healthy heart booklet

8/8/2019 Healthy Heart Booklet

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Akhilesh Verma, 54, Company Director

because I understand my condition.

heart diseaseIm winning against

CALL TOLL FREE 1800-345-1066

A Cardiovascular Disease Management Program for

Hypertension Angina Dyslipidemia

Knowledge about your condition and

cardiovascular disease management.

Access to the Healthy Heart Team aids co-ordination and follow-up.

Lifestyle advice by professionals

(diet, physiotherapy and yoga).

Education material on cardiovascular

risk factors.

BP monitoring instrument(subsidised price) and training.

Invitations to select Group Sessions.

Access to ATM (Any Time Medicine)

A joint initiative by Pfizer and Apollo Hospitals

Your heart beats

for you ...its time

you did.

Heres how you benefit from the Healthy Heart Program.

Indraprastha Apollo HospitalsDelhi-Mathura Road, Jasola Vihar

New Delhi-110044 Ph: 011- 2682 5604

PFIZER LIMITEDPfizer Centre, Patel Estate Off S.V. Road,Jogeshwari (W), Mumbai 400 102


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Cardiovascular disease burden in India is on the rise with changing lifestyles. In

our country, nearly 50% of CVD-related deaths occur below the age of 70,

compared with just 22% in the West. That trend is particularly alarming and

thus warrants aggressive therapy that aims to drive treatment goals to lower

levels, which are often difficult to attain and maintain.

identifies the people who are at

risk or have past history for hypertension, Coronary Artery Disease and

dyslipidemia and sets up a lifelong preventive and promotive healthcare

program by using medical intervention and lifestyle management. Thisprogram is the first of its kind in India, and through it PFIZER and APOLLO

hospital group will treat such patients through the application of medical care

and lifestyle management. This cardiovascular disease management program

has been reviewed and approved by the Apollo Hospital Ethics Committee.

Your voluntary enrolment in this program will be documented through the

signing of an informed consent form.

To know more about the "Healthy Heart" program and for details of

enrollment you can mail us on [email protected] or call us on

1800 345 1066 "or" +91-40-60601066.

The Healthy Heart Program

hypertension

heart attack

angina

diabetes

taking care

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contents welcome!


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hypertensionHypertension is synonymous with high blood pressure. Blood

pressure is a measure of the force of blood against the walls of

the arteries, which are the conduits that carry blood from the

heart to other parts of the body. In some people, the blood

cannot flow easily through these arteries. For example, if the

arteries are narrowed for some reason, the pressure will go up

to keep the blood flowing. This is high blood pressure. If you

have it, you are not alone. Hypertension is a very commoncondition; however, if left untreated, it can become serious.

silent killerIf you have hypertension, chances are that you may not have any symptoms atall. Hypertension is often called the silent killer because most people whohave it do not feel sick, but if left uncontrolled, it can lead to a heart attack orkidney disease. This is why it is so important to treat hypertension even if you

feel fine.

Many people can keep their hypertension under control by making somechanges in their daily activities, such as increasing exercise and eating ahealthier diet. Other people may need to take medicine in addition to dietand/or exercise.

changes

why is high blood pressure a problem?When your blood pressure is high, your heart has to work harder just to pump anormal amount of blood through your body. The higher pressure in your arteriesmay cause them to weaken and bleed, resulting in a stroke. Over time, bloodvessels may become hardened. This often occurs as people age. High bloodpressure speeds this process. Blood vessel damage is bad because hardenedor narrowed arteries may be unable to supply the amount of blood the body'sorgans need. The higher artery pressure may lead to atherosclerosis, in whichdeposits of cholesterol, fatty substances, and blood cells clog up an artery.Atherosclerosis is the leading cause of heart attacks. It can also cause strokes.

The added workload on the heart causes thickening of the heart muscle. Overtime, the thickening damages the heart muscle so that it can no longer pumpnormally. This can lead to a disease called heart failure.

Your kidneys or eyes may also be damaged.The longer you have high blood pressure and

the higher it is, the more likely it is youwill develop problems.

cholesterol deposited on the insides of an arter y

what is considered high blood pressure?The pressures are measured in millimeters of mercury.

Healthy blood pressure is less than 120/80.

Pre-high blood pressure (prehypertension) is from 120/80 to 139/90.

Stage I high blood pressure ranges from 140/90 to 159/99.Stage II high blood pressure is over 160/100.

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complianceactive partnerIt is important that you become an active partner with your doctor in taking careof yourself. At first, as you adjust your daily habits to the treatment programadvised to you, making these changes may seem difficult. After a while, thesechanges will become routine. So the sooner you begin to make these changes,the better.

Most treatments include a combination of diet, exercise and medication. Hereare some important suggestions to consider

If you weigh too much, your heart may have to work harder to pump blood.Find out what your ideal weight range should be. This is important to knowbecause as you gain weight, your blood pressure sometimes increases. Losingextra weight is often the best way to lower blood pressure.

If you are overweight, you may have to reduce the amount of food you eat.Once you lose weight, it is important to keep it off.

shed weight

medication

medication

Keep appointments with your doctor and have your blood pressure checkedregularly. By doing so, you will know if your blood pressure is under control.

Tell your doctor about the progress you are making or any problems youhaving. Further, be sure to ask any questions you may have concerning yourdiet, exercise, or medication.

In the treatment of heart disease alone, noncompliance with drug regimens is

believed to cause as many as 125,000 avoidable deaths every year.

Compliance with antihypertensive drug regimens is cost-effective, because thecost of treating cardiovascular disease that may arise from untreatedhypertension is substantially higher than the cost of treating hypertension beforeit progresses to disease.

Patient compliance can be defined as the extent to which a

persons behaviour, in terms of taking prescribed medication,

following dietary regimens, or executing recommended

lifestyle changes, is consistent with medical or health advice.

Research has shown that patients can have clinically significant

increases in blood pressure within 24-48 hours of missing a

dose of a calcium-channel blocker or beta-blocker, and that

even patients taking their blood pressure medications 80-99%of the time can experience up to a two-fold increase in risk for a

cardiovascular event as a result of the occasional missed dose.

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Cramer, Am J Managed Care, 1998

McCarthy, Business Health, 1998 Rizzo and Simons, Clin Ther, 1997


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It is best to limit or avoid certain foods to help control your blood pressure:

Limit the amount of salt you eat. Avoid foods high in salt.

Read food labels to check the amount of salt in prepared foods.

Avoid eating foods high in fat like bacon, egg yolks. Avoid cookingwith excess butter.

Cigarette smoking is damaging to the heart and blood vessels.Stopping will lower your risk of a heart attack or stroke over time.

Alcohol can also raise your blood pressure. Avoid or limit drinking.

Exercise can help lower your blood pressure and reduce your weight.It will only help, however, if you exercise on a regular basis. Consult

your doctor for an exercise plan that is right for you.

lifestyleLet your familyknow that you have high blood pressure. This is importantbecause high blood pressure tends to run in the family. It is a good idea for othermembers of your family, age 20 and older, to get their blood pressure checkedas well. Your family can help you follow your doctors advice and remind you totake your medication.

family

cholesterolCholesterol is a type of fat in the blood that plays an important role in someessential body functions. Too much cholesterol in the blood, however, can leadto atherosclerosis, a common disease characterized by plaque formation in thearteries.

Most cholesterol is produced by the liver, but the foods you eat can also affectyour cholesterol levels. Your physician can measure the cholesterol in yourblood with a simple blood test.

reduce it!Reducing your cholesterol level can help lower your risk of atherosclerosis andheart disease. Try these simple lifestyle changes:

Talk to your physician about a regular exercise program that is right

for you.Your physician may prescribe a medicine to help lower your bloodcholesterol level.

Reduce your intake of foods high in cholesterol and saturated fats, andadd more fruits, vegetables, and breads to your diet.

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A blood clot is the most common cause of a blocked coronary artery. Usually,

the artery is already partially narrowed by atheromas. An antheromatousplaque may rupture or tear and create more blockage through clot formation.This complete blockage stops the flow of oxygen-rich blood to the heart.Without oxygen, the cells of the heart begin to die. This death of heart tissue iscalled a heart attack, or myocardial infarction.

Unlike angina, the chest pains caused by a heart attack do not diminish withrest. The following symptoms are noticeable in case of heart attack:

the chest lasting more than a few minutes.Pain spreading to the shoulders, neck or arms. The pain may be mildto intense. It may feel like pressure, tightness, burning, or heavy

weight. It may be located in the chest, upper abdomen, neck, jaw, orinside the arms or shoulders.

Chest discomfort with lightheadedness, fainting, sweating, nausea orshortness of breath.

Anxiety, nervousness and/or cold, sweaty skin.

Nausea, vomiting, dizziness, fainting.

Increased or irregular heart rate.

Uncomfortable pressure, fullness, squeezing or pain in the center of

signs and symptoms

The most common cause of a heart attack is atherosclerosis, a cardiovasculardisease in which fatty materials in the blood form sticky plaques in the arteries,as described earlier in this booklet. These plaques can get larger and larger,until they completely block the flow of blood to the heart muscle.

plaque

blood clot

complete blockage

Acute myocardial infarction, more commonly known as a heart

attack, occurs when the blood supply to a part of the heart is

interrupted. The resulting ischemia, or oxygen shortage, causes

damage and potential death of heart tissue. It is a medical

emergency, and the leading cause of death for both men and

women all over the world. Source: en.wikipedia.org/wiki/heart_attack

cardiac rehabilitationIf there is adequate blood flow following aheart attack, then the damaged heart tissuebegins to heal. Dead heart tissue is replacedwith scar tissue, which does not functionnormally.

When you are ready to leave the hospital,your doctor will usually perform a series oftest, including an ECG stress test, a coronaryangiogram and an echocardiogram

Your recovery will depend on many factors,especially your physical condition, age, andthe severity of your heart attack. A low-fatdiet, a supervised exercise program, stressreduction, and medication will all help youprevent further heart attacks and reduce the

progression of heart disease.

heart attack

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You are more likely to have angina when your heart is working harder, forexample, when:

You are exercising, such as walking.

You are upset.You are in cold air.

You are digesting a big meal.

However, you can also have angina when you are resting or sleeping.

The symptoms of angina may include:

Heavy, strangling chest painPain that starts in the chest and spreads to the throat, arms (usually theleft arm), and jaws, and between the shoulder blades; the pain canalso spread to the stomach and feel like an ulcer or indigestion.

A feeling of tightness or heaviness in the chest with no pain.

Nausea

Sweating

Trouble breathing

when could it occur?

signs and symptoms

Angina pectoris is a feeling of tightness, squeezing, or pain in

the chest. It happens when the heart does not get enough

oxygen-rich blood. Angina can occur in men and women of

any age, but it is more common among the middle-aged and

elderly.

how does it occur?Angina may be caused by any condition that affects the blood flow to yourheart, such as:

Coronary artery disease: The walls of the arteries that carry blood tothe heart develop atherosclerosis (fatty deposits). This restricts the flowof blood, so less oxygen reaches the heart muscle. This is by far themost common cause of angina.

Coronary artery spasm: A temporary narrowing of a coronary arterycauses blood to slow or stop flowing through the artery. When thespasm stops, the artery and blood flow return to normal.

Abnormal heart valves

Abnormal heart rhythms

Anemia: The levels of red blood cells or hemoglobin (the oxygen-carrying chemical in the blood) are too low.

Polycythemia: The blood has too many red blood cells, which causesthe blood to thicken.

A thyroid problem

angina

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Often the symptoms of angina can be controlled with medicine. Nitrates suchas nitroglycerin increase the blood flow to the heart. They reduce the workloadon the heart by dilating (expanding) the coronary blood vessels and loweringblood pressure slightly. Drugs called beta blockers and calcium channel

blockers are also effective. Other medicines your doctor may prescribe areACE (angiotensin-converting enzyme) inhibitors, aspirin, and cholesterol-lowering medicines. Your doctor will determine which type of medicine is rightfor you based on your test results and any other medical problems you have.

Angina caused by blocked arteries can be treated with two types of surgery:

balloon angioplasty and coronary bypass graft surgery.

Your doctor will ask about yoursymptoms and medical history. Youwill have a physical exam. You mayhave one or more of these tests:

Electrocardiogram (ECG) andtreadmill electrocardiogram(TME): These tests showelectrical changes in heartmuscle getting too little oxygen.

Nuclear heart scan: This scanmeasures blood flow in theheart.

Stress echocardiogram: This test

shows how a lack of bloodoxygen affects the heart'sability to squeeze (contract).

When angina is caused by coronary artery disease, treatment often involveschanges in your lifestyle. This may include:

Quitting smoking.Losing weight.

Getting more regular exercise, as prescribed by your doctor.

Lowering your blood pressure (if high).

Lowering your blood cholesterol (if high).

Lowering your blood sugar (if high).

treatment

surgery

diagnosis of angina

lifestyle changes

In coronary bypass graft surger y, blood vessels are taken from other parts of your body and attached to the blocked coronary arteries beyond theblockage. The blood is then able to flow around, or bypass, the blockages.This procedure usually requires a stay in the hospital of at least 1 week,

followed by several weeks of recovery.

Balloon angioplasty is a simplerprocedure than coronary bypasssurgery. A tube with a balloon tip isplaced in your artery. The balloon isinflated where the artery is blocked. Thisexpands the artery enough to let bloodflow normally. Most people have a stentinserted as part of this procedure to helpkeep the artery open. With stents, your

risk of having the artery become blockedagain is only 10% to 15%. The balloonis then deflated and removed with thetube from your artery. If you have thissurgery, you may need to stay at thehospital just a day or two.

inflatedangioplastybaloon

athero-sclerotic

deposites

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Follow the treatment prescribed by your doctor. In addition, follow theseguidelines:

Begin a regular exercise program under your doctor's supervision.

If you are overweight, begin a weight-loss program under thesupervision of your doctor or a dietitian.

Eat a healthy, well-balanced diet and avoid foods high in cholesteroland fat (especially saturated fat).

Have your blood pressure checked regularly. High blood pressureincreases your risk for heart disease.

Get enough sleep each night.

Try to avoid emotional upset and stressful situations.

Always carry your medicine with you.

Take nitroglycerin if stopping an activity doesn't help your pain, or ifthe pain occurs when you are resting. It may be more comfortable totake it while sitting in a chair. Some people help prevent symptoms bytaking nitroglycerin before any activity that usually causes angina.

See your doctor if the angina becomes worse or occurs more often. Sometimes

it's hard to tell a severe attack of angina from the beginning of a true heartattack. Call your doctor or go to a hospital emergency room right away i f:

You have chest discomfort with light-headedness.

You are sweating a lot during an attack of angina.

You have chest discomfort (pressure, fullness, squeezing, or pain) thatlasts more than 10 minutes or goes away and comes back.

You still have pain after taking 3 nitroglycerin tablets 5 minutes apart.

prevention of angina

be alert to:

insulin

diabetesWhen you have type 2 diabetes, your body does not make

enough insulin or is unable to use insulin properly. This problem

with insulin causes the level of sugar in your blood to become

abnormally high.

When your body does not have enough insulin, sugar cannot get into your

cells. As a result, you have high levels of sugar in your blood. When you havetoo much sugar in your blood, many problems may begin to occur. Theseproblems can be life-threatening if they are not treated. However, propertreatment can control your blood sugar level.

Type 2 diabetes occurs mostly in adults over age 40, especially overweightadults. Overweight children and adolescents can also have this type ofdiabetes. More people, including children and adolescents, are becomingdiabetic as more people become overweight. India is home to about 35million diabetics more than any other country in the world.* And withIndians being more susceptible to diabetes than some, that number is only

expected to increase.*

Insulin is a hormone produced by the

pancreas. (The pancreas is the largegland that lies behind the stomach.)When you digest food, your bodybreaks down much of the food into sugar(glucose). Your blood carries the sugar tothe cells of your body for energy. Insulinhelps the sugar leave the bloodstreamand enter the cells. This is how insulinlowers the level of sugar in your blood.

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*http://www.worlddiabetesfoundation.org/composite-35.htm


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Your doctor or a dietitian will giveyou clear guidelines about whichfoods you should eat and howmany calories you should eat

each day. If you areoverweight, losing weightwill help you decrease yourblood sugar.

Choosing healthy foods foryour diet will help you loseweight. Sometimes losing just7 to 10 pounds can reduce oreliminate your need to takemedicine for diabetes.

Physical activity is important in managing type 2 diabetes. Exercise issometimes all some diabetics need to do to control their blood sugar. Exerciseimproves your circulation, uses up more sugar in your blood, and helps yourbody use insulin more efficiently. Walking is one of the best exercises you cando. Ask your health care provider for exercise recommendations.

meal planning

exercise

insulin

Exercising more and not overeating can

often help the body restore its balance

of sugar and insulin.

You may or may not need tocontinue taking medicine.

Your improvement depends

on following the diet and

exercise plans prescribed

by your doctor to keep

your blood sugar in

the recommendedrange.

If you need insulin, your doctor will teach you how to give shots to yourself. Youmay need a shot 1 to 4 times a day. Premixed insulin combines short-acting andintermediate-acting forms in one dose (in one needle and syringe). No otherinsulins can be given in the syringe with insuline glargine insulin. When you are

using any type of diabetic medicine, you must carefully follow your health careprovider's directions for checking your blood sugar. This will not only help youachieve good blood sugar control, but it will help you prevent possibly life-threatening low blood sugar (hypoglycemia).

medicationIf you can't control your blood sugar with diet and exercise, your doctor willprescribe medicine to lower your blood sugar. You may need more than onetype of medicine to keep your blood sugar in the normal range.

Most of the common blood-sugar-lowering medicines taken by mouth for type 2diabetes. Insulin is used when diet, exercise, and oral medicines are notkeeping your blood sugar levels normal or if ketones are present at the time ofdiagnosis.

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Possible diabetic complications include heart disease, stroke,

blindness, kidney failure, and nerve damage, especially to

your feet and legs. Carefully controlling your blood sugar and

blood pressure will delay or prevent these complications.

Heres a check-list to personal health-care

taking care

Follow your diet plan.

Learn how to make healthy choices when you eat out.

Ask for diabetic meals when you travel (for instance, at hotels or onplanes).

Drink water or other non-caloric drinks when you have the urge to eatbetween meals.

Avoid compulsive eating.

Limit the amount of alcohol you drink.

Buy only the types of food included in your diet plan.

Eat on a regular schedule.

Eat slowly and chew your food thoroughly.

Choose physical activities you like.

Exercise with friends.

Stop smoking. Smoking speeds up the damage to the heart and bloodvessels.

Carefully follow the instructions your health care provider has givenyou for taking any medicine he or she has prescribed.

If you have a family history of diabetes, you should get your bloodsugar checked every year.

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group sessionsIn our endeavor to help you manage your cardiovascular risk factors and topromote better quality of life, this program provides an opportunity toparticipate in select support group sessions which are presided by a Consul-tant Cardiologist / Internal Medicine Physician. These monthly sessions alsoattempt to support you on your lifestyle aspects in the presence of qualifiedlifestyle / yoga experts. In a nut-shell the group session helps you in:

Re-inforcing your understanding about the heart and associated riskfactors.

Providing you clarity on the treatment/therapy and management.

Importance of lifestyle modification with live assistance from aconsultant physiotherapist/yoga specialist.

Follow-up diet session with your dietician.

Question & Answer session with the above professionals.

A joint initiative by Pfizer and Apollo Hospitals

I now have

lifestyle advice

thats relevant

to me.

Being able to

monitor my BP

at home is

so convenient.

My Healthy

Heart Team

actually makes

house calls.

Group Sessions

with others

have taught me

so much more.

healthy heart booklet

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