BIOLOGY

Investigatory project

TYPES OF HEART DISEASES

their causes, effects, remedial measures and
many more
 Name of the project -
Types of Heart Diseases
NAME- Rahul Ghosh
AISSCE: 2021-22
BOARD ROLL NUMBER:
12675688
_________________
This is to certify that Rahul Ghosh is a
bonafide student of Delhi Public School Ruby
Park, Kolkata. He has successfully completed
biology investigatory project for AISSCE
2021-2022 as prescribed by CBSE.

Signature of Signature of
External Examiner Internal Examiner
Date: Date:

______________ ______________
 ACKNOWLEDGEMENT

I would like to express my special thanks to my

biology teacher, Rohan sir, for his valuable
guidance and suggestions which helped me go
through the entire task. I would like to thank my
friends and my parents who have supported me
throughout and once again helped getting the best
results. A sincere thanks and gratitude to you all.
INDEX

1. Certificate

2. Acknowledgement

3. Introduction

4. Discussion
 Overview
 Causes
 Effects
 Remedial Measures
5. Observation

6. Case study

7. Conclusion

8. Bibliography

9. End
Introduction

Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an
estimated 17.9 million lives each year. CVDs are a group of disorders of the heart and blood
vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease
and other conditions. More than four out of five CVD deaths are due to heart attacks and
strokes, and one third of these deaths occur prematurely in people under 70 years of age.

The most important behavioural risk factors of heart disease and stroke are unhealthy diet,
physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk
factors may show up in individuals as raised blood pressure, raised blood glucose, raised
blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured
in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure
and other complications.

Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables,
regular physical activity and avoiding harmful use of alcohol have been shown to reduce the
risk of cardiovascular disease. Health policies that create conducive environments for making
healthy choices affordable and available are essential for motivating people to adopt and
sustain healthy behaviours.

Identifying those at highest risk of CVDs and ensuring they receive appropriate treatment can
prevent premature deaths. Access to no communicable disease medicines and basic health
technologies in all primary health care facilities is essential to ensure that those in need
receive treatment and counselling.
1. CARDIAC ARREST

Overview

Sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness. The
condition usually results from a problem with your heart's electrical system, which disrupts
your heart's pumping action and stops blood flow to your body.

Sudden cardiac arrest isn't the same as a heart attack, when blood flow to a part of the heart is
blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to
sudden cardiac arrest.

If not treated immediately, sudden cardiac arrest can lead to death. Survival is possible with
fast, appropriate medical care. Cardiopulmonary resuscitation (CPR), using a defibrillator —
or even just giving compressions to the chest — can improve the chances of survival until
emergency workers arrive.

Cardiac arrest is an extremely serious health issue. The Institute of Medicine reports that
every year, more than half a million people experience cardiac arrest in the United States.
The condition can cause death or disability. If you or someone you’re with is experiencing
symptoms of cardiac arrest, seek emergency health assistance immediately. It can be fatal.
Immediate response and treatment can save a life.
CAUSES

The usual cause of sudden cardiac arrest is an abnormal heart rhythm (arrhythmia), which
happens when your heart's electrical system isn't working correctly. The heart's electrical
system controls the rate and rhythm of your heartbeat. If something goes wrong, your heart
can beat too fast, too slowly or irregularly (arrhythmia). Often these arrhythmias are brief and
harmless, but some types can lead to sudden cardiac arrest. The most common heart rhythm
at the time of cardiac arrest is an arrhythmia in a lower chamber of your heart (ventricle).
Rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping
blood (ventricle fibrillation).

Sudden cardiac arrest can happen in people who have no known heart disease. However, a
life-threatening arrhythmia usually develops in a person with a pre-existing, possibly
undiagnosed heart condition. Conditions include:

 Coronary artery disease. Most cases of sudden cardiac arrest occur in people who
have coronary artery disease, in which the arteries become clogged with cholesterol and
other deposits, reducing blood flow to the heart.

 Heart attack. If a heart attack occurs, often as a result of severe coronary artery
disease, it can trigger ventricular fibrillation and sudden cardiac arrest. Also, a heart
attack can leave scar tissue in your heart. Electrical short circuits around the scar tissue
can lead to abnormalities in your heart rhythm.

 Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular
walls stretch and enlarge or thicken. Then your heart's muscle is abnormal, a condition
that often leads to arrhythmias.

 Valvular heart disease. Leaking or narrowing of your heart valves can lead to
stretching or thickening of your heart muscle. When the chambers become enlarged or
weakened because of stress caused by a tight or leaking valve, there's an increased risk
of developing arrhythmia.

 Heart defect present at birth (congenital heart disease). When sudden cardiac arrest
occurs in children or adolescents, it can be due to congenital heart disease. Adults
who've had corrective surgery for a congenital heart defect still have a higher risk of
sudden cardiac arrest.

 Electrical problems in the heart. In some people, the problem is in the heart's
electrical system itself instead of a problem with the heart muscle or valves. These are
called primary heart rhythm abnormalities and include conditions such as Brugada
syndrome and long QT syndrome.
EFFECTS

If you have experienced cardiac arrest, it’s important to understand the cause. Your long-term
outlook will depend on the reason you experienced cardiac arrest. Your doctor can talk to you
about treatment options to help protect your heart and prevent cardiac arrest from happening
again.

REMEDIAL MEASURES

 Exercise for at least half an hour most days of the week.

 Eat right -- preferably a diet low in unhealthy fats and high in fruits and vegetables.
 Lose weight (if you're overweight).
 Don't smoke -- smokers are 2 to 4 times as likely to develop plaque in the coronary
arteries.
 Reduce emotional stress.

Sudden cardiac arrest requires immediate action for survival.

CPR

Immediate CPR is crucial for treating sudden cardiac arrest. By maintaining a flow of
oxygen-rich blood to the body's vital organs, CPR can provide a vital link until more-
advanced emergency care is available.

If you don't know CPR and someone collapses unconscious near you, call emergency medical
help. Then, if the person isn't breathing normally, begin pushing hard and fast on the person's
chest — at a rate of 100 to 120 compressions a minute, allowing the chest to fully rise
between compressions. Do this until an automated external defibrillator (AED) becomes
available or emergency personnel arrive

.
Defibrillation

Advanced care for ventricular fibrillation, a type of arrhythmia that can cause sudden cardiac
arrest, generally includes delivery of an electrical shock through the chest wall to the heart.
The procedure, called defibrillation, momentarily stops the heart and the chaotic rhythm. This
often allows the normal heart rhythm to resume.

Defibrillators are programmed to recognize ventricular fibrillation and send a shock only
when it's appropriate. These portable defibrillators, such as AEDs, are increasingly available
in public places, including airports, shopping malls, casinos, health clubs, and community
and senior citizen centers.

At the emergency room

Once you arrive in the emergency room, the medical staff will work to stabilize your
condition and treat a possible heart attack, heart failure or electrolyte imbalances. You might
be given medications to stabilize your heart rhythm.

Long-term treatment

After you recover, your doctor will discuss with you or your family what other tests might
help determine the cause of the cardiac arrest. Your doctor will also discuss preventive
treatment options with you to reduce your risk of another cardiac arrest.

Treatments might include:

 Drugs. Doctors use various anti-arrhythmic drugs for emergency or long-term treatment
of arrhythmias or potential arrhythmia complications. A class of medications called beta
blockers is commonly used in people at risk of sudden cardiac arrest.

Other possible drugs that can be used to treat the condition that led to the arrhythmia
include angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers.

 Implantable cardioverter-defibrillator (ICD). After your condition stabilizes, your

doctor is likely to recommend an ICD, a battery-powered unit that's put into your body
near your left collarbone. One or more electrode-tipped wires from the ICD run through
veins to your heart.
 The ICD constantly monitors your heart rhythm. If it detects a rhythm that's too slow, it
paces your heart as a pacemaker would. If it detects a dangerous heart rhythm change, it
sends out low- or high-energy shocks to reset your heart to a normal rhythm.

 Coronary angioplasty. This procedure opens blocked coronary arteries, letting blood
flow more freely to your heart, which might reduce your risk of serious arrhythmia. A
long, thin tube is passed through an artery, usually in your leg, to a blocked artery in
your heart. This catheter is equipped with a special balloon tip that briefly inflates to
open the blocked artery.

At the same time, a metal mesh stent might be inserted into the artery to keep it open
long term, restoring blood flow to your heart. Coronary angioplasty can be done at the
same time as a coronary catheterization, a procedure that doctors do to locate narrowed
arteries to the heart.

 Coronary bypass surgery. Also called coronary artery bypass grafting, bypass surgery
involves sewing veins or arteries in place at a site beyond a blocked or narrowed
coronary artery, restoring blood flow to your heart. This can improve the blood supply
to your heart and reduce the frequency of racing heartbeats.

 Radiofrequency catheter ablation. This procedure can be used to block a single

abnormal electrical pathway. One or more catheters are threaded through your blood
vessels to inside your heart. They're positioned along electrical pathways identified by
your doctor as causing your arrhythmia.

Electrodes at the catheter tips are heated with radiofrequency energy. This destroys a
small spot of heart tissue and creates an electrical block along the pathway that's
causing your arrhythmia to stop your arrhythmia.

 Corrective heart surgery. If you have a congenital heart deformity, a faulty valve or
diseased heart muscle tissue due to cardiomyopathy, surgery to correct the abnormality
might improve your heart rate and blood flow, reducing your risk of fatal arrhythmias.
2. Heart arrhythmia

Overview

A heart arrhythmia (uh-RITH-me-uh) is an irregular heartbeat. Heart rhythm problems (heart

arrhythmias) occur when the electrical signals that coordinate the heart's beats don't work
properly. The faulty signaling causes the heart to beat too fast (tachycardia), too slow
(bradycardia) or irregularly.

Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However,
some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs
and symptoms.

However, sometimes it's normal for a person to have a fast or slow heart rate. For example,
the heart rate may increase with exercise or slow down during sleep.

Heart arrhythmia treatment may include medications, catheter procedures, implanted devices
or surgery to control or eliminate fast, slow or irregular heartbeats. A heart-healthy lifestyle
can help prevent heart damage that can trigger certain heart arrhythmias.

Types

In general, heart arrhythmias are grouped by the speed of the heart rate. For example:
  Tachycardia (tak-ih-KAHR-dee-uh) is a fast heart. The resting heart rate is greater than
100 beats a minute.

 Bradycardia (brad-e-KAHR-dee-uh) is a slow heartbeat. The resting heart rate is less

than 60 beats a minute.
Fast heartbeat (tachycardia)

Types of tachycardias include:

 Atrial fibrillation (A-fib). Chaotic heart signaling causes a rapid, uncoordinated heart
rate. The condition may be temporary, but some A-fib episodes may not stop unless
treated. A-fib is associated with serious complications such as stroke.

 Atrial flutter. Atrial flutter is similar to A-fib, but heartbeats are more organized. Atrial
flutter is also linked to stroke.

 Supraventricular tachycardia. Supraventricular tachycardia is a broad term that

includes arrhythmias that start above the lower heart chambers (ventricles).
Supraventricular tachycardia causes episodes of a pounding heartbeat (palpitations) that
begin and end abruptly.

 Ventricular fibrillation. This type of arrhythmia occurs when rapid, chaotic electrical
signals cause the lower heart chambers (ventricles) to quiver instead of contacting in a
coordinated way that pumps blood to the rest of the body. This serious problem can lead
to death if a normal heart rhythm isn't restored within minutes. Most people who have
ventricular fibrillation have an underlying heart disease or have experienced serious
trauma.

 Ventricular tachycardia. This rapid, regular heart rate starts with faulty electrical
signals in the lower heart chambers (ventricles). The rapid heart rate doesn't allow the
ventricles to properly fill with blood. As a result, the heart can't pump enough blood to
the body. Ventricular tachycardia may not cause serious problems in people with an
otherwise healthy heart. In those with heart disease, ventricular tachycardia can be a
medical emergency that requires immediate medical treatment.
Slow heartbeat (bradycardia)

Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low
resting heart rate doesn't always signal a problem. If you're physically fit, your heart may still
be able to pump enough blood to the body with fewer than 60 beats a minute at rest.

If you have a slow heart rate and your heart isn't pumping enough blood, you may have a type
of bradycardia. Types of bradycardias include:
  Sick sinus syndrome. The sinus node is responsible for setting the pace of the heart. If
it doesn't work properly, the heart rate may alternate between too slow (bradycardia)
and too fast (tachycardia). Sick sinus syndrome can be caused by scarring near the sinus
node that's slowing, disrupting or blocking the travel of impulses. Sick sinus syndrome
is most common among older adults.

 Conduction block. A block of the heart's electrical pathways can cause the signals that
trigger the heartbeats to slow down or stop. Some blocks may cause no signs or
symptoms, and others may cause skipped beats or bradycardia.
Premature heartbeats

Premature heartbeats are extra beats that occur one at a time, sometimes in patterns that
alternate with the normal heart beat. The extra beats may come from the top chamber of the
heart (premature atrial contractions) or the bottom chamber (premature ventricular
contractions).

A premature heartbeat may feel like your heart skipped a beat. These extra beats are generally
not concerning, and they seldom mean you have a more serious condition. Still, a premature
beat can trigger a longer-lasting arrhythmia, especially in people with heart disease.
Occasionally, very frequent premature beats that last for several years may lead to a weak
heart.

Premature heartbeats may occur when resting. Sometimes premature heartbeats are caused by
stress, strenuous exercise or stimulants, such as caffeine or nicotine.

Causes

To understand the cause of heart arrhythmias, it may be helpful to know how the heart
typically works.

How does the heart beat? The heart is made of four chambers — two upper chambers (atria)
and two lower chambers (ventricles).The heart's rhythm is normally controlled by a natural
pacemaker (the sinus node) in the right upper chamber (atrium). The sinus node sends
electrical signals that normally start each heartbeat. These electrical signals move across the
atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the signals arrive at a cluster of cells called the AV node, where they slow down. This
slight delay allows the ventricles to fill with blood. When the electrical signals reach the
ventricles, the chambers contract and pump blood to the lungs or to the rest of the body.
In a healthy heart, this heart signaling process usually goes smoothly, resulting in a normal
resting heart rate of 60 to 100 beats a minute.

Things that can cause an irregular heartbeat (arrhythmia) include:

 Current heart attack or scarring from a previous heart attack

 Blocked arteries in the heart (coronary artery disease)

 Changes to the heart's structure, such as from cardiomyopathy

 Diabetes

 High blood pressure

 Infection with COVID-19

 Overactive thyroid gland (hyperthyroidism)

 Sleep apnea

 Underactive thyroid gland (hypothyroidism)

 Certain medications, including cold and allergy drugs bought without a prescription

 Drinking too much alcohol or caffeine

 Drug abuse

 Genetics

 Smoking

 Stress or anxiety

EFFECTS

Some arrhythmias can be serious and lead to sudden cardiac arrest or stroke. If blood cannot
be pumped efficiently from the heart, it may pool and clot, later clogging an artery and
cutting off blood flow to the heart, brain, or other organs. If an arrhythmia causes your heart
to pump inefficiently for an extended period, permanent damage can occur resulting in heart
failure.
Some arrhythmias are fatal and require medical attention immediately.
REMEDIAL MEASURES
Treatment for heart arrhythmias depends on whether you have a fast heartbeat (tachycardia)
or slow heartbeat (bradycardia). Some heart arrhythmias do not need treatment. Your doctor
may recommend regular checkups to monitor your condition.

Heart arrhythmia treatment is usually only needed if the irregular heartbeat is causing
significant symptoms, or if the condition is putting you at risk of more-serious heart
problems. Treatment for heart arrhythmias may include medications, therapies such as vagal
maneuvers, cardioversion, catheter procedures or heart surgery.

Medications

Medications used to treat heart arrhythmias depend on the type of arrhythmia and potential
complications.

For example, drugs to control the heart rate and restore a normal heart rhythm are often
prescribed for most people with tachycardia.

If you have atrial fibrillation, blood thinners may be prescribed to prevent blood clots. It's
very important to take the medications exactly as directed by your doctor in order to reduce
the risk of complications.

Therapies to treat heart arrhythmias include vagal maneuvers and cardioversion to stop the
irregular heartbeat.

 Vagal maneuvers. If you have a very fast heartbeat due to supraventricular

tachycardia, your doctor may recommend this therapy. Vagal maneuvers affect the
nervous system that controls your heartbeat (vagus nerves), often causing your heart
rate to slow. For example, you may be able to stop an arrhythmia by holding your
breath and straining, dunking your face in ice water, or coughing. Vagal maneuvers
don't work for all types of arrhythmias.

 Cardioversion. This method to reset the heart rhythm may be done with medications or
as a procedure. Your doctor may recommend this treatment if you have a certain type of
arrhythmia, such as atrial fibrillation.

During the cardioversion procedure, a shock is delivered to your heart through paddles
or patches on your chest. The current affects the electrical impulses in your heart and
can restore a normal rhythm.
Treatment for heart arrhythmias may also involve catheter procedures or surgery to implant a
heart (cardiac) device. Certain arrhythmias may require open-heart surgery.

Types of procedures and surgeries used to treat heart arrhythmias include:

 Catheter ablation. In this procedure, the doctor threads one or more catheters through
the blood vessels to the heart. Electrodes at the catheter tips use heat or cold energy to
create tiny scars in your heart to block abnormal electrical signals and restore a normal
heartbeat.

 Pacemaker. If slow heartbeats (bradycardias) don't have a cause that can be corrected,
doctors often treat them with a pacemaker because there aren't any medications that can
reliably speed up the heart.

A pacemaker is a small device that's usually implanted near the collarbone. One or
more electrode-tipped wires run from the pacemaker through the blood vessels to the
inner heart. If the heart rate is too slow or if it stops, the pacemaker sends out electrical
impulses that stimulate the heart to beat at a steady rate.

 Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this

device if you're at high risk of developing a dangerously fast or irregular heartbeat in
the lower heart chambers (ventricular tachycardia or ventricular fibrillation). If you
have had sudden cardiac arrest or have certain heart conditions that increase your risk of
sudden cardiac arrest, your doctor may also recommend an ICD.
 An ICD is a battery-powered unit that's implanted under the skin near the collarbone —
similar to a pacemaker. One or more electrode-tipped wires from the ICD run through
veins to the heart. The ICD continuously monitors your heart rhythm.

If the ICD detects an abnormal heart rhythm, it sends out low- or high-energy shocks to
reset the heart to a normal rhythm. An ICD doesn't prevent an irregular heart rhythm
from occurring, but it treats it if it occurs.

 Maze procedure. In the maze procedure, a surgeon makes a series of incisions in the
heart tissue in the upper half of your heart (atria) to create a pattern (or maze) of scar
tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical
impulses that cause some types of arrhythmia.

 Coronary bypass surgery. If you have severe coronary artery disease in addition to a
heart arrhythmia, your doctor may perform coronary bypass surgery. This procedure
may improve the blood flow to your heart.
3. High Blood Pressure (hypertension)

Overview

High blood pressure (hypertension) is a common condition in which the long-term force of
the blood against your artery walls is high enough that it may eventually cause health
problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount
of resistance to blood flow in your arteries. The more blood your heart pumps and the
narrower your arteries, the higher your blood pressure. A blood pressure reading is given in
millimetres of mercury (mm Hg). It has two numbers.

 Top number (systolic pressure). The first, or upper, number measures the pressure in
your arteries when your heart beats.

 Bottom number (diastolic pressure). The second, or lower, number measures the
pressure in your arteries between beats.

You can have high blood pressure for years without any symptoms. Uncontrolled high blood
pressure increases your risk of serious health problems, including heart attack and stroke.
Fortunately, high blood pressure can be easily detected. And once you know you have high
blood pressure, you can work with your doctor to control it.
 CAUSES

In about 1 in 20 cases, high blood pressure happens as the result of an underlying health
condition or taking a certain medicine.

Health conditions that can cause high blood pressure include:

 kidney disease
 diabetes
 long-term kidney infections
 obstructive sleep apnoea – where the walls of the throat relax and narrow during sleep,
interrupting normal breathing
 glomerulonephritis – damage to the tiny filters inside the kidneys
 narrowing of the arteries supplying the kidneys
 hormone problems – such as an underactive thyroid, an overactive thyroid, Cushing's
syndrome, acromegaly, increased levels of the hormone aldosterone (hyperaldosteronism),
and phaeochromocytoma
 lupus – a condition in which the immune system attacks parts of the body, such as the skin,
joints and organs
 scleroderma – a condition that causes thickened skin, and sometimes problems with organs
and blood vessels

Medicines that can increase your blood pressure include:

 the contraceptive pill

 steroids
 non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and naproxen
 some pharmacy cough and cold remedies
 some herbal remedies – particularly those containing liquorice
 some recreational drugs – such as cocaine and amphetamines
 some selective serotonin-noradrenaline reuptake inhibitor (SSNRI) antidepressants – such
as venlafaxine

In these cases, your blood pressure may return to normal once you stop taking the medicine
or drug.
EFFECTS
1. It raises your risk of heart attack and stroke.
High blood pressure damages the walls of your arteries. This makes them more likely
to develop deposits of plaque that harden, narrow or block your arteries. These
deposits also can lead to blood clots. Blood clots can flow through your bloodstream
and block blood flow to your heart or brain, resulting in a heart attack or stroke.
2. It makes you more likely to develop heart failure.
When your arteries are hardened or narrowed, your heart has to work harder to
circulate your blood. This increased workload can cause your heart to become larger
and fail to supply your organs with blood.
3. You may experience chest pain.
Chest pain, also called angina, occurs when the heart does not get the blood it needs.
When people with high blood pressure perform activities such as walking uphill,
going up steps, or exercising, angina can cause pressure, squeezing, pain, or a feeling
of fullness in the chest.
4. It can cause kidney damage.
Your kidneys help your body get rid of toxins and regulate many of your body’s
complex functions. High blood pressure can cause damage to the arteries around your
kidneys. This can reduce their ability to do their job and, at worst, lead to kidney
failure.
5. You are more likely to develop vision problems.
Your eyes are full of small blood vessels that can easily be strained or damaged by
high blood pressure. It also can cause swelling of your optic nerve. Lowering your
blood pressure sometimes can reverse vision problems. But high blood pressure left
untreated can cause permanent vision loss or impairment.
6. You could develop sexual dysfunction.
High blood pressure can cause low libido in women and erectile dysfunction in men.
7. It raises your risk for peripheral artery disease (PAD).
PAD occurs when the arteries in your legs, arms, stomach, or head become narrowed
and cause pain, cramping, and fatigue. If you have PAD, you also are at an increased
risk of heart attack and stroke.
8. You have a higher risk of hypertensive crisis.
A hypertensive crisis is a medical emergency that causes your blood pressure to rise
above 180/120 rapidly. If your blood pressure gets too high, it can cause damage to
your organs and other potentially life-threatening complications. Symptoms of a
hypertensive crisis include:
o Blurry vision or other vision problems
o Dizziness
o Severe headaches
o Nosebleed
o Shortness of breath
o Chest discomfort or pain
o A feeling of anxiety or that something is not right
 REMEDIAL MEASURES
You can help prevent high blood pressure by having a healthy lifestyle. This means

 Eating a healthy diet. To help manage your blood pressure, you should limit the amount
of sodium (salt) that you eat and increase the amount of potassium in your diet. It is also
important to eat foods that are lower in fat, as well as plenty of fruits, vegetables, and whole
grains. The DASH eating plan is an example of an eating plan that can help you to lower your
blood pressure.
 Getting regular exercise. Exercise can help you maintain a healthy weight and lower your
blood pressure. You should try to get moderate-intensity aerobic exercise at least 2 and a half
hours per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week.
Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and
you use more oxygen than usual.
 Being at a healthy weight. Being overweight or having obesity increases your risk for high
blood pressure. Maintaining a healthy weight can help you control high blood pressure and
reduce your risk for other health problems.
 Limiting alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra
calories, which may cause weight gain. Men should have no more than two drinks per day,
and women only one.
 Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk for
heart attack and stroke. If you do not smoke, do not start. If you do smoke, talk to your health
care provider for help in finding the best way for you to quit.
 Managing stress. Learning how to relax and manage stress can improve your emotional and
physical health and lower high blood pressure. Stress management techniques include
exercising, listening to music, focusing on something calm or peaceful, and meditating.
4. STROKE

Overview

A stroke occurs when the blood supply to part of your brain is interrupted or reduced,
preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.

A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce
brain damage and other complications.

The good news is that many fewer Americans die of stroke now than in the past. Effective
treatments can also help prevent disability from stroke.

Causes

There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting
of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption
of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause
lasting symptoms.

Ischemic stroke
This is the most common type of stroke. It happens when the brain's blood vessels become
narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed
blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or
other debris that travel through your bloodstream and lodge in the blood vessels in your brain.

Some initial research shows that COVID-19 infection may be a possible cause of ischemic
stroke, but more study is needed.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain
hemorrhages can result from many conditions that affect your blood vessels. Factors related
to hemorrhagic stroke include:

 Uncontrolled high blood pressure

 Overtreatment with blood thinners (anticoagulants)

 Bulges at weak spots in your blood vessel walls (aneurysms)

 Trauma (such as a car accident)

 Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral
amyloid angiopathy)

 Ischemic stroke leading to hemorrhage

A less common cause of bleeding in the brain is the rupture of an abnormal tangle of thin-
walled blood vessels (arteriovenous malformation).

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — sometimes known as a ministroke — is a temporary

period of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent
damage. They're caused by a temporary decrease in blood supply to part of your brain, which
may last as little as five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to
part of your nervous system.
EFFECTS

A stroke can sometimes cause temporary or permanent disabilities, depending on how long
the brain lacks blood flow and which part was affected. Complications may include:

 Paralysis or loss of muscle movement. You may become paralyzed on one side of
your body, or lose control of certain muscles, such as those on one side of your face or
one arm.

 Difficulty talking or swallowing. A stroke might affect control of the muscles in your
mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also
may have difficulty with language, including speaking or understanding speech,
reading, or writing.

 Memory loss or thinking difficulties. Many people who have had strokes experience
some memory loss. Others may have difficulty thinking, reasoning, making judgments
and understanding concepts.

 Emotional problems. People who have had strokes may have more difficulty
controlling their emotions, or they may develop depression.

 Pain. Pain, numbness or other unusual sensations may occur in the parts of the body
affected by stroke. For example, if a stroke causes you to lose feeling in your left arm,
you may develop an uncomfortable tingling sensation in that arm.

 Changes in behavior and self-care ability. People who have had strokes may become
more withdrawn. They may need help with grooming and daily chores.

REMEDIAL MEASURES
Many stroke prevention strategies are the same as strategies to prevent heart disease. In
general, healthy lifestyle recommendations include:

 Controlling high blood pressure (hypertension). This is one of the most important
things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood
pressure can help prevent a subsequent TIA or stroke. Healthy lifestyle changes and
medications are often used to treat high blood pressure.

 Avoiding illegal drugs. Certain street drugs, such as cocaine and methamphetamine,
are established risk factors for a TIA or a stroke
 Lowering the amount of cholesterol and saturated fat in your diet. Eating less
cholesterol and fat, especially saturated fat and trans fats, may reduce the buildup in
your arteries. If you can't control your cholesterol through dietary changes alone, your
doctor may prescribe a cholesterol-lowering medication.

 Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers
exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.

 Managing diabetes. Diet, exercise and losing weight can help you keep your blood
sugar in a healthy range. If lifestyle factors don't seem to be enough to control your
diabetes, your doctor may prescribe diabetes medication.

 Maintaining a healthy weight. Being overweight contributes to other stroke risk

factors, such as high blood pressure, cardiovascular disease and diabetes.

 Eating a diet rich in fruits and vegetables. A diet containing five or more daily
servings of fruits or vegetables may reduce your risk of stroke. The Mediterranean diet,
which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.

 Exercising regularly. Aerobic exercise reduces your risk of stroke in many ways.
Exercise can lower your blood pressure, increase your levels of good cholesterol, and
improve the overall health of your blood vessels and heart. It also helps you lose
weight, control diabetes and reduce stress. Gradually work up to at least 30 minutes of
moderate physical activity — such as walking, jogging, swimming or bicycling — on
most, if not all, days of the week.

 Drinking alcohol in moderation, if at all. Heavy alcohol consumption increases your

risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may
also interact with other drugs you're taking. However, drinking small to moderate
amounts of alcohol, such as one drink a day, may help prevent ischemic stroke and
decrease your blood's clotting tendency. Talk to your doctor about what's appropriate
for you.

 Treating obstructive sleep apnea (OSA). Your doctor may recommend a sleep study
if you have symptoms of OSA — a sleep disorder that causes you to stop breathing for
short periods repeatedly during sleep. Treatment for OSA includes a device that delivers
positive airway pressure through a mask to keep your airway open while you sleep.
5. CONGENITAL HEART DISEASE

Overview

Congenital heart disease is one or more problems with the heart's structure that exist since
birth. Congenital means that you're born with the defect. Congenital heart disease, also called
congenital heart defect, can change the way blood flows through your heart. Some congenital
heart defects might not cause any problems. Complex defects, however, can cause life-
threatening complications.

Advances in diagnosis and treatment have allowed babies with congenital heart disease to
survive well into adulthood. Sometimes, signs and symptoms of congenital heart disease
aren't seen until you're an adult.

If you have congenital heart disease you likely will need care throughout your life. Check
with your doctor to determine how often you need a checkup.

Causes
Researchers aren't sure what causes most types of congenital heart disease. Some congenital
heart diseases are passed down through families (inherited).

To understand congenital heart disease, it helps to know how the heart works.

 The heart is divided into chambers — two upper chambers (atria) and two lower
chambers (ventricles).

 The right side of the heart moves blood to the lungs through blood vessels (pulmonary
arteries).

 In the lungs, blood picks up oxygen and then returns to the left side of your heart
through the pulmonary veins.

 The left side of the heart then pumps the blood through the aorta and out to the rest of
the body.

Congenital heart disease can affect any of these heart structures, including the arteries,
valves, chambers and the wall of tissue that separates the chambers (septum).

EFFECTS

 Irregular heartbeats (arrhythmias). Arrhythmias occur when the electrical signals

that coordinate your heartbeat don't work properly. Your heart may beat too fast, too
slowly or irregularly. In some people, severe arrhythmias can cause stroke or sudden
cardiac death if not treated. Scar tissue in your heart from previous surgeries can
contribute to this complication.

 Heart infection (endocarditis). Endocarditis is an infection of the inner lining of the

heart (endocardium). It generally occurs when bacteria or other germs enter your
bloodstream and move to your heart. Untreated, endocarditis can damage or destroy
your heart valves or trigger a stroke. If you are at high risk of endocarditis, it's
recommended that you take antibiotics one hour before dental cleanings. Regular dental
checkups are important. Healthy gums and teeth reduce the risk that bacteria will enter
the bloodstream.

 Pulmonary hypertension. This is a type of high blood pressure that affects the arteries
in your lungs. Some congenital heart defects send more blood to the lungs, causing
pressure to build. This eventually causes your heart muscle to weaken and sometimes to
fail.

 Heart failure. Heart failure (congestive heart failure) means your heart can't pump
enough blood to meet your body's needs. Some types of congenital heart disease can
lead to heart failure.
REMEDIAL MEASURES

As so little is known about the causes of congenital heart disease, there's no guaranteed way
of avoiding having a baby with the condition.

The following advice can help reduce the risk:

 Ensure you are vaccinated against rubella and flu.

 Avoid drinking alcohol or taking medication.

 Check with your GP or pharmacist before you take any medicine during pregnancy,
including herbal remedies and medicine that's available over the counter.

 Avoid contact with people who are known to have an infection.

 If you have diabetes, make sure it's controlled.

 Avoid exposure to organic solvents, such as those used in dry cleaning, paint thinners
and nail polish remover.

See vitamins, supplements and nutrition in pregnancy, infections in pregnancy and your
antenatal care for more information and advice.
OBSERVATION
The past half-century has witnessed remarkable and unprecedented progress in addressing
cardiovascular disease (CVD), marked by a large and continuing reduction in CVD-related
mortality. Yet, even with this progress, CVD remains the leading cause of death and
disability both in the United States and globally, affecting 85.6 million Americans and
accounting for 1 in every 6 healthcare dollars spent. Despite promising new models of care
and further opportunities for biomedical innovation, recent trends are concerning. The decline
in population mortality rates for CVD is slowing, with increases for some groups (ie, age-
adjusted stroke mortality rose by 0.8% from 2016 to 2017). Cardiovascular drug innovation is
lagging, large variations in outcomes exist, and CVD costs are continuing to rise. As our
nation’s population ages, there is an urgent need for action to improve innovation in,
treatment of, and payment for cardiovascular health. When we talk with patients, we hear
about their appreciation for lifesaving and life-improving treatments, but also their rising
concerns about whether they can afford the cost of that care. Beyond affordability, patients
report that care improvements are not equally shared (with significant disparities in mortality
and outcomes), that care is often complex for them to manage and does not reflect their goals
and priorities, and that they struggle with addressing “upstream” risk factors such as diet,
smoking, and activity.

Cardiovascular mortality rate : Despite this progress, CVD remains the leading cause
of death globally. It accounts for 17.3 million deaths globally per year and is expected to
account for >23.6 million deaths per year by 2030. Most strikingly, the large mortality
declines appear to be dissipating. In recent years, age-adjusted CVD mortality has remained
essentially flat (slowing at ≈0.5%/y), whereas cancer mortality rates have continued to
decrease ≈1.5% annually from 2000 to 2015. 2. CVD mortality declines have slowed for all
races and ethnicities, with increases in some groups, such as large increases in mortality for
rural, middle-aged Indians. 3. The decline in-hospital mortality for heart failure is also
levelling off. In-hospital heart failure mortality decreased from 6.5% in 1993 to 3.1% in 2010
but has not changed significantly since, with 2015 mortality at 2.8%. 4. Declines in age-
adjusted stroke mortality have similarly plateaued. Whereas stroke mortality decreased
annually from 1999 to 2013 (61.6 versus 36.2 per 100 000 personyears), rates have risen and
fluctuated since (37.6 per 100 000 person-years in 2017)
The Value of Cardiovascular Care Appears to Be Declining: Alongside
concerning recent mortality trends, cardiovascular spending has risen steadily over the past 2
decades. Total cardiovascular expenditures (in nominal dollars) increased by 147%, and
expenditures per person using care have more than doubled, compared with a 52% increase in
the Consumer Price Index between mid-1996 and 2015. The American Heart Association and
American Stroke Association estimate that costs for all aspects of CVD total $318 billion in
2015, and spending for all cardiovascular conditions is projected to continue to rise. In
addition to direct costs, there are substantial indirect costs such as lost productivity at work,
the need to hire help for household tasks given functional limitations, and individuals leaving
the workforce. One study suggests that indirect costs were $237 billion in 2015 and will rise
to $368 billion by 2035. Out-of-pocket spending is also rising for many patients who need
substantial CVD care, a particular challenge for low-income patients. One study
demonstrated that 1 in 4 low-income families with at least 1 family member diagnosed with
atherosclerotic CVD had high Although spending on technological changes for
cardiovascular care showed high value through the 1990s, with benefits in length and quality
of life that far outweighed their costs, the currently stagnating (or worsening) trends in
cardiovascular outcomes alongside higher spending suggest that this trend no longer holds.
Cardiovascular care costs are not increasing uniformly, with some geographic areas or
organizations able to produce similar or better outcomes for similar populations at
substantially lower cost. This variation—in price, in technology use, and by geography, not
necessarily tied to quality and health outcome—is consistent with the conclusion of some that
almost onethird of all healthcare spending is on services and treatments that do not improve
patient outcomes.

Cardiovascular Health Disparities Persist: Cardiovascular mortality trends differ

substantially among different groups, and the evolving picture is complex and
multidimensional. Outcomes and quality continue to vary by sex, race, and ethnicity. Graphs
shows how cardiovascular mortality diverges by race and ethnicity. However, in recent years,
cardiovascular mortality is increasingly determined by geographic location, wealth, and
education. As shown in diagram, people living in the South are seeing higher and increasing
age-adjusted morality rates. Disparities may be attributable to lower access to basic primary
care and treatments to modify cardiovascular risk factors, challenges with social determinants
(eg: income and educational attainment), and modifiable risk factors (eg: diet, physical
activity, and smoking). For instance, evidence shows that access, use of treatments, and long-
term adherence can vary on the basis of sex and race; examples include reduced use of statin
therapies by sex, increased odds of statin nonadherence for women and non-whites, and less
access to intravenous tissue-type plasminogen activator for acute ischemic stroke for black
patients. Moreover, risk factor trends such as childhood obesity show substantial differences
by race. Failure to Diagnose: Despite progress, 20% to 40% of heart attacks occur in patients
previously undiagnosed with CVD. Hypertension is important (and relatively easy) to
diagnose, with estimates suggesting that ≈46% of the population have hypertension on the
basis of the most recent high blood pressure guidelines.
CASE STUDY

Coronary artery diseases - A

21-year-old male college
student, Adam Levine, felt
heaviness in his chest after
walking a slight incline on
campus. He was extremely
short of breath, and collapsed
on a nearby sofa to rest. He
was rushed to the hospital
where diagnostic tests
[electrocardiogram (ECG), chest X-ray, and cardiac enzymes] did not reveal any acute
pathology. The patient's extremities were well perfused. He had a 3 pack-year smoking
history and a family history of CHD, including his maternal aunt and great grandparents. The
patient underwent echocardiography, which showed mild concentric left ventricular
hypertrophy, revealed a large soft plaque in the distal left main coronary artery. Due to
LMCA involvement and his progressive anginal symptoms, the patient underwent coronary
bypass surgery in addition to optimal medical therapy and strict risk factor reduction. Atrial
fibrillation - A 67-year-old man, Walter White, presents to the emergency department with
palpitations and dyspnea which began approximately 4 hours ago. He has a history of
hypertension, diabetes, and gastroesophageal reflux disease. His current medications are
lisinopril, metformin, and omeprazole. He has no history of congestive heart failure, stroke,
or transient ischaemic attack (TIA).He appears to be in mild respiratory distress. Blood
pressure is 88/60 mmHg, pulse rate is 140 bpm, respiratory rate is 24/min, and temperature is
normal. Oxygen saturation is 90% on 40% oxygen by face mask. Cardiac exam reveals
tachycardia with an irregularly irregular tachycardic rhythm. There are crackles in the lower
lung fields. Electrocardiogram demonstrates atrial fibrillation (AF) with rapid ventricular
rate. Given his presentation of AF with hypotension and pulmonary made, he undergoes
immediate direct-current cardioversion without anticoagulation. His rhythm converts to
normal sinus rhythm. His vital signs return to normal and his symptoms dissipate.
CONCLUSION

Despite the advances made in cardiac care over the

previous century, it is thought that the global epidemic of
cardiovascular diseases is both increasing and shifting
from developed to developing countries (Mackay and
Mensah, 2004). While treatments are available for some
cardiovascular disease patients, prevention must remain a
priority through the reduction of known risk factors.
Whether or not people have already been diagnosed with
cardiovascular diseases, taking account of the risk factors
and minimising them where possible should result in
positive changes and improved health in individuals and their families.

Now you will be very familiar with cardiovascular diseases, their development and their
diagnosis. You will also know their treatment and many of the cardiovascular disease risk
factors – what they are and how they can be influenced positively to minimise cardiovascular
diseases. You will understand the overall importance of a balanced diet, regular exercise and
weight management (guided by adiposity measurements) throughout life, to maintain cardiac
and vascular health. You will also be able to explain the negative effect of behaviours such
as smoking and drinking too much alcohol. You should have an appreciation of the ‘bigger
picture’ and see how all these factors combine to influence our cardiovascular health that in
itself will affect our relationships and our daily lives, at home and at work.
BIBLIOGRAPHY

 http://www.wikipedia.org/

 https://www.mayoclinic.org/

 https://www.nhs.uk/

 https://www.healthline.com/

 https://www.ncbi.nlm.nih.gov/

 Reference articles from various blogs.

 TRUEMAN’S ELEMENTARY BIOLOGY BY

K.N.BHATIA & M.P.TYAGI