 Welcome to this short talk, hopefully, about heart health, heart disease, what is it, and how to prevent it. But before that, I would like to welcome people here and also who are watching online to the first medical day at MCC. And I would like to thank the Muslim Medical Student Association for organizing this day. The volunteer physicians who also joined today and also for MCC staff that made this happen. So thank you all. So, then to today's talk, we're going to be just an overview of heart health and heart disease. And we're talking, of course, here about physical, heart medical problem of the heart. Before we start with that, I'm just going to, this is a cartoon, just kind of an overview of the heart and the blood vessels, the circulatory system or the cardiovascular system. The main function of the heart is to deliver oxygenated blood, oxygen and nutrient to the rest of the body. And the heart is a small, relatively small organ the size of the fist. It beats 100,000 times an average a day. That's come to 36 million beats a year. So it works nonstop from the day we're going to start in utero before we're born until death. So to do that, the heart has to receive the blood from the body, then push the blood to the lungs and receive, get oxygenated, receive it back and then push it again out to the rest of the body. To be able to do that, the heart kind of have four chambers separated from each other. There is a set of flaps of tissue or valves that direct the blood one direction. And interestingly, although the heart contains the blood, but it can't use that blood for its own use. So it has its own set of blood vessels. So what kind of heart problem we could think of? So if the heart muscle itself is too weak or too stiff, that's when people have congestive heart failure or heart failure. One of the valves is too narrowed or too leaky. That's when you have a blocked valve or a leaky valve. And the other set of diseases of the heart, the blood supply of the heart itself. It's called the coronary arteries. And the blood supplies of the heart itself, if they have a blockage in them or a problem of them, that's when people have chest pain, heart attacks and so on. Another set of heart problems, potential heart problems, is electrical issues of the heart. The heart has to be continuously as we said. So it has its own natural base maker. So if any problem with that, we end up having a problem with too fast heart rate, too slow heart rate, or irregular heart rates. So this is just an overview of the heart physiology or normal function. Another big word is atherosclerosis, which means it's hardening of the artery due to buildup of cholesterol of black inside the blood vessels. On the right side of the screen, the top panel says normal artery. You can see the normal arteries are usually thin, flexible. There is no black buildup inside them. So they allow unrestricted flow of blood to the organ supply. If the organ is the heart, then that is the coronary arteries that supply the heart itself. With people with high cholesterol, high blood pressure, diabetes and other risk factors, these small black buildup, cholesterol which attract inflammation as well, start building up inside the artery and over the years continue to grow until it kind of impairs blood flow to the heart itself. And if any of these cholesterol black kind of pierce into the blood flow or reach into the blood flow, it promotes blood clotting. And that's when a complete blockage happens and end up with a heart attack. So again, if this process, atherosclerosis or hardening of the arteries or a black buildup, if this happens in the arteries of the brain, that's when someone has a stroke, for example. If it's happened in the heart, that's when a heart attack or angina happens. If it happens in the leg, that's peripheral arterial disease or PAD when people kind of have pain when they're trying to exercise in the legs. So it is the same process, but it depends which area of the body it happens that when we see the specific symptoms. Now we're going to focus on the coronary artery disease. Coronary arteries are the arteries supplying the heart itself. And coronary artery disease is the narrowing of the coronary arteries where the blood supply to the heart is not enough to meet its demand. This can result in symptoms like chest pain, heart attack, heart failure, or sometimes heart rhythm problem. It is the most common type of heart disease. And as about 400,000 people die annually, that's related to the coronary artery disease. So heart attack is kind of the worst complication or the feared complication of coronary artery disease. A blood flow to the heart stops completely. It happens 800,000 people a year. And when it happens, time is muscle. That's kind of the, you need to have the artery open as soon as possible. The longer the artery is applied, the more damage to the heart is going to happen. Typical symptoms of a heart attack. The most common thing is chest pain. Some people kind of, that's not the main symptoms. They might have shortness of breath. Sometimes discomfort in the back, the jaws in the arms. Heart pain like symptoms. Sometimes dizziness, nausea, vomiting. So sometimes that does not, heart attack does not present with a typical severe chest pain that we all know about. So the message here, if you're suspecting you're having a heart attack, then you need to get to the hospital as soon as possible. Typically that's by calling 9-1-1. So hopefully we do want to deal with treating heart attacks or we'll work focus on more of preventing heart attack. And there's a lot of things we could do to prevent heart attacks. Avoid bad habits. Don't smoke. Adopt a heart-healthy eating plan. Manage stress. We can come back to that in a second. Exercise regularly. And part of what we're doing today in the medical day is knowing your numbers. Know what your blood pressure is because know what your cholesterol was, your sugar. Unfortunately, these three diseases, they don't cause symptoms until it is too late. So if you want to wait for someone to feel bad, sometimes it's too late. And get to a healthy body weight is also very important. Stress is recognized more recently as a major factor. And if you look at people with stressful jobs, physicians, one of those stressful jobs, you feel that the risk of heart disease has been higher with those. So always find a way to manage stress. Now, heart-healthy nutrition doesn't come in one prescription. So the idea is to eat a well-balanced diet. Avoid artificial food as much as possible. Eat a fresh food. Avoid fatty food, red meat, more vegetable protein, lean meat, or fish. Go from refined sugar, refined carbs to whole grains and kind of have a good mix of the verse on the left side from the Holy Qur'an, O believers, eat of the good and the pure that we have provided you with and be grateful to Allah if you truly worship Him. So the idea is to eat a healthy balanced diet and for each person that might mean different things. One thing, I mean, the two kind of component in our diet that affects kind of adversely the heart the most are the two whites, the sugar and the salt. And the sugar is what we talked about about the carbs, trying to avoid that as much as possible. And the other one is the salt. And a lot of time people with heart disease, we recommend for them a low sodium diet. The salt, the chemical in the salt, the table salt is the sodium chloride. So the low sodium diet is what we recommend usually. And luckily most foods are labeled for how much sodium to it, but sometimes it can be confusing. So you have from sodium free to reduced sodium and that could mean different things to different people. Usually we would want for people with heart disease depending on what the specific condition. We're talking about two to four grams a day, no more than that. And that's not easily we can get over that. What that ended up meaning not adding salt to the food at all and looking for ingredients when we buy stuff to make sure they're not high in sodium. So unfortunately some patients end up getting some heart disease whether it's a blockage in the heart or angina or a heart attack. So the treatment, the first step in treatment also is lifestyle changes. So you want to address those two. There are certain medications that can be used to treat, for example, high blood pressure, treat diabetes, treat high cholesterol and make sure these numbers are under control. And for good proportion of people this would be enough to control the problem. But unfortunately some patients will need procedures done. So some probably heard about the stints. Balloon angioplasty tried to open the artery and place a stint to keep the artery open. And for some people even that is not enough and the patient ended up needing open heart surgery. One of the medication we commonly use for heart disease is the aspirin. And the last few years there was some controversy about aspirin especially in the media. So it's not for the kind of the medical literature but in the media. So aspirin, if someone has heart disease, heart attack, previous stint, previous heart surgery or previous stroke or the doctor recommend being an aspirin it is very good medicine and we use it a lot and it decrease the risk of heart attack and strokes. The only group of patients that's kind of they don't have to take aspirin if people who never had a heart attack, a stroke or by bad surgery or a stint basically previously healthy and they're taking it only for prevention in this kind of situation they don't have to take the aspirin. But if you are on aspirin because your doctor recommended it or because you have one of those procedures it would be very dangerous to stop it without talking with your physician. I think that's everything I have. I thank you for attending and I wonder if anybody in the room have any questions? Yes. Yes, we'll start with the caffeine. I mean among the many kind of habits or the drinks we do caffeine is probably the least harmful. In fact, coffee in moderation might be helpful as well. I would say that with a caffeine coffee is not the same thing as the drink you get from Starbucks with 400, 600 or sometimes 1,000 calories in it. So talking about caffeine by itself has been shown, I mean again when studying things like diet and people do kind of you can't control it very well but it seems to be definitely not harmful and in moderation it might be helpful as well for heart health. As far as the stints the stint available right now they don't have any biological material so they are the metal platform and then one of the a version of anti-medication to prevent silicone so it's not nothing with it kind of come from animal source. So they're kind of halal if you think that way. The other question we get about that is heart valves. So we said some of the people with heart valve they need the valve replaced and the replacement it ended up being either a metal valve or a tissue valve and the tissue valve usually either comes from fashioned from tissues from cow or tissues from pig. So the one from the pig if the other one is available and there is equivalent there is not the pig valves are not any better than the other ones so if you have the choice between the two then probably the divine one would be more aligned with our kind of religious beliefs. So the question was about how we focus about high blood pressure but also there are some people who have low blood pressure and that's a very good question. So there is two group of people we have noticed low blood pressure either young people or young women sometimes their blood pressure run in the low side as long as they're not having dizziness basically not having symptoms and functioning normally people could have a lower blood pressure in the 90s for example and typically we don't do anything for that so if there is no symptoms and the functioning normally we didn't have not doing we don't give medication to the raise of blood pressure. The other group of people we see that is older patients and they have what we call orthostatic hypertension or low blood pressure when they stand up they will be blood pressure okay at rest they stand up they feel dizzy and light-headed and that's because the communication between the brain and the heart is slowed down and that's one of those things sometimes difficult to kind of treat but with adequate hydration and certain medication that we could help it depend on the situation but as a general rule if you're not having symptoms even if the blood pressure is low usually we don't treat that any other questions well thank you very much and I think the medical day still going until 6 p.m. is alright so it would come any time yes until 5 p.m. sorry so we're still at MCC and at Pleasanton until 5 p.m. today thank you very much