Guide to Heart Disease

Heart attacks kill an increasing number of people every year. One in three middle aged men today dies of a heart attack and the victims are getting younger and younger.

What to do
1. Stop smoking. If you smoke 20 or more cigarettes a day, you double your chance of having a heart attack.
2. Have your blood pressure checked by your doctor and keep to his treatment if it is high.
3. Cut down on fatty meat; use soft margarine instead of butter; use corn or sunflower oil for cooking; avoid cream; eat fewer than 3 eggs per week; cut down on pastries, cakes and biscuits; eat more fruit and vegetables; and eat wholemeal bread and wholemeal flour products. The advice here on cutting down on cholesterol-rich foods is currently under scrutiny, but it will do no harm to reduce cholesterol-containing foods. Do not cut them our altogether though.
4. Get your weight down to what your doctor suggests. Start by cutting your sugar intake by half and eventually cutting it out altogether. This alone will reduce your weight surprisingly quickly.
5. Sedentary people have 3 times the chance of having a heart attack than active ones, so take regular exercise. Active people have 3 times the chance of surviving their first heart attack compared with inactive ones. Walk or jog regularly (2-3 times per week) in such a way as to raise your pulse to 120 beats per minute or more. Anything less than this cannot be considered to be ‘protective’ exercise. Having said this, take care not to exercise too much too soon, but work it up gradually.
6. Stress, especially in the presence of other risk factors, can be an important trigger. Avoiding stress can be difficult, but it is worth trying to steer clear of the things that upset you or cause tension at work.

Remember A heart attack does not just happen to other people — it could happen to you.

Coronary Artery Disease (CAD) is one of the most common causes of death in India. It is caused by narrowing of the coronary arteries, which results in a reduction in blood supply which results in a reduction in blood supply to the heart muscle. In severe cases this leads to a myocardial infarction, more commonly known as a heart attack.
Risk Factors: A high level of blood cholesterol, obesity, diabetes, mental stress, smoking and high BP are the main risk factors for CAD. Rigorous exercising is detrimental in middle-aged people who’ve been out of training. In women, increase in CAD has been associated with high dose estrogen pills.
Diagnosis & Treatment: Detection involves the use of ECG, stress test and nuclear imaging. Management of CAD includes necessary changes in diet, smoking habits and lifestyle. Drugs and surgery maybe suggested depending on the condition of the heart.
Prevention: Cut down on saturated fat and increase the intake of fibrous foods, vegetables and fruits. Avoid excess consumption of salt and sugar. Control your weight. Do not drink more than 4-5 cups of coffee a day. Avoid large quantities of alcohol. Exercise regularly.
In comparison reducing dietary cholesterol intake from 385 to 300 mg/day decreases the amount of absorbed cholesterol by only 45 mg per day. For the overweight patients reducing excess body weight has a more significant quantitative impact on the mass of cholesterol the body must transport, metabolize and excrete daily than can be achieved by decreasing dietary cholesterol intake. Increased body weight probably has its greatest effect by increasing work-load of the heart. A mild stenosis associated with obesity can be critical in a situation of added stress. In the Framingham off-spring study, all obese subjects were found to have a higher ratio of total cholesterol to HDL cholesterol than subjects of normal weight.

Heart works for many years without tiring and rests between beats. It gets a very good supply of blood so that it has a lot of energy available. It is made of a special kind of muscle that is very strong and is called cardiac muscle. It can contract quickly and strongly without getting tired. The muscle cells in the heart seem to run together so that they look like one giant cell. This allows the heart to “pull together.” The heart is made up of two halves because it is really two pumps connected together. Each pump has arteries taking blood away and veins bringing it back.
One of the pumps sends the blood to the lungs. The blood picks up oxygen there. When this blood returns to the heart, the second pump sends it out through arteries to the cells in the body. It picks up carbon dioxide, a waste product of the cells. When you cut, bleeding comes from capillaries and blood soon form clot. Sometimes people are born with blood that cannot form clot. They have a disease called hemophilia. For them even a small cut is dangerous. Each half of the heart has two kinds of chambers. There is a thin-walled chamber at the top. It is called the atrium, from the Latin word for “entrance hall.” The blood enters the atrium first. Under the atrium is a ventricle, which means “little hollow.” It has thick, muscular walls. There are four chambers in the heart : a right atrium, a right ventricle, a left atrium, and a left ventricle.
During its trip through the arteries, the blood delivers oxygen to the rest of the body. It passes to the liver. In the liver, it picks up glucose. The glucose is supplied to the body’s cells. And the body’s cells give their wastes to the blood. This exchange of materials always occurs through the capillaries. The capillaries then join into small veins, which join into larger veins, and so on. The largest veins bring the blood back to the right atrium. By now, the oxygen is all used up and the whole cycle is gone through once more.
The valves in the veins of the legs are especially important Blood must flow up the legs toward the heart, against the force of gravity, which pulls the blood downward. The valves in the veins keep the blood from falling back down. This is one reason why walking is good exercise. The working of the leg muscles keeps the blood moving in the leg veins. When a person stands a lot and has little exercise, the blood may not move fast enough. The blood may collect in the veins and cause them to swell up.
If a vein is cut, the bleeding that results can be controlled without much trouble. Blood flow from a vein is slow. And the thin walls of a vein can be easily pressed shut. But when an artery is cut, that is dangerous indeed. The blood gushes out forcefully with each heartbeat, and it is hard to close the artery’s muscular walls.

The main objectives in the dietary management of hypertension involve :
• minimizing the strain on the heart.
• lowering and normalization of blood lipid levels, if elevated, especially cholesterol.
• preventing or controlling hypertension and other related Complications.
• maintaining satisfactory nutritional status and body weight at ideal or 5% below the ideal level.

The following guidelines may be used to assess the nutritional requirements, keeping in mind the effect of various dietary components on blood lipid profile and hypertension.
Energy: The intake is dependent on body weight at ndeal or 5% below it. For weightloss, which should be gradual, a daily reduction of 500-1000 keal may be made. This alone can help normalize blood lipid profile and lower blood pressure, if hypertension is present.
Protein: Normal intake is recommended, preferably from foods of vegetable origin or lean meat and skimmed milk and its products.
Fat: Total intake should provide about 20% of the energy and definitely below 30%. Intake of SFA should be reduced with emphasis on PUFA. An eqqal ratio is recommended for PUFA : SFA : MUFA.
Cholesterol: Intake should be restricted to 300 mg per day and 150 mg in cases of familial hypercholesterolemia.
Carbohydrate: About 60-65% of the calories may be from carbohydrate with not more than 10-15% from single sugars. Emphasis should be on complex carbohydrate with not more than 10-15% from simple sugars. Emphasis should be on complex carbohydrates rich and fibre.
Minerals: Intake should be adequate with special attention on protective minerals like calcium and potassium. Sodium should be restricted for prevention or control of hypertension.
Vitamins: Intake should be adequate with emphasis on vitamins E, C, B6 and Niacin.
Dietary fibre: Atleast 30-40g dietary fibre should be incorporated in the daily diet, with emphasis on the soluble, viscos fibre like pulse fibres, gums and pectins.
Fluid: Intake can be normal.
These principles constitute the ‘prudent diet’ which can be used as prophylactic or therapeutic measure.

Since it is the circulation of blood that keeps the body healthy by providing food to the tissues and eliminating their wastes, it is necessary to know something about blood and its circulation.
The circulation of blood is performed by the means of a muscular pump, which is the HEART. The muscles of heart contract periodically and cause the heart to pump blood. The blood is carried to different parts of the body through arteries and capillaries. Arteries are larger and they take blood from the heart to supply it to various tissues via (the smaller) capillaries, while the veins return blood from the tissues to the heart. The blood that is carried from the heart to the tissues in the arteries (the arterial blood) is rich in oxygen and dissolved foods, while the blood in the veins (the venous blood) that is carried back from the tissues to the heart via the lungs, contains carbon dioxide and waste material, which is supplied first to the lungs by the pulmonary artery. From the lungs, the pulmonary vein supplies the purified- blood rich with oxygen, back to the heart, thus completing one cycle of blood-circulation in the body.
This process goes on repeatedly in the body, the blood performing the distribution of food to the tissues and then cleaning them of the CO2 and waste material. The dual function of supply and drainage, by the blood, goes on in the system, the heart contracting each time and thus performing the circulating function, which it does 72 times in a minute in an adult person. This rate increases to 100 or more during activity or excitement. The total volume of blood in the system is about 5 or 6 liters, while the heart pumps out about 5 liters of blood every minute.