the B-Hemolytic Streptococci group.
Myocardial Ischemia is reduction in blood supply to the heart muscle due to formation of blockages (Plaque, Thrombus or clot) in the coronary arteries. The symptom following Myocardial Ischemia is “Angina.”
Angina may be Stable Angina where the patient has symptoms lasting a few months to a few years. or Unstable Angina where the patient has symptoms whose onset is a few hours to days to 1-2 months. Patients with Unstable Angina are at high risk of developing Heart Attack(Acute Myocardial Infarction) where there is a total stoppage of blood flow to a portion of heart muscle due to complete blockage of a coronary artery. What is Atherosclerosis ? Athero-Means Porridge & Sclerosis Means Hardening. Atherosclerosis is the disease process in Ischemic Heart Disease. Normally the arteries do not contain calcium & fat substances. The process whereby calcium, fat substances, blood cells collect together, form a plaque, and layer by layer form a thrombus and lead to narrowing of a artery is called as Atherosclerosis. Thereby blood flow is reduced to the portion of the body supplied by that
Following Acute Rheumatic Fever : The disease process following Acute Rheumatic Fever is a result of cross-reaction between the protein of heart-muscle and protein of bacterial cell-wall.
Acute Rheumatic Fever affects mainly the heart valves and over a period of time leads to Valvular Heart Disease. The Common diseases of the heart valves following Acute Rheumatic Fever are Mitral Stenosis, Aortic Stenosis Mitral Regurgitation & Aortic Regurgitation
Stenosis of the Mitral Valve & Aortic Valve means reduction in area of the respective valves. For example, in Mitral Stenosis which is the most common valve disease, the area of the mitral valve is reduced. (Normal Mitral valve Area is around 3-4sq.cm) Regurgitation is leakage of blood across the valve. For example,
HUMAN ARTERIAL SYSTEM
ATHEROSCLEROSIS OR FORMATION OF BLOCKAGES IN THE ARTERY
artery. Atherosclerosis may involve the arteries of the heart, brain or kidneys leading to serious consequences.
cavity which may present as an emergency. Infective endocarditis is disease caused by bacterial infection of the inner endothelial lining of the heart.
Cardiomyopathy is a disease of the heart muscle which usually presents with heart failure. There are various causes and varieties of cardiomyopathy.
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It is mandatory for all patients to undergo routine heart checkup before undergoing any major surgery. The heart can also be affected by tumors, chest injury, depression and anxiety disorders.
Heavy, regular usage of alcohol leads to cardiomyopathy. Myocarditis is infection of the heart muscle which is usually a result of viral infection. AIDS involves the heart in various ways.
HEART DISEASE IN PREGNANCY
All pregnant women who have symptoms suggestive of heart disease should undergo a preliminary cardiovascular examination. Hypertension, Valvular heart diseases are some of the common heart problems encountered during pregnancy. All pregnant women in whom heart disease is confirmed, should be under constant supervision during the last few months of pregnancy and time of delivery. In some conditions like Peripartum cardiomyopthy and primary
OTHER SITUATIONS WHERE HEART DISEASE IS USUALLY ENCOUNTERED
Drugs:Some of the anticancer drugs, antidepressants used for psychiatric illness, oral contraceptives, cocaine (Drug abuse) can lead to heart disease.
Electric injury, scorpion sting,organophosphate poisoning may produce emergency heart problems.
DISEASES OF THE PERICARDIUM
Pericarditis is infection of the Pericardium i.e. the protective covering over the heart. One of the common causes of Pericarditis in our country is Tuberculosis, apart from viral infection.
Sometimes there is excessive collection of fluid in the pericardial
pulmonary Hypertension future conception is not advisable.
Hypertension or Heart Disease is a cause of grave concern to the mother or fetus. Hence it is always advisable to follow doctor’s advice.
Heart attack also weakens the heart muscles as it damages part of the heart muscle thereby putting additional workload on the remaining musculature. Diabetes mellitus increases the incidence of coronary artery disease and congestive heart disease. Chronic kidney failure is another important cause for development of CHF as it causes retention of water which puts additional workload on the heart muscles.
CONGESTIVE HEART FAILURE
What is Congestive Heart Failure? Due to the weakening of the heart muscles, their capacity to pump blood to all parts of the body decreases. This leads to the accumulation of a small portion of blood in the left ventricle. Thus every time the heart beats a small amount of blood is left in the left ventricle, leading to congestion. When the heart is full of this unpumped blood there is no room for newly oxygenated blood to enter the left ventricle. At this time the heart suddenly stops functioning. How does it develop? Since this problem is due to the weakening of the heart muscles we shall find out the conditions which could lead to this.
What are the signs and symptoms? The typical signs and symptoms that you would experience are feeling weak or tired upon usual exertion shortness of breath or sudden cough upon exertion swelling of the feet difficulty in breathing upon lying down frequent urination sudden instances of dizziness disturbance in sleep due to coughing and shortness of breath.
One most potential culprit is Coronary Artery Disease. Due to the deposition of fat on the inner walls of the coronary arteries the blood supply to the heart muscles is lessened. Over a period of time the heart muscles weaken due to lack of blood supply and their ability to pump blood completely from the left ventricle, decreases. If your heart muscles are affected and develop some disease which affects their ability to pump blood efficiently it is called as Cardiomyopathy and may be caused by alcohol abuse or certain toxic drugs. The incidence of this is very rare. Hypertension is also a major contributing factor. In hypertensive patients the heart has to work harder to pump the blood. Over a period of time this causes enlargement of the chambers of the heart and weakens the heart muscles.
How does a doctor diagnose CHF? The doctor can diagnose your problem by using one of more of the following techniques. He will ask you about your previous health record and your family history. This will help him to know whether you are likely to suffer from heart problems by virtue of heredity.
Electrocardiogram helps in finding out how your heart is functioning and whether the heart is getting proper blood supply. Echocardiogram shows whether the heart is enlarged, how well does the heart pump, whether the heart wall is thickened etc., There are other methods to identity abnormal heart beats, weakened areas of the heart, blockages in the coronary arteries.
What is the treatment? The treatment is divided into two types viz. 1. 2. Personal health care i.e. regular physical activity, healthy food habits, weight control/reduction, sufficient rest, etc. Medicines - These include the following
Cardiac Asystole or Cardiac Arrest.
Vasodilators dilate the blood vessels and thus reduce the blood pressure. The workload on heart is thus lowered hence it can pump more blood. Currently the most acceopted drugs are the ACE inhibitors due to their benefits. Diuretics help in relieving you from the excess fluid that is accumulated in the body which increases the workload on heart. Digitalis is cardioprotective in nature and helps in restoring the force of contraction of the heart muscle. Digitalis also helps in an irregular heart beat. Anticoagulants, are although not directly for CHF but they help in preventing the formation of blood clots which may lead to heart attack etc. Antiarrhythmic agents help in regularizing the irregular heart beat thereby reducing the workload on heart.
CAUSES OF SUDDEN DEATH IN HEART DISEASE
Sudden Cardiac Death results within I hour of onset of symptoms in a person who has not been documented to have heart desease. Causes of sudden Death in patients of heart disase:Sudden Death in patients of heart disease may be due to serious disturbances in heart rate and rhythm like: Ventricular Tachycardia Ventricular Fibrillation Complete Heart Block
Timely action by giving DC Shock using a Defibrillator or temporary pacing may save a few patients.
7. CARDIOPULMONARY RESUSCITATION
What to do in case you encounter a person who suddenly collapses?
=> Place the heel of one hand over the lower part of the breast bone just above the abdomen. Keeping the arms straight, place the heel of the other hand over the first to reinforce the downward pushing action, Without bending the arms, depress the breast bone about 2+/– 1/2 inches. After this release the pressure suddenly to allow the breast bone to recoil upwards (in order to fill the heart with blood). => Simultaneously with external compression, commence mouth-to-mouth respiration. Tilt the head backwards and lift the back of the neck (Fig.4). Pull the lower jaw to displace the tongue forward (Fig.5), Open the mouth and use your fingers to clear the food, fluid, vomit, artificial dentures etc. (Fig.6). All these steps will help in opening up the airway passages. Look, listen and feel for breathing. => If the patient does not start breathing, start mouth-to-mouth respiration. Pinch the nostrils, seal the patient’s open mouth with your own and deliver rapid mouth-to-mouth breaths (Fig.7). Observe for chest expansion and presence of pulse, continue mouth-to-mouth respiration at the rate of one every 5 seconds (fig.8) => If only one person is present, 2 lung inflations alternated with 15 chest compressions at a rate of 80-100 per minute should be carried out. If an assistant is available, one should deliver chest compression at a rate of 80-100 per minute while the other ventilates the patient at slow ventilatory breaths lasting for 1 to 1 & 1/2 seconds, once every 5th compression. Cardiac compression alongwith artificial ventilation should be carried out rhythmically, regularly and sincerely until effective spontaneous breathing is re-established. A few precautions should be taken while performing CPR. A) B) Do not exert pressure on the top of the abdomen as this can harm the liver. Pressure should be exerted only with the heel. See that the fingers are lifted and do not touch the ribs.
When a person suddenly collapses infront of you, you should perform CPR i.e. Cardiopulmonary Resuscitation.
In the event of cardiac arrest there is sudden drop in blood supply to the brain which leads to unconciousness, absence of heart beat, gasps and absence of pulsation in large arteries. Recognizing the signs of cardiopulmonary arrest, providing effective artificial respiration (CPR-Cardio Pulmonary Resuscitation), stabilizing the patient and transferring him to an appropriate cardiac care centre should take care of the emergency. What is CPR? Cardio Pulmonary Resuscitation is a technique whereby you maintain patient’s breathing through artificial respiration and blood flow by external chest compression How to perform CPR?
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Place the patient on his back on a hard flat surface. Keep the legs raised (Fig.1) Give one or two sharp and forceful blows with the closed fist on the middle of the chest (Fig.2). This will help to restore effective beating of the heart.
* Start compressing the heart externally as shown in (fig.3) at the rate of 80-100 compressions per minute in the following manner. => Place yourself in a kneeling position by the side of the patient lying flat on the hard surface.
The compression should be smooth, regular, uninterrupted with 50% of the cycle for compression and remaining 50% for relaxation. Continue CPR for 3 to 4 minutes until the patient has stabilized and transfer the patient to a cardiac care centre.
Device closure or closure of the defect using an artificial device is the latest modality of treatment for some conditions. Defects in the heart which are very small do not require any treatment. Surgery may be quite beneficial in some complex congenital heart diseases, while in some it may offer short-term relief and in some others surgery may not provide any relief.
8. METHODS OF TREATING HEART DISEASE
A proper diagnosis of heart disease helps in choosing the treatment modality. Treatment of heart disease aims at relief of symptoms and prolonging life. Treatment involves use of medicines, interventional methods or surgery. The choice of treatment depends on the type of heart disease and its severity.
TREATMENT OF RHEUMATIC HEART DISEASE
Acute Rheumatic Fever is usually treated with Aspirin and Inj.Penicillin. In Mitral Stenosis, which is a common disease of the heart valves, the area of the mitral valve is increased by either the non-surgical way of Percutaneous Balloon Valvotomy or surgery. Depending on the nature of the valve disease, the type of surgery may be Valve Repair or Valve Replacement using an artificial valve.
TREATMENT OF CONGENITAL HEART DISEASE
TREATMENT OF ISCHEMIC HEART DISEASE
The treatment of Ischemic Heart Disease in its initial stages involves Medical treatment-ie use of drugs like nitrates and aspirin.
Babies who present with heart failure are treated with drugs. ‘Holes’ in the heart or developmental defects like Atrial septal Defect or Ventricular septal Defect may close naturally by the age of 10 years. Meanwhile, depending on the size of the defect, disease severity and symptoms & thereby proper assessment during follow-up, surgery may be required. (Surgical closure of Atrial septal Defect or Ventricular septal Defect or Ligation of Patent Ductos Arteriosus).
In case of severe symptoms like in unstable Angina, hospitalisation involving admission of a patient in an Intensive coronary care unit is suggested.
We already know that complete blockage of a coronary artery leads to Heart Attack or Acute Myocardial Infarction. The process of dissolving the clot or thrombus using clotdissolving agents or thrombolytic agents like Streptokinase or Urokinase is called thrombolysis.
Timely use of these drugs after onset of heart attack may lessen
the damage to heart muscle.
Where facilities are available, Primary Angioplasty is also one method which is very useful in patients with heart attack.
serious disturbances in heart rate or rhythm are detected by Electrophysiological studies and treated by using electrical energy (Radio frequency Ablation). Life-threatening disturbances of heart rate and rhythm which do not respond to drugs like ventricular Tachycardia are treated by implantation of a battery operated instrument called Automatic Implantable Cardioverter - Defibrillator (AICD).
In view of the different life-threatening complications, a patient with heart-attack is usually monitored in an intensive-care setting for around 5 to 7 days.
In a patient with Ischemic heart disease or particularly following a heart attack, if he has disabling symptoms and not relieved by optimum dosage of drugs, Coronary angiography is done to detect the blockages. 1. 2. 3. 4.
IF YOU ARE A PATIENT WITH HEART DISEASE
Please follow instructions regarding treatment and life-style as advised by your doctor. Please maintain your records properly. Do not travel alone. It is always better if you have an attendant along with you. You should be aware of the common side-effects of the drugs.
Depending on the number of blockages and arteries involved, percentage of blockage in an artery, either balloon angioplasty, Stent Implantation or Bypass surgery are chosen.
Balloon Angioplasty is the method of opening the blocked coronary artery. Stenting is the procedure where a stent (spring or conduit) is placed at the site of blockage. This lessens the chances of blockage developing again. Coronary Artery Bypass graft surgery is the surgical procedure in which blood vessels are joined by "bypassing" the site of blockage. The blood vessel or graft. which is used for bypass surgery can be a Artery graft or a venous graft.
TREATMENT OF RHYTHM DISTURBANCES OF THE HEART
Disturbances in Heart rate and rhythm like Complete Heart Block are treated by surgical implantation of a pacemaker. A pacemaker is a battery-operated modality which artificially regulates heart rate and rhythm.
Sometimes, abnormal or accessory pathways which lead to
5. 6. –
Periodic check-up is essential. Do not get depressed. Please discuss freely with your doctor regarding your disease. He will guide you regarding the methods of treatment and getting well. In case of any emergency, please contact your nearest doctor/ hospital.
9. PREVENTION OF HEART DISEASE
1. 2. 3. 4. 5. 6. 7. 8. 9. Regular exercise like walking for 30 min. a day for atleast 5 times a week will help you have a healthy heart for life. Diets with low fat are to be taken Maintain a healthy weight. Stop smoking. Avoid stress Check your B.P. Check if you have diabetes Watch your cholesterol. Have periodic health check up.
EXERCISE AND THE HEART
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Exercise is good for your heart. Your heart is a muscle. Like any other muscle it needs to stay active. You should ask your doctor what exercise is right for you-before embarking on it. For most people moderate exercise for 20-30 min., five times a week helps reduce the risk of Coronary Artery Disease significantly.
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Wishing you a healthy
Regular exercise helps to raise the level of good cholesterol. HDL helps remove bad Cholesterol from your arteries. Exercise also helps lower B.P. Exercise helps you to lose your weight. 39 Exercise also strengthens your lungs, tones the muscles and
KNOW YOUR HEART
Dr. R. SRINIVAS
SRINIVASA HEART CENTRE
Residence : “SRIDHATRI”, H.No. 2-4-617/4, Ramnagar, Hanamkonda, Warangal, A.P.
Dr. R. SRINIVAS
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