SREE CHITHIRA THIRUNAL RESIDENTIAL CENTRAL SCHOOL, KUNNATHUKAL, KARAKONAM P.

O, TRIVANDRUM

BIOLOGY PROJECT

Name: ABHIJITH.J.B Class: XII Reg No:

Cardiac Disease

CERTIFICATE
This is to certify the project entitled CARDIAC DISEASES being submitted by ABHIJITH.J.B of this school is bonafide record of the work done by him under my supervision and guidance with his own effort and has not been submitted anywhere else.

Examiner

Teacher in charge

Head of the institution

DECLARATION
I ABHIJITH.J.B of class XII Sree Chithira Thirunal Residential Central School Kunnathukal,Karakonam P.O hereby declare that the report presented here is the original report of the work done by myself for the fulfillment of AISSCE March 2012 biology practical examination has not been submitted anywhere else.

Kunnathukal 2012

ABHIJITH J B XII

Acknowledgment
I have taken efforts in this project. However, it would not have been possible without the kind support and help of many individuals and organizations. I would like to extend my sincere thanks to all of them. I am highly indebted to biology sir Mr. VINOD.S for his guidance and constant supervision as well as for providing necessary information regarding the project & also for his support in completing the project. I would like to express my gratitude towards my parents & member of my group Akash for his kind co-operation and encouragement which helped me in completion of this project. .I also thank our principal Smt. S.PUSHPAVALLY for providing me all the facilities to finish the project on time. I would like to express my special gratitude and thanks to the institution for giving me such attention and time. My thanks and appreciations also go to my friends in developing the project and people who have willingly helped me out with their abilities.

CONTENTS
1. 2. 3. 4. 5. 6. 7. 8. 9. INTRODUCTION CAUSES OF CARDIAC DISEASE RISK FACTORS FOR CARDIAC DISEASE SYMPTOMS OF CARDIAC DISEASES TYPES OF CARDIAC DISEASES CARDIAC DISEASE TEST TREATMENT REDUCING RISKS OF CARDIAC DISEASE CONCLUSION 10.BIBLIOGRAPHY

INTRODUCTION
The heart is like any other muscle, requiring blood to supply oxygen and nutrients for it to function. The heart's needs are provided by the coronary arteries, which begin at the base of the aorta and spread across the surface of the heart, branching out to all areas of the heart muscle. Heart disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina. A heart attack or myocardial infarction occurs when a plaque ruptures, allowing a blood clot to form. This completely obstructs the artery, stopping blood flow to part of the heart muscle, and that portion of muscle dies. As of 2007, it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.

Causes of Cardiac disease

The heart is a muscle that requires a steady supply of oxygen in order to pump blood effectively through the body. Oxygen is supplied to the heart by blood that flows through the coronary arteries. Some types of heart disease damage or block the coronary arteries and the flow of oxygen to the heart. Other forms of heart disease damage or impair the functioning of the heart and blood vessels. These disorders include:
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Abnormal electrical conduction in the heart causing cardiac arrhythmias or abnormal heart rhythms. These include ventricular tachycardia, heart blocks, ventricular fibrillation, a systole, supraventricular tachycardia, and bradycardia. Atherosclerosis, a buildup of plaque on the walls of the coronary arteries. Atherosclerosis narrows the coronary arteries and results in angina. It can also lead to the formation of a blood clot that blocks blood flow to the heart (heart attack). Birth defects, also called congenital heart or blood vessel defects. These include atrial septal defect, coarctation of the aorta, and atrioventricular septal defect. Heart damage, such as heart failure or cardiomyopathy, that weakens the pumping action of the heart Heart valve abnormalities, which are also called heart valve disorders. Heart valve disorders include mitral valve insufficiency, mitral valve prolapse, mitral valve stenosis, tricuspid valve insufficiency, and tricuspid valve stenosis.

Risk factors for Cardiac disease

Risk factors for heart disease include:
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Smoking High blood pressure (hypertension) High cholesterol Diabetes Family history Peripheral artery disease Obesity Long-term stress

Symptoms of Cardiac disease

The typical symptoms of coronary artery disease are associated chest pain with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of presentations, and there may not even be specific chest pain. There may be shoulder or back ache, nausea, indigestion or upper abdominal pain. Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue. Healthcare providers and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain. People with coronary artery disease usually have gradual progression of their symptoms over time. As an artery narrows over time, the symptoms that it causes may increase in frequency and/or severity. Healthcare providers may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?) and whether there has been an acute change in the symptoms. Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care

Types of Cardiac Diseases

 Coronary heart disease
Coronary heart disease refers to the failure of the coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. Coronary heart disease is most commonly equated with Coronary artery disease although coronary heart disease can be due to other causes, such as coronary vasospasm. Coronary artery disease is a disease of the artery caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium. Angina pectoris (chest pain) and myocardial infarction (heart attack) are symptoms of and conditions caused by coronary heart disease. Over 459,000 Americans die of coronary heart disease every year. In the United Kingdom, 101,000 deaths annually are due to coronary heart disease.

 Cardiomyopathy
Cardiomyopathy literally means "heart muscle disease" (Myo= muscle, pathy= disease) It is the deterioration of the function of the myocardium (i.e., the heart muscle) for any reason. People with cardiomyopathy are often at risk of arrhythmia and/or sudden cardiac death.
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Extrinsic cardiomyopathies cardiomyopathies where the primary pathology is outside the myocardium itself. Most cardiomyopathies are extrinsic, because by far the most common cause of a cardiomyopathy is ischemia. Intrinsic cardiomyopathies weakness in the muscle of the heart that is not due to an identifiable external cause.

 Cardiovascular disease
Cardiovascular disease is any of a number of specific diseases that affect the heart itself and/or the blood vessel system, especially the veins and arteries leading to and from the heart. Research on disease dimorphism suggests that women who suffer with cardiovascular disease usually suffer from forms that affect the blood vessels while men usually suffer from forms that affect the heart muscle itself. Known or associated causes of cardiovascular disease include diabetes mellitus, hypertension, hyperhomocysteinemia and hypercholesterolemia.

 Ischaemic heart disease

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Ischaemic heart disease another disease of the heart itself, characterized by reduced blood supply to the organs.

 Heart failure
Heart failure, also called congestive heart failure (or CHF), and congestive cardiac failure (CCF), is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. Therefore leading to the heart and body's failure.

 Hypertensive heart disease

Hypertensive heart disease is heart disease caused by high blood pressure, especially localized high blood pressure. Conditions that can be caused by hypertensive heart disease include:
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Left ventricular hypertrophy Coronary heart disease (Congestive) heart failure Hypertensive cardiomyopathy Cardiac arrhythmias

 Inflammatory heart disease

Inflammatory heart disease involves inflammation of the heart muscle and/or the tissue surrounding it.
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Endocarditis inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves. Inflammatory cardiomegaly Myocarditis inflammation of the myocardium, the muscular part of the heart.

 Valvular heart disease

Valvular heart disease is disease process that affects one or more valves of the heart. There are four major heart valve which may be affected by valvular heart disease, including the tricuspid and aortic valves in the right side of the heart, as well as the mitral and aortic valves in the left side of the heart.

Cardiac disease tests

The diagnosis of heart disease begins with obtaining a history that the potential for coronary artery disease exists. Risk factors need to be assessed, and then testing may be required to confirm the presence of heart disease.

o Electrocardiogram (ECG or EKG)

The heart is an electrical pump, and the electrical impulses it generates can be detected on the surface of the skin. Normal muscle conducts electricity in a reproducible fashion. Muscle that has decreased blood supply conducts electricity poorly. Muscle that has lost its blood supply and has been replaced with scar tissue cannot conduct electricity. The electrocardiogram (EKG) is a noninvasive test used to reflect underlying heart conditions by measuring the electrical activity of the heart. Some people have "abnormal" EKGs at baseline but this may be normal for them. It is important that an electrocardiogram be compared to previous tracings. If a patient has a baseline abnormal EKG, they should carry a copy with them for reference if they ever need another EKG.

o Stress testing
If the baseline EKG is relatively normal, then monitoring the EKG tracing while the patient exercises may uncover electrical changes that may indicate the presence of coronary artery disease. There are a variety of testing protocols used to determine whether the exercise intensity is high enough to prove that the heart is normal. Some patients are unable to exercise on a treadmill test, but they can still undergo cardiac stress testing by using intravenous medication that causes the heart to work harder. Stress testing is done under the supervision of medical personnel because of the p otential of provoking angina, shortness of breath, abnormal heart rhythms, and heart attack.

TREATMENTS
Medical Treatment
Medical treatment may be started immediately, before a definite diagnosis of a heart problem is made. General treatment measures include the following:
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Oxygen through a tube in the nose or face mask Nitro-glycerine under the tongue Pain medicines (morphine or meperidine) Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).

Clot-dissolving medicines: The tissue plasminogen activators (tPAs) can actually dissolve clots in some circumstances.
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The earlier these drugs are given, the better the chance of opening the blocked artery and of protecting the cardiac muscle from further injury. If more than 6 hours has passed since the onset of chest pain, these drugs are less helpful. Potential risks of this therapy include bleeding. The most serious risk is a stroke (bleeding into the brain).

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Angioplasty: Emergency coronary angiography and coronary balloon angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) are available in hospitals equipped with a full-service cardiac catheterization laboratory. This is the most direct method of relieving blockage in a coronary artery.
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Coronary balloon angioplasty is an extension of coronary angiography. A long, thin tube (catheter) is inserted in an artery in the groin or arm. At the tip of the catheter is a tiny, elongated balloon, which is threaded over a hairthin guide wire into the narrowed coronary artery. Once the balloon is positioned at the blockage in the coronary artery, it is inflated. The balloon pushes aside the plaque and clot that are blocking the artery, allowing blood to flow more freely. The balloon is then deflated and removed with the catheter.

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Stenting: A stent is a small, spring like device that may be inserted into a coronary artery after balloon angioplasty. After the catheter and balloon are removed, the stent stays in place, holding the artery open. A stent is better than angioplasty alone at keeping the artery from narrowing again. Atherectomy: Sometimes the plaques are too rigid, bulky, or calcified to be treated by balloon angioplasty. In these cases, the plaque often can be removed by cutting it out with a drill-like rotary blade or a laser or other tool.

Surgery
Sometimes cardiac catheterization reveals extensive coronary artery disease. In such cases, you will need to undergo coronary bypass surgery.
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Standard coronary artery bypass grafting (CABG) is performed if many coronary arteries are narrowed or blocked. This is especially recommended when the left main coronary artery shows significant blockage. This is "open heart surgery," meaning that the chest wall is opened. When performing a bypass, heart surgeons use sections of the mammary artery from the chest or veins from the legs to create detours around the blocked arteries. For this surgery, you will be connected to a bypass pump, which does the work of the heart during the operation. Although this sounds dangerous, this surgery is considered very safe and has a very low rate of complications. Off-pump bypass surgery: Sometimes the surgeon can perform open heart surgery without using a bypass pump. The heart continues to beat during surgery. This type of surgery has even fewer complications than the standard procedure but is not always feasible. Minimally invasive coronary bypass: If just the front or the right coronary artery needs bypass, the bypass may be performed via a small keyhole-type incision without a large incision in the chest. The internal mammary artery is used for the bypass.

Reducing risk of Cardiac disease

Not all people who are at risk for heart disease will develop heart disease, and not all people who develop heart disease have risk factors. You can reduce your risk of some forms of heart disease by:
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Eating a diet that is low in saturated fat and high in fiber, whole grains, fruits, and vegetables Maintaining a healthy weight Not drinking alcohol or limiting alcohol consumption to one drink per day for women and two drinks per day for men Not smoking or quitting smoking Participating in a regular exercise program Reducing excessive stress Seeking regular medical care and following your treatment plan for such conditions as high cholesterol, hypertension and diabetes

CONCLUSION
we have examined quality improvement in the area of cardiovascular disease (CVD). To be effective in the primary and secondary prevention of CVD, health care organizations should be aware of the concept of overall cardiovascular risk, which takes into account the combined impact of multiple cardiovascular risk factors. This concept is based on findings from the Framingham Heart Study, which brought to light the clustering of cardiovascular risk factors, the multiplicative impact of multiple risk factors, and the substantial risk imparted by even mild-to-moderate levels of multiple risk factors. Although the quality of cardiovascular care has been steadily improving, there is still a gap between how cardiovascular care is generally practiced and how it should be practiced, particularly for patients with multiple risk factors. The more risk factors a patient has, the less likely it is that all of the risk factors will be in control. In their role as managers of health care for millions of Americans, health plans can use their expertise and resources to conduct quality improvement (QI) initiatives that will improve the health care management of patients with multiple cardiovascular risk factors.

BIBLIOGRAPHY
1. www.google.co.in 2. www.wikipedia.com 3. "WHO Disease and injury country estimates". World Health

Organization. 2009.
4. http://www.who.int/healthinfo/global_burden_disease/estimates_cou

ntry/en/index.html. Retrieved Nov. 11, 2009.

5. www.ias.ac.in 6. www.medicinenet.com 7. Britanica Encyclopedia