Cardio Vascular Diseases, Stroke, Treatment, Public Health threat from CVD's

1. CARDIOVASCULAR DISEASES

2. Introduction
 CVD’s comprises of a group of diseases of the heart
and vascular system.
 The major conditions are :
IHD
HT
CVD (Stroke)
CHD
RHD
Non Communicable

3. PROBLEM : (No. of Deaths) Worldwide
0
5
10
15
20
25
30
35
40
Category 1 Category 2
Deaths due to Non
Communicable diseases
Deaths due to CVD's

4. In India

5. CORONARY HEART DISEASE
 Impairment of heart function due to inadequate blood
flow to the heart compared to its needs, caused by
obstructive changes in the coronary circulation to the
heart.

6. Manifestations of Coronary Heart
Disease
 Angina pectoris
 Myocardial infarction
 Cardiac failure

7. EPIDEMICITY
 In USA, 1920’s, 1930’s in Britain.
 MONICA………………

8. MONICA
 WHO has completed a project known as MONICA.
 Multinational Monitoring of Trends and Determinants
in Cardiovascular Diseases.
 Is to elucidate CHD issue.
 41 centres in 26 countries were participating in this
issue.
 Ended in 1994.

9. In India
INDICES URBAN RURAL
Prevalence rate/1000 64.37 25.27
Death rate/1000 0.8 0.4
DALY/100,000 2703.4 986.2

10. RISK FACTORS
Non Modifiable Modifiable
AGE
SEX
GENETIC HISTORY
FAMILY HISTORY
Cigarette Smoking
High BP
Elevated Serum Cholesterol
Diabetes
Obesity
Sedentary Habits
Stress

11. PREVENTION OF CHD
• Prevention in Whole Population
• Primordial Prevention
Population
Strategy
High Risk Strategy
Secondary Prevention

12. POPULATION
STRATEGY

13.  CHD is primarily a mass disease.
 So, the strategy should be therefore mass approach.
 Should focus mainly on control of risk factors.
Small
changes in
risk factor
levels
In Total
Population
Biggest
reduction in
Mortality

14. SPECIFIC INTERVENTIONSDietaryChanges
• Limitation
of
consumption
of fatty
acids.
• Reduction in
dietary
Cholesterol.
• MUFA &
PUFA.
Smoking
• No safer
cigarette
• So, smok
e free
society
BloodPressure
• Prudent
Diet.
• Reduced
salt intake.
• Avoidance
of high
alcohol
intake.
PhysicalActivity
• Regular
physical
activity.
• Encourage
children to
continue
throughout
their life.

15. PRIMORDIAL PREVENTION
 It involves preventing the emergence and spread of
CHD risk factors and life styles that have not yet
appeared or become endemic.
 Prevention should be multifactorial because the
aetiology is multifactorial.
 The aim should be to change the community as a
whole, not the individual subjects living in it.

16. HIGH RISK STRATEGY

17. HIGH RISK STRATEGY
Identifying
Risk
Can be started only when
those high risk
individuals are
identified.
BP, Increased serum
cholesterol
levels, Family history of
CHD, OCP’S.
Specific
Advice
Bring them under
preventive care. Motivate
them to take positive
action against all the
identified factors.
An elevated BP should
be treated.
Nicotine chewing gum to
wean from smoking.
Disadvantage
Intervention is effective
in reducing the disease
only in high risk group.
Might not reduce to same
extent in general
population.
More than half of the
CHD cases occurs in
those who are not at high
risk.

18. SECONDAY PREVENTION

19.  Forms an important part of an overall strategy.
 Aim is to prevent the recurrence and progression of
CHD.
 Rapidly expanding field with much of research in
progress. [ E.g. drug trials, coronary surgery, pace
makers ]

20. Principles Governing Secondary
Prevention
Cessation
of
Smoking
Control of
Hyperten
sion and
Diabetes
Healthy
Nutritio
n
Exercise
Promoti
on

21. Revascularization procedures
 CABG - Coronary Artery Bypass Graft
 PTCA - Percutaneous Transluminal Coronary
Angioplasty

22. STROKE

23. WHO Definition
 Rapidly developed clinical signs of focal disturbance
of cerebral function ; lasting more than 24 hours or
leading to death, with no apparent cause other than
vascular origin.
 Excludes TIA.

24. Causes
Stenosis
Occlusion
Rupture of Arteries

25. Signs & Symptoms
Coma
Multiple Paralysis
Monoplegia
Hemiplegia(90%)
Paraplegia
Sensory Impairment
Speech Disturbance
Nerve Paresis

26. WHO’S INTERNATIONAL
CLASSIFICATION
 Subarachnoid Haemorrhage
 Cerebral Haemorrhage
 Cerebral Thrombosis or Embolism
 Occlusion of Pre-Cerebral arteries
 TIA ( more than 24 hrs )
 Ill defined cardiovascular disease.

27. In India
 Prevalence rate of Stroke : 1.54/1000
 Death Rate : 0.6/1000
 DALY’s lost : 597.6/1,00,000

28. RHEUMATIC HEART DISEASE

29. RHEUMATIC HEART DISEASE
 Rheumatic fever (RH) and RHD cannot be separated
from an epidemiological point of view.
 Lancefield Group A β Haemolytic Streptococci.
 Starts as a pharyngitis.
 Not a communicable disease.

30. In India
 RHD is prevalent in the range of 5-7/1000 in 5-15yrs
age group and about 1 million cases of RHD in our
country.

31. Duckett Jones Criteria’s
MAJOR MANIFESTATIONS MINOR MANIFESTATIONS
PANCARDITIS Fever
POLYARTHRITIS Previous RF
SYDENHAM’s CHOREA Raised ESR/CRP
ERYTHEMA MARGINATUM First degree AV block
SUBCUTANEOUS NODULES Leucocytosis

32. Diagnosis
 ASOT
 ESR
 CRP
 JONES criteria :
2 major criteria & 1 minor criteria

33. PREVENTION
Non – Medical Measures
Improving living conditions, Socio-
economic status etc.
Breaking the poverty-disease-poverty
cycle
Secondary Prevention
Prevention of recurrences of RF
Persons with RF – IM Inj. of Benzathine
Benzyl Penicillin
Primary Prevention
Prevent first attack of RF by identifying
patients with streptococcal throat.
Concentrate on high risk groups such as
school children.

34. NATIONAL PROGRAMME FOR PREVENTION
AND CONTROL OF
DIABETES, CARDIOVASCULAR DISESES AND
STROKE

35.  In India, 53% of deaths are due to NCD’s (2005)
 Pilot programme for prevention and control of
cardiovascular diseases, diabetes and stroke.
 Launched on Jan 4th 2008 in 7 states with one district
each.

36.  Assam – Kamrup
 Punjab – Jalandhar
 Rajasthan – Bhilwara
 Karnataka – Shimoga
 Tamil Nadu – Kancheepuram
 Kerala – Thiruvananthapuram
 Andhra Pradesh – Nellore
 Financial outlay for the pilot phase is 5 crores.

37. Programme Interventions
Health Promotion for the General Population
• Targeted to healthy, Risk free population.
• Community based, Work based and School based Interventions.
Disease Prevention for the High Risk Group
• Early diagnosis and appropriate management.
Assessment of Prevalance of Risk Factors – through
surveillance.