UNIT III

CARDIOVASCULAR DISEASES
Introduction
Cardiovascular diseases are conditions that affect the structures or function of your heart, such
as:
• Abnormal heart rhythms, or arrhythmias
• Aorta disease and Marfan syndrome
• Congenital heart disease
• Coronary artery disease (narrowing of the arteries)
• Deep vein thrombosis and pulmonary embolism
• Heart attack
• Heart failure
• Heart muscle disease (cardiomyopathy)
• Heart valve disease
• Pericardial disease
• Peripheral vascular disease
• Rheumatic heart disease
• Stroke
• Vascular disease (blood vessel disease)
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They
include:
• coronary heart disease – a disease of the blood vessels supplying the heart muscle;
• cerebrovascular disease – a disease of the blood vessels supplying the brain;
• peripheral arterial disease – a disease of blood vessels supplying the arms and legs;
• rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic
fever, caused by streptococcal bacteria;
• congenital heart disease – birth defects that affect the normal development and
functioning of the heart caused by malformations of the heart structure from birth; and
• deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which
can dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that
prevents blood from flowing 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 the heart or brain. Strokes
can be caused by bleeding from a blood vessel in the brain or from blood clots.
Risk factors for cardiovascular disease
The most important behavioural risk factors of heart disease and stroke are unhealthy
diet, physical inactivity, tobacco use and harmful use of alcohol. Amongst environmental risk
factors, air pollution is an important factor. The effects of behavioural risk factors may show
up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and
overweight and obesity. These “intermediate risks factors” can be measured in primary care
facilities and indicate an increased risk of heart attack, stroke, heart failure and other
complications.
Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables,
regular physical activity and avoiding harmful use of alcohol have been shown to reduce the
risk of cardiovascular disease. Health policies that create conducive environments for making
healthy choices affordable and available, as well as improving air quality and reducing
pollution, are essential for motivating people to adopt and sustain healthy behaviours.
There are also a number of underlying determinants of CVDs. These are a reflection of
the major forces driving social, economic and cultural change – globalization, urbanization and
population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.
In addition, drug treatment of hypertension, diabetes and high blood lipids are necessary
to reduce cardiovascular risk and prevent heart attacks and strokes among people with these
conditions.
Common symptoms of cardiovascular diseases
Symptoms of heart attacks and strokes
Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack
or stroke may be the first sign of underlying disease. Symptoms of a heart attack include:
• pain or discomfort in the centre of the chest; and/or
• pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.
In addition the person may experience difficulty in breathing or shortness of breath; nausea
or vomiting; light-headedness or faintness; a cold sweat; and turning pale. Women are more
likely than men to have shortness of breath, nausea, vomiting, and back or jaw pain.
The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most
often on one side of the body. Other symptoms include sudden onset of:
• numbness of the face, arm, or leg, especially on one side of the body;
• confusion, difficulty speaking or understanding speech;
• difficulty seeing with one or both eyes;
• difficulty walking, dizziness and/or loss of balance or coordination;
 • severe headache with no known cause; and/or
• fainting or unconsciousness.
People experiencing these symptoms should seek medical care immediately.
Cardiovascular heart disease diagnosed
Diagnosis of coronary heart disease depends on your symptoms and what condition
your doctor thinks you may have.
Tests may be based on your family history and can include:
• blood tests
• chest x-ray
• electrocardiogram (ECG)
• echocardiogram
• CT scan
• MRI scan.
Coronoary atherosclerosis
Atherosclerosis is a condition that develops when a substance called plaque builds up
in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow
through. If a blood clot forms, it can block the blood flow. This can cause a heart attack or
stroke. Heart and blood vessel disease, also called heart disease, includes numerous problems,
many of which are related to atherosclerosis. Disease linked to atherosclerosis is the leading
cause of death in the United States.
Atherosclerosis develops slowly as cholesterol, fat, blood cells and other substances in
your blood form plaque. When the plaque builds up, it causes your arteries to narrow. This
reduces the supply of oxygen-rich blood to tissues of vital organs in the body.
Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from
the heart to the rest of the body (arteries) become thick and stiff — sometimes restricting blood
flow to the organs and tissues. Healthy arteries are flexible and elastic. But over time, the walls
in the arteries can harden, a condition commonly called hardening of the arteries.
Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery
walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood
flow. The plaque can also burst, leading to a blood clot.
Although atherosclerosis is often considered a heart problem, it can affect arteries
anywhere in the body. Atherosclerosis can be treated. Healthy lifestyle habits can help prevent
atherosclerosis.
Atherosclerosis is a specific type of arteriosclerosis.
 Atherosclerosis can affect most of the arteries in the body, including arteries in the heart,
brain, arms, legs, pelvis, and kidneys. It has different names based on which arteries are
affected.
• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
• Peripheral artery disease (PAD) most often is plaque buildup in the arteries of the
legs, but it can also build up in your arms or pelvis.
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to
the brain.
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your
kidneys.
• Vertebral artery disease is atherosclerosis in the arteries that supply blood to the back
of the brain. This area of the brain controls body functions that are needed to keep you
alive.
• Mesenteric artery Ischemia is plaque buildup in the arteries that supply the intestines
with blood. Learn more about plaque buildup in the mesenteric arteries
Reduced blood flow can lead to symptoms such as angina. If a plaque bursts, a Blood clots may
form that may block the artery completely or travel to other parts of the body. Blockages, either
complete or incomplete, can cause complications, including heart attack, stroke, vascular
dementia, erectile dysfunction, or limb loss. Atherosclerosis can cause death and disability.
Heart attack
A heart attack occurs when the blood flow to a part of the heart is blocked by a blood
clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that
artery begins to die.
Most people survive their first heart attack and return to their normal lives, enjoying
many more productive years. But having a heart attack does mean that you need to make some
changes.
The medications and lifestyle changes that your health care professional recommends
may vary according to how badly your heart was damaged, and to what degree of heart disease
caused the heart attack.
Stroke
An ischemic stroke, which is the most common type of stroke, occurs when a blood
vessel that feeds the brain gets blocked, usually from a blood clot.
 When the blood supply to a part of the brain is cut off, some brain cells will begin to
die. This can result in the loss of functions controlled by that part of the brain, such as walking
or talking.
A hemorrhagic stroke occurs when a blood vessel within the brain bursts. This is most
often caused by uncontrolled high blood pressure.
Some effects of stroke are permanent if too many brain cells die after being starved of
oxygen. These cells are never replaced.
The good news is that sometimes brain cells don’t die during stroke — instead, the
damage is temporary. Over time, as injured cells repair themselves, previously impaired
function improves. In other cases, undamaged brain cells nearby may take over for the areas of
the brain that were injured.
Either way, strength may return, speech may get better and memory may improve. This
recovery process is what stroke rehabilitation is all about.
Heart failure
Heart failure, sometimes called congestive heart failure, means the heart isn’t pumping
blood as well as it should. Heart failure does not mean that the heart stops beating — that’s a
common misperception. Instead, the heart keeps working, but the body’s need for blood and
oxygen isn’t being met.
Heart failure can get worse if left untreated. If your loved one has heart failure, it’s very
important to follow their health care professional’s treatment plan.
Arrhythmia
Arrhythmia refers to an abnormal heart rhythm. There are various types of arrhythmias.
The heart can beat too slow, too fast or irregularly.
Bradycardia, or a heart rate that’s too slow, is when the heart rate is less than 60 beats
per minute. Tachycardia, or a heart rate that’s too fast, refers to a heart rate of more than 100
beats per minute.
An arrhythmia can affect how well your heart works. With an irregular heartbeat, your
heart may not be able to pump enough blood to meet your body’s needs.
Heart valve problems
When heart valves don’t open enough to allow the blood to flow through as it should,
a condition called stenosis results. When the heart valves don’t close properly and thus allow
blood to leak through, it’s called regurgitation. If the valve leaflets bulge or prolapse back into
the upper chamber, it’s a condition called prolapse. Discover more about the roles your heart
valves play in healthy circulation.
Symptoms
Mild atherosclerosis usually doesn't have any symptoms.
Atherosclerosis symptoms usually don't happen until an artery is so narrowed or
clogged that it can't supply enough blood to organs and tissues. Sometimes a blood clot
completely blocks blood flow. The clot may break apart and can trigger a heart attack or stroke.
Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For
example:
• If you have atherosclerosis in your heart arteries, you may have chest pain or
pressure (angina).
• If you have atherosclerosis in the arteries leading to your brain, you may have
sudden numbness or weakness in your arms or legs, difficulty speaking or slurred
speech, temporary loss of vision in one eye, or drooping muscles in your face. These
signal a transient ischemic attack (TIA). Untreated, a TIA can lead to a stroke.
• If you have atherosclerosis in the arteries in your arms and legs, you may have
symptoms of peripheral artery disease, such as leg pain when walking (claudication) or
decreased blood pressure in an affected limb.
• If you have atherosclerosis in the arteries leading to your kidneys, you may develop
high blood pressure or kidney failure.
Causes of atherosclerosis
Doctors don't know exactly how atherosclerosis starts. But it's believed to begin when
the endothelium, the thin layer of cells that lines your arteries, somehow gets damaged. It's a
progressive disease that can begin in childhood.
Common causes of damage to the endothelium include:
• High cholesterol
• High blood pressure
• Inflammation, like from arthritis or lupus
• Obesity or diabetes
• Smoking
Stages of atherosclerosis
When "bad" (LDL) cholesterol in your blood crosses a damaged endothelium, it enters
the wall of your artery. Your white blood cells stream in to digest the LDL. Over the years,
cholesterol and cells become plaque in the artery wall. This plaque creates a bump on your
artery wall. As atherosclerosis gets worse, the bump gets bigger. When it gets big enough, it
can create a blockage. That slow and gradual process goes on throughout your entire
body. Atherosclerosis usually doesn’t cause symptoms until you’re middle-aged or older.
Plaques from atherosclerosis can behave in different ways.
• They can stay in your artery wall. There, the plaque grows to a certain size and then
stops. Since this plaque doesn't block blood flow, it may never cause symptoms.
• Plaque can grow in a slow, controlled way into the path of blood flow. Over time, it
causes significant blockages. Pain in your chest or legs when you exert yourself is the
usual symptom.
• They can suddenly rupture. This allows blood to clot inside an artery. In your brain, this
causes a stroke; in your heart, a heart attack.
The process of atherosclerosis begins with:
• Fatty streak. A yellow strip lining the walls of major arteries, fatty streak has been
found in children as young as 10. In the fatty streak stage, you feel no symptoms.
• Fibrous plaque. The second and more dangerous phase of atherosclerosis begins when
the cholesterol-containing plaque expands into blood vessels -- the bump.
• Complicated lesion. In the last and most serious stage of atherosclerosis, the plaque
begins to break up. This exposes the cholesterol and tissue beneath it, causing unseen
but serious harm that your immune system tries to fight off. Blood-clotting cells, which
block blood flow, are formed in response. The blood clots, combined with the exposed
plaque, create what's called a complicated lesion.
Symptoms of atherosclerosis
You might not have symptoms until your artery is nearly closed or until you have a
heart attack or stroke. Symptoms can also depend on which artery is narrowed or blocked.
Symptoms related to your coronary arteries include:
• Arrhythmia, an unusual heartbeat
• Pain or pressure in your upper body, including your chest, arms, neck, or jaw. This is
known as angina.
• Shortness of breath
Symptoms related to the arteries that deliver blood to your brain include:
• Numbness or weakness in your arms or legs
• A hard time speaking or understanding someone who’s talking
• Drooping facial muscles
• Paralysis
 • Severe headache
• Trouble seeing in one or both eyes.
Symptoms related to the arteries of your arms, legs, and pelvis include:
• Leg pain when walking, called intermittent claudication
• Numbness
• Cold feet
• Aching or burning in your toes and feet when you're at rest
• Frequent sores or infections on your feet that won't heal
Symptoms related to your kidneys include:
• High blood pressure
• Kidney failure
Risk Factors of atherosclerosis
Atherosclerosis starts when you’re young. Research has found that even teenagers can
have signs. If you’re 40 and generally healthy, you have about a 50% chance of getting serious
atherosclerosis in your lifetime. The risk goes up as you get older. Most adults over 60 have
some atherosclerosis, but most don’t have noticeable symptoms.
The following can increase your risk of atherosclerosis. These risk factors are behind more
than 90% of all heart attacks:
• Abdominal obesity ("spare tire")
• Diabetes and insulin resistance
• Family history of heart disease
• High alcohol intake (more than one to two drinks a day, depending on your size)
• High blood pressure
• High LDL cholesterol
• High levels of C-reactive protein (CRP) in your blood, which is a signal of
inflammation
• High triglycerides
• Not eating fruits and vegetables
• Not exercising regularly
• Sleep apnea
• Smoking
• Stress
Rates of death from atherosclerosis have fallen 25% in the past 3 decades. This is because
of improved treatments and lifestyles.
Atherosclerosis Diagnosis
Your doctor will start with a physical exam. They’ll listen to your arteries and check for
weak or absent pulses. You might need tests, including:
• Angiogram, in which your doctor puts dye into your arteries so they’ll be visible on an
X-ray
• Ankle-brachial index, which compares blood pressures in your lower leg and arm
• Blood tests to look for things that raise your risk of atherosclerosis, like high cholesterol
or blood sugar
• Carotid ultrasound, an imaging test that shows whether there's hardening of the arteries
in your neck
• Abdominal ultrasound, which checks for bulges or excess plaque in the aorta, the main
artery supplying blood to your lower body
• Chest X-ray
• CT scan or magnetic resonance angiography (MRA) to look for hardened or narrowed
arteries. This is also known as a coronary calcium scan or heart scan.
• Doppler ultrasound, which measures blood flow in your arteries.
• Echocardiogram, which takes images of the chambers and valves in your heart to see
how well it pumps
• EKG, or electrocardiogram, a record of your heart’s electrical activity
• Stress test, in which you exercise while health care professionals watch your heart rate,
blood pressure, and breathing.
You might also need to see doctors who specialize in certain parts of your body, like
cardiologists or vascular specialists, depending on your condition.
Complications of Atherosclerosis
Complications of atherosclerosis include:
• Aneurysms
• Angina
• Chronic kidney disease
• Coronary or carotid heart disease
• Heart attack
• Heart failure
• Peripheral artery disease
• Stroke
• Unusual heart rhythms
The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:
• Coronary artery disease: Stable plaques in your heart's arteries cause angina (chest
pain). Sudden plaque rupture and clotting cause heart muscle to die. This is a heart
attack.
• Cerebrovascular disease: Ruptured plaques in your brain's arteries cause strokes with
the potential for permanent brain damage. Temporary blockages in your artery can also
cause something called transient ischemic attacks (TIAs), which are warning signs of a
stroke. They don’t cause any brain injury.
• Peripheral artery disease: When the arteries in your legs narrow, it can lead to poor
circulation. This makes it painful for you to walk. Wounds also won’t heal as well. If
you have a severe form of the disease, you might need to have a limb removed
(amputation).
Atherosclerosis Treatment
Once you have a blockage, it's generally there to stay. But with medication and lifestyle
changes, you can slow or stop plaques. They may even shrink slightly with aggressive
treatment.
Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That
means a healthy diet, exercise, and no smoking. These changes won't remove blockages, but
they’re proven to lower the risk of heart attacks and strokes.
Medication: Drugs for high cholesterol and high blood pressure will slow and may even halt
atherosclerosis. They lower your risk of heart attack and stroke. Diabetes raises the risk for
atherosclerosis, so taking medicines to control your diabetes can help lower your risk. Your
doctor may prescribe antiplatelet medicines like aspirin, a blood thinner, to help prevent clots.
Because long-term aspirin use can cause stomach bleeding, talk with your doctor before you
start taking it every day.
Your doctor can use more invasive techniques to open blockages from atherosclerosis or
go around them:
• Angiography and stenting: Your doctor puts a thin tube into an artery in your leg or
arm to get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty
(using a catheter with a balloon tip) and stenting can often open a blocked artery.
Stenting helps ease symptoms, but it does not prevent heart attacks.
• Bypass surgery: Your doctor takes a healthy blood vessel, often from your leg or chest,
and uses it to go around a blocked segment.
 • Endarterectomy: Your doctor goes into the arteries in your neck to remove plaque and
restore blood flow. They also may place a stent in higher-risk patients.
• Fibrinolytic therapy: A drug dissolves a blood clot that’s blocking your artery.
Atherosclerosis Prevention
You can make changes to your lifestyle to prevent atherosclerosis or slow down its
progression. Some things that may help:
• Lower your stress through yoga, mindfulness, or deep breathing. These practices can
help lower your blood pressure too.
• Stop smoking (and vaping), which raises your risk for heart disease. Nicotine narrows
blood vessels, forcing your heart to work harder. Quitting smoking is one of the most
important lifestyle changes you can make to prevent damage to your heart from
atherosclerosis.
• Follow a healthy diet rich in low-fat proteins, fish, fruits, vegetables, and whole grains.
This will help you manage your weight and lower cholesterol, blood pressure, and blood
sugar levels.
• Lose weight and keep it off. Even a small amount will help lower your risk.
• Exercise regularly to maintain a healthy blood pressure and improve blood flow. Aim
for at least 150 minutes of moderate exercise or 75 minutes of brisk exercise a week.
• Keep on top of your other health conditions by having regular checkups and
following your doctor's treatment plan.
Coronary Artery Disease
Coronary artery disease (CAD) is a condition which affects the arteries that supply the
heart with blood. It is usually caused by atherosclerosis which is a buildup of plaque inside the
artery walls. This buildup causes the inside of the arteries to become narrower and slows down
the flow of blood.
There are many risk factors for CAD, Some are not controllable, but others can be
modified. CAD develops over a long period of time and eventually progresses to the point
where you may feel symptoms such as chest pain. Diagnosis is made using various tests such
as an electrocardiogram (ECG) or a stress test. Treatment for CAD includes lifestyle changes,
medications, and sometimes, cardiac procedures or surgery.
About Coronary Artery Disease
The heart is a muscle which pumps blood around the body through a network of blood
vessels called arteries.
 The left side of the heart receives fresh, oxygen-rich blood from the lungs and then
pumps it out through a large artery called the aorta. The aorta branches into smaller arteries
that go to all parts of the body. The various parts of the body take the oxygen out of the blood.
The now stale, oxygen-poor blood is returned to the right side of the heart through blood vessel
called veins. The right side of the heart pumps this stale blood to the lungs where it picks up
more oxygen and the cycle begins again.
The Coronary Arteries
The heart muscle, like every other part of the body, needs its own oxygen-rich blood
supply. Arteries branch off the aorta and spread over the outside surface of the heart feeding
oxygen to the muscle. The right coronary artery (RCA) supplies the bottom part of the heart.
The short left main (LM) artery branches into the left anterior descending (LAD) artery that
supplies the front of the heart and the circumflex (Cx) artery which supplies the back of the
heart.
In coronary artery disease, there is a blockage in the arteries that supply blood and
oxygen to the heart. The most common cause is atherosclerosis which is a buildup of plaque
inside the walls of the arteries.
Plaque is made of several substances including cholesterol. Plaque buildup can start at
an early age and is caused by a combination of genetic and lifestyle factors that are called risk
factors. As plaque builds up over time, the arteries become increasingly narrow. Eventually,
blood flow to parts of the heart is slowed or blocked.
Poor blood flow to the heart can cause angina. Blood clots are more likely to form in
arteries which have reduced blood flow, which then further block the arteries. CAD can
eventually lead to unstable angina or a heart attack.
Causes
Coronary artery disease is caused by a combination of genetic and lifestyle factors. These
are called risk factors. The following risk factors are important to be aware of, but are not
considered to be controllable:
• Age: As you get older, your risk of heart disease increases
• Gender:
o Men: Men over the age of 55 are at higher risk of heart disease
o Women: After menopause, a woman’s risk of heart disease gradually increases
until it becomes the same as a man’s
 • Heredity: Your risk of heart disease is increased if close family members—a parent,
brother or sister developed heart disease before age 55 or, in the case of female relatives,
before menopause.
• Ethnicity: First nations people and people of African or Asian descent are at higher risk
of developing heart disease than other groups.
The risk factors that you can control are:
• Smoking
• Excess body weight, especially around your waist
• Diabetes
• High blood pressure (hypertension)
• Abnormal blood cholesterol levels
• Lack of regular exercise
• Excessive stress levels
• Depression
These are modifiable risk factors.
Diagnosis
Tests commonly used to diagnose CAD include:
• Electrocardiogram: to identify problems with heart rhythm or signs of a heart attack
• Treadmill testing: to measure how well the heart functions when challenged to work
harder than normal (during exercise)
• Nuclear perfusion imaging: to identify areas of the heart that are receiving less blood
• Echocardiogram: to determine the volume of blood pumped by the heart. This test may
be done during exercise or after the administration of medication to stimulate the heart
• CT coronary angiography: to identify blockages in the arteries in the heart
• Cardiac catheterization: to identify blocked or restricted arteries
Symptoms
CAD usually has no symptoms for several years during its early stages. Eventually, the
disease progresses until the symptoms of angina or heart attack occur. These symptoms can be
experienced during activity or at rest:
• Chest pain, or a feeling of heaviness in the chest
• Pain in the arm, neck or jaw
• Shortness of breath
• Sweating
• Nausea
 • Heart palpitations (a racing or irregular heartbeat)
• Loss of consciousness
For women, the signs of heart attacks in women can be far more subtle. Early signs in women
include:
• Fatigue: A significant change in energy level, something out of the norm that lasts more
than a few days. At 70%, unusual fatigue is the single most common long-term
symptom for women.
• Sleep difficulties: Trouble falling asleep, or waking up in the night more than usual,
often because of an ache or pain that won’t let you sleep.
• Shortness of breath: Becoming winded doing the most basic activities, but especially
during exercise.
• Indigestion: Feeling uncomfortably full soon after eating, sometimes with pain or
burning in the upper abdomen.
• Chest discomfort: It may be mild discomfort, it may seem like indigestion.
• Anxiety: Feeling nervous or apprehensive for no apparent reason, or more than usual.
Symptoms women commonly experience when a heart attack occurs include:
• Chest pain: While men having a heart attack often report a crushing or stabbing pain in
their chest, many women say they felt pressure, tightness or aching in their chest or
back.
• Fatigue: More than feeling tired, this overwhelming fatigue makes it hard to do
anything.
• Breathing difficulties: It’s suddenly a struggle to take a full breath.
• Radiating pain: Pain spreads across the jaw, arm, shoulder or radiating across the back
Treatments
Treatments for CAD usually include lifestyle changes and medications, sometimes in
combination with cardiac procedures or surgery. The best treatment combination will be
determined based on your individual circumstances.
Medications
There are many medications that can help coronary artery disease. Your doctor will likely
prescribe a combination of medications which will work to:
• Lower the workload of your heart
• Help relax the blood vessels
• Lower cholesterol
• Help prevent blood clots from forming
 • Lower the overall risk of you having a heart attack
You will be taking these medications for the rest of your life.
Cardiac Procedures:
Sometimes an angiogram is needed to show the blockages and determine whether
medications are sufficient for treatment or whether an angioplasty (the use of a balloon to open
the blockage) and stent (a wire mesh tube to keep the artery open) are required.
Sometimes coronary artery bypass surgery is necessary to attach new arteries or veins to go
around the blockages.
Lifestyle Changes
To manage CAD, it is important to:
• Quit smoking because cigarette smoking narrows the blood vessels. Smoking-cessation
aids are available to patients who find it difficult to quit on their own.
• Get your cholesterol checked and get high cholesterol under control.
• Eat a healthy diet low in saturated fat, cholesterol, and salt.
• Exercise regularly.
• Maintain a healthy weight. Losing weight if you are overweight, reduces the burden
excess weight places on the heart. Regular exercise can help control weight and reduce
other risk factors for CAD, such as high blood pressure.
Fat and lipids
Over 200 risk factors for cardiovascular disease (CVD) have now been identified.
Among these, the three most important are (1) abnormal lipids, including the fact that there are
more than 15 types of cholesterol-containing lipoproteins and four different types of
triglyceride-rich particles, some of which are very atherogenic, (2) high blood pressure, and (3)
cigarette smoking. In addition, many other factors including diabetes, haemostatic factors such
as fibrinogen, factor VII, plasminogen activator inhibitors, and new factors such as
apolipoprotein E4 and homocysteine, are known to increase the risk of developing clinical
CVD. A low risk for CVD requires that these various factors are present in the circulation in
the correct proportions. Two simple tests for determining plasma lipid levels can be used to
identify those individuals with an atherogenic lipid profile and who are, therefore, at increased
risk for CVD. Firstly, the ratio of total cholesterol to high density cholesterol (HDL cholesterol)
should be determined, followed by measurement of plasma triglyceride concentrations. This
will allow differentiation of whether the low density lipoproteins (LDL), HDL cholesterol or
triglyceride-rich particles such as the small dense beta-very low density lipoproteins (VLDL)
are the major cause for concern. Once identified, those individuals with a high lipid risk profile
should be treated before, rather than after, experiencing coronary heart disease (CHD).
With regard to CVD there are very few well conducted randomized controlled trials and
most of the information is derived from observational studies that demonstrate associations.
These observational studies have found that fruits, vegetables, beans/legumes, nuts/seeds,
whole grains, fish, yogurt, fiber, seafood omega-3 fatty acids, and polyunsaturated fats were
associated with a decreased risk of CVD while unprocessed red meats, processed meats, sugar-
sweetened beverages, high glycemic load CHO, and trans-fats were associated with an
increased risk of CVD. Randomized trials have shown that a Mediterranean diet reduces CVD.
Based on this information current guidelines for the general population recommend
1. A diet emphasizing intake of vegetables, fruits, legumes, nuts, whole grains, and fish
2. Replacement of SFA (saturated fatty acids) with MUFA (Monounsaturated fatty
acids) and PUFA (polyunsaturated fatty acids)
3. A reduced amount of dietary cholesterol
4. Minimizing intake of processed meats, refined CHO (Carbohydrates), and sweetened
beverages and
5. Avoidance of TFA (Trans fatty acids). For individuals with a high LDL-C limiting
dietary SFA, TFA, and cholesterol and increasing fiber and phytosterols will help lower LDL-
C while in individuals with high TG limiting low quality CHO, particularly simple sugars, and
ethanol with weight loss, if indicated, will help lower TG.
Summary of the Effect of Dietary Constituents on Lipid and Lipoprotein
SFA Increase LDL-C and modest increase HDL-
C
MUFA and PUFA Decrease LDL-C
TFA Increase LDL-C and decrease HDL-C
Cholesterol Increase LDL-C
CHO Increase TGs particularly simple sugars
Fiber Decrease LDL-C
Phytosterols Decrease LDL-C
Dietary Monounsaturated Fatty Acids
Olive oil, canola oil, peanut oil, safflower oil, sesame oil, avocados, peanut butter, and
many nuts and seeds are major sources of MUFA. Soybean oil, corn oil, sunflower oil, some
nuts and seeds such as walnuts and sunflower seeds, tofu, and soybeans are major sources of
PUFA. Omega-3-fatty acids, eicosapentaenoic acid (EPA, 20:5) and docosahexaenoic acid
(DHA, 22:6), are mostly found in fish and other seafood, while another omega-3 fatty acid,
alpha-linolenic acid (ALA, 18:3) is found mostly in nuts and seeds such as walnuts, flaxseed,
and some vegetable oils such as soybean and canola oils. The body is capable of converting
ALA into EPA and DHA but the conversion rates are low.
Fat Composition of Oils, Lard, Butter, and Margarine
Type of Oil SFA (%) MUFA (%) PUFA (%)
Corn oil 13.6 28.97 57.43
Safflower oil
6.51 15.1 78.4
(linoleic)
Canola oil 7.46 64.1 28.49
Almond oil 8.59 73.19 18.22
Olive oil 14.19 74.99 10.82
Soybean oil 16.27 23.69 60.0
Sesame oil 14.85 41.53 43.62
Sunflower oil
10.79 20.42 68.8
(linoleic)
Avocado oil 12.1 73.8 14.11
Peanut oil 17.77 48.58 33.65
Palm oil 51.57 38.7 9.73
Coconut oil 91.92 6.16 1.91
Lard 41.1 47.23 11.73
Butter 68.1 27.87 4.0
Margarine (soft) 20 47 33
Margarine (hard) 80 14 6

DIETARY CHOLESTEROL
The primary food sources of dietary cholesterol are egg yolks, shrimp, beef, pork,
poultry, cheese, and butter with the top five food sources being eggs and mixed egg dishes,
chicken, beef, burgers, and cheese. In the US the typical cholesterol intake varies from 50 to
400mg per day with a mean of 293 mg/day (348 mg/day for men and 242 mg/day for women).
 Cholesterol Content of Food
Food mg per 100
grams
Egg 373
Butter 215
Shrimp 125
Cheese 108
Beef 90
Chicken 88
Pork 80
Ice Cream 47
Effect of Dietary Cholesterol on Cardiovascular Disease
In reviews of prospective observational studies an association between dietary
cholesterol and CVD has not been clearly demonstrated with some studies reporting an
association and others no association. Most of these studies did not adjust for the amount and
types of fatty acids consumed, which could influence the results as foods containing large
amounts of cholesterol are also rich in SFA. Dietary cholesterol was not associated with
cardiovascular risk among >80,000 nurses and 43,000 male health care professionals after
adjusting for energy intake, PUFA, trans fatty acid, and SFA intake.
Most foods that contain cholesterol also contain significant amounts of SFA. An
exception are eggs which contain significant amounts of cholesterol and only small amounts
of SFA. It is therefore of interest to examine the effect of egg consumption on CVD. In an
analysis of 7 cohort studies no association between egg intake and coronary heart disease was
observed and egg intake may be associated with a reduced risk of stroke. A recent meta-analysis
of 23 prospective studies with 1,415,839 individuals and a median follow-up of 12.28 years
also found that increased consumption of eggs was not associated with increased risk of CVD.
Other meta-analyses and reviews have also not demonstrated a consistent link between eggs
and CVD. However, a recent very large meta-analysis with 3,601,401 participants with 255,479
events showed that the consumption of 1 additional 50-g egg daily was associated with a very
small increase in CVD risk (pooled relative risk, 1.04; 95% CI 1.00-1.08). Thus, eggs have
either no effect or a very small effect on CVD that can be seen only in very large studies.
There appears to be no randomized studies of the effect of decreasing cholesterol intake
on CVD. Do recognize that the studies of decreasing dietary SFA intake described earlier also
result in a decrease in cholesterol intake. Thus, at this time there is very limited data linking
dietary cholesterol intake with an increased risk of CVD.
Comparison Of Different Carbohydrates On Lipids
A meta-analysis of twenty-eight randomized controlled trials comparing low- with high
glycemic index diets (1,272 participants) reported that low glycemic index diets significantly
decreased LDL-C levels by 6.2mg/dL; P < 0.0001) with no effect on HDL-C or TGs. The
decrease in LDL-C was related to the amount of fiber and/or phytosterols in the low glycemic
diet (see Fiber and Plant Sterols/Stanols section below).
High fructose corn syrup (HFCS) has become a major source of fructose intake (HFCS
made for beverages contains 55% fructose and 45% glucose). Because sucrose and HFCS are
major contributors to total CHO intake there has been interest in the effect of fructose, glucose,
and sucrose on lipid levels. In a comparison of isocalorically substituting starch for glucose,
fructose, or sucrose there were no difference in TG levels but there was a decrease in LDL-C
(approximately 7.8mg/dL).
A meta-analysis by Te Morenga and colleagues examined the effect of the addition of
sugar on lipid levels. In studies where energy intake was isocaloric, sugar intake increased TG
levels by 11.7mg/dL, LDL-C by 6.6mg/dL, and HDL-C by 0.8mg/dL. In a similar meta-
analysis by Fattore and colleagues an isocaloric substitution of free sugars for complex CHO
increased TGs by 8.3mg/dL, LDL-C by 7.1mg/dL, and HDL-C by 1.3mg/dL. The increase in
TG and LDL-C levels were larger in the trials where greater amounts of free sugar were
employed.
In a meta-analysis of adding fructose to the diet there was no significant effect on
fasting TG levels at dietary fructose < 100 grams per day but at higher amounts fructose
increased fasting TG levels. Fructose is more likely to have adverse effects on lipids when
intake is high and/or when caloric excess is present. For example, in young healthy individuals,
a 2-week intervention with 25% of energy requirements as HFCS or fructose sweetened
beverages resulted in significant increases in fasting LDL-C, small dense LDL particles, non-
HDL-C, apo B, and HDL-C and postprandial TGs. High quantities of glucose did not affect
LDL-C, non-HDL-C, Apo B, HDL-C, or postprandial TG levels but did increase fasting TG
levels.
Thus, the effect of CHO on lipids can vary depending upon the particular type of CHO
studied. In the case of glycemic index (complex CHO) and starch vs sugar some of the
difference in lipid response could be due to other dietary constituents (i.e., fiber, phytosterols).
Alcohol and Cardiovascular Diseases
Excessive consumption of alcohol is not only a social problem, but it also significantly
increases the morbidity and mortality rates of many societies. A correlation has been
demonstrated between alcohol consumption and increased mortality from cancer, accidents and
injuries, liver cirrhosis and other causes. Alcohol abuse increases the incidence of
haemorrhagic stroke and the risk of ischemic stroke, induces serious arrhythmias, adversely
affects blood pressure and damages the heart muscle. The dose and way of drinking alcohol
play a crucial role in assessing whether this drink allows people to maintain health or whether
it is a great health and social threat. The beneficial effects of low and moderate doses of alcohol
on the occurrence of cardiovascular diseases have been shown in many population studies and
meta-analyses in which the effect of U-shaped or J-shaped curves relating alcohol intake to
cardiovascular mortality was observed, especially in ischemic heart disease. However, due to
the fact that alcohol consumption is associated with many health hazards, it is not
recommended to consume it as a preventive action of cardiovascular diseases. Moreover, recent
studies suggest that association of low-to-moderate alcohol consumption with the reduction in
cardiovascular risk is a result of lifestyle changes and that any reduction in alcohol
consumption is in fact beneficial in terms of general health.
Alcohol and alcoholic beverages contain ethanol, which is a psychoactive and toxic
substance with dependence-producing properties. Alcohol has been widely used in many
cultures for centuries, but it is associated with significant health risks and harms. Worldwide,
2.6 million deaths were attributable to alcohol consumption in 2019, of which 2 million were
among men and 0.6 million among women. The highest levels of alcohol-related deaths per
100 000 persons are observed in the WHO European and African Regions with 52.9 deaths and
52.2 deaths per 100 000 people, respectively.
People of younger age (20–39 years) are disproportionately affected by alcohol
consumption with the highest proportion (13%) of alcohol-attributable deaths occurring within
this age group in 2019. The data on global alcohol consumption in 2019 shows that an estimated
400 million people aged 15 years and older live with alcohol use disorders, and an estimated
209 million live with alcohol dependence. There has been some progress; from 2010 to 2019,
the number of alcohol-attributable deaths per 100 000 people decreased by 20.2% globally.
There has been a steady increase in the number of countries developing national alcohol
policies. Almost all countries implement alcohol excise taxes. However, countries report
continued interference from the alcohol industry in policy development. Based on 2019 data,
about 54% out of 145 reporting countries had national guidelines/standards for specialized
treatment services for alcohol use disorders, but only 46% of countries had legal regulations to
protect the confidentiality of people in treatment.
Access to screening, brief intervention and treatment for people with hazardous alcohol
use and alcohol use disorder remains very low, as well as access to medications for treatment
of alcohol use disorders. Overall, the proportion of people with alcohol use disorders in contact
with treatment services varies from less than 1% to no more than 14% in all countries where
such data are available.
There are multiple reasons that the belief that alcohol is good for cardiovascular health
is no longer acceptable:
• Such evidence has been mostly based on observational studies.
• Comparisons to people who do not use alcohol are often confounded by social, cultural,
religious, and medical reasons to not drink.
• Studies have been conducted in predominantly older (>55 years of age) and Caucasian
populations.
• Some studies that show positive effects are funded by the alcohol industry.
• Alcohol use is often associated with other heart disease risk factors including tobacco
use, access to health care, and other social determinants of health.
• No randomized controlled trials (RCTs) have confirmed health benefits of alcohol.
Alcohol increases the risk for hypertensive heart disease, cardiomyopathy, atrial fibrillation,
flutter and strokes. Alcohol consumption (100 g/week) is linearly associated with a higher risk
of stroke, heart failure, fatal hypertensive disease and fatal aortic aneurysm, and has a
borderline elevation in the risk of coronary heart disease, as compared to those consuming
between 0–25 g/week. It has been argued that people with moderate consumption and no binge
episodes may appear to have a slightly lower risk of ischaemic heart disease (IHD), but the
protective effect of moderate alcohol consumption for CVD has been challenged
Electrocardiography
An electrocardiograph or ECG is a test used to measure the electrical activity of the
heart. The test takes only about a few minutes and is devoid of any pain.
The electrical activity of the heart causes the heart muscles to contract that results in
the pumping of the heart. The ECG is in the form of spikes and dips known as waves. The wave
pattern helps in assessing the rate and rhythm of our heartbeat.
The human heart produces an electrical impulse by itself. As this electrical impulse
passes through our heart, it generates an electrical current that spreads over our body and
reaches the skin.
 The patient is connected to the Electrocardiograph (ECG) machine with three electrical
leads (one each to both wrists and the third to the left ankle of the patient), that is used to
monitor the activity of the heart. This is standard ECG testing.
Process
The process of electrocardiograph includes:
• Small sticky electrodes are attached to the arms, chest and legs.
• These electrodes are connected to the ECG machine through wires that help in detecting
the electrical impulses occurring at each heartbeat.
• These electrodes usually detect the very minute form of changes in an electrical path
on the skin which arises from the heart muscles and the electrophysiologic patterns of
the depolarizing during every heartbeat.
Explanation of the Electrocardiograph
P to T in the graph represents a specific activity of the heart. Let’s break it down.
• The P wave is the electrical excitation of the atria, or depolarization, initiating atrial
contraction.
• The QRS complex is the depolarization of ventricles, initiating ventricular contraction.
Marking the beginning of the systole.
• T wave means the return of ventricles to the normal state (repolarization). Marking the
end of the systole.
By counting the number of QRS complexes we can evaluate the heartbeat rate of the
patient. Any deviations in this shape results in heart diseases or an abnormal heart rhythm
which can either be slow, irregular or very fast heartbeats. Hence it is essential equipment in
the field of medicine.
Types of ECG Test
There are three main types of ECG tests:
Resting ECG
This type of ECG is used to examine the electrical activity of the heart at rest. While performing
this test, the patient is asked to relax and then, their heartbeat is recorded.
Exercise ECG
This type of ECG is used to examine the electrical activity of the heart during stress or exercise.
In this test, a patient is asked to run or walk on the treadmill or a cycle while the heartbeat is
recorded.
24-hour ECG
As the name suggests, this type of ECG is conducted for 24 hours. The heart’s electrical
impulses are measured by a device called the Holter Monitor.
Medical Uses of ECG
The main goal of electrocardiography is to obtain information regarding the heart’s
electrical impulses. This means it can find evidence of past heart attacks or even any
undiagnosed heart disease. The medical uses of such information are very valuable and grant a
deeper insight into conditions like:
• Seizures
• Fainting
• Pulmonary embolism
• Cardiac dysrhythmias
• Myocardial infarction or heart attack
• Arrhythmia
• Deep vein thrombosis
• Ventricular hypertrophy
It also proves itself useful in applications such as:
• Biotelemetry of the patient
• The testing of Cardiac stress
• Diagnosis of structural heart diseases
• Monitoring the effects of heart medication
• Assessing the severity of the abnormalities in the electrolyte
• The monitoring of the form of anaesthesia that is involved
• CTA- Computed tomography angiography and also the MRA- Magnetic resonance
angiography of the heart
• The screening of Hypertrophic cardiomyopathy in adolescents as a part of the sports-
related deaths, such as sudden cardiac death.
Why is an ECG done?
An electrocardiograph is done for the following reasons:
• To check the heart health in case of other diseases such as diabetes, high blood pressure,
high cholesterol, etc.
• To check the thickness of the chambers of the heart wall.
• To monitor if the medicines are causing any side-effects.
• To check if the mechanical devices implanted in the heart are working properly or not.
Echocardiograph
An echocardiogram uses sound waves to create pictures of the heart. This common test
can show blood flow through the heart and heart valves. Your health care provider can use the
pictures from the test to find heart disease and other heart conditions.
Other names for this test are:
• Heart ultrasound.
• Heart sonogram.
There are different types of echocardiograms. The type you have depends on the reason for the
test and your overall health. Some types of echocardiograms be done during exercise or
pregnancy.
Types of echocardiograms
There are different types of echocardiograms. The type you have depends on the
information your health care provider needs.
• Transthoracic echocardiogram, also called a TTE. This is a standard
echocardiogram. It's also called a heart ultrasound. It's a noninvasive way to look at
blood flow through the heart and heart valves. A TTE creates pictures of the heart from
outside the body. Dye, called contrast, may be given by IV. It helps the heart's structures
show up better on the images.
• Transesophageal echocardiogram, also called a TEE. If a standard echocardiogram
doesn't provide as many details as needed, your provider may do this test. It gives a
detailed look at the heart and the body's main artery, called the aorta. A TEE creates
pictures of the heart from inside the body. It's often done to examine the aortic valve.
This test shouldn't be done if you have bleeding in the upper gastrointestinal tract or a
tumor or tear in the esophagus.
• Fetal echocardiogram. This type of echocardiogram is done during pregnancy to
check the baby's heart. It's a noninvasive test that involves moving an ultrasound wand
over the pregnant person's belly. It lets a health care provider see the unborn baby's
heart without using surgery or X-rays.
• Stress echocardiogram. A stress echocardiogram is done right before and after you
exercise at a medical office. It checks how the heart responds to physical activity or
stress. Your health care provider may order this test if they think you have coronary
artery disease. If you can't exercise, you may be given medicine to make your heart
work harder.
Echocardiogram methods
There are several parts to an echocardiogram. They include:
• Two-dimensional (2D) or three-dimensional (3D) echocardiogram. These images
provide pictures of the heart walls and valves and of the large vessels connected to your
heart. A standard echocardiogram begins with a 2D study of the heart.
A 3D echocardiogram is available in some medical centers and hospitals. It's often done
to get more details about the lower left heart chamber. This chamber is the heart's main
pumping area.
• Doppler echocardiogram. Sound waves change pitch when they bounce off blood
cells moving through the heart and blood vessels. These changes are called Doppler
signals. This part of the test measures the speed and direction of blood flow within the
heart and vessels. It can help show blocked or leaking valves and check blood pressure
in the heart arteries.
• Color flow imaging. This displays the blood flow in the heart in color. It helps identify
leaky heart valves and other changes in blood flow.
Risks
Echocardiography uses harmless sound waves, called ultrasound. The sound waves
pose no known risk to the body. There is no X-ray exposure.
Other risks of an echocardiogram depend on the type of test being done.
If you have a standard transthoracic echocardiogram, you may feel some discomfort
when the ultrasound wand pushes against your chest. The firmness is needed to create the best
pictures of the heart.
There may be a small risk of a reaction to the contrast dye. Some people get backaches,
headaches or rashes. If a reaction occurs, it typically happens right away, while you are still in
the test room. Severe allergic reactions are very rare.
If you have a transesophageal echocardiogram, your throat may be sore for a few hours
afterward. Rarely, the tube used for this test may scrape the inside of the throat. Other risks of
a TEE include:
• Difficulty swallowing.
• Weak or scratchy voice.
• Spasms of the muscles in the throat or lungs.
• Minor bleeding in the throat area.
• Injury to teeth, gums or lips.
• Hole in the esophagus, called esophageal perforation.
 • Heart rhythm problems, called arrhythmias.
• Nausea from medicines used during the test.
Medicine given during a stress echocardiogram may temporarily cause a fast or irregular
heartbeat, a flushing feeling, low blood pressure or allergic reactions. Serious complications,
such as a heart attack, are rare.
Results
Information from an echocardiogram may show:
• Changes in heart size. Weakened or damaged heart valves, high blood pressure or
other diseases can cause thickened heart walls or enlarged heart chambers.
• Pumping strength. An echocardiogram can show how much blood pumps out of a
filled heart chamber with each heartbeat. This is called the ejection fraction. The test
also shows how much blood the heart pumps in one minute. This is called cardiac
output. If the heart doesn't pump enough blood for the body's needs, heart failure
symptoms occur.
• Heart muscle damage. The test can show how the heart wall helps the heart pump
blood. Areas of heart wall that move weakly may be damaged. Such damage might be
due to a lack of oxygen or a heart attack.
• Heart valve disorders. An echocardiogram can show how the heart valves open and
close. The test is often used to check for leaky heart valves. It can help diagnose valve
disorders such as heart valve regurgitation and valve stenosis.
• Heart problems present at birth, called congenital heart defects. An
echocardiogram can show changes in the structure of the heart and heart valves. The
test is also used to look for changes in the connections between the heart and major
blood vessels.
Treatment
Heart disease treatment depends on the cause and type of heart damage. Treatment for heart
disease may include:
• Lifestyle changes such as eating a diet low in salt and saturated fat, getting more
exercise, and not smoking.
• Medicines.
• A heart procedure.
• Heart surgery.
Medications
You may need medicines to control heart disease symptoms and prevent complications. The
type of medicine used depends on the type of heart disease.
Surgery or other procedures
Some people with heart disease may need a heart procedure or surgery. The type of treatment
depends on the type of heart disease and how much damage has happened to the heart.
Lifestyle and home remedies
Lifestyle changes are an important part of heart disease treatment and prevention. The
following changes are recommended to improve heart health:
• Don't smoke. Smoking is a major risk factor for heart disease. If you smoke and can't
quit, talk with your healthcare team about programs or treatments that can help.
• Eat healthy foods. Eat plenty of fruits, vegetables and whole grains. Limit sugar, salt
and saturated fats.
• Control blood pressure. Uncontrolled high blood pressure increases the risk of serious
health conditions. Get your blood pressure checked at least every two years if you're 18
or older. If you have risk factors for heart disease or are over age 40, you may need
more-frequent checks. Ask your healthcare professional what blood pressure reading is
best for you.
• Get a cholesterol test. Get a cholesterol test when you're in your 20s and then at least
every 4 to 6 years. You may need to start testing earlier if high cholesterol is in your
family history. You may need cholesterol checks more often if your test results aren't in
a desirable range or you have risk factors for heart disease.
• Manage diabetes. If you have diabetes, controlling your blood sugar can help reduce
the risk of heart disease.
• Exercise. Staying active keeps the heart healthy. Exercise at least 30 minutes a day on
most days of the week. Talk with your healthcare team about the amount and type of
exercise that's best for you.
• Keep a healthy weight. Being overweight increases the risk of heart disease. Ask your
healthcare professional what weight is best for you.
• Manage stress. Find ways to help reduce emotional stress. Some tips are to get more
exercise, practice mindfulness and connect with others in support groups.
• Practice good hygiene. Regularly wash your hands and brush and floss your teeth to
keep yourself healthy.
 • Get good sleep. Poor sleep may increase the risk of heart disease and other long-term
health conditions. Adults should try to get 7 to 9 hours of sleep daily. Kids often need
more. Go to bed and wake at the same time every day, including on weekends. If you
have trouble sleeping, talk with your healthcare professional about strategies that might
help.
Coping and support
Here are some ways to help manage heart disease and improve quality of life:
• Cardiac rehabilitation. This is a personalized program of education and exercise. It
includes exercise training, emotional support and education about a heart-healthy
lifestyle. The supervised program is often recommended after a heart attack or heart
surgery.
• Support groups. Connecting with friends and family or joining a support group is a
good way to reduce stress. You may find that talking about your concerns with others
in similar situations can help.
• Get regular health checkups. Seeing your healthcare professional regularly helps
make sure you're properly managing your heart disease.
Ayurvedic treatment for heart disease emphasizes the importance of maintaining balance in the
body's doshas (energies) and ensuring proper digestion. Key components of this approach
include:
• Maintaining a healthy body weight: Essential for supporting cardiovascular health
and reducing strain on the heart.
• Supporting healthy cholesterol levels: Ayurveda offers natural remedies and dietary
recommendations to help manage cholesterol and prevent cardiovascular problems.
• Reducing stress and promoting relaxation: Ayurvedic practices such as yoga and
meditation can help alleviate stress, which is beneficial for heart health.
By integrating these principles, Ayurveda can contribute to a holistic approach to managing
heart disease, complementing conventional medical treatments and enhancing overall well-
being.
Cardiac rehabilitation
Cardiac rehab (cardiac rehabilitation) is a complete program you can do after you’ve
had cardiac surgery or treatment for a heart issue, such as a heart attack. Cardiac rehab helps
you recover and get stronger.
 Multiple healthcare providers, including exercise and nutrition experts, offer guidance
during your personal cardiac rehab program. It typically takes at least three months. Cardiac
rehab can help you regardless of your age, sex or whether your heart issue was minor or major.
What are the five main components of cardiac rehab?
A cardiac rehab program combines:
• Exercise training.
• Cardiac risk factor changes.
• Heart health education.
• Diet and nutrition counseling.
• Emotional support.
What are the three phases of cardiac rehab?
Cardiac rehab may begin before the hospital discharges you and should continue long-term.
Cardiac rehab phases are:
• Phase 1: Inpatient (starting while you’re in the hospital).
• Phase 2: Outpatient (going to appointments and then going home afterward).
• Phase 3: On your own (keeping up exercises on your own and at your own expense).
What conditions are treated/managed with cardiac rehab?
Cardiac rehab is important for people who’ve had some kind of heart or blood vessel issue,
such as:
• Heart attack.
• Heart failure.
• Use of a ventricular assist device.
• Stable angina.
• Heart or heart-lung transplant.
• Heart valve repair or replacement.
• Coronary artery bypass grafting (CABG).
• Coronary artery angioplasty with or without a stent.
• Peripheral artery disease.
Procedure Details
What happens before cardiac rehab?
Before creating a program for you, staff at the cardiac rehab center will give you a
brief physical exam and get your medical history. They may also ask you to have basic testing,
which may include:
• Cardiac imaging.
 • Electrocardiogram (EKG).
• Tests to check your blood sugar and cholesterol.
• Exercise stress test with a treadmill or stationary bike.
Your cardiac rehab staff will work with you and your provider to:
• Review and assess your risk factors for heart and blood vessel disease.
• Develop a treatment plan to guide you through your program.
• Identify safe and effective target training zones for your exercise training.
• Set heart-healthy goals for you to reach while in the program and in the long term.
What happens during cardiac rehab?
In a group setting, the cardiac rehab staff will supervise you as you exercise. You’ll start
out slowly according to their instructions.
As you complete more sessions, you’ll gain confidence and endurance. Gradually,
you’ll increase the intensity and/or duration of your exercise according to your fitness level
and medical history. Cardiac rehab staff will check your heart rate and blood pressure regularly
to make sure you’re safe while exercising.
What exercises do you do at cardiac rehab?
Cardiac rehab exercises can vary depending on the fitness level and risk factors you started
with. Exercises may include:
• Aerobic exercises, like walking, riding a stationary bike or using an elliptical or step
trainer.
• Activities to strengthen your muscles, like lifting free weights or using cable machines
and resistance bands.
What does cardiac rehab consist of?
In addition to exercise, cardiac rehab helps you with:
• Eating heart-healthy.
• Learning how to manage stress.
• Getting to and staying at a healthy weight.
• Stopping the use of tobacco products and/or other substances.
• Taking and managing your medicines.
• Managing your blood pressure, cholesterol and blood sugar levels.
How long is cardiac rehab?
Most insurance companies (and Medicare) cover a 12-week cardiac rehab program with a total
of 36 sessions. That works out to three one-hour sessions a week.
Risks / Benefits
Completing a cardiac rehab program can add up to five years to your life expectancy, according
to studies. Cardiac rehab is good for you in many ways. It can:
• Help you recover and get stronger after a heart attack, heart surgery or another heart
issue.
• Get your body moving so your everyday activities are easier.
• Improve your daily quality of life.
• Help lower your risk of having another heart attack.
• Decrease your risk of becoming very ill or dying from heart disease in the coming
years.
• Help you manage mental health and possible feelings of depression and anxiety after a
heart attack.
• Show you ways to ease stress.
• Help you manage your weight.
• Teach you healthier lifestyle habits, such as heart-healthy eating, not using tobacco
products, sitting less and exercising more.
• Help with your chest pain and shortness of breath.
Cardiac rehab helps people who’ve had a heart attack or other heart problems recover. It creates
a personal plan for safely improving physical health and managing other risk factors.
Having a heart attack or other heart issue can also be scary and make you feel depressed.
Cardiac rehabilitation stresses the importance of mental health and quality of life. It provides
holistic support for every part of rehab so you’re not alone in reaching your goals.