This is my first presentation in NIUM bangalore.

1. Presented by
Dr Mohd Shahid
P G Scholar
D/O Moalajat
NIUM Bangalore

2. Summary
 Introduction
Primary prevention
 Definition
 Etiopathogenesis
 Classification
 Clinical features
 Anatomy
 Line of Management
 Pathology
 Treatment
Factors responsible for
IHD

3. “Heart is a miracle organ that starts working
as soon as 21st day of conception in mother’s
womb and goes on till the last breathes of
life. It keeps pumping the blood to the cells
of human body, spending sleepless nights
and days i.e. lifetime. However, even the
importance of heart is countless; we often
get casual about our heart”.

4. Introduction
 Cardiovascular diseases (CVD) are responsible for
nearly 50% (17.3 million of deaths due to
noncommunicable diseases (NCDs).
 Out of the 17.3 million deaths, heart attacks and
strokes account for 7.3 million and 6.2 million
respectively.
 Projected estimates reveal that in 2030 coronary
heart disease and cerebrovascular disease will
continue to be the leading causes of the global
disease burden.

5. Cont....
 An action plan for implementation of a Global
Strategy for prevention and control of NCDs including
CVD was endorsed by the World Health Assembly in
2008.

6. Definition
 IHD is define as acute or chronic form of Cardiac
disability arising from imbalance between the
Myocardial supply and demand for oxygenated
blood
 Ischemia results when there is an imbalance
between myocardial oxygen supply and demand
 Since narrowing or Obstruction of the Coronory
artirial system is the most common cause of
Myocardial anoxia, “ CAD” used as synonym

7. CORONARY ARTERY
DISEASE
 ASYMTOMATIC STATE
 ANGINA PECTORIS
 MYOCARDIAL INFARCTION
 CHRONIC ISCHAEMIC HEART DISEASE
 SUDDEN CARDIAC DEATH

8. Facts and figures
 MI occurs every 2 mins in UK
 Account for 100,000 deaths annually
 Cardiovascular death accounts for 40% all deaths
under the age 75 yrs
 Major cause of cardiac arrest
 Survival to discharge of all rhythm cardiac arrests
is 10.7%

9. Mechanisms of ischaemia
 Ischaemia – disturbance in myocardial oxygen
supply and demand
 Impaired coronary artery blood flow
 Atherosclerosis
 Coronary artery spasm
 Tachycardia – shortened diastole
 Impaired oxygen delivery
 Hypoxia
 Anaemia
 Increased cardiac work

10. Anatomy
1. Aorta
2. Right Coronary
Artery
3. Left Anterior
Descending Artery
4. Circumflex
Coronary Artery
5. Left main stem

11. Atherosclerosis

12. Risk Factors
 Fixed  Modifiable
 Age  Smoking
 Male sex  Hypertension
 Genetic factor  Hyperlipidaemia
 Diabetes mellitus
 Familial and racial
factors  Obesity
 Alcohol
 Sedentary lifestyle

13.  Circumflex artery obstruction
 Lateral infarction
 ECG changes leads I, AVL and V4-V6
 20% cases
 Left anterior descending
obstruction
 Anterior infarction
 ECG changes V1-V4
 50% cases – most likely to cause left ventricular
dysfunction

14. Right coronary artery
obstruction
 Inferior infarction
 ECG changes in II, III & AVF
 30% cases
Posterior myocardial
infarction
 Usually right coronary artery but may be
circumflex
 ST depression in anterior leads

15. Clinical Features
 Prolonged cardiac
pain; chest, throat,
arms, epigastrium or
back
 Anxiety and fear of
impending death
 Nausea and vomiting
 Breathlessness
 Syncope/Collapse

16. HISTORY
 It was amazing to find that, the knowledge of
heart and its function was much clear to the
man in 4000 B.C itself (Ahmed W et all. Cardiology with special
reference to Al-qanoon and advia wal qalbiya. JISHIM 2007-2008, 6-7.)
 There is an abundant literature on anatomy,
physiology and cardiac diseases described by
our Atibba

17. contd…
 Jalinoos (Galen) is the first to explain the circulation
and Ibn Sina has explained the same in his book ‘Al
Qanoon fil tib’.
 Jalinoos and Ibn sina - there are 3 ventricles in
animal or human heart.
 They also stated that there is a pore in the ventricular
septum.
 These theories were discarded by Ibn Nafis.

18. Ibn Nafis
 He has clearly described the mechanism of Pulmonary
circulation.
 He stated that there are only 2 ventricles and also there
is no pore b/w the two vetricles.
 Right side is filled with blood.
 Left side is filled with blood and Vital spirit. (Husain F et al. Ibn al-Nafis, A
biographical sketch of discoverer of pulmonary and coronary circulaion.. JISHIM 2003,1)

19. Concept of cardiac disorders
Based on the following fundamentals….
 Sue Mizaj
1) Sue mizaj sada(extrinsic factor)
2) Sue mizaj maddi (altered humour)
3) Sue mizaj Mufrad
4) Sue mizaj Murakkab
 Amraaz-e-Trkeeb

20. Cont.....
 Amraaz-e-Tafarruk
 Auraam (Inflammatory disease)
 Amraaz-e-Shirki
“If the altered temperament becomes
irreversible then treatment becomes
almost impossible”. (Ibne Sina)

21. Co-Relation of IHD disease
in Our System

22. Khafqaan
 Khafqaan Qalb ki harkat-e-tabayi mai zyadti ka
naam hai (kitab-ul-teseer )
 Us harkat ka naam hai, jo Qalb ke andar gair
tabayi tor par ho (Moalajat-e-Buqratiya)
 Qalb ka Khafqaan ek aisi harkat ka naam hai jo
Qalb mai tezi ke saath musalsal Ikhtilaaj ke
mushaaba hoti hai (Kitab-ul-Haavi V-7)
 Qalb ki gair tabayi harkat, jo Ikhtilaaj se mushaaba
hoti hai. Aur is ka sabab har aisi cheez hai jis se
Qalb ko Aziyat pohunchti ho. (Akseer-e- Azam)

23. Asbaab
 Khafqaan ka sabab saare badan ka Imtila hai. Jis ki
wajah se Qalb Iztarabi aur Ikhtilaaji harkat karne
lagta hai. Taake taklif ya Raghon ki tangi door
kar sake
 Baaz aukaat Qalb ki Raghon haad Khilt-e-
Suadavi jama (Accumulate) ho jane ki wajah se
(Kitab-ul-teseer )
 Qalb ke andar siyah gaadhe khoon ki wajha se
hota hai, jo jigar ke andar behta hai (Kitab-ul-
Haavi V-7)

24. Asbaab cont…..
 Qalb ko Aziyat pohunchane wale asbab
1. Sue Mizaj Qalb
2. Qalb ki ghilaaf ki wajha se
3. Qalb ke qaribee Aaza ki Msharikat se
a) Maida/Stomach
b) Dimaagh/Brain
c) Jigar/Liver
d) Riya/Lungs
e) Tamam hijab

25. Asbaab cont…..
f) Miraaq
g) Ama/Intestine
h) Reham/Uterus
i) tamam badan/ full body
 Khilti Madda
 Ghair Khilti Madda
 Waram(Inflammation)
 Tafarruk-e-Ittisaal

26. Asbaab cont…..
 Sudda
 Asbab-e-ghariba
 Qalb ki badhi hui hiss
 Zoef-e-Qalb

27. Types of Khafqaan
1. Khafqaan Damvi
2. Khafqaan Safravi
3. Khafqaan Balgami
4. Khafqaan Suadavi
5. Khafqaan Reehi
6. Khafqaan Suddi

28. Khafqaan Suddi
Qalb ki gair tabayi harkat, jo
Ikhtilaaj se mushaaba hoti hai aur
is ka sabab koi sudda hota hai

29. Advia e Qalbia
The drugs which are used in the treatment of Amraz e
Qalb are …
 Mufarreh
 Muqawwie Qalb

30. .

32. Drugs mentioned which lower
the hyperlipidaemia…..
 Garlic(lahsan)
 Tinospora cordifolia
(Gilo)
 Terminalia arjuna Hypolipidemic activity
(Arjun)
 Ocimum sativum(Tulsi)
 Curcuma longa (Haldi)

33.  Sabab ka izala karen
 Agar sirf sue mizaj hai to taadeel se
hi kaam len
 Sue mizaj maddi hai to tanqiya kare

34.  Nuskha baraye Khafqaan Suddi
 Tukhm kasooss, tukhme badranjboya, shahtra,
badiyan har ek 7 masha
 Badranjboya, gule surkh, aftimoon har ek 9 masha
 Bisfaij, daronaj akrabi, har ek 4 masha
 Tukhm qurtum 1 tola
 Mawiz munaqqa 3 tola
 Gule gaouzaban 5 masha, sab ko josh de kar gul
qand 4 tola shamil kar ke 2 hafte tak istemaal
karaen.

35. Cont...
Ishaal ke liye;
 Gule surkh 1.5 tola  Sharbat-e- Ilahi Alvi
 Barge sana 2 tola khan 3 tola
 Revand khatai 9 masha  Sharbat warde
 Sheer khasht 4 tola
mukarrar halelji 3 tola
 Roghan badam 7
 Turanjabeen 3 masha
masha, nuskhe mai
 Khiyar shambar 7 tola
zyada kar k pilaye
 Gulab ek botal

36. Cont...
 Kamil tanqie k baad taadil ke liye
 Khamira Gauzaban, arqe guzar ke sath pilaye