KNOW YOUR

HEART

Compiled & Published as a Public Education Service by

Dr. R. SRINIVAS, M.D., D.M.

Consultant Cardiologist
SRINIVASA HEART CENTRE
HANAMKONDA, WARANGAL, A.P.
 FACTS YOU ALWAYS WANTED TO KNOW

1) Structure of the Human Heart.

- Gross structure of the Human heart.
- The Human circulatory system.
- Coronary arteries.
- Conduction system of the heart.

2) Functioning of the Human Heart.

This book is 3) Symptoms of Heart Disease.

dedicated to 4)

5)
Tests done to detect Heart Disease.

Risk factors for Heart disease.

all those to whom 6) Types of Heart Disease.

7) Cardiopulmonary Resuscitation.

“HEART” 8) Methods of Treating Heart Disease.

9) Prevention of Heart Disease.

matters.
 1. STRUCTURE OF THE HUMAN HEART ✤ Tricuspid valve: Situated between the right atrium & right
ventricle.

GROSS STRUCTURE : ✤ Aortic Valve : This is situated between the left ventricle and the
aorta.
✤ The Heart is a major organ of the human circulatory system.
✤ Pulmonary Valve: This is situated between the right ventricle
✤ The heart lies in the chest cavity with a major portion on the left
and the pulmonary artery.
side.
✤ The average weight of the human heart :
Males : 325 ± 75 gms
THE STRUCTURE OF THE HUMAN HEART
Females : 275± 75 gms.
✤ The heart has 3 layers :
Pericardium : This is the outer protective cover which has 2
layers. (Serous pericardium & parietal pericardium). The
Pericardium is a thin fibrous baglike structure within which the Aorta
Superior venacava
heart lies. The two layers of the pericardium are separated by a
small amount of lubricating fluid - pericardial fluid. This allows
movement of the heart during contraction and relaxation to occur Pulmonary veins
without disturbance of the surrounding lungs. Pulmonary artery

✤ The Pericardial cavity normally contains over 10-20 ml of Pulmonary valve

Left atrium
pericardial fluid. Interatrial septum
Aortic valve
✤ The middle one is the Myocardium and the inner layer is the Right atrium
Mitral valve
Endocardium.
Tricuspid valve Left ventricle
✤ The Heart has four chambers.
Right ventricle
✤ The 2 upper chambers - left atrium & right atrium. Interventricular
septum
✤ The 2 lower chambers : Left ventricle & Right ventricle.
Inferior venacava
✤ The upper chambers - left atrium & right atrium are separated
by the Interatrial Septum and the lower chambers - left ventricle
and right ventricle are separated by the Interventricular
Septum. These prevent mixing of blood from both sides.
✤ The heart has four valves:
✤ The mitral valve: Situated between the left atrium & left ventricle.

1 2
 THE HUMAN CIRCULATORY SYSTEM THE CORONARY ARTERIES

The Major Blood Vessels : Aorta

The Aorta is a major artery which
Right atrial branch of Left main coronary artery
arises from the left ventricle. The Right coronary artery
branches of the Aorta supply Left circumflex artery
pure blood containing oxygen & Right coronary artery

nutrients to different parts of the Left anterior descending

artery
body - head, upper limbs,
abdominal organs including
kidneys & lower limbs.
✤ The impure blood containing Co2
& waste material from all parts
of the body reaches the right side
of the heart - Rt.Atrium through
the major veins - Superior
venacavae from the upper body
and inferior venacavae from the
lower body.
✤ The impure blood from the Right
Aorta
Atrium passes in to the right
ventricle and reaches the lungs Left main coronary
artery
through the Pulmonary Artery. In
Left circumflex Left anterior
the lungs, this gets oxygenated artery descending artery
or purified and the oxygenated Septal
Right coronary Branch
or pure blood reaches the left side of the heart (left Atrium) artery
through the pulmonary veins. Obtuse
marginals Diagonal
Branches

Posterior
descending artery

3 4
✤ The coronary arteries supply blood to the different portions of CONDUCTION SYSTEM OF THE HEART
heart muscle.
✤ The coronary arteries arise from the Aorta.
✤ The Left main coronary artery arises from the aorta and
divides into Left anterior descending artery and Left Sino atrial node Atrial muscle
circumflex artery.
✤ The branches of the left anterior descending artery are the
Diagonals and Septals. Atrio ventricular node Bundle branches

✤ The branches of the left circumflex artery are the Obtuse Common bundle
marginals.
Purkinje fibers
✤ The right coronary artery gives rise to the posterior descending
artery and posterolateral branches.
✤ The diameter of the coronary arteries varies from 2-3.5 mm. Ventricular muscle

The conduction system of the Human Heart is similar to the

electrical circuit.
Symptoms of rhythm disturbance of Heart :
Palpitations : Undue awareness of one's own heart beat.
Syncope : Momentary loss of consciousness.
Patients with rhythm disturbances may present with palpitations,
syncope or heart failure. The cardiac impulse passes through
different structures of the conduction system of the heart as shown
in the diagram. The cardiac impulse originates in the sinoatrial
node which is called the pacemaker of the Heart.
The normal heart rate and rhythm are maintained by the
conduction system of the heart.
Abnormalities of heart rate and rhythm are called Arrhythmias.
Arrhythmias may be due to abnormal formation of cardiac impulse
or abnormal Impulse conduction through the structures of the
conduction system. Sometimes, abnormal impulse conduction may
be through Accessory pathways.
5 6
 Arrhythmias may be Tachyarrhythmias (where heart rate is very 2. FUNCTIONING OF THE HUMAN HEART
high) or Bradyarrhythmias (Heart rate is low).
Arrhythmias are diagnosed by the resting ECG, 24 hrs Holter
(24 hrs ECG monitoring), event recorder and Electrophysiological To body
From body
studies.
Drugs which are used to treat arrhythmias are called
antiarrhythmic drugs.
Certain arrhythmias which may present as an emergency and To lungs
do not respond to drugs or presenting with low blood pressure or To lungs
heart failure are treated with direct current electrical shock, using From lungs
defibrillator. The energy delivered may vary from 1 joule to 360
joules. From lungs

Radiofrequency ablation therapy is a type of treatment for certain

Right atrium
arrhythmias which do not respond to drugs. In this method of
Left atrium
treatment, the focus of origin of rhythm disturbance in the heart
muscles is destroyed by delivering electrical energy.
Some rhythm disturbances like 'Heart Block' where the heart Right ventricle
rate is very low are treated by placement of permanent pacemaker
in the chest.
Left ventricle
Patients who have already undergone permanent pacemaker
placement should undergo periodic check-up. From body
To body
Implantable cardioverter - defibrillator placement is done in
patients who already experienced a life - threatening rhythm
disturbance like ventricular tachycardia or in preventing sudden
death in those who are at high risk. ✤ The basic function of the heart is to act like a pump, pumping
blood from the left ventricle to the entire body, supplying oxygen
and nutrients to the various organs.
✤ The impure or venous blood flows back to the right side of the
heart and goes to the lungs from the right ventricle.
✤ In the lungs, the impure blood is purified or oxygenated and
enters the left atrium and left ventricle.

7 8
Do you know ?
✤ The Heart beats around 70 times a minute. If the heart rate is
above 100 it is called Tachycardia and if is below 60 it is called
Bradycardia.
✤ The Heart functions by Cardiac cycle. The cardiac cycle has
two phases - Systole and Diastole.
✤ Systole - contraction of the heart muscle.
Diastole - relaxation of the heart muscle.
✤ The duration of the cardiac cycle is 0.8 sec.
✤ The amount of blood released with each contraction is around
70-80 ml.
✤ The amount of blood pumped by the heart per minute 70 ml X
72 = 5050ml. - i.e. cardiac output is around 5 liters per minute
or per hour 5 X 60 = 300 liters, or per day = 300X24=7200
liters.
✤ Blood constitutes 8% of the body weight (i.e. around 5.6 liters).
✤ The normal blood flow through coronary arteries is 70-90ml/
100gms/min.
✤ The heart muscle uses 8-10ml/100gms/min. of oxygen.
✤ The above values change during various body conditions and
9 10
diseases.
3. SYMPTOMS OF HEART DISEASE
It is important to have a knowledge of common symptoms of
heart disease. This will help in knowing the need to consult a doctor.
1. Chest Pain
2. Breathlessness
3. Loss of consciousness
4. Palpitations
5. Swelling of the body.
1. CHEST PAIN
The causes of chest pain are many. Out of these, heart disease
is a serious cause of chest pain.
Hence, any person suffering from chest pain should have a
preliminary consultation by a doctor.
What is Angina?
Angina is central chest discomfort, tightness or heaviness
occurring on exertion and relieved by rest. It may be associated with
pain in one or both arms or lower jaw pain, or tightness of throat.
✤ Localised chest pain may not be related to heart disease.
✤ Sometimes chest pain related to heart disease may be confused
with symptoms due to hyperacidity, abdominal pain due to
stones in gallbladder or muscular pain.
Angina results from reduction in blood flow to heart muscle
(Myocardial Ischemia) due to blockages in the coronary arteries.
Any chest pain which results following exertion, i.e. on walking,
climbing stairs or slopes, lifting heavy weights is suggestive of
ANGINA & this should alert you to consult a doctor immediately.
✤ Angina is a symptom of Ischemic Heart Disease.
What is Heart Attack? 4. TESTS DONE TO DETECT HEART DISEASE
Heart Attack or Myocardial Infarction results from total stoppage
Based on the symptoms complained by the patient, his age,
of blood flow to a portion of heart muscle due to total blockage
associated risk factors like Diabetes, Hypertension, smoking,
of a coronary artery.
hypercholesterolemia and family history of heart disease, a
preliminary examination of the heart is done. This involves
2. BREATHLESSNESS
examination of the pulse, blood pressure and examination of the
✤ Breathlessness on exertion may be a sign of heart disease.
✤ Breathlessness occurring at midnight or waking from sleep
should alert one to consult a doctor.
✤ Apar t from diseases of the lungs, sudden onset of
breathlessness may be a sign of heart disease.

3. LOSS OF CONSCIOUSNESS
✤ Momentary loss of consciousness may be due to irregularity in
heart beat - (Arrhythmias) or diseases of the heart valves like heart. The heart sounds are heard using the STETHOSCOPE.
aortic stenosis.
The blood pressure is noted using the blood pressure apparatus or
✤ Neurological problems like fits or Transient Ischemic Attack (TIA
- i.e. reduction in blood flow to brain) should also be considered
in those presenting with history of unconsciousness.

4. PALPITATIONS
Undue awareness of one's own heart beat is palpitation. Apart
from situations of anxiety, palpitations may be a symptom of
irregularity in heart beat.

5. SWELLING
Swelling of legs or body may be a symptom of Heart failure,
apart from diseases of the liver, kidneys, or blockage of the large
veins in the leg.

11 12
Sphygmomanometer. ✤ ECG reflects the effect of different diseases on the heart.
Biochemical Investigations : Chest X-ray :
Fasting lipid profile : This involves testing of levels of cholesterol Apart from detecting lung problems and rib cage abnormalities,
and its different fractions in the blood in a fasting state. chest X-ray gives indirect information about heart size and effect of

Electrocardiogram :
This determines the electrical activity of the heart.
✤ A Normal ECG will not rule out heart disease.
✤ In the absence of heart disease, sometimes Nonspecific
changes may appear in the ECG.
✤ An initial ECG is done in any person who complains of chest
pain.

various diseases on the heart.

✤ Two-Dimensional
Echocardiogram - Colour
Doppler:
This helps us in knowing the
heart structure, function and
blood flow within the heart.
✤ Echocardiogram helps in
detecting various diseases
like birth defects in the heart,

13 14
 diseases of the heart valves and abnormal heart function due heart valves, cardiac catheterisation is a test done for
to heart attack. confirmation & to know the need for surgery.
Treadmill test or Exercise test (TMT) : 5. RISK FACTORS FOR HEART DISEASE
This test is done in those complaining of chest pain to rule out Persons with risk factors are usually at high risk of developing
heart disease. This test gives indirect information about heart disease heart disease. Hence, those with risk factors should undergo a
periodic heart check-up to rule out silent disease.
Risk Factors for Heart Disease :
1. Diabetes Mellitus
2. Hypertension
3. Smoking
4. Hypercholesterolemia
5. Family history of heart disease.

1) DIABETES MELLITUS PRODUCES HEART DISEASE

due to the effect of exercise on the heart. In case of an abnormal
TMT, coronary angiography is usually recommended.
✤ Information given by tests like Dobutamine stress Echo or stress
Thallium which are done in some patients is of more value
than treadmill test.
24 hours ECG recording or Holter monitor :
This helps in recording of ECG during the entire day while the
person does his usual activities. This helps in detecting disturbances
of the heart rate and rhythm.
Arteriography or Angiography & Cardiac catheterisation
Coronary Angiography : Is a test which is done to know the site,
severity of blockages in the coronary arteries which supply blood to
the heart. Commonly this is done through the arteries in the thigh
or sometimes through the artery in the hand.
✤ In those with birth defects of the heart and diseases of the
15
IN MANY WAYS.
✤ Patients with Diabetes are at risk of having silent heart disease.
Hence, routine heart-check is a must in very diabetic.
✤ Long standing diabetes may lead to heart failure due to disease
of the heart muscle.
✤ Diabetes increases the chances of producing blockages in the
coronary arteries leading to heart attack.
✤ Patients with diabetes may have silent heart attacks and hence
even in the absence of symptoms of heart disease, all Diabetics
should undergo a periodic checkup of the heart.
2) HYPERTENSION
Facts you always wanted to know
What is Blood Pressure ?
Blood Pressure is the pressure exerted by the blood on the
walls of the arteries. Your Doctor always indicates your B.P. by a set
16
of two numbers.
Eg:- 120/80 mmHg
What are these numbers ?
✤ The upper one denotes the pressure on the arteries when the
heart is contracting. This is called “systolic pressure”
✤ The lower one is the pressure on the arteries when the heart is
relaxed. This is called “diastolic pressure”.
After repeated Blood Pressure measurement with an instrument
— Blood Pressure Apparatus or Sphygmomanometer your doctor
has diagnosed that you are suffering from High Blood Pressure —
Hypertension.
Remember
✤ Hypertension is very common.
✤ It is often without any symptoms. A few cases may Have
Headache, Tinnitus(ringing in the ears) Giddiness and fainting.
✤ HTN is readily detectable
✤ Usually easily treatable
It is necessary to continue treatment regularly as per doctor’s
advice. If left untreated, Hypertension can lead to:
Heart Diseases
Brain Diseases
Kidney Diseases
Eye problems
Why HTN is called a “silent killer” ?
Majority of patients with HTN have no specific symptoms.
Therefore, a person does not realise the damage to the heart
17
and other organs done by HTN for as long as 10 to 20 years.
This is the reason why it is called a “silent killer”.
3) SMOKING
✤ Smoking or use of tobacco in any form is injurious to health in
general and heart in particular.
✤ Apart from heart disease, smokers are at risk of developing
diseases of the lungs, digestive system and urinary
system(bladder cancer).
✤ “Second-hand smoking” or Passive Smoking is also equally
injurious to the body.
✤ Smoking increases the risk of heart disease by the increase in
oxidation products in the body which are harmful.
✤ Nicotine in tobacco and carbon monoxide which is released on
smoking injure the endothelium-which is the inner lining of blood
vessel. This increases the chance of producing blockages in
the blood vessels supplying the heart and thereby leading to
heart attack.
✤ Stopping smoking reduces the chance of developing heart
disease.
4) HYPERCHOLESTEROLEMIA
What is Cholesterol ?
Cholesterol is a waxy, fat-like substance that is present in every
cell in the body. Some cholesterol is needed for our body to function.
Our liver produces enough cholesterol for the body. However certain
foods provide additional amount of cholesterol, which may be more
than our body needs.
18
 While some cholesterol in the blood is essential to our health, The definition of high cholesterol can vary depending on other
too much can be harmful. risk factors.
IF THE CHOLESTEROL LEVEL IS TOO HIGH, IT MAY INCREASE Discuss with your doctor what is considered high for you.
OUR RISK OF HEART DISEASE.
Detection and treatment of high blood cholesterol in adults is
There are many reasons for a high cholesterol level : based on guidelines incorporated in the National Cholesterol
Education Program-developed by the National Institute of Health
These include diet, family history, obesity, diseases such as
(NIH), USA.
diabetes, thyroid gland abnormalities.
Are there different kinds of cholesterol ?
Yes. Different types of cholesterol and fats have different effects. 5) FAMILY HISTORY OF HEART DISEASE :
The most commonly known types are:- Family members (1st degree relatives) of those persons who
LDL Cholesterol :- had unexplained death at a young age or history of heart attack
should also undergo heart check-up.
Low-density lipoprotein or LDL Cholesterol is known as “the
bad cholesterol.” Excess LDL builds up in our arteries and may lead
to heart disease. The higher the level of LDL, the higher the risk for
heart disease.
LOWERING ELEVATED LDL CHOLESTEROL CAN PREVENT
HEART ATTACKS AND SAVE LIVES.
HDL CHOLESTEROL - High - density Lipoprotein, or HDL
cholesterol has earned the nickname “the good cholesterol.” That is
because it is believed to remove cholesterol from the blood. High
levels of HDL in the blood may help to reduce our risk of coronary
heart disease. Low HDL levels can increase our risk of heart disease.
Triglycerides :
Triglycerides are another type of fat in our blood stream. People
with a high blood triglyceride may also have a high LDL. Those with
a high triglyceride Level in addition to an elevated LDL cholesterol
level may be at an increased risk of coronary heart disease.
What is high cholesterol ?

19 20
 Physical inactivity and obesity also increase the chance of
developing heart disease.
CONGENITAL HEART DISEASE
6. TYPES OF HEART DISEASE
1. Congenital Heart Disease:- Diseases present by birth. These are defects in the heart which result due to abnormalities
2. Rheumatic Heart Diseases are those which affect the heart in development of heart in the fetal stage.
valves following Acute Rheumatic Fever leading to disease of Holes in the Heart :
the heart valves.
Abnormalities of Development of septum between Atria leads
3. Ischemic Heart Disease:- Results from reduction in blood supply to Atrial septal Defect & between the ventricles leads to Ventricular
to the heart muscle. Septal Defect.
4. Cardiomyopathy:- Is a disease of the heart muscle. ✤ If the communication between the Aorta and Pulmonary artery
5. Pericardial disease is a disease of the pericardium which is the ie Ductus Arteriosus which normally closes in the fetal stage or
protective cover around the heart. immediately after birth, dees not close it leads to a disease
called Patent Ductus Arteriosus.
6. Arrhythmias are disorders of heart rate and rhythm due to
disease of the conducting system of the heart. ✤ Some Complex congenital Heart diseases where there is an
abnormality of the major blood ressels of the heart and heart
valves are really serious.
✤ Symptoms of babies with Congenital Heart Disease:-
1. Frequent respiratory infections.
2. Difficulty in taking breast feeds.
3. Delayed milestones or abnormalities in physical development.
4. Some babies with complex congenital heart disease present
with bluish discoloration of the lips, tongue, fingers and toes
due to mixing of blood from both sides of the heart.
✤ Congenital Heart Diseases are usually suspected on routine

21 22
 examination by children specialists.
RHEUMATIC HEART DISEASE
✤ This is a very common heart disease in our country.
✤ This usually affects the heart valves and initially may present
as Acute rheumatic fever.
Acute Rheumatic Fever :-
✤ Usually affects children between 5 and 15 years.
✤ Children with Acute Rheumatic fever usually have joint pains,
fever and sore-throat.
✤ Acute rheumatic fever results from throat infection due to
bacteria of the B-Hemolytic Streptococci group.
Following Acute Rheumatic Fever :
The disease process following Acute Rheumatic Fever is a
result of cross-reaction between the protein of heart-muscle and
protein of bacterial cell-wall.
✤ Acute Rheumatic Fever affects mainly the heart valves and over
a period of time leads to Valvular Heart Disease. The Common
diseases of the heart valves following Acute Rheumatic Fever
are Mitral Stenosis,
Aortic Stenosis
Mitral Regurgitation &
Aortic Regurgitation
Stenosis of the Mitral Valve & Aortic Valve means reduction in
area of the respective valves.
For example, in Mitral Stenosis which is the most common valve
disease, the area of the mitral valve is reduced. (Normal Mitral valve
Area is around 3-4sq.cm)
Regurgitation is leakage of blood across the valve. For example,
23
in Mitral Regurgitation there is leakage of blood acroos the Mitral
Valve.
ISCHEMIC HEART DISEASE
OR
CORONARY ARTERY DISEASE
The non-stop function of the heart is facilitated by blood supply
to heart muscle through coronary arteries.
✤ Myocardial Ischemia is reduction in blood supply to the heart
muscle due to formation of blockages (Plaque, Thrombus or
clot) in the coronary arteries.
✤ The symptom following Myocardial Ischemia is “Angina.”
Angina may be Stable Angina where the patient has symptoms
lasting a few months to a few years.
or
Unstable Angina where the patient has symptoms whose onset
is a few hours to days to 1-2 months.
Patients with Unstable Angina are at high risk of developing
Heart Attack(Acute Myocardial Infarction) where there is a total
stoppage of blood flow to a portion of heart muscle due to complete
blockage of a coronary artery.
What is Atherosclerosis ?
Athero-Means Porridge & Sclerosis Means Hardening.
Atherosclerosis is the disease process in Ischemic Heart
Disease. Normally the arteries do not contain calcium & fat
substances.
The process whereby calcium, fat substances, blood cells collect
together, form a plaque, and layer by layer form a thrombus and
lead to narrowing of a artery is called as Atherosclerosis. Thereby
blood flow is reduced to the portion of the body supplied by that
24
HUMAN ARTERIAL SYSTEM ATHEROSCLEROSIS
OR
FORMATION OF BLOCKAGES IN THE ARTERY

25 26
artery. cavity which may present as an emergency.
Atherosclerosis may involve the arteries of the heart, brain or ✤ Infective endocarditis is disease caused by bacterial infection
kidneys leading to serious consequences. of the inner endothelial lining of the heart.

CARDIOMYOPATHY MISCELLANEOUS SITUATIONS

Cardiomyopathy is a disease of the heart muscle which usually
presents with heart failure. There are various causes and varieties
of cardiomyopathy.
✤ Heavy, regular usage of alcohol leads to cardiomyopathy.
✤ Myocarditis is infection of the heart muscle which is usually a
result of viral infection.
✤ AIDS involves the heart in various ways.
OTHER SITUATIONS WHERE HEART DISEASE IS
USUALLY ENCOUNTERED
Drugs:-
Some of the anticancer drugs, antidepressants used for
psychiatric illness, oral contraceptives, cocaine (Drug abuse) can
lead to heart disease.
✤ Electric injury, scorpion sting,organophosphate poisoning may
produce emergency heart problems.
✤ It is mandatory for all patients to undergo routine heart check-
up before undergoing any major surgery.
✤ The heart can also be affected by tumors, chest injury,
depression and anxiety disorders.
HEART DISEASE IN PREGNANCY
✤ All pregnant women who have symptoms suggestive of heart
disease should undergo a preliminary cardiovascular
examination.
✤ Hypertension, Valvular heart diseases are some of the common
heart problems encountered during pregnancy.
✤ All pregnant women in whom heart disease is confirmed, should
be under constant supervision during the last few months of
pregnancy and time of delivery.
✤ In some conditions like Peripartum cardiomyopthy and primary

DISEASES OF THE PERICARDIUM

✤ Pericarditis is infection of the Pericardium i.e. the protective
covering over the heart.
One of the common causes of Pericarditis in our country is
Tuberculosis, apart from viral infection.
✤ Sometimes there is excessive collection of fluid in the pericardial

27 28
 pulmonary Hypertension future conception is not advisable.
✤ Hypertension or Heart Disease is a cause of grave concern to
the mother or fetus. Hence it is always advisable to follow doctor’s
advice.
CONGESTIVE HEART FAILURE
What is Congestive Heart Failure?
Due to the weakening of the heart muscles, their capacity to
pump blood to all parts of the body decreases. This leads to the
accumulation of a small portion of blood in the left ventricle. Thus
every time the heart beats a small amount of blood is left in the left
ventricle, leading to congestion. When the heart is full of this
unpumped blood there is no room for newly oxygenated blood to
enter the left ventricle. At this time the heart suddenly stops
functioning.
How does it develop?
Since this problem is due to the weakening of the heart muscles
we shall find out the conditions which could lead to this.
✤ One most potential culprit is Coronary Artery Disease. Due to
the deposition of fat on the inner walls of the coronary arteries
the blood supply to the heart muscles is lessened. Over a period
of time the heart muscles weaken due to lack of blood supply
and their ability to pump blood completely from the left ventricle,
decreases.
✤ If your heart muscles are affected and develop some disease
which affects their ability to pump blood efficiently it is called as
Cardiomyopathy and may be caused by alcohol abuse or certain
toxic drugs. The incidence of this is very rare.
✤ Hypertension is also a major contributing factor. In hypertensive
patients the heart has to work harder to pump the blood. Over
a period of time this causes enlargement of the chambers of
the heart and weakens the heart muscles.
29
✤ Heart attack also weakens the heart muscles as it damages
part of the heart muscle thereby putting additional workload on
the remaining musculature.
✤ Diabetes mellitus increases the incidence of coronary artery
disease and congestive heart disease.
✤ Chronic kidney failure is another important cause for
development of CHF as it causes retention of water which puts
additional workload on the heart muscles.
What are the signs and symptoms?
The typical signs and symptoms that you would experience are
- feeling weak or tired upon usual exertion
- shortness of breath or sudden cough upon exertion
- swelling of the feet
- difficulty in breathing upon lying down
- frequent urination
- sudden instances of dizziness
- disturbance in sleep due to coughing and shortness of breath.
How does a doctor diagnose CHF?
The doctor can diagnose your problem by using one of more of
the following techniques.
- He will ask you about your previous health record and your
family history. This will help him to know whether you are likely
to suffer from heart problems by virtue of heredity.
Electrocardiogram helps in finding out how your heart is functioning
and whether the heart is getting proper blood supply.
Echocardiogram shows whether the heart is enlarged, how well
does the heart pump, whether the heart wall is thickened etc.,
There are other methods to identity abnormal heart beats,
weakened areas of the heart, blockages in the coronary arteries.
30
What is the treatment? Cardiac Asystole or Cardiac Arrest.
The treatment is divided into two types viz.
1. Personal health care i.e. regular physical activity, healthy food
habits, weight control/reduction, sufficient rest, etc.
1
2. Medicines - These include the following
Vasodilators dilate the blood vessels and thus reduce the
blood pressure. The workload on heart is thus lowered hence it can
pump more blood. Currently the most acceopted drugs are the
ACE inhibitors due to their benefits.
Diuretics help in relieving you from the excess fluid that is
accumulated in the body which increases the workload on heart. 2 3

Digitalis is cardioprotective in nature and helps in restoring the

force of contraction of the heart muscle. Digitalis also helps in an
irregular heart beat.
Anticoagulants, are although not directly for CHF but they
help in preventing the formation of blood clots which may lead to
heart attack etc. 4 5 6
Antiarrhythmic agents help in regularizing the irregular heart
beat thereby reducing the workload on heart.

CAUSES OF SUDDEN DEATH IN HEART DISEASE

Sudden Cardiac Death results within I hour of onset of symptoms
in a person who has not been documented to have heart desease.
Causes of sudden Death in patients of heart disase:- 7 8

Sudden Death in patients of heart disease may be due to serious

disturbances in heart rate and rhythm like:
Ventricular Tachycardia
Ventricular Fibrillation
Complete Heart Block

31 32
 Timely action by giving DC Shock using a Defibrillator or
temporary pacing may save a few patients.
7. CARDIOPULMONARY RESUSCITATION
What to do in case you encounter a person who suddenly
collapses?
✤ When a person suddenly collapses infront of you, you should
perform CPR i.e. Cardiopulmonary Resuscitation.
In the event of cardiac arrest there is sudden drop in blood
supply to the brain which leads to unconciousness, absence of heart
beat, gasps and absence of pulsation in large arteries.
Recognizing the signs of cardiopulmonary arrest, providing
effective artificial respiration (CPR-Cardio Pulmonary Resuscitation),
stabilizing the patient and transferring him to an appropriate cardiac
care centre should take care of the emergency.
What is CPR?
Cardio Pulmonary Resuscitation is a technique whereby you
maintain patient’s breathing through artificial respiration and blood
flow by external chest compression
How to perform CPR?
✤ Place the patient on his back on a hard flat surface.
✤ Keep the legs raised (Fig.1)
✤ Give one or two sharp and forceful blows with the closed fist on
the middle of the chest (Fig.2). This will help to restore effective
beating of the heart.
* Start compressing the heart externally as shown in (fig.3) at
the rate of 80-100 compressions per minute in the following manner.
=> Place yourself in a kneeling position by the side of the patient
lying flat on the hard surface.
33
=> Place the heel of one hand over the lower part of the breast
bone just above the abdomen. Keeping the arms straight, place the
heel of the other hand over the first to reinforce the downward pushing
action, Without bending the arms, depress the breast bone about
2+/– 1/2 inches. After this release the pressure suddenly to allow
the breast bone to recoil upwards (in order to fill the heart with
blood).
=> Simultaneously with external compression, commence
mouth-to-mouth respiration. Tilt the head backwards and lift the back
of the neck (Fig.4). Pull the lower jaw to displace the tongue forward
(Fig.5), Open the mouth and use your fingers to clear the food, fluid,
vomit, artificial dentures etc. (Fig.6). All these steps will help in
opening up the airway passages. Look, listen and feel for breathing.
=> If the patient does not start breathing, start mouth-to-mouth
respiration. Pinch the nostrils, seal the patient’s open mouth with
your own and deliver rapid mouth-to-mouth breaths (Fig.7). Observe
for chest expansion and presence of pulse, continue mouth-to-mouth
respiration at the rate of one every 5 seconds (fig.8)
=> If only one person is present, 2 lung inflations alternated
with 15 chest compressions at a rate of 80-100 per minute should
be carried out. If an assistant is available, one should deliver chest
compression at a rate of 80-100 per minute while the other ventilates
the patient at slow ventilatory breaths lasting for 1 to 1 & 1/2 seconds,
once every 5th compression.
Cardiac compression alongwith artificial ventilation should be
carried out rhythmically, regularly and sincerely until effective
spontaneous breathing is re-established.
A few precautions should be taken while performing CPR.
A) Do not exert pressure on the top of the abdomen as this can
harm the liver.
B) Pressure should be exerted only with the heel. See that the
fingers are lifted and do not touch the ribs.
34
C) The compression should be smooth, regular, uninterrupted with
50% of the cycle for compression and remaining 50% for
relaxation.
Continue CPR for 3 to 4 minutes until the patient has stabilized
and transfer the patient to a cardiac care centre.
8. METHODS OF TREATING HEART DISEASE
✤ A proper diagnosis of heart disease helps in choosing the
treatment modality.
✤ Treatment of heart disease aims at relief of symptoms and
prolonging life.
✤ Treatment involves use of medicines, interventional methods
or surgery.
✤ The choice of treatment depends on the type of heart disease
and its severity.
TREATMENT OF CONGENITAL HEART DISEASE
✤ Babies who present with heart failure are treated with drugs.
✤ ‘Holes’ in the heart or developmental defects like Atrial septal
Defect or Ventricular septal Defect may close naturally by the
age of 10 years.
✤ Meanwhile, depending on the size of the defect, disease severity
and symptoms & thereby proper assessment during follow-up,
surgery may be required.
(Surgical closure of Atrial septal Defect or Ventricular septal
Defect or Ligation of Patent Ductos Arteriosus).
35
✤ Device closure or closure of the defect using an artificial device
is the latest modality of treatment for some conditions.
✤ Defects in the heart which are very small do not require any
treatment.
✤ Surgery may be quite beneficial in some complex congenital
heart diseases, while in some it may offer short-term relief and
in some others surgery may not provide any relief.
TREATMENT OF RHEUMATIC HEART DISEASE
- Acute Rheumatic Fever is usually treated with Aspirin and
Inj.Penicillin.
- In Mitral Stenosis, which is a common disease of the heart
valves, the area of the mitral valve is increased by either the
non-surgical way of Percutaneous Balloon Valvotomy or surgery.
✤ Depending on the nature of the valve disease, the type of
surgery may be Valve Repair or Valve Replacement using an
artificial valve.
TREATMENT OF ISCHEMIC HEART DISEASE
The treatment of Ischemic Heart Disease in its initial stages
involves Medical treatment-ie use of drugs like nitrates and aspirin.
✤ In case of severe symptoms like in unstable Angina,
hospitalisation involving admission of a patient in an Intensive
coronary care unit is suggested.
We already know that complete blockage of a coronary artery
leads to Heart Attack or Acute Myocardial Infarction.
The process of dissolving the clot or thrombus using clot-
dissolving agents or thrombolytic agents like Streptokinase or
Urokinase is called thrombolysis.
✤ Timely use of these drugs after onset of heart attack may lessen
36
 the damage to heart muscle. serious disturbances in heart rate or rhythm are detected by
Electrophysiological studies and treated by using electrical
✤ Where facilities are available, Primary Angioplasty is also one
energy (Radio frequency Ablation).
method which is very useful in patients with heart attack.
Life-threatening disturbances of heart rate and rhythm which
In view of the different life-threatening complications, a patient
do not respond to drugs like ventricular Tachycardia are treated by
with heart-attack is usually monitored in an intensive-care setting
implantation of a battery operated instrument called Automatic
for around 5 to 7 days.
Implantable Cardioverter - Defibrillator (AICD).
✤ In a patient with Ischemic heart disease or particularly following
a heart attack, if he has disabling symptoms and not relieved
by optimum dosage of drugs, Coronary angiography is done to
IF YOU ARE A PATIENT WITH HEART DISEASE
detect the blockages.
1. Please follow instructions regarding treatment and life-style as
Depending on the number of blockages and arteries involved, advised by your doctor.
percentage of blockage in an artery, either balloon angioplasty, Stent
Implantation or Bypass surgery are chosen. 2. Please maintain your records properly.

✤ Balloon Angioplasty is the method of opening the blocked 3. Do not travel alone. It is always better if you have an attendant
coronary artery. along with you.

✤ Stenting is the procedure where a stent (spring or conduit) is 4. You should be aware of the common side-effects of the drugs.
placed at the site of blockage. This lessens the chances of
blockage developing again.
✤ Coronary Artery Bypass graft surgery is the surgical procedure
in which blood vessels are joined by "bypassing" the site of
blockage. The blood vessel or graft. which is used for bypass
surgery can be a Artery graft or a venous graft.

TREATMENT OF RHYTHM DISTURBANCES OF THE HEART

Disturbances in Heart rate and rhythm like Complete Heart Block

are treated by surgical implantation of a pacemaker.
A pacemaker is a battery-operated modality which artificially
regulates heart rate and rhythm.
✤ Sometimes, abnormal or accessory pathways which lead to

37 38
5. Periodic check-up is essential.
6. Do not get depressed.
– Please discuss freely with your doctor regarding your disease.
He will guide you regarding the methods of treatment and getting
well.
7. In case of any emergency, please contact your nearest doctor/
hospital.
9. PREVENTION OF HEART DISEASE
1. Regular exercise like walking for 30 min. a day for atleast 5
times a week will help you have a healthy heart for life.
2. Diets with low fat are to be taken
3. Maintain a healthy weight.
4. Stop smoking.
5. Avoid stress
6. Check your B.P.
7. Check if you have diabetes
8. Watch your cholesterol.
9. Have periodic health check up.

EXERCISE AND THE HEART

✤ Exercise is good for your heart. Your heart is a muscle. Like any
other muscle it needs to stay active.
✤ You should ask your doctor what exercise is right for you-before
embarking on it.
✤ For most people moderate exercise for 20-30 min., five times a
week helps reduce the risk of Coronary Artery Disease
significantly.
✤ Regular exercise helps to raise the level of good cholesterol.

✤
Wishing you a healthy
HDL helps remove bad Cholesterol from your arteries.
Exercise also helps lower B.P. Exercise helps you to lose your
weight. 39
✤ Exercise also strengthens your lungs, tones the muscles and
 KNOW YOUR
HEART

Dr. R. SRINIVAS
M.D.,D.M.
Consultant Cardiologist

SRINIVASA HEART CENTRE

Residence :
“SRIDHATRI”, H.No. 2-4-617/4, Ramnagar, Hanamkonda, Warangal, A.P.

Dr. R. SRINIVAS
M.D., D.M.