1. HYPERTENSION
HEART ATTACK
DIABETES

2. HYPERTENSION
 What is Hypertension?
 High pressure in the blood vessels
 NOT excessive emotional tension
 > 140/90 mm Hg - confirmed on
multiple occasions

3. How is the blood pressure
measured?
 Patient to be seated comfortably
with his arm on a table in a relaxed
posture.
 Single reading is not sufficient.
 Best with a mercury type of apparatus.
 White coat Hypertension.

4. What causes hypertension?
 Primary Hypertension - 95%
 High intake of salt.
 Age, Black race, Genetic (30%),
 Obesity
 Secondary Hypertension - 5%
 Due to kidney, Aortic, Adrenal diseases.

5. How do alcohol, coffee, and
smoking influence blood pressure?
 Smoking rises BP by 5-10 mm.
 Alcohol rises BP on the long run.
 Caffeine also rises BP.

6. What do patients feel with high
blood pressure?
 No symptoms for many years (silent
killer)
 May present with fatal complications.
 Hence periodic BP check up is essential.
 Some may have giddiness, SOB,
Headache, Blurred vision.
 May come with kidney failure, HA, vision
loss on THE FIRST VISIT ITSELF.

7. Complications of
Hypertension
 Enlarged heart.
 Kidney failure.
 Brain damage.
 Changes in the eye (retina)
- Leaking of blood in the
retina.
- Swelling of the eye nerve.

8. Lifestyle modifications
Diet
Restricting salt
Reducing wt.
Exercise
Quitting alcohol
Quitting Smoking

9. Obesity
 Problem of sleep Apnoea syndrome
 Increased incidence of BP
On reduction of wt -
 BP reduces
 BP drugs act well
 Insulin also acts well

10. Regular exercise
 Jogging, Bicycle riding, Swimming for
30 to 45 minutes daily - lowers BP by
5-15 mm.
 The more you exercise (up to a point),
the more you lower the blood
pressure.

11. What are the goals of anti-
hypertensive treatment?
 Treat hypertension early, before it
damages critical organs.
 Goal – 130/80 mm of Hg.
 Even lower if patient has Diabetes or
Kidney failure.

12. Treatment of hypertension
 Not possible to control BP in a
single day or a few days.
 For a good control of BP, it may
take even a month.
 May require one or more drugs
most of the times.
 Initially he has to make frequent
visits to doctor for assessment of
BP control and titration of dose.

13. Treatment of hypertension
 Once hypertension is detected in a
patient, he or she would require
treatment life long.
 There is no need for taking food before
taking these medicines.
 Once the BP is under control with the
medicines he has to continue the
medicines and stopping drugs would
again increase the BP.

14. HEART ATTACK

15. What is a heart attack?
 Known as a Myocardial Infarction
 Sudden blockage blood vessel
 Death of heart muscle
 Causes chest pain and pressure
 Muscle continues to die for 6-8 hours
 Heart muscle is replaced by scar tissue

16. What causes a heart attack?
 Atherosclerosis - Deposition of
cholesterol in the walls of vessels
 Hardening of the arterial walls and
narrowing of the inner channels
 Cannot deliver enough blood
 Atherosclerosis can remain silent for
years or decades
 Atherosclerosis can begin as early as
the teenage years

17. What causes a heart attack?
 symptoms appear when the blood
vessels are critically narrowed
 Aggravating factors:
 Smoking
 High blood pressure
 Diabetes
 Elevated cholesterol
 Family history of heart attack

18. Angina
 Chest pain
 Coronary arteries are narrowed by
more than 50 to 70 %
 Arteries cannot increase the supply of
blood to the heart muscle during
exertion
 Diabetics – no pain occurs but just
shortness of breath

19. Angina
 Angina is like a pressure, heaviness,
squeezing, or aching across the chest
 This pain may travel to the neck, jaw, arms,
back, or even the teeth
 May be accompanied by shortness of
breath, nausea, vomiting or a cold sweat
 Angina lasts for 1 to 15 minutes
 Relieved by rest or by placing a
Nitroglycerine tablet under the tongue.
 Can even occur at rest.

20. Angina
 Too often patients attribute heart attack
symptoms to "indigestion," "fatigue," or
“stress” and consequently delay seeking
prompt medical attention.
 Early diagnosis and treatment saves lives,
and delays in reaching medical assistance
can be fatal. A delay in treatment can lead
to permanently reduced function of the
heart due to more extensive damage to the
heart muscle.

21. What are the complications of a
heart attack?
 Heart failure
 Ventricular fibrillation

22. How is a heart attack
treated?
 Medications to prevent formation of blood
clots
 Medications to prevent growth of blood clots
 PTCA with or without stenting to open
blocked coronary arteries
 Clot-dissolving medications to open blocked
arteries
 Oxygen to increase the supply of oxygen to
the heart's muscle
 Medications to prevent abnormal heart rate

23. DIABETES
 What is Diabetes Mellitus?
 Defects in INSULIN secretion or action
 Diabetes means "sweet urine."
 Elevated levels of blood glucose lead
to spillage of glucose into the urine

24. INSULIN
 Released from Pancreas in response to
elevated glucose (sugar) levels
 Normally Insulin controls blood sugar
 If deficient, glucose levels increase
 It’s a chronic condition - lasts for life
 Hence treatment is life long

25. What causes Diabetes?
 Body cells cannot use glucose in the
absence of Insulin.
 Cells are starved of glucose energy
 There is starvation in the midst of
plenty
 Unutilized glucose is wastefully
excreted in the urine

26. What is the impact of
Diabetes?
 Blindness
 Kidney failure
 Nerve damage
 Accelerating the hardening and
narrowing of the arteries
 That leads to strokes, coronary heart
diseases

27. What are the different types
of Diabetes?
 Type I – no insulin – young
 Damage of pancreas due to infections
 Due to genetic factors
 Type II – Inadequate insulin
 Normally in adults, rarely in teen age
 Risk factor – obesity

28. What are the symptoms of
Diabetes?
 Increased urine output
 Increase in appetite
 Increase in thirst
 Urinary Infections
 Skin Infections
 Weakness
 Coma

29. How is Diabetes diagnosed?
 The Fasting sugar test is the preferred
way to diagnose diabetes
 No need to do GTT
 Normally fasting sugar levels are less
than 110mg/dl
 If more than 126mg/dl, it is diagnostic
of Diabetes

30. Goal of Diabetes
treatment
 To keep the blood sugar levels
between 70 to 120mg/dl before each
meal.
 To keep the level under 140 mg/dl at
2 hours after eating

31. What are the complications
of Diabetes?
 Ketoacidosis
 Electrolyte imbalance
 Hypoglycemia
 Heart disease
 Eye problems
 Strokes
 Kidney failure

32. What are the complications
of Diabetes?
 Cataract
 Glaucoma
 Neurological problems
 Weight loss
 Loose motions
 Depression.

33. What can be done to slow
Diabetes complications?
 Aggressive and intensive control of
elevated levels of blood sugar
 Means achieving fasting glucose levels
between 70-120 mg/dl;
 Glucose levels of less than 140 mg/dl
after meals.

34. If treated well
 In intensively treated patients
 Diabetic eye disease decreased by
76%
 Kidney disease decreased by 54%
 Nerve disease decreased by 60%.

35. How is Diabetes treated?
 Life style modification, weight
reduction
 Diet
 Exercise
 Oral drugs
 Insulin

36. THANK YOU