Heart attack & stroke

Heart Attack
And Stroke

Fighting isolation, Fighting isolation, To work for the cause and care of disadvantaged aged persons and to improve their quality of life HelpAge India is thankful to the following experts for the preparation of this manuscript: Dr. G.S. Meena
Department of Community Medicine
Maulana Azad Medical College
New Delhi -110002
Dr. Rajesh Kumar
Asstt. Professor
Department of Community Medicine
Maulana Azad Medical College
New Delhi -110002
Series Editor
Anupama Datta
Deputy Director (R&SD)
Introduction to Cardiovascular Diseases
Heart is one of the most important organs of the body. It is connected to
a system of vessels, through which it supplies blood containing nutrition
and oxygen to all the parts of body. This system of heart and vessels
(known as Cardio-vascular system) needs special care, but on the
contrary, most of people are ignorant about it. The risk factors related to
cardio-vascular diseases (CVDs) start early in life and their cumulative
effect leads to disease manifestation. Once the disease has already
occurred it becomes difficult to control it, therefore the best strategy is
to prevent the development of the disease, and even more important is
to prevent the development of risk factors itself. Coronary heart
diseases are now the leading cause of death worldwide. It is on the rise
and has become a true pandemic that respects no borders.
Some Facts about Cardio-Vascular Diseases
• An estimated 17.5 million people died from CVDs in 2005, representing 30% of all global deaths. • Over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women; • At least 20 million people survive heart attacks and strokes every year; many require continuing costly clinical care. • Of all coronary heart disease patients who die within 28 days after the onset of symptoms, about two-thirds die before reaching hospital. This highlights not only the need for early recognition of the warning signs of a heart attack, but also that prevention is the best strategy.
• Stroke is the third most common cause of death in developed countries, exceeded only by coronary heart disease and cancer.
What are Cardiovascular Diseases?
The following group of disorders of the heart and blood vessels are
Coronary heart disease: disease of the vessels supplying blood to
the heart muscle. If there is a narrowing of these vessels it leads to
Angina which is a chest pain syndrome, where one does not
actually get a heart attack; but, gets a serious pain in the chest on
exertion or on mental stress. If there is complete blockage of
blood supply to any part of the heart, the muscles in that part of
heart die, leading to Heart Attack.
Cerebro-vascular disease: If there is blockage of blood supply to
any part of the brain, the nerve cells in that part of brain die,
leading to Stroke.
There are other diseases also included in CVDs but are out of scope of this booklet. Both these diseases are usually acute events caused by a blockage that prevents blood flow to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply blood to the heart or brain. Symptoms of Heart Attack
Chest discomfort: D
iscomfort in the center of the chest that lasts more
than a few minutes. It can also feel like uncomfortable pressure,
squeezing, fullness or pain.
Discomfort in other areas of the upper body: Symptoms may include
pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath: May occur before or along with the chest
Other symptoms: May include breaking out in a cold sweat, nausea or
Not all these symptoms occur in every heart attack. Sometimes these
symptoms may go away and return. If any of these symptoms occur, get
help immediately!
What is to be done if Heart Attack occurs?
Do not waste time act Immediately
Make the person lie down comfortably. He/ she should not exert himself/ herself, as exertion may further damage the heart.
If the person is breathless, give him/ her a few pillows to raise Loosen his/ her clothes and reassure the person.
If conscious, take the person to the hospital as soon as possible.
If the person is alone and there is no help available, the person should cough vigorously 2-3 times, take a deep breath. The cycle of coughing and breathing should be repeated till S/he feels comfortable and then get help immediately. If the person has been advised, some self medication may be done after keeping a tablet of sorbitrate under the tounge. Treatment of Cardio-Vascular Diseases includes:
1. Proper treatment of the following with drugs:
High blood pressure Coronary heart disease Arrhythmia (heart rhythm disorders) Blood clotting disorders 2. If by medication alone we can not manage, Operations are required: Coronary artery bypass Balloon angioplasty Valve repair and replacement Heart transplantation Artificial heart operations 3. Some artificial Devices can be used like: Prosthetic valves The risk factors for heart attacks
There are more than 220 risk factors, but some are major risk factors.
Before discussing these risks, one must understand some general
principles of risk. First is that, risk is something that does not occur as an
all or none phenomenon. Risk occurs in a step-wise fashion. So, if
somebody has a blood pressure of 160/100, he is at a greater risk than
somebody with 140/90, but that person is at a greater risk than
somebody with 130/86 and that in turn has a greater risk than 120/80.
So, there is a step-wise rise in risk and this is true for cholesterol, blood
sugar, body weight and even for smoking. A person who smokes four
cigarettes a day is at a greater risk than a non-smoker and a person who
smokes 20 cigarettes a day is at an even greater risk.
Another principle is that if multiple risk factors co-exist, then the overall risk of CVDs is much more. If a person has a slightly elevated blood pressure, slightly elevated cholesterol, and he is a smoker, then he is at a much greater risk than a person with markedly elevated single risk factor alone. The combination of risk factors adds up to a much greater risk. In most populations, the people who get heart attacks in the largest number are people with borderline elevations of many risk factors. So, remember it is important for us to reduce all risk factors together. Some of CVDs risk factors are modifiable and some non-modifiable. The major modifiable risk factors are: High blood pressure Physical inactivity Psychosocial stress Abnormal lipids profile At least 80% of premature deaths from heart disease and stroke could be avoided through healthy diet, regular physical activity and avoiding tobacco. Let us understand in detail how these risk factors affect the cardio-vascular system.
High blood pressure
It is one of the most important causes of heart attacks as well as strokes.
What blood pressure does to the body is dependent also on other risk
factors. The ideal blood pressure is 120/80 or lower, this is true even for
an elderly person. A blood pressure of 140/90 or higher for any length of
time is considered high blood pressure.
The blood vessels loose their elasticity with age; particularly, above the age of 60. Due of this, even small changes in the blood volume can lead to marked changes in the blood pressure. After a meal; the blood supply gets diverted to the stomach and intestine; so, when the person gets up he start feeling giddy. On the other hand, if he takes a little extra salt, blood pressure can really shoot up. There are no early symptoms of high blood pressure. For this reason it is often called the silent killer. High blood pressure contributes to around half of all cardiovascular disease and Systolic hypertension is especially dangerous for the elderly.
To Control High Blood Pressure:
• One must get blood pressure checked, at least once every six
And if found to be hypertensive follow the prescribed treatment plan: Take the prescribed medicines regularly.
Reduce salt in diet to less than 5gm per day.
Do regular exercise.
Control other risk factors like obesity, smoking, stress etc.
Physical activity
Physical activity, even at an older age, can significantly reduce the risk of
coronary heart disease, diabetes, high blood pressure, and obesity, help
reduce stress, anxiety and depression, and improve lipid profile. For
protection against CVDs, recommended physical activity is at least be 30
minutes with 5 minutes of warm up and 5 minutes of cool down.
Minimum required for a Cardio vascular effect is 3 4 times a week. You
can split it up into 10 minutes but that 10 minutes we are not including
the warm-up. If you want fitness, then 45 minutes per day is recommended and for weight reduction it is 60 minutes per day. Whenever one starts exercise, it should be gradually increased to desired level, not exerting too much. Additional benefits of exercise: Muscle tone increases, calories are
burnt, improves self image; it gives resistance to fatigue, helps to
counter anxiety, stress and depression, helps you feel safe and sleep
well. Any kind of yoga which involves a relaxation type of an exercise or a
dynamic movement is also good. Try doing physical work whenever
possible like using staircase, walk or jog etc.
Tobacco use
Smoking promotes CVDs through several mechanisms. It damages the
endothelium lining of the blood vessels, increases cholesterol plaques
(fatty deposits in the arteries), increases clotting and promotes
coronary artery spasm. Nicotine accelerates the heart rate and raises
blood pressure. Women smokers are at a higher risk of heart attack than
male smokers. Therefore, avoid tobacco in all forms, even oral tobacco
is dangerous. Tobacco cessation helps to reduce the risk. It is never too
late to give up smoking.
Coronary heart disease or heart attacks, stroke, some cancers, diabetes,
osteoporosis etc. are related to diet. Risk factors like high blood
pressure, abnormal blood lipids, high blood sugar, overweight and
obesity can be altered by diet. High amount of fats, salt and refined
carbohydrates should be avoided.
Unhealthy fats are critical source of heart diseases because they raise cholesterol level in blood and cause fatty deposition in the blood vessels (atherosclerosis) leading to narrowing of blood vessels. Food like; cheese, meats and organ meats, chicken, eggs, noodles, cakes, biscuits, confectionaries, white bread, cookies, biscuits doughnuts, potato chips, French fries, namkeens and pickles etc. should be avoided.
Take whole grain cereals, fair amount of fruits, green leafy vegetables and other vegetables as these are rich in anti-oxidants, fibers and potassium. Seasonal fruit, whatever is available is fine, but take whole fruit instead of juices. If one takes fish consumption is protective, it has omega 3 factor, which is very protective; sea fish are a little more protective than the river fish. For cooking of food, instead of just depending on one oil we should use a combination of saturated fats, fair amount of poly unsaturated fats with a good deal of Omega 3 fats in it and the rest can be made up of mono unsaturated fats. It is better to take more frequent but smaller meals.
The Body Mass Index (BMI), a measure of weight in relation to height, is
commonly used for classifying overweight and obesity.
Body Mass Index (BMI) = Weight (kg)/ Height (m)
BMI should be maintained below 25, (and preferably 20 to 22 for Asians). A person with a BMI of over 25 is considered overweight, while someone with a BMI of over 30 is obese. The ideal body weight should be maintained by proper diet and regular exercise.
Psycho-social stress
Chronic life stress, depression, social isolation and anxiety increase the
risk of heart disease and stroke. Meditation is very effective for stress
management. A good laughter is very healthy for heart; it improves the
lungs muscles; it increases the Oxygenation and gives glow to the
person and improves general well being. A good night sleep is very
relaxing; half an hours nap after lunch is believed to be really good for
mental activity.
Abnormal blood lipids
High total cholesterol, LDL-cholesterol and triglyceride levels, and low
levels of HDL cholesterol increase risk CVDs. The ratio of total
cholesterol to HDL cholesterol, more than 4 is not desirable and
anything more than 4.5 is certainly more likely to carry increased risk.
Diabetes mellitus
is a major risk factor in the Indian setting (because of high
number of patients). It can cause heart attacks at a much earlier stage
than in non-diabetic persons and the blood vessels are also more
diffusely diseased than in a non-diabetic person. For prevention, diet
modification has already been mentioned; apart from this one must
take the proper treatment, and do regular exercise.
Alcohol use
If one takes, one to two drinks (30ml/peg) per day may reduce heart
disease, but heavy drinking damages the heart muscle.
Non-modifiable risk factors
Advancing age
Risk of cardiovascular disease increases with age; risk of stroke doubles
every decade after 55 years of age.
Heredity or family history
Increased risk if there is a family history of CVDs
There is a higher rate of coronary heart disease among men compared
with women (premenopausal age); risk of stroke is similar for men and
women. Some women are at higher risk because of Oral Contraceptive
use, Hormone replacement therapy and/or Polycystic ovary syndrome.
Risk of heart attack is highest, early in each menstrual cycle.
Ethnicity or race
Increased cardiovascular disease deaths are noted for South Asians
Stroke is a cardiovascular disease that affects the blood vessels supplying blood to the brain. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is blocked by a blood clot or some other particle. Because of this rupture or blockage, part of the brain does not get the blood supply it needs. Deprived of oxygen, nerve cells in the affected area of the brain die within minutes. When nerve cells cannot function, the part of the body controlled by these cells cannot function either. The devastating effects of stroke are often permanent because dead brain cells are not replaced.
Symptoms of stroke
• Sudden numbness or weakness of the face, arm or leg especially on
one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
Sudden, severe headache with no known cause.
Risk factors for stroke
The major risk factors for stroke are similar to those for coronary heart
disease; with high blood pressure and tobacco use being the most
significant modifiable risks. Treating hypertension can reduce the risk of
a stroke by up to 40%.
Prevention of risk factors by lifestyle modifications smoking cessation, adequate diet, regular exercise, and low sodium intake etc.
Treatment with the drugs like Antithrombotics (aspirin), Antihypertensives, Thrombolytics, and Anticoagulants etc.
Even where advanced technology and facilities are available, 60% of those who suffer a stroke die or become dependent.
Points to Remember
1. Severe oppressive pain in chest often radiating to arms, shoulder, neck and jaw or uncomfortable pressure in the chest are warning signals of heart attack.
2. Consult the doctor immediately or call ambulance at 102. Following a heart attack, the chances of the survival of a patient are greater in a hospital than home.
3. A heart patient should avoid exertion, strain, smoking and diet rich in fat.
Key messages
1. Heart attacks and strokes are major killers but they can be prevented by investing a little time and effort. 2. Stopping tobacco use, decrease the chance of a heart attack or 3. Regular physical activity for at least 30 minutes daily helps to keep our heart healthy.
4. Eat fair amount of fruits and vegetables daily and limit salt intake to less than one teaspoon. Use fats from multiple sources and limit the total fat content in diet.
5. Have your blood pressure checked regularly, every six months. 6. Maintain an ideal body weight, take regular physical activity and eat a healthy diet. 7. Reduce stress in life by doing yoga, meditation and breathing This booklet is not intended to be a substitute for professional medical advice. If in doubt, please consult your doctor and follow his/her instructions. All the statements have been made by the contributors in their individual capacity. Heart attacks and strokes are major killers but they
can be prevented by investing a little time and effort

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