1.CARDIOVASCULAR DISEASES

2. Introduction CVDs 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, 1920s, 1930s 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, OCPS. 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. WHOS 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 DALYs 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 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 Criterias MAJOR MANIFESTATIONS MINOR MANIFESTATIONS PANCARDITIS Fever POLYARTHRITIS Previous RF SYDENHAMs 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 NCDs (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.