CARDIOVASCULAR AND HEART
DISEASES
Dr. Manzoor Ahmad Mir
M. Sc, Ph.D. (Immunopathology)
What is Atherosclerosis
what is coronary artery disease?
• Over time, fatty deposits called plaque build up within the artery
walls. The artery becomes narrow. This is atherosclerosis
• When this occurs in the coronary arteries, heart does not get
sufficient blood, the condition is called coronary artery disease,
or coronary heart disease
Myth : fat deposits at old age!
It starts from 2 years of Complicated
age
Foam
Cells
Fatty
Streak
From First
Decade
Intermediate
Lesion
Atheroma
From Third
Decade
Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).
Fibrous
Plaque
Lesion/
Rupture
From Fourth
Decade
Are Other organs Affected?
Ischemic Stroke
Coronary Heart Disease
• Angina
• MI (Heart Attack)
• Sudden Cardiac Death
Peripheral Vascular
Disease
How Big is the Problem ?
• No. 1 killer disease worldwide
– 12 Million deaths annually
• During last 30 years large declines in
developed countries -rising health
awareness and government
programmes
• Alarming increase in developing
countries especially India
Cardiovascular(Heart) Disease
 Cardiovascular disease includes a number of conditions affecting the
structures or function of the heart. They can include:
 Coronary artery disease (narrowing of the arteries)
 Heart attack
 Abnormal heart rhythms or arrythmias
 Heart failure
 Heart valve disease
 Congenital heart disease
 Heart muscle disease (cardiomyopathy)
 Pericardial disease
 Aorta disease and Marfan syndrome
 Vascular disease (blood vessel disease)
 Cardiovascular disease is the leading cause of death for both men and
women in the world.
Cardiovascular Disorders:
Major cardiovascular disorders include atherosclerosis,
stroke, heart attack, aneurysm, and hypertension.
Atherosclerosis:
Atherosclerosis is due to a build-up of fatty material
(plaque), mainly cholesterol, under the inner lining of
arteries. The plaque can cause a thrombus (blood clot) to
form. The thrombus can dislodge as an embolus and lead
to thromboembolism .
Stroke, Heart Attack, and Aneurysm:
Stroke:
A cerebrovascular accident , or stroke , results when an
embolus lodges in a cerebral blood vessel or a cerebral blood vessel
bursts; a portion of the brain dies due to lack of oxygen. A myocardial
infarction , or heart attack , occurs when a portion of heart muscle dies
due to lack of oxygen.
Angina pectoris:
It is the partial blockage of a coronary artery
causes angina pectoris , or chest pain.
Aneurysm: An aneurysm is a ballooning of a blood vessel, usually
in the abdominal aorta or arteries leading to the brain. Death results if
the aneurysm is in a large vessel and the vessel bursts.
Atherosclerosis and hypertension weaken blood vessels over time,
increasing the risk of aneurysm.
Hypertension:
Hypertension About 20% of Americans suffer
from hypertension (high blood pressure).
Hypertension is present when systolic pressure
is 140 or greater or diastolic pressure is 100 or
greater; diastolic pressure is emphasized when
medical treatment is considered. A genetic
predisposition for hypertension occurs in those
who
have
a
gene
that
codes
for
angiotensinogen , a powerful vasoconstrictor.
SYMPTOMS OF A HEART ATTACK
• Discomfort, pressure, heaviness, or pain in the chest, arm, or
below the breastbone.
• Discomfort radiating to the back, jaw, throat, or arm.
• Fullness, indigestion, or choking feeling (may feel like heartburn).
• Sweating, nausea, vomiting, or dizziness.
• Extreme weakness, anxiety, or shortness of breath.
• Rapid or irregular heartbeats.
During a heart attack, symptoms typically last 30 minutes or longer
and are not relieved by rest or oral medications. Initial symptoms may
start as a mild discomfort that progresses to significant pain.
Some people have a heart attack without having any symptoms,
which is known as a "silent" myocardial infarction (MI). It occurs
more often in people with diabetes.
 Pulmonary heart disease, a failure of the right
side of the heart.
 Hereditary heart disease, heart disease caused
by inavoidable genetic factors
 Hypertensive heart disease, heart disease
caused by high blood pressure, especially
localised high blood pressure
 Inflammatory heart disease, heart disease that
involves inflamation of the heart muscle
and/or the tissue surrounding it.
 Valvular heart disease, heart disease that
affects the valves of the heart.
 Arteriosclerosis and atherosclerosis, are conditions in which the walls
of the arteries become thick and stiff. This can sometimes restrict
blood flow to the organs and tissues. The process of this thickening
and stiffening is arteriosclerosis. Atherosclerosis is the most common
form of arteriosclerosis. Although the two terms are often used
interchangeably, atherosclerosis refers to hardening of the arteries
caused by accumulation of fatty deposits (plaques) and other
substances. The heart is one of the organs commonly affected by
atherosclerosis. When the arteries of the heart (coronary arteries)
narrow – may experience chest pain or a heart attack.
 High blood pressure (hypertension), is the excessive force of blood
pumping through the blood vessels. It's perhaps the most common
form of cardiovascular disease in the Western world, affecting about
one in four Americans. Although potentially life-threatening, it’s one
of the most preventable and treatable types of cardiovascular disease.
High blood pressure also causes many other types of cardiovascular
disease, such as stroke and heart failure.
 Stroke, is a sudden loss of brain function. It occurs when
blood flow to the brain is interrupted (ischemic stroke) or
when blood vessels in the brain rupture (hemorrhagic stroke).
These, in turn, cause the death of brain cells in the affected
areas. Stroke is often thought of as a neurological disorder
because of the many complications it causes.
 Aneurysm, is a bulge or weakness in the wall of an artery or
vein. Aneurysms usually enlarge over time. Because of that,
they have the potential to rupture and cause life-threatening
bleeding. Aneurysms can occur in arteries in any location in
the body. The most common sites include the abdominal aorta
and the arteries at the base of the brain.
 Vasculitis, This is an inflammation of the blood vessels. It usually involves the
arteries but may also affect veins and capillaries. The inflammation may
damage the wall of the artery or vein and impair blood flow to the region of
the body supplied by that vessel. Sometimes vasculitis occurs along with a
generalized disorder, such as lupus or rheumatoid arthritis, but it may also
occur on its own.
 Venous thrombosis, This is the formation of a blood clot (thrombus) in a
vein. This condition may damage the vein and its valves. In addition, clots
that break off and travel in the bloodstream can lodge in the lungs, a
condition known as pulmonary embolism. In some cases, this type of clot
can also cause a stroke. May be more familiar with deep vein thrombosis, in
which a clot develops deep within a muscle, such as one in the calf.
 Varicose veins, This is a condition in which the veins become twisted and

enlarged. The veins are usually located on the backs of the calves or on the
inside of the legs, from the groin to the ankle. When valves in the veins
don't function properly, blood can accumulate in the legs, causing the veins
to bulge and twist. The veins appear blue because they contain less oxygen.
Lymphedema, This is an obstruction of the lymphatic vessels. It results in
an excessive buildup of fluid, which can cause swelling and pain. It can be
caused by infections, trauma, tumors, surgery and radiation treatment. In
rare cases, someone may be born with lymphedema.
Arrhythmia / Dysrhythmia
Heart block / Atrio ventricular block: Failure of conduction of impulses
through the A.V.Node.
Damage to the S.A.Node causes week impulses failing to reach the
ventricles. Cardiac pacemaker establishes normal rhythm. It is a small,
battery-operated electronic device. It is inserted under the skin. It has
leads that travel through a large vein to the heart, where the wires are
anchored, which send the electrical impulses to the heart.
Flutter:
Rapid, regular contraction of atria or ventricle
reaching upto 250/300 beats per minute.
Fibrillation: Rapid, random, irregular contraction reaching
upto 350-400 beats per minute.
Defibrillator is
cardioversion.
applied
to
the
chest
wall
to
help
in
Defibrillation is a technique used to counter the onset of
ventricular fibrillation, a common cause of cardiac arrest.
Defibrillation is part of an advanced cardiac life support. It applies
a controlled electric shock.
Cardiac Arrest: Sudden stoppage of heart.
Palpitation: Uncomfortable
associated with arrhythmia.
sensation
in
the
chest
Angina Pectoris
Hardening of the arteries, and the
presence of a thrombus, or clot, in a
blood vessel are the most common
causes of obstruction.
Arteriosclerosis is responsible for
most of the deaths resulting from
heart attacks. Spasms of the
coronary arteries can also result in a
heart attack.
What Increases Risk?
You can’t help it !
• Age:
Men > 45;
Women > 55
• Sex
• Race
• Family History
You can !!
• High Cholesterol
• Smoking
• High Blood Pressure
• Diabetes
• Obesity
• Alcohol
• Physical Inactivity
Good vs. BAD Cholesterol
• LDL cholesterol is known as bad
cholesterol. It has a tendency to
increase risk of heart disease
• LDL cholesterol is a major component
of the plaque that clogs arteries
• HDL cholesterol is known as the good
cholesterol. Higher in women,
increases with exercise
• HDL cholesterol helps carry some of
the bad cholesterol out of arteries.
Obesity
• People who are overweight (10-30 % more
than their normal body weight)
• Obese have 2 to 6 times the risk of
developing heart disease
• Normal Waist-Hip Ratio
< 0.85 for women;
< 0.95 for men
• Pears or apples?
Pears and Apples
Apple- shaped are at a higher risk
Pear-shaped paunch store fat on the
hips and thighs, just below the surface of
the skin.
Apple-shaped paunch store body fat
around the abdomen and chest,
surrounding internal organs
Physical Inactivity
Every morning my brain
tells me to exercise…
….. and my body
laughs at the idea
Cigarette Smoking
•
•
•
•
•
Increases blood pressure
Decreases HDL
Damages arteries and blood cells
Increases heart attacks
Cigarette smoke contains more than
4,000 chemicals, and 200 of these
chemicals are poisonous
Cigarette Smoking
If you think YOU are smoking the cigarette, you are mistaken…
It’s the other way round !
Alcohol Consumption
• In small amounts it is beneficial: 1-2
drinks
• In large amounts it adds fat and
calories & raises BP!
• 4 drinks per day. You end up with
gastroenterologist instead of
cardiologist
• This is a very fine line! Finer for
women as they are at higher risk
Diabetes
• At any given cholesterol level, diabetic
persons have a 2 or 3 x higher risk of heart
attack or stroke
• A diabetic is more likely to die of a heart
attack than a non-diabetic
• ~80% Diabetics die from heart disease
• Risk of sudden death from a heart attack
for a diabetic is the same as that of
someone who has already had a heart
attack.
Preventing Heart Disease
Rule #1 Look before your eat
• Eat a variety of fruits and vegetables every day.
(5 servings - they are naturally low in fat and
high in vitamins and minerals and anti
oxidants). Eat colored vegetables and fruits
• Eat a variety of grain products
• Choose nonfat or low-fat products.
• Use less fat meats- chicken, fish and lean cuts
 Switch to fat-free milk—toned/skimmed milk
Dietary Guidelines
• Limit your intake of foods high in
calories and low in nutrition, including
foods like soft drinks, candy, junk food
• Limit foods high in saturated fat, transfat and cholesterol
• Eat less than 6 gms of salt a day
• Have no more than1-2 alcoholic drink a
day if you are a regular drinker
Limit / Avoid
• Foods rich in Cholesterol and Saturated
fats
–
–
–
–
Egg Yolk
Fatty meat & organ meat( Liver)
Butter chicken / Batter fried fish !
Milk fat – Desi Ghee, Butter, Cheese, Malai,
Rabri, Khurchan, Doda, Ice Cream, full
cream milk,
– Hidden Fat like Bakery biscuits, Patties (!),
Cakes, Pastries,
Cooking Oils: The mystery of
PUFA / MUFA
• Saturated Fats : Increase Cholesterol – Avoid
– Coconut oil, Palm oil, Vanaspati ghee
• Monounsaturated Fats (MUFA): Heart healthy
– Olive oil, Groundnut oil, Canola oil, Mustard oil
• Polyunsaturated Fats (PUFA): Heart healthy
– Sunflower oil, Soybean oil
• Omega-3-Fatty acids Fish oil : Heart Healthy
Rotate the oils or Mixture of oils
Preventing Heart Disease
Rule #2 Exercise
• Maintain a level of physical activity that
keeps you fit and matches the calories
you eat
• Serves several functions in preventing
and treating those at high risk
• Reduces incidence of obesity
• Increases HDL
• Lowers LDL and total cholesterol
• Helps control diabetes and hypertension
Exercise, Exercise, Exercise
•Mortality is halved in retired men who walk
more than two miles every day
•Regular exercise can halve the risk of heart
disease, particularly in men who walk briskly
•Someone who is inactive has as great a risk of
having heart disease as someone who
smokes, has high blood pressure or has high
cholesterol
•Exercise significantly reduces the chances of
diabetes and stroke
•With regular exercise, blood pressure in those
with hypertension is reduced by as much as
20mms Hg
Exercise and Heart Disease
Moderate to intense physical activity for 30-45
minutes on most days of the week is recommended
Rule # 3 Stop Smoking NOW!
• The risk of heart attack starts decreasing
within 24 hours of quitting smoking, within
1 year of quitting, CHD risk decreases
significantly, within 2 years it reaches the
level of a nonsmoker
• Smell and taste improve within days
• Within three months of quitting, the
smokers' cough disappears in most people
Rule # 3 Stop Smoking NOW!
Benefits much beyond Heart Disease
Tobacco
Cardiovascular
Cancers
Diet
Diabetes
Physical Activity
Chronic Respiratory Diseases
Osteoporosis
Alcohol
Oral Health
Mental Health
Rule # 4 Know your Number!
And that’s not your Mobile Number!
Desirable numbers
• Total cholesterol < 200;
• LDL < 100
• HDL > 40
• triglycerides < 200
• Get the levels tested routinely and keep them
under control
• The only thing worse than finding out that
you have one of these conditions is…….NOT
finding out that you have it!!
Controlling Blood Pressure
• Adults should have their blood pressure
checked at least once every two years, as
there are no symptoms to tell if you have
high blood pressure
• Optimal levels : 120 /80 mm Hg
• If high
– Modify your lifestyle – Diet, Weight, Exercise,
Salt restriction
– Adhere to the prescribed medication without fail,
to decrease chances of getting heart disease – Do
not stop your medicines without consulting your
doctor, even if the blood pressure becomes
normal
Controlling Blood Sugar
• All adults should have their blood sugar
checked regularly, as there are no early
symptoms of diabetes
• Normal blood sugar:
• Fasting < 100; post meals <140
• If high
– Modify your lifestyle – Diet, Weight, Exercise
– Adhere to the prescribed medication without fail,
to decrease chances of getting heart disease – Do
not stop your medicines without consulting your
doctor, even if the blood sugar becomes normal
If you or someone in your family
already diagnosed with heart disease
• Don’t get disheartened – science has made
significant progress
• Just monitor risk factors much more aggressively
– Eat healthy
– Walk regularly
– Watch your weight
– Quit smoking immediately
– Keep your weight under control
– In addition to improving your heart – health these measures
are sure to enhance your appearance !!
• Adhere to you medicines & listen to your doctor