bombay talk july 11

7/31/2019 Bombay Talk July 11

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Expert Consultant&Expert Consultant&

AdvisorAdvisorCentral Bank Of IndiaCentral Bank Of India

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Formerly:

Cleveland Clinic ,Cleveland , Ohio,USA

Royal Prince Alfred Hospital Sydney Australia

West mead Hospital Sydney ,Australia

Chief Cardiac Surgeon ,Z H S Medical college Dhaka


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I acknowledge the real Heroes of this country without whom our existence is impossible!

Anonymous
http://search.live.com/images/results.aspx?q=Indian+Army+Photo&FORM=ZZIR16


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The magnitude of problem!


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Prevalence of Coronary HeartPrevalence of Coronary Heart

DiseaseDisease 6.5-13.2% Urban6.5-13.2% Urban

1.5-7.4% Rural population (Heart 2008 :941.5-7.4% Rural population (Heart 2008 :94

;16-26);16-26)

Around :5- 10% people have CAD(Easy toAround :5- 10% people have CAD(Easy to

remember!)remember!)

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CVD IN INDIACVD IN INDIA

Cardiovascular disease has reached epidemic propor- tions

in India and is estimated to result in more than 3 million

deaths each year.4-6 Although CVD burden is high among

Indian urban residents, in certain regions even in rural

populations, CVD has emerged as the leading cause ofdeath.7

7


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Compared with Western populations, CVD occurs at arelatively younger age in Indians with a higher rate of

mortality.8,9

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CVD IN IndiaCVD IN India

Report from the World Health Organization (WHO) show

that by 2030, CVD will be the main cause of death

throughout India as a whole, accounting for more than

35% of mortality cases. Compared with Western

populations, CVD occurs at a relatively younger age inIndians with a higher rate of mortality.8,9

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These

premature deaths due to heart disease, stroke, and diabetes

are projected to increase cumulatively, and India's

financial losses due to CVD are estimated at US $237

billion for the period of 2005 to 2015.4 Further- more,

because the majority of these deaths are premature, there

is a substantial loss of lives during the peak productivity

years as compared with other countries. The potentially

productive years of life lost due to CVD among those aged35 to 64 years was 9.2 million in 2000 and is expected to rise

to 17.9 million by 2030more than the losses predicted for

China, Russia, the United States, Portugal, and South

Africa combined (16.2 million).10 10


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EVERY MINUTE 2 PEOPLE DIE OF HEART ATTACK IN INDIA

10-15% INDIAN HAS CORONARY ARTERY DISEASE

INDIA HAS ~15 MILLION OF CAD


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Life Expectancy:1950 ~46 yr

Life expectancy:1998~66 yr

Present:?


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~15 MILLION CAD IN INDIA

~5 MILLION CASES OF RHD DIAGNOSED PER YEAR IN INDIA!

~2,LAKH CHILDREN ARE BORN WITH HEART PROBLEM EVERY YEAR IN INDIA!


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~60,000 OPEN HEART SURGERY DONE IN INDIA /YEAR

~5,000 CHILDREN HEART SURGERY IN INDIA /YEAR

PRESENT :?


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Problems in effectiveness of health care plans:

SCAMS

POPULATION

POVERTY

IGNORANCE

GOVT PRIORITIES


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A bit of Cardiac surgery!


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OPEN HEART SURGERY

CLOSED HEART SURGERY


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HENRY SOUTTAR 1925

Did First Mitral Commisurotomy

& wrote

Heart should be amenable to surgery as any other organ inthe body !

82 years back


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Main problem of heart surgery

Movement of the heart!

Solution --------


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Cardio pulmonary bypass i.e. we have to bypass the work of

heart & lung

Ways to do that:

use the parents of the patient or

controlled cross circulation or

use Machine i.e. Heart Lung Machine


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Michael Ellis DeBakeyMichael Ellis DeBakey

The legend!The legend!


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http://en.wikipedia.org/wiki/File:1783_balloonj.jpg


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http://en.wikipedia.org/wiki/File:LeBris1868.jpg


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AIRBUS 380


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SARNS HEART LUNG MACHINE


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Blood will clot if you use this machine!


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Heparin :1936

We should allow it to reverse i.e.Protamine


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OPEN HEART SURGERY :

CABG

VALVE SURGERY

PEDIATRIC HEART SURGERY

AORTIC SURGERY FOR ANEURYSM


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CLOSED HEART SURGERY

Closed mitral valvotomyPatent ductus arteriosus Ligation


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Bypass surgery:

We bypass the occluded coronary vessels so thatblood flows to heart

Using heart Lung Machine

by

or

Beating Heart surgery


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Two types of Valve:

1.Mechanical valve: Needs medicine ,lasts longer

2.Tissue valve :do not need medicine , does not lasts long


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Congenital heart surgery

ASD

VSD

TOF

PDA


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RESULTS OF CABG:All scientific studies done so far have provedsuperiority of this modality of treatment over other forms of treatment!

Mortality :1-2 %

Improved symptom free survival i. e No angina /Heart attack

Improved quality of life

New Block at a later date could be a problem

Morbidity:1-2%

Long lasting benefit


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Results of Angioplasty:Early results are OK But late result are less satisfactory than CABG.

Stent thrombosis(occlusion) & Heart attack are problems after some time.


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Conclusions CABG remains the standard of care for patientswiththree-vessel or left main coronary artery disease, since the

use of CABG, as compared with PCI, resulted in lower rates

ofthe combined end point of major adverse cardiac or cerebrovascular

events at 1 year. (ClinicalTrials.gov number, NCT00114972 [ClinicalTrials.gov] .)

Syntax Trial:Sept 2008
http://content.nejm.org/cgi/external_ref?access_num=NCT00114972&link_type=CLINTRIALGOVhttp://content.nejm.org/cgi/external_ref?access_num=NCT00114972&link_type=CLINTRIALGOV


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Results :

Valve surgery

Almost normal life

Can have problems due to valve or medications (anticoagulant)

Stroke/Bleeding/clotting of valve


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Pediatric heart surgery:Results are dependent on different disease.

Results:


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Common Myth:

After heart surgery I will not be able to do all activities normally!Its nearly impossible to live normally!

C C


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Common Concerns:

1.Will I be alright for normal living?

a) Normal Physical working capacity ?

b) Normal mental capacity?

c) Normal sexual activity?

d) Normal social activity?

e) Normal traveling?

f) Do I need to take life long medicines ?

2.Is there a high chance of my death?

3.Is there a high Chance of Disability?

4.Suitability for job of choice?

5.Social acceptability?


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NEIL ARMSTRONG 1969


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NEIL ARMSTRONG
http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4


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NEIL ARMSTRONG
http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4


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Chandrayan I


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Negligible!

IN 2010/2011


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WHAT IS THE CAUSE OF MOST OF THE DISEASES?


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GOD ?


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YES ?


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GENETIC PREDISPOSITION !


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Persons with family history of Heart Attack!


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My golden word:


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OF COURSE!


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Avoid Smoking!

Avoid Fatty food!

Control Diabetics !

Control Blood pressure !

OF COURSE!


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CABG

ANGIOPLASTY


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Balance it!


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You decide !


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COMMON ADVISECOMMON ADVISE

1.Finance under control1.Finance under control

2.Regular exercise2.Regular exercise

3. Three monthly visit to doctor3. Three monthly visit to doctor

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Thank you !


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JAI HIND!


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bombay talk july 11

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