A fairly large number of elderly patients suffer from ischemic heart Disease (IHD). The IHD manifests in many ways ranging from totally symptomless or occasional chest pain, to Myocardial infarct. And these patients will follow up with you for many long years. Some of these patients may undergo coronary angiography and a definitive procedure like Angioplasty or Bypass Surgery. But a large number will remain under Medical treatment for various reasons:
The patient may not afford the surgery.
The patient may refuse invasive procedure. Especially in the elder age group, and specially after an infarct has occurred
The patient may be unfit for the surgery.
Some of this patient does meet n early death. But, most patient s will do very well with medical treatment and change of lifestyle, and under the guidance of cardiologist, you should be able to take good care of these patients. This also holds true fore the patients undergoing angioplasty or Bypass surgery, as they to follow the same treatment, to prevent reocclusion of the grafts and vessels.It is scientifically proved by Dr.dean ornish, that in many instance, you may be able to reverse the atherosclerotic blocks or develop good collateral circulation. This means that the medical treatment can be not just preventive but also curative!The treatment is a five-step approach to the disease:
Exercise.
Stress management
Low fat diet
Elimination of known risk factors.
Drugs.
Now we will discuss each in details. 1.Exercise :Brisk walking for 45 minute every day, at least 5 days a week. Walking is the best aerobic exercise for IHD. Yogasanaas, to relax and stretch various muscles. These should be learnt under the guidance of an expert, and also after discussing with the physician as to which exercises and asanaas are permitted to their specific heart condition. Pranayam: the breath control exercise should be learnt under expert guidance. In its simplest form, i.e. Deep breathing: Sit comfortably. Take slow inspiration over 4-5 seconds. Then release the air slowly over 6-10 seconds. Concentrate only on the sound of breathing and practice for 10 minutes. In severe heart disease, isometric exercises like pull ups, Bull worker, weight lifting and complicated Asanaas are contraindicated. So also, strenuous aerobic exercises like jogging, swimming mountain climbing may not be advisable. If you don’t have an expert guidance, walking remains the best and safest exercise.2.Stress management :Medication for 15 minutes everyday. The aim s to blank the mind from the tensions of daily life, thinks positively about your own health, and thinks positively about your own life. One of the ways is to think the god. Another way is to imagine blank white curtain before the eyes and visualize the blocked vessels getting cleared.One may for learning the techniques of stress management.It is also important to understand that at this age, small matters and disagreements in family life should not be taken so seriously as to affect your own health. Own must learn to live with a relaxed mind. 4.low fat diet : The aim is to keep Serum cholesterolbelow 200mg%HDLabove 45mg%LDLbelow 130mg5(see table below)Less than 10% of the day’s calorie intake should from fats. (that too form unsaturated fats)Absolute "No" to cholesterol rich food items. i.e.In vegetarian diet – Butter, ghee, cheese, unskimmed milk, saturated oils (Dalda, Vanaspati oil, coconut oil), oil seed nuts, deep fried foods (Poories, Bhujees, potato chips etc.)In Non-vegetarian diet – Yellow of the egg or whole egg, Red meat, Marbled beef, Duck, goose, Regular Hamburger & sausages, deep-fried fish.
Risky Levels
Healthy Levels
For High Risk patients
s.cholesterol
>240mg%
<200mg%
<150mg%
HDL
<35%
>45%
>45%
LDL
>160mg%
130mg%
100mg%
S.Triglycerides
>200mg%
150-200mg%
<150mg%
Tab. Aspirin 150mg. once a day, after meals. (anti-platelet)Tab. Lovastatin 5-10 mg. once a day after night meal. (Statin: controls hyperlipidemia and is supposed to stabilize the atherosclerotic plaques, preventing plaque rupture which is the cause of infarct)Tab. Ramipril 1.25mg. Once a day. (ACE inhibitor and also supposed to stabilize atherosclerotic plaques)Tab. Antoxid 1 daily. (anti- oxidant = vitamin # 400 iu/day, Vitamins C & A, trace elements – Zinc & selenium, Beta-carotene, omega-3 fatty acids,)The above drugs are of preventive importance in IHD and should be prescribed whenever the patient can afford them. If not, then prescribe only aspirin 150mg. per day, That’s enough!Coronary vasodilators should be used when patient is symptomatic – Tab. Ismo 20mg 1-1-0Tab. Isordil 10mg. or Tab. Angised to be taken sublingually if there is anginal pain. Keep the vasodilator tablets at hand – in the bedroom, in the bathroom, at the office, in travel kits etc it is also very important that the relatives know where the tablets will always be found in case of emergency.In case of emergency, i.e. severe chest pain, or suspected heart attack, take 1-2 tablets of sorbitrate (or nitroglycerine) sublingually, and one tablet of Aspirirn (Soluble tablet) sublingually.Tab. Aspirin 150mg. once a day, after meals. (anti-platelet)Tab. Lovastatin 5-10 mg. once a day after night meal. (Statin: controls hyperlipidemia and is supposed to stabilize the atherosclerotic plaques, preventing plaque rupture which is the cause of infarct)Tab. Ramipril 1.25mg. Once a day. (ACE inhibitor and also supposed to stabilize atherosclerotic plaques)Tab. Antoxid 1 daily. (anti- oxidant = vitamin # 400 iu/day, Vitamins C & A, trace elements – Zinc & selenium, Beta-carotene, omega-3 fatty acids,)The above drugs are of preventive importance in IHD and should be prescribed whenever the patient can afford them. If not, then prescribe only aspirin 150mg. per day, That’s enough!Coronary vasodilators should be used when patient is symptomatic – Tab. Ismo 20mg 1-1-0Tab. Isordil 10mg. or Tab. Angised to be taken sublingually if there is anginal pain. Keep the vasodilator tablets at hand – in the bedroom, in the bathroom, at the office, in travel kits etc it is also very important that the relatives know where the tablets will always be found in case of emergency.In case of emergency, i.e. severe chest pain, or suspected heart attack, take 1-2 tablets of sorbitrate (or nitroglycerine) sublingually, and one tablet of Aspirirn (Soluble tablet) sublingually.Tab. Aspirin 150mg. once a day, after meals. (anti-platelet)Tab. Lovastatin 5-10 mg. once a day after night meal. (Statin: controls hyperlipidemia and is supposed to stabilize the atherosclerotic plaques, preventing plaque rupture which is the cause of infarct)Tab. Ramipril 1.25mg. Once a day. (ACE inhibitor and also supposed to stabilize atherosclerotic plaques)Tab. Antoxid 1 daily. (anti- oxidant = vitamin # 400 iu/day, Vitamins C & A, trace elements – Zinc & selenium, Beta-carotene, omega-3 fatty acids,)The above drugs are of preventive importance in IHD and should be prescribed whenever the patient can afford them. If not, then prescribe only aspirin 150mg. per day, That’s enough!Coronary vasodilators should be used when patient is symptomatic – Tab. Ismo 20mg 1-1-0Tab. Isordil 10mg. or Tab. Angised to be taken sublingually if there is anginal pain. Keep the vasodilator tablets at hand – in the bedroom, in the bathroom, at the office, in travel kits etc it is also very important that the relatives know where the tablets will always be found in case of emergency.In case of emergency, i.e. severe chest pain, or suspected heart attack, take 1-2 tablets of sorbitrate (or nitroglycerine) sublingually, and one tablet of Aspirirn (Soluble tablet) sublingually.
Avoid alcohol, which increases Triglyceride levels.Avoid caffeine.Avoid TobaccoWhat to take?-More of soups (Tomato, Vegetable, corn), but without butter.-Plenty of salads of uncooked or boiled vegetable like leafy vegetables, Cabbage, cauliflower, Tomato, cucumber, carrot etc.-Sprouted pulses (raw). These should from a major part of the meal and should provide the bulk that give satiety of a meal More -More of Bhajis prepared with minimum or "No" oil, from vegetable like Lady’s finger, Brinjal, Tomato, Cabbage, Cauliflower, Green leafy vegetables (like spinach), Radish, Pumpkin, tondle, Dodka, etc. -Roti or Phulka without oil-Daals – Pulses & legumes,-Skimmed milk upto 1 cup per day,-Margarine (limited) instead of butter,-Fruits-Items that actually help to reduce cholesterol – onion, Garlic (Lasson), soya bean, Curds of skimmed milk, Apple. -Tea or coffee should be taken plain, without milk (as milk destroys the falvonoids in them)In non-vegetarian food, flesh food should be limited to less than 100g/day.-Fish, Turkey, white of the egg.-Limited quantities of lean meat, chicken, lamb or pork after all visible fat is trimmed.Limited use of monounsaturated oils - Olive oil, Groundnut oil, Mohari oil, Canola oil. Limited use of Polyunsaturated oils – Sunflower oil, Corn oil, Karadai oil. Do not take saturated oils – Coconut oil, Dalda, Butter, and Ghee.Remember that even the unsaturated oils do contain a certain percentage of saturated oils. So overall, the intake of oils should be restricted 2 tsp per day. Secondly, never heat oil twice. Twice heated oil is rich in free radicals.Increase the fibre intake, as fibers reduced the cholesterol absorption from the gut and give early satiely. Eat more vegetable & fruits. Fruits with edible covers should be eaten with the covers Elimination of known risk factors : Smoking is single most important risk factor for IHD, which must be stopped altogether, passive smoking (sitting near a smoker) has an equal risk as smoking. Obesity :Weight reduction to ideal weight as per Body mass index i.e. weight (in kg) divided by (height in meters)2 should be between 18.5 to 25.The presence of IHD is a signal that you are overweight, and except in a thin patient, the body weight must be reduced by at least 10% within a span of 2-3 months and maintained so. For example, if the patient’s weight 65kg. At the time of infarct or detection of IHD, let it come down to 58kg. If it is 75kg let it come down to 65kg. If patient is grossly overweight, then calculate the body mass index as given above. (for details refer chapter on obesity)Diabetes: should be strictly controlled.
Avoid mental strains, through relaxation, and if possible, change of job
Tab. Aspirin 150mg. once a day, after meals. (anti-platelet)Tab. Lovastatin 5-10 mg. once a day after night meal. (Statin: controls hyperlipidemia and is supposed to stabilize the atherosclerotic plaques, preventing plaque rupture which is the cause of infarct)Tab. Ramipril 1.25mg. Once a day. (ACE inhibitor and also supposed to stabilize atherosclerotic plaques)Tab. Antoxid 1 daily. (anti- oxidant = vitamin # 400 iu/day, Vitamins C & A, trace elements – Zinc & selenium, Beta-carotene, omega-3 fatty acids,)The above drugs are of preventive importance in IHD and should be prescribed whenever the patient can afford them. If not, then prescribe only aspirin 150mg. per day, That’s enough!Coronary vasodilators should be used when patient is symptomatic – Tab. Ismo 20mg 1-1-0Tab. Isordil 10mg. or Tab. Angised to be taken sublingually if there is anginal pain. Keep the vasodilator tablets at hand – in the bedroom, in the bathroom, at the office, in travel kits etc it is also very important that the relatives know where the tablets will always be found in case of emergency.In case of emergency, i.e. severe chest pain, or suspected heart attack, take 1-2 tablets of sorbitrate (or nitroglycerine) sublingually, and one tablet of Aspirirn (Soluble tablet) sublingually.
