G K SHETTY VIVEKANANDA VIDYALAYA

JUNIOR COLLEGE, AMBATTUR, CHENNAI- 53

TOPIC:
STUDY OF HEART DISEASAE

NAM E : A.R.LOKESH

YEAR : 20 17 2018

CLASS : XII - B2

EXAM NO :

DATE :
 BONAFIDE CERTIFICATE
G K SHETTY VIVEKANANDA VIDYALAYA JUNIOR COLLEGE
Unit of VIVEKANANDA EDUCATIONAL SOCIETY
C T H Road, Ambattur, Chennai - 600 053

This is to certify that this project entitled

STUDY OF HEART DISEASAE

for the requirement of twelfth standard

Is the bonafide record of work
carried out by

NAME : A.R.LOKESH

ROLL NUMBER : ____________________

At the DEPARTMENT OF BIOLOGY,
G K SHETTY VIVEKANANDA VIDYALAYA JUNIOR COLLEGE,
Ambattur, Chennai - 600 053

INTERNAL EXAMINER SEAL EXTERNAL EXAMINER Date:

 ACKNOWLEDGEMENT

I sincerely thank Smt.S.USHARANI M.A., M.Ed.,

M.Phil, Principal, and G.K.Shetty Vivekananda Vidyalaya Junior
College for rendering enough facilities for the project.

I thank Dr.S.DEEPA, M.Sc., and M.phil. (Zoo), M.Ed,

M.Phil. (Edn.), Ph.D. (Biotech), PGDGC (Guidance and Counseling)
for suggesting this project and for inspiring guidance and
encouragement throughout the successful completion of the
project.

I express my heartful thanks to our laboratory

assistants Smt.LEELAVATHY, B.sc (Zoo) and
Smt.Gomathipakiyam B.Sc. (Phy) for their guidance in doing the
project.
I express my thanks to our librarian Smt.S.UMA
SARASWATHI B.Sc., B.Ed, M.L.I.S, M.Phil. For helping me in the
effective work of the project
INTRODUCTION TO THE DOCTER

( Dr. T R Muralidharan )

INTRODUCTION TO HEART

INTRODUCTION TO THE DISEASE

(Heart failure (HF))

INTERVIEW WITH THE DOCTER

(Causes and prevention of Heart Problems)

SYMPTOMS OF THE DISEASE

CAUSES

CONCLUSION

BIBLOGRAPHY
 Introduction of the doctor
Dr. T R Muralidharan

Dr.T R Muralidharan is a Consultant Cardiologist and Head of the

Department of Cardiology at Sri Ramachandra University Medical Centre,
Porur, Chennai. He is also in charge of the Cardiac Cath Lab and
Electrophysiology Unit at the same institute, where approximately a
hundred Pacemaker implants, 60 Electrophysiology studies and
Radiofrequency Ablations (RFA) are done in a year.

Education:
MD (Medicine), DM (Cardiology)

Area(s) of Specialization:
Clinical Cardiology, Interventional Cardiology, Electro Physiology
Study & Echocardiogram, PTMC, EPS With RFA, ASD, VSD, PDA,
ICD, CRTD, CRTP, TAVI

Experience:
In Cardiology since 1995.

HEART
 The heart is a muscular organ in humans and other
animals, which pumps blood through the blood vessels of the
circulatory system. Blood provides the body with oxygen and
nutrients, as well as assists in the removal of metabolic
wastes. In humans, the heart is located between the lungs, in
the middle compartment of the chest.
In humans, other mammals, and birds, the heart is
divided into four chambers: upper left and right atria; and
lower left and right ventricles. Commonly the right atrium and
ventricle are referred together as the right heart and their left
counterparts as the left heart. Fish, in contrast, have two
chambers, an atrium and a ventricle, while reptiles have three
chambers. In a healthy heart blood flows one way through the
heart due to heart valves, which prevent backflow. The heart is
enclosed in a protective sac, the pericardium, which also
contains a small amount of fluid. The wall of the heart is made
up of three layers: epicardium, myocardium, and
endocardium.
 The heart pumps blood with a rhythm determined
by a group of pacemaking cells in the sinoatrial node. These
generate a current that causes contraction of the heart,
traveling through the atrioventricular node and along the
conduction system of the heart. The heart receives blood low in
oxygen from the systemic circulation, which enters the right
atrium from the superior and inferior venae cavae and passes
to the right ventricle. From here it is pumped into the
pulmonary circulation, through the lungs where it receives
oxygen and gives off carbon dioxide. Oxygenated blood then
returns to the left atrium, passes through the left ventricle and
is pumped out through the aorta to the systemic
circulationwhere the oxygen is used and metabolized to
carbon dioxide. The heart beats at a resting rate close to 72
beats per minute. [9] Exercise temporarily increases the rate,
but lowers resting heart rate in the long term, and is good for
heart health.
Cardiovascular diseases (CVD) are the most common
cause of death globally as of 2008, accounting for 30% of
deaths. Of these more than three quarters are a result of
coronary artery disease and stroke. Risk factors include:
smoking, being overweight, little exercise, high cholesterol,
high blood pressure, and poorly controlled diabetes, among
others. Cardiovascular diseases frequently have no symptoms
or may cause chest pain or shortness of breath. Diagnosis of
heart disease is often done by the taking of a medical history,
listening to the heart-sounds with a stethoscope, ECG, and
ultrasound. Specialists who focus on diseases of the heart are
called cardiologists, although many specialties of medicine
may be involved in treatment.
LOCATION AND SHAPE
 The human heart is in the middle of the thorax, with
its apex pointing to the left.
The human heart is situated in the middle mediastinum,
at the level of thoracic vertebrae T5-T8. A double-membraned
sac called the pericardium surrounds the heart and attaches to
the mediastinum. The back surface of the heart lies near the
vertebral column, and the front surface sits behind the
sternum and rib cartilages. The upper part of the heart is the
attachment point for several large blood vessels the venae
cavae, aorta and pulmonary trunk. The upper part of the heart
is located at the level of the third costal cartilage. The lower
tip of the heart, the apex, lies to the left of the sternum (8 to 9
cm from the midsternal line) between the junction of the fourth
and fifth ribs near their articulation with the costal cartilages.
The largest part of the heart is usually slightly
offset to the left side of the chest (though occasionally it may
be offset to the right) and is felt to be on the left because the
left heart is stronger and larger, since it pumps to all body
parts. Because the heart is between the lungs, the left lung is
smaller than the right lung and has a cardiac notch in its
border to accommodate the heart. The heart is cone-shaped,
with its base positioned upwards and tapering down to the
apex. An adult heart has a mass of 250350 grams (912
oz). The heart is typically the size of a fist: 12 cm (5 in) in
length, 8 cm (3.5 in) wide, and 6 cm (2.5 in) in thickness.
Well-trained athletes can have much larger hearts due to the
effects of exercise on the heart muscle, similar to the response
of skeletal muscle.
 Heart

The human heart

Details

System Circulatory

Artery Aorta, pulmonary trunk and right and left pulmonary arteries
Right coronary artery, left main coronary artery

Vein Superior vena cava, inferior vena cava, right and left pulmonary
veins, great cardiac vein, middle cardiac vein, small cardiac
vein, anterior cardiac veins.

Nerve Accelerans nerve, vagus nerve.

I
NTRODUCTION TO THE DISEASE
(HEART FAILURE (HF))
 Heart failure (HF), often referred to as congestive heart
failure (CHF), occurs when the heart is unable to pump
sufficiently to maintain blood flow to meet the body's needs.
Signs and symptoms commonly include shortness of breath,
excessive tiredness, and leg swelling. The shortness of breath
is usually worse with exercise, while lying down, and may
wake the person at night. A limited ability to exercise is also
a common feature. Chest pain, including angina, does not
typically occur due to heart failure.
Common causes of heart failure include coronary
artery disease including a previous myocardial infarction
(heart attack), high blood pressure, atrial fibrillation, valvular
heart disease, excess alcohol use, infection, and
cardiomyopathy of an unknown cause. These cause heart
failure by changing either the structure or the functioning of
the heart. There are two main types of heart failure: heart
failure due to left ventricular dysfunction and heart failure
with normal ejection fraction depending on whether the ability
of the left ventricle to contract is affected, or the heart's ability
to relax. The severity of disease is usually graded by the
degree of problems with exercise. Heart failure is not the
same as myocardial infarction or cardiac arrest. Other
diseases that may have symptoms similar to heart failure
include obesity, kidney failure, liver problems, anemia, and
thyroid disease.
The condition is diagnosed based on the history of
the symptoms and a physical examination with confirmation
by echocardiography. Blood tests, electrocardiography, and
chest radiography may be useful to determine the underlying
cause. Treatment depends on the severity and cause of the
disease. In people with chronic stable mild heart failure,
treatment commonly consists of lifestyle modifications such as
stopping smoking, physical exercise, and dietary changes, as
well as medications. In those with heart failure due to left
ventricular dysfunction, angiotensin converting enzyme
inhibitors or angiotensin receptor blockers along with beta
blockers is recommended. Sometimes, depending on the cause,
an implanted device such as a pacemaker or an implantable
cardiac defibrillator may be recommended. In some moderate
or severe cases cardiac resynchronization therapy (CRT) may
be suggested or cardiac contractility modulation may be of
benefit. A ventricular assist device or occasionally a heart
transplant may be recommended in those with severe disease
despite all other measures.
Heart failure is a common, costly, and potentially
fatal condition. In 2015 it affected about 40 million people
globally. In developed countries, around 2% of adults have
heart failure and in those over the age of 65, this increases to
610%. In the year after diagnosis the risk of death is about
35% after which it decreases to below 10% each year. This is
similar to the risks with a number of types of cancer. In the
United Kingdom the disease is the reason for 5% of
emergency hospital admissions. Heart failure has been known
since ancient times with the Ebers papyrus commenting on it
around 1550 BCE.
 Interview with Cardiologist
(Dr. T R Muralidharan)
Q: What are the rules-of-thumb for a regular person
to take care of his or her heart?
A: 1. Diet - Less of carbohydrate, more of protein,
less oil. 2. Exercise - Half an hour's walk, at least
five days a week, avoiding lifts and being sedentary
for long periods. 3. Quit smoking. 4. Keep body
weight under control. 5. Keep blood pressure and
blood sugar levels under control.
Q: Its still shocking to hear of a perfectly healthy
individual going into cardiac arrest. How do we put
this into perspective?
A: This is called a silent attack. Its the reason why
everyone over the age of 30 should undergo routine
health check-ups.

Q: Are heart diseases hereditary?

A: Yes.
Q: Is walking better than jogging, or is more
intensive exercise required to maintain a healthy
heart?
A: Its preferable to walk regularly rather than jog,
because youre still making your heart work without
putting unnecessary strain on your leg joints.

Q: Can people with low blood pressure suffer from

heart disease?
A: Its extremely rare for them to do so.
Q: Does cholesterol accumulate right from an early
age (I'm currently only 22) or do you have to worry
about it only after you are above 30 years of age?
A: Cholesterol accumulates from childhood.

Q: How do irregular eating habits affect the heart?

A: Excess salt from junk food can lead to high
blood pressure and diabetes. Excess fat can lead to
hypercholesterolemia, along with various other
consequences.
Q: How can I control cholesterol content without
using medicines?
A: Control your diet, walk and eat walnuts.

Q: Can yoga prevent heart ailments?

A: Yoga certainly helps with that.

Q: Which is the best and worst food for the heart?

A: Fruit and vegetables are the best, and the worst is
oil.

Q: Which oil is better - groundnut, sunflower, olive?

A: All oils are bad.

Q: What is the routine check-up one should go

through? Is there any specific test?
A: Routine blood test to ensure sugar and
cholesterol levels are okay. Check BP, Treadmill test
after an echo.
Q: What are the first aid steps to be taken when
someone is having a heart attack?
A: Help the person into a sleeping position, place an
aspirin tablet under the tongue with a sorbitrate
tablet if available, and rush him to a coronary care
unit since the maximum physical damage usually
takes place within the first hour.

Q: How do you differentiate between pain caused by

a heart attack and that caused due to gastric
trouble?
A: This is extremely difficult to do unless an ECG
scan is undertaken.

Q: Is it possible for a person to have blood pressure

outside the normal range of 120/80 and yet be
perfectly healthy?
A: Yes.

Q: What is the main cause of the steep increase in

heart problems observed in young people? I see
people aged between 30 and 40 having heart attacks
and serious heart problems.
A: Sedentary lifestyles, smoking, junk food and a
lack of exercise. Not to mention that Indian people
are genetically three times more vulnerable to heart
attacks than Europeans and Americans.

Q: Intermarriage between closely-related family

members can lead to heart problems for the child. Is
it true?
A: Yes, consanguinity can lead to congenital
abnormalities.

Q: Many of us have an irregular daily routine and,

many times, we have to stay late at the office. Does
this affect our heart?
A: When you are young, nature protects you against
all these irregularities. However, as you grow older,
you should pay more respect to your biological clock.

Q: Will taking anti-hypertensive drugs cause some

other complications (short / long term)?
A: Yes, most drugs have some side effects. However,
modern anti-hypertensive drugs are extremely safe.
Q: Will consuming more coffee/tea lead to heart
attacks?
A: No.
Q: Are asthma patients more prone to heart disease?
A: No.
Q: How would you define junk food?
A: Fried food like Kentucky, McDonalds, samosas,
and even masala dosas.
Q: You mentioned that Indians are three times more
vulnerable. What is the reason for this, as Europeans
and Americans also eat a lot of junk food?
A: Every race is vulnerable to some disease and
unfortunately; Indians are vulnerable for the most
expensive disease.
Q: Does consuming bananas help reduce
hypertension?
A: No.

Q: Do, in any way, low white blood cells and low

hemoglobin count
lead to heart problems?
A: No. But it is ideal to have normal hemoglobin level
to increase your exercise capacity.
Q: Sometimes, due to the hectic schedule we are not
able to exercise. So, does walking while doing daily
chores at home or climbing the stairs in the house,
work as a substitute for exercise?
A: Certainly. Avoid sitting continuously for more than
half an hour and even the act of getting out of the chair
and going to another chair and sitting helps a lot.
Q: Is there a relation between heart problems and
blood sugar?
A: Yes. A strong relationship since diabetics is more
vulnerable to heart attacks than non-diabetics.
Q: What are the things one needs to take care of
after a heart
operation?
A: Diet, exercise, drugs on time. Control cholesterol,
BP, weight.
Q: Are people working on night shifts more
vulnerable to heart disease when compared to day
shift workers?
A: No.
Q: What are the modern anti-hypertensive drugs?
A: There are hundreds of drugs and your doctor will
chose the right combination for your problem, but my
suggestion is to avoid the drugs and go for natural ways
of controlling blood pressure by walk, diet to reduce
weight and changing attitudes towards lifestyles.
Q: Does dispirin or similar headache pills increase
the risk of heart attacks?
A: No.
Q: Why is the rate of heart attacks more in men than
in women?
A: Nature protects women till the age of 45.
Q: How can one keep the heart in a good condition?
A: Eat a healthy diet, avoid junk food, exercise
everyday, do not smoke and, go for a health checkup if
you are past the age of 30 for at least once in two yrs.
And work very hard
SYMPTOMS OF THE DISEASE
Heart failure symptoms are traditionally
and somewhat arbitrarily divided into "left" and
"right" sided, recognizing that the left and right
ventricles of the heart supply different portions of the
circulation. However, heart failure is not exclusively
backward failure (in the part of the circulation which
drains to the ventricle).
There are several other exceptions to a
simple left-right division of heart failure symptoms.
Additionally, the most common cause of right-sided
heart failure is left-sided heart failure. The result is
that patients commonly present with both sets of signs
and symptoms.
Left-sided failure
The left side of the heart is responsible for receiving
oxygen-rich blood from the lungs and pumping it
forward to the systemic circulation (the rest of the body
except for the pulmonary circulation). Failure of the left
side of the heart causes blood to back up (be congested)
into the lungs, causing respiratory symptoms as well as
fatigue due to insufficient supply of oxygenated blood.
Common respiratory signs are increased rate of
breathing and increased work of breathing (non-specific
signs of respiratory distress). Rales or crackles, heard
initially in the lung bases, and when severe, throughout
the lung fields suggest the development of pulmonary
edema (fluid in the alveoli). Cyanosis which suggests
severe low blood oxygen, is a late sign of extremely
severe pulmonary edema.
Additional signs indicating left ventricular
failure include a laterally displaced apex beat (which
occurs if the heart is enlarged) and a gallop rhythm
(additional heart sounds) may be heard as a marker of
increased blood flow or increased intra-cardiac
pressure. Heart murmurs may indicate the presence of
valvular heart disease, either as a cause (e.g. aortic
stenosis) or as a result (e.g. mitral regurgitation) of the
heart failure.
Backward failure of the left ventricle causes
congestion of the lungs' blood vessels, and so the
symptoms are predominantly respiratory in nature.
Backward failure can be subdivided into the failure of
the left atrium, the left ventricle or both within the left
circuit. The patient will have dyspnea (shortness of
breath) on exertion and in severe cases, dyspnea at
rest. Increasing breathlessness on lying flat, called
orthopnea, occurs. It is often measured in the number of
pillows required to lie comfortably, and in orthopnea,
the patient may resort to sleeping while sitting up.
Another symptom of heart failure is paroxysmal
nocturnal dyspnea: a sudden nighttime attack of severe
breathlessness, usually several hours after going to
sleep. Easy fatigability and exercise intolerance are
also common complaints related to respiratory
compromise.
"Cardiac asthma" or wheezing may occur.
Compromise of left ventricular forward function
may result in symptoms of poor systemic circulation
such as dizziness, confusion and cool extremities at
rest.
Right-sided failure
Severe peripheral (pitting) edema
Right-sided heart failure is often caused by
pulmonary heart disease (cor pulmonale), which is
usually caused by difficulties of the pulmonary
circulation, such as pulmonary hypertension or
pulmonic stenosis.
Physical examination may reveal pitting
peripheral edema, ascites, and liver enlargement.
Jugular venous pressure is frequently assessed as a
marker of fluid status, which can be accentuated by
eliciting hepatojugular reflux. If the right ventricular
pressure is increased, a parasternal heave may be
present, signifying the compensatory increase in
contraction strength.
Backward failure of the right ventricle leads
to congestion of systemic capillaries. This generates
excess fluid accumulation in the body. This causes
swelling under the skin (termed peripheral edema or
anasarca) and usually affects the dependent parts of the
body first (causing foot and ankle swelling in people
who are standing up, and sacral edema in people who
are predominantly lying down). Nocturia (frequent
nighttime urination) may occur when fluid from the legs
is returned to the bloodstream while lying down at
night. In progressively severe cases, ascites (fluid
accumulation in the abdominal cavity causing swelling)
and liver enlargement may develop. Significant liver
congestion may result in impaired liver function
(congestive hepatopathy), and jaundice and even
coagulopathy (problems of decreased or increased blood
clotting) may occur.
Biventricular failure
Dullness of the lung fields to finger
percussion and reduced breath sounds at the bases of
the lung may suggest the development of a pleural
effusion (fluid collection between the lung and the chest
wall). Though it can occur in isolated left- or right-sided
heart failure, it is more common in biventricular failure
because pleural veins drain into both the systemic and
pulmonary venous systems. When unilateral, effusions
are often right sided.
If a person with a failure of one ventricle
lives long enough, it will tend to progress to failure of
both ventricles. For example, left ventricular failure
allows pulmonary edema and pulmonary hypertension
to occur, which increase stress on the right ventricle.
Right ventricular failure is not as deleterious to the
other side, but neither is it harmless.
 Heart failure

The major signs and symptoms of heart failure

Symptoms Shortness of breath, feeling tired, leg swelling

Duration Often lifelong

Causes Heart attack, high blood pressure, abnormal heart rhythm,

excessive alcohol use, infection, heart damage

Risk factors Smoking, sedentary lifestyle

Similar conditions Kidney failure, thyroid disease, liver disease, anemia, obesity[5]

Medication Diuretics, cardiac drugs

Frequency 40 million (2015), 2% of adults (developed countries)

Deaths 35% risk of death in first year

 CAUSES
CONGESTIVE HEART FAILURE
Heart failure may also occur in situations
of "high output" (termed "high-output heart failure"),
where the amount of blood pumped is more than is
typical and the heart is unable to keep up. This can
occur in overload situations (blood or serum infusions),
kidney diseases, chronic severe anemia, beriberi
(vitamin B1/thiamine deficiency), hyperthyroidism,
Paget's disease, arteriovenous fistulae, or
arteriovenous malformations.
Viral infections of the heart can lead to
inflammation of the muscular layer of the heart and
subsequently contribute to the development of heart
failure. Heart damage can predispose a person to
develop heart failure later in life and has many causes
including systemic viral infections (e.g., HIV),
chemotherapeutic agents such as daunorubicin and
trastuzumab, and abuse of drugs such as alcohol and
methamphetamine. Additionally, infiltrative disorders
such as amyloidosis and connective tissue diseases such
as systemic lupus erythematosus have similar
consequences. Obstructive sleep apnea (a condition of
sleep wherein disordered breathing overlaps with
obesity, hypertension, and/or diabetes) is regarded as
an independent cause of heart failure.

ACUTE DECOMPENSATION
Main article: Acute decompensated heart failure
Chronic stable heart failure may easily
decompensate. This most commonly results from an
intercurrent illness (such as pneumonia), myocardial
infarction (a heart attack), abnormal heart rhythms,
uncontrolled hypertension, or a patient's failure to
maintain a fluid restriction, diet, or medication. Other
well recognized factors that may worsen CHF include the
following: anemia and hyperthyroidism which place
additional strain on the heart muscle, excessive fluid or
salt intake, and medication that causes fluid retention
such as NSAIDs and thiazolidinediones. NSAIDs in
general increase the risk twofold.
 BIBLOGRAPHY

https://en.wikipedia.org /wiki/Main Page

www.heart.org/HEARTORG/.../Heart
Failure/HeartFailure_UCM_002019_SubHomeP

https:// www
.webmd.com/heartdisease/guide-heart-failure

https://mwww.bhf.org.uk/hearthealth/conditio
ns/heart-failure

www.google.com

School Library