What are the different types of diabetes?

There are three main types of diabetes.
In type 1 diabetes, the cells in the pancreas that make insulin are destroyed. If you have type 1 diabetes, you need to get insulin from shots or a pump everyday. Most teens can learn to adjust the amount of insulin they take according to their physical activity and eating patterns. This makes it easier to manage your diabetes when you have a busy schedule. Type 1 used to be called “insulin dependent” or “juvenile” diabetes.

In type 2 diabetes, the pancreas still makes some insulin but cells cannot use it very well. If you have type 2 diabetes, you may need to take insulin or pills to help your body’s supply of insulin work better. Type 2 used to be called “adult onset diabetes.” Now more teens are getting type 2, especially if they are overweight.

Gestational (jes-TAY-shon-al) diabetes is a type of diabetes that occurs when women are pregnant. Having it raises their risk for getting  diabetes, mostly type 2, for the rest of their lives. It also raises their child’s risk for being overweight and for getting type 2 diabetes.

What do I need to do to take care of my diabetes?

The key to taking care of your diabetes is to keep your blood glucose as close to normal as possible.
The best way to do this is to:
• make healthy food choices
• eat the right amounts of food
• be active everyday
• stay at a healthy weight
• take your medicines and check your blood glucose as planned with your health care team

Your doctor will tell you what blood glucose level is right for you. Your goal is to keep your blood glucose as close to this level as you can. Your doctor or diabetes educator will teach you how to check your blood glucose with a glucose meter.

It helps to know what affects your blood glucose level. Food, illness, and stress raise your blood glucose. Insulin or pills and being physically active lower your blood glucose. Talk with your doctor or diabetes educator about how these things change your blood glucose levels and how you can make changes in your diabetes plan.

Carbohydrates (CAR-boh-HY-drates), or carbs for short, are a good source of energy for our bodies. But if you eat too many carbs at one time, your blood glucose can get too high. Many foods contain carbs. Great carb choices include whole grain foods, nonfat or low-fat milk, and fresh fruits and vegetables. Eat more of them rather than white bread, whole milk, sweetened fruit drinks, regular soda, potato chips, sweets, and desserts.

What is Autoimmune Diabetes Mellitus?

This form of diabetes, previously encompassed by the terms insulin–dependent diabetes, Type 1 diabetes, or juvenile– onset diabetes, results from autoimmune mediated destruction of the beta cells of the pancreas. The rate of destruction is quite variable, being rapid in some individuals and slow in others. The rapidly progressive form is commonly observed in children, but also may occur in adults. The slowly progressive form generally occurs in adults and is sometimes referred to as latent autoimmune diabetes in adults (LADA). Some patients, particularly children and adolescents, may present with ketoacidosis as the first manifestation of the disease. Others have modest fasting hyperglycaemia that can rapidly change to severe hyperglycaemia and/or ketoacidosis in the presence of infection or other stress. Still others, particularly adults, may retain residual beta–cell function, sufficient to prevent ketoacidosis, for many years. Individuals with this form of Type 1 diabetes often become dependent on insulin for survival eventually and are at risk for ketoacidosis. At this stage of the disease, there is little or no insulin secretion as manifested by low or undetectable levels of plasma C–peptide.

Markers of immune destruction, including islet cell autoantibodies, and/or autoantibodies to insulin, and autoantibodies to glutamic acid decarboxylase (GAD) are present in 85–90 % of individuals with Type 1 diabetes mellitus when fasting diabetic hyperglycaemia is initially detected. The peak incidence of this form of Type 1 diabetes occurs in childhood and adolescence, but the onset may occur at any age, ranging from childhood to the ninth decade of life. There is a genetic predisposition to autoimmune destruction of beta cells, and it is also related to environmental factors that are still poorly defined. Although patients are usually not obese when they present with this type of diabetes, the presence of obesity is not incompatible with the diagnosis. These patients may also have other autoimmune disorders such as Graves’ disease,
Hashimoto’s thyroiditis, and Addison’s disease.

How To Reduce High Blood Fat Levels

Blood fats, or lipids, include cholesterol and triglycerides. The body needs a certain amount of cholesterol, but when there are too many fats in the blood (hyperlipidaemia), fatty deposits build up in the arteries, increasing the risk of heart attacks and strokes.

“Good” and “bad” cholesterol:
Cholesterol cannot dissolve in blood, so it needs “carrier” proteins to transport it around the body. The carrier proteins are called lipoproteins.

There are two main kinds:
High density lipoprotein (HDL): When cholesterol is carried by HDL, it is called HDL cholesterol. This is “good” cholesterol, and reduces the risk of heart disease and strokes.

Low density lipoprotein (LDL): When cholesterol is carried by LDL, it is called LDL cholesterol. This is “bad” cholesterol, and increases the risks of heart attacks and strokes.

What causes high blood fat levels?
High cholesterol levels may run in some families. But most often, high blood fat levels are caused by an unhealthy diet and lack of physical activity. High blood fat levels rarely produce symptoms or warning signs. When cholesterol levels are very high, some people develop skin growths called xanthomas. To check your blood fat levels, ask your doctor for a simple blood test.

In some cases, a high blood fat level may be associated with an undiagnosed medical condition, like diabetes.

What should I do if I have a high blood fat level?
• Eat a healthy diet that is rich in fruits and vegetables, and low in animal fat, saturated fat, and cholesterol .
• Maintain a healthy body weight.
• Stay active.

If these things do not lower your blood fat levels enough, your doctor can prescribe medicines. You must take these regularly, even if you cannot feel their effects, and you must keep following a healthy lifestyle.

How To Reduce High Blood Sugar

People with high blood sugar levels, or diabetes, have a higher risk of heart attacks and strokes. At least half of the people who have diabetes do not know they have it.

Diabetes speeds up the development of atherosclerosis – the narrowing and hardening of the arteries that causes heart attacks and strokes. Untreated diabetes can also lead to blindness, kidney failure, nerve damage, leg ulcers and coma. Pregnancy is much more diffi cult for diabetic women and their babies are more likely to have birth defects.

What causes diabetes?
Diabetes occurs when the body fails to produce enough insulin, or cannot use it properly. Sugar then builds up in the blood. There are two main types of diabetes:

Type I Diabetes develops most often in children and young adults. Patients need to have daily injections of insulin to survive.
Type II Diabetes is the most common form -- almost 95 % of people with diabetes have this type. Patients with type II diabetes cannot produce enough insulin or cannot use insulin properly. It occurs mostly in middle-aged people, but children and young adults can also develop it, particularly if they are obese, have an unhealthy diet, and are physically inactive. The number of children and young adults with type II diabetes is increasing. This type of diabetes can usually be treated through lifestyle changes and oral medicines.

The causes of diabetes include hereditary factors, obesity, an unhealthy diet and lack of physical activity. If you keep an ideal body weight, regularly take physical activity, and consume a healthy diet, you reduce your risk of getting diabetes.

How do I know if I have diabetes?
Some people have few or no symptoms at all until they start having serious problems. The early signs of diabetes include:
• tiredness and weakness;
• frequent need to urinate (pass water);
• unusual thirst;
• weight loss or gain;
• blurred vision;
• frequent infections;
• wounds that heal slowly.

A doctor can diagnose diabetes by measuring the blood sugar level using a simple blood test. If necessary, you may be asked to take a special drink with glucose (sugar) so that your blood sugar level can be measured afterwards.

How can I control my diabetes?
If diabetes is well controlled, the risk of developing heart attack, stroke, or heart failure will decrease. Lifestyle changes can often help to control blood sugar levels. These changes include:

• eating a healthy diet;
• avoiding foods that are high in sugars, fats, and calories;
• maintaining a healthy body weight;
• drinking less alcohol;
• staying active.

If lifestyle changes do not reduce your blood sugar levels enough, you will need to take medicine. Many people with type II diabetes can be treated with oral medicine alone. Some may need insulin injections, or sometimes both.

At the time of diagnosis, the doctor will do tests to detect any complications from the diabetes and will advise on treatment. If you have diabetes, you should have regular check-ups. You should also follow carefully instructions for making lifestyle changes and taking medicine. Be sure to ask questions if there is anything you do not understand.

You may have to measure the sugar levels in your blood or urine in between check-ups. Your doctor will show you how to do this if it is necessary.

Medicines used to treat diabetes:
Many people with type II diabetes can be treated with oral medicines (medicine taken by mouth). You can read more about them in the Annex.

If lifestyle changes and oral medicines are not enough to control the diabetes, the doctor will prescribe insulin. This is injected, using a syringe or a “pen-type” injector.

Patients with type I diabetes need insulin injections; they cannot be treated with oral medicine.

Watching your blood sugar levels
When you have diabetes, you have to watch your blood sugar level, because if it is too low or too high you could get very sick. When the blood sugar level drops, you could become nervous, shaky, and confused. You may be advised to carry sugar cubes or drops to take when you feel these symptoms. If level drops very low, it can lead to fainting, coma, and even death. If the blood sugar level is too high, it can also lead to a diabetic coma.
Here are some tips for keeping your blood sugar level correct:
• Never miss doses of your medicine.
• Do not stop taking your medicines without asking your doctor.
• Do not miss meals.
• Be careful about taking your medicine when you are sick and not eating as much as you usually do (e.g. When you have a cold and your appetite is less than usual and cannot eat as much as you usually do). Seek your doctor’s advice on this.

How To Reduce Blood Pressure?

What is high blood pressure?
Blood pressure is measured in millimeters of mercury (mmHg), and it has two numbers. The fi rst is the systolic blood pressure, and is the pressure when the heart is contracting. The second is the diastolic blood pressure, and is the pressure when the heart is resting. A person has high blood pressure, or hypertension, when the fi rst pressure is above 140 mmHg or the second is above 90 mmHg.

What causes high blood pressure?
Some people have high blood pressure because it runs in the family. Blood pressure also tends to increase with age. But lifestyle factors can also cause high blood pressure or make it worse.

These factors include:
• being overweight or obese;
• eating too much salt in the diet;
• drinking too much alcohol.

High blood pressure can also be linked to some illnesses, such as kidney disease. Some medicines, such as birth control pills, can increase blood pressure.

Why is high blood pressure dangerous?
High blood pressure makes the heart work harder than it should, causing it to get weaker over time. The higher your blood pressure, the greater your risk of heart attack and stroke.

How do I know if I have high blood pressure?
You cannot tell if you have high blood pressure unless you have it measured. You should have it measured once a year. The measurement is quick and painless.

What should I do if I have high blood pressure?
• Maintain a healthy body weight.
• Stay active.
• Eat a healthy diet that is low in salt and fat and high in fruit and vegetables.
• Do not smoke.
• Do not drink too much alcohol.
• Have your blood pressure taken regularly.

If you are doing these things and your blood pressure is still high, your doctor can prescribe medicines. These do not cure high blood pressure, but they control it. You must take them as directed, probably for the rest of your life. You should have your blood pressure checked regularly.

Causes And Symptoms Of Rheumatic heart disease

Rheumatic fever is a disease that causes inflammation of the joints and the heart. If untreated, it can lead to rheumatic heart disease, heart failure, severe disability and even death. Rheumatic fever begins with a sore throat, caused by bacteria called streptococci (“strep sore throat”). This is often seen in school-age children and is easily passed from child to child. A child with strep sore throat has a sudden sore throat and a high fever (over 38 °C or 100 °F). The back of the child’s mouth and tonsils become very red and swollen. Painful and tender nodes or lumps develop under the skin of the neck, which can be felt by touching.

If strep sore throat is not treated, it can develop into rheumatic fever. Rheumatic fever causes swelling and pain (arthritis) in large joints, such as the knees and elbows. It also causes swelling and pain in the heart muscle and close properly. The abnormal heart function or heart failure that this damage causes is called rheumatic heart disease.

Who is at risk of rheumatic heart disease?
Acute rheumatic fever usually occurs in children aged 5 to 15 years, after one or more attacks of strep sore throat. Rheumatic fever is more frequent in children whose close family members have had rheumatic fever. Anyone who has had one or more attacks of rheumatic fever is very prone to develop rheumatic heart disease. With each repeat attack, the heart valves become more damaged.

What should I do to prevent rheumatic fever from developing?
The best defence against rheumatic heart disease is to prevent rheumatic fever. If you think that you, your child, or another family member has strep sore throat, go to the doctor as soon as you can. Treating strep sore throat with penicillin or other antibiotics can usually prevent acute rheumatic fever from developing. It also stops the infection spreading to others at home or at school.

Note: If the patient is allergic to penicillin, be sure to tell the doctor right away so that he or she can prescribe a different antibiotic.

What are the signs of rheumatic fever and rheumatic heart disease?

There are signs of fever – high temperature, tiredness, weakness, and lack of appetite. There may also be pain and swelling in the joints and shortness of breath – a sign that the heart is not working normally. A doctor may be able to detect an abnormal heart ‘murmur’ when listening to the heart.

Treating rheumatic fever and rheumatic heart disease:
Diagnosing rheumatic fever or heart disease involves taking a history of the person’s past health, a physical examination, and blood and other tests, such as an electrocardiogram, chest X-ray, and echocardiogram. Then, the doctor will give short-term treatment to slow or stop the disease and relieve symptoms. Children who have had rheumatic fever need long-term treatment and care, including the following:

• Treatment to prevent repeat fever. A return of the fever will do more harm to the heart. Penicillin or other drugs can be used to prevent this. The drugs are given once a month as injections or daily, as tablets. Children who have had rheumatic fever need to keep taking penicillin for 5 to 10 years, or even longer, depending on the advice of the doctor.
• Treatment for rheumatic heart disease. If rheumatic heart disease has developed, the doctor will prescribe medicine. The doctor may also recommend surgery to repair damaged heart valves. After surgery there is an increased danger of blood clots forming in the heart, so anticoagulant medicines to thin the blood are given to prevent this.
• Treatment for irregular heartbeat. Some patients with rheumatic heart disease also have irregular heartbeat, called atrial fi brillation. This can increase the risk of blood clots forming, so the patient must take anticoagulant medicines.
• Treatment for infection. Patients with rheumatic heart disease have a greater chance of getting infections of the inside walls of the heart, called infective endocarditis. These infections can occur as a result of surgery or dental procedures. Patients must check with their doctor before having any such procedure.

Causes And Symptoms Of Congenital heart disease

In congenital heart disease, a person is born with some abnormal structure or function of the heart (a heart defect). The most common heart defect is a hole in the wall that separates the right and left sides of the heart. The larger and more complex the defect, the more serious the heart disease.

Who is at risk of congenital heart disease?
If your family has a history of congenital heart disease, then your risk may be higher. Children whose parents are blood relatives, such as cousins, are more prone to heart defects. The defect can also develop during the early months of pregnancy, if the mother:

• has an infection, such as German measles (rubella);
• drinks alcohol;
• takes certain medicines;
• has X-rays.

What are the signs of congenital heart disease?
If the defect is small, it may not cause any symptoms. If the defect is more serious, the doctor will probably detect symptoms right after birth or within a few weeks. These may include:
• blue skin (cyanosis);
• diffi culty breathing;
• poor weight gain;
• feeding problems.
If your baby has these symptoms or any features that you think are abnormal, tell your doctor as soon as you can. A baby with congenital heart disease may need surgery, sometimes right after birth.

How can you lower the risk of heart defects for your baby?
• Avoid cousin (blood relative) marriages.
• Be vaccinated against rubella (German measles).
• If you are pregnant, avoid alcohol, X-rays, and any medicine that your doctor has not prescribed or approved for you.

Can a baby with congenital heart disease live a normal life?
Yes. Babies born with a mild heart defect can grow up to live a fairly normal life. Some may not be able to exercise as much as others. They will also have a greater chance of getting infections of the inside walls of the heart, called infective endocarditis. These infections can occur as a result of surgery or dental procedures. They must check with their doctor before having any such procedures.

If a baby has severe and complex heart defects, his or her life will become much more limited. Some children will not grow as well as they should.

Causes And Symptoms Of Heart Failure

Heart failure occurs when the heart cannot fi ll up with enough blood or pump the blood through the body with enough force. Because of the decreased blood fl ow, the body cannot function normally. Water builds up in the body because of the weak pumping function of the heart.

The most common cause of heart failure is damage to the muscles of the heart, as a result of previous heart attacks.

Who is at risk of heart failure?
The people at greatest risk are those who have had one or more heart attacks. The risk increases in people over the age of 65. People at risk may also have:

• high blood pressure;
• abnormal heart valves;
• rheumatic heart disease;
• congenital heart disease; or
• diabetes.

Less common causes are:
• heart muscle disease or infl ammation;
• severe lung disease; and
• thyroid disease.

What are the signs of heart failure?
In its early stages, the signs of heart failure often appear after physical activity. As the disease gets more severe, the symptoms last longer. They include:

• shortness of breath, or diffi culty breathing;
• tiredness and weakness;
• swelling of the ankles, feet, legs, or abdomen;
• weight gain from water build-up;
• coughing, especially at night or when lying down, including bloody, frothy sputum (spit).

What should I do if I think I am having heart failure?
Contact your doctor as soon as possible. Do not wait to see if the symptoms go away. Even if they pass quickly, they could be warning signs of serious illness. Sometimes heart failure starts suddenly, with severe shortness of breath. This is the result of water build-up in the lungs and needs to be treated right away.

Treating heart failure:
The care you receive will depend on how severe your heart failure is. It will probably include:
• Diagnosis: This includes taking a history of your past health, a physical examination, and tests to fi nd the cause of the heart failure and the extent of the damage done to the heart.
• Short-term treatment: If you are acutely or severely ill, treatment will probably be given in hospital to relieve the symptoms and slow down or stop the cause of the heart failure.
• Long-term treatment: Heart failure can happen again and can get worse. To manage it, you will need regular follow-up with doctors, medicines, and changes in your lifestyle.

What you can do to help your treatment succeed?
• Take any medicine prescribed for you as instructed.
• Follow your doctor’s advice about lifestyle changes. This includes stopping smoking, eating a healthy diet, and taking exercise that your heart can handle.
• Do not drink alcohol. Alcohol reduces the power of your heart to pump blood. Sometimes, alcohol itself can be a cause of heart failure.
• Avoid crowds and people who have colds or fl u. An infection such as infl uenza or pneumonia would be an added burden to your heart.
• Watch your body weight. If you put on weight, it may mean that water is building up in your body because of weak heart function. Tell your doctor about any sudden increase in your body weight.

Medicines used to treat heart failure:
Medicines used to treat heart failure include:
• diuretics (to get rid of excess water);
• angiotensin converting enzyme inhibitors (to relax blood vessels and reduce the burden on the heart) and cardiac glycosides, such as digoxin (to increase the strength of heart muscles and help the heart pump blood);
• medicines to relax the blood vessels;
• beta-blockers (to slow the heart rate and make the heart beat with less force).

What are the signs of stroke and what should you do?

Major stroke:
The most common symptom of a stroke is sudden weakness of the face, arm or leg, most often on one side of the body. Other symptoms include sudden onset of:

• numbness of the face, arm, or leg, especially on one side of the body;
• confusion, diffi culty speaking or understanding speech;
• diffi culty seeing with one or both eyes;
• diffi culty walking, dizziness, loss of balance or coordination;
• severe headache with no known cause;
• fainting or unconsciousness.

The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A stroke may affect just one part of the body, such as the face, an arm or a leg. It can also completely paralyse one side of the body. A very severe stroke can cause sudden death.

Minor stroke:
A minor stroke is also called a transient ischaemic attack or TIA. The features of minor strokes may be similar to those of major strokes, but they are milder and last only a short time, usually less than an hour. Often, the person recovers without treatment. These “mini-strokes” are warning signs; most people who have had one or more minor strokes will later have a major stroke.

What to do in the case of a stroke?
If you see someone showing signs of a stroke, call a doctor or ambulance right away, or take the person to the emergency room of the nearest hospital. Do this even if the symptoms are not very severe, because a stroke can progress. You should also do this in the case of a minor stroke. If there is no hospital or health centre near you, call a doctor immediately.

Treating stroke:
The level of medical care you will receive can vary from place to place. The amount of care you will need depends on how severe the stroke was.

If you arrive at a hospital within 3 hours after the fi rst sign of a stroke, the doctor there may give you a thrombolytic medicine right away, to dissolve any blood clots in your arteries. However the choice of treatment will depend on the exact cause of the stroke.

To diagnose what type of stroke you have had, doctors will take your medical history, examine you, and perform tests such as computerized tomography (CT) and magnetic resonance imaging (MRI). These tests will show whether you have had an ischaemic stroke (caused by a blockage) or an intracerebral haemorrhage (caused by a burst blood vessel in the brain).

The doctor will probably prescribe medicines to help relieve your symptoms and prevent future strokes, and give you advice on changing your lifestyle to lower your risk. If you take this advice, you will get the best possible results. Listen carefully to your doctor’s instructions and ask questions if you need to.

For some patients, special surgical procedures to open up the blockage of neck arteries, such as carotid endarterectomy or stenting, can help prevent future strokes.

Rehabilitation and long-term care:
Patients who become paralysed following a stroke need special care in hospital to help them recover and to avoid complications and long-term disability. Most patients who have a stroke are left with some physical disability and may need long-term care at home. A large part of stroke rehabilitation involves teaching patients how to exercise safely. It also includes:

• helping to improve walking, eating, dressing, bathing, cooking, reading, writing and going to the toilet;
• speech therapy;
• checking to make sure that patients can live safely at home;
• helping to organize medical and rehabilitative care and schedules;
• counselling patients and families, including advice about managing money, legal, and business affairs;
• occupational therapy to help patients stay active and involved;
• physiotherapy to help get back movement.

Medicines used to treat and manage stroke patients
Medicines often used to treat stroke include:
• antiplatelet agents, such as aspirin;
• anticoagulants or blood thinners, such as warfarin;
• medicines to control blood pressure, such as calcium-channel blockers, and angiotensin converting enzyme inhibitors;
• medicines to lower blood fats.
These medicines must be used under a doctor’s supervision. You can read more about stroke medicines and their side effects in Annex.

Treatment of intracerebral haemorrhage:
About 10–15% of all strokes are caused by bleeding into the brain due to rupture of a blood vessel. In many cases this is associated with high blood pressure. When strokes due to intracerebral haemorrhage occur, the diagnosis is usually made on a CT or MRI scan. The management is then usually as
described above, including stroke rehabilitation, except that blood-thinning medicines, such as anticoagulants and antiplatelet agents, are not given. Blood pressure control is very important for this type of stroke and management in a stroke unit is also desirable as for other forms of strokes. Occasionally, surgical procedure may be required depending on the patient’s condition.

Can a person recover from a stroke?
Yes, but the amount of long-term disability depends on how much lasting brain damage the stroke caused. Many stroke survivors are left with mental and physical disabilities. They need support from family members and friends to help them cope.

How can I avoid having another stroke?
It is important to maintain a healthy lifestyle and to follow carefully your medical treatment, such as taking aspirin and medicine to lower your blood pressure. People who have had one stroke are more likely to have another. If you have an irregular heart beat (atrial fi brillation), it is also important to recognize it and seek medical care to prevent future strokes. Consult your doctor about this. You can avoid a repeat stroke by
adopting a healthy life style and taking medications.

What are the signs of a heart attack and what should you do?

Most heart attacks are sudden and intense. But sometimes a heart attack starts slowly, with mild pain or discomfort. People often aren’t sure what is wrong, and wait too long before getting help. A severe heart attack can stop the heart, causing sudden death.


Major heart attack:
A major heart attack is called a myocardial infarction. It usually starts with pain or discomfort in the centre of the chest, which lasts for more than a few minutes or keeps coming back. The discomfort can feel like pressure, squeezing, or fullness. Pain or discomfort may also be felt in the arms, the left shoulder, elbows, jaw, or back. Other symptoms include:

• diffi culty breathing or shortness of breath;
• feeling sick or vomiting;
• feeling light-headed or faint;
• breaking into a cold sweat;
• becoming pale.

Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain. People who have had diabetes for a long time may not feel the chest pain as much, because diabetes can damage the nerves.

What to do if you are having a heart attack
Many patients who have a heart attack die before reaching hospital. So act fast. Every second counts.
There are treatments that can dissolve the blood clot and restore blood fl ow to the heart. The treatment works best if it is given within an hour of the attack. If treatment is started quickly, there will be less damage to the heart muscle.

If there is a hospital nearby, have someone call an ambulance or take you to the emergency room right away. If there is no hospital or health care centre nearby, call a doctor immediately.


Angina:
If the heart blood vessels are blocked only partially and the blood fl ow to the heart is decreased but not stopped, it can cause chest pain called angina or angina pectoris. The person may have pain or discomfort in the centre of the chest that lasts for a few minutes. Often it is triggered by physical activity and relieved by rest. It may also be brought on by strong emotions, stress, or extreme heat or cold. The pain may spread to the arms, back, jaw, neck and stomach. People who have angina are at high risk of having a major heart attack. People with angina should monitor their chest pain. The angina may be getting worse if the chest pain:
• occurs more often;
• lasts longer than usual;
• is combined with shortness of breath or a fast or irregular heart beat;
• occurs with smaller amounts of exercise or stress.

What to do if you are having an angina attack?
Stop what you are doing and rest until the pain has passed. Your doctor may have prescribed a tablet for you to keep under your tongue or a spray that helps relieve the discomfort. Follow your doctor’s instructions. If these things do not help, call an ambulance to take you to the emergency room of the nearest hospital. If there is no hospital or health care centre nearby, call your doctor immediately.

Treating a heart attack:
The level of medical care you will receive can vary from place to place. The amount of care you will need depends on how severe the attack was.

If you go to the emergency department of your nearest hospital, the doctor there may give you a thrombolytic medicine right away, to dissolve any blood clots in your arteries.

You will probably have a number of tests, such as blood tests, an electrocardiogram, and a coronary arteriogram.

The doctor will probably prescribe medicines to help you manage your heart condition, and give you advice on changing your lifestyle to lower your risk of having another heart attack. If you take this advice, you will get the best possible results. Listen carefully to your doctor’s instructions and ask questions
if you need to.

There are special procedures that can improve the blood supply to the heart, such as angioplasty or coronary artery bypass surgery. Those procedures will be applied to patients depending on the individual condition.

After you go home:
Many patients will be offered cardiac rehabilitation. This is a medically supervised programme for patients who have suffered heart attacks and angina. It helps you adapt to daily life, and helps prevent repeat attacks. The programme usually includes:

• physical activity prescribed by doctors;
• help with taking medicines and going through medical treatment;
• support for lifestyle changes, like quitting smoking;
• health education and counselling tailored to your needs and risk factors;
• help with regaining strength and independence and improving your quality
of life;
• support for going back to work.


Medicines used to treat heart attack and angina
Medicines often used to treat heart attacks and angina include:
• antiplatelet agents, such as aspirin;
• nitrates and other medicines to relax blood vessels;
• medicines to control blood pressure, such as calcium-channel blockers, and angiotensin converting enzyme inhibitors;
• diuretics to help get rid of excess water;
• medicines to lower blood-fats.
These medicines must be used under a doctor’s supervision. You can read more about heart medicines and their side effects in Annex.

Vitamins and heart attacks:
There is no evidence that taking extra vitamin supplements, such as vitamins A, C, and E, prevents heart attacks. The important thing is to eat a healthy, balanced diet.


Can the heart recover from a heart attack?
Yes, but the degree of recovery depends on how much damage was done to the heart muscle. You should get treatment as soon as you feel the symptoms of a heart attack. The sooner you get treatment, the more muscle doctors may be able to save. That’s why they say, “Time is muscle.”


How can I avoid having another heart attack?
Someone who has had a heart attack has a high risk of having another one that could be even more serious and of having complications like acute heart failure. In order to decrease the chance of a future attack, you must:

• follow your doctor’s advice and adopt a healthy lifestyle;
• work hard at the rehabilitation programme prescribed by your doctor;
• take your medicines regularly and according to the instructions. Most patients need to continue taking medicines on a long-term basis.

Causes And Risk Factors Of Heart Attack

Tobacco use:
Tobacco smoke is full of substances that damage your lungs, blood vessels and heart. They take the place of the oxygen in the blood that your heart and brain need to work properly. Tobacco use greatly increases your chance of having a heart attack or stroke. Tobacco also causes cancer and lung disease, and harms babies during pregnancy. Inhaling the tobacco smoke of other smokers is as harmful as smoking yourself.

Unhealthy diet:
An unhealthy diet is one with:
• too much food (too many calories);
• too much fat, sugar or salt;
• not enough fruit and vegetables.
If you eat a lot of food and you are not active enough to burn it off, you will put on weight. You could slowly become overweight or even obese. Being overweight can lead to diabetes, high blood pressure, and high blood fat levels. All of these physical problems increase the risk of heart attacks and strokes. Obese people are at especially high risk if they have a lot of fat around the waist and stomach area. An unhealthy diet often contains too much “fast food”, which is high in fat and sugar, and sugar-loaded soft drinks. Fast food is also very high in salt, which increases blood pressure.

Lack of physical activity
When people do not stay active, their risk of heart attack and stroke increases greatly. Physical activity lowers your risk of heart attacks and strokes by:
• helping your body burn sugars and fats and assisting in keeping a good
weight;
• lowering your blood pressure;
• increasing oxygen levels in your body;
• reducing stress;
• strengthening your heart muscle and bones;
• improving blood circulation and muscle tone.

Staying active also reduces the risk of other illnesses, such as cancer. Active people usually feel better and happier. They are likely to sleep better and to have more energy, self-confi dence, and concentration. You do not have to be in training for the Olympics to get these benefi ts! Walking, gardening, or doing housework for at least 30 minutes on most days can help you prevent heart attacks and strokes.

High blood pressure (hypertension):
Blood pressure is the force with which the blood pushes against the walls of arteries. If blood pressure is high, the heart is working harder than it should;over time, this will cause it to weaken. High blood pressure is one of the major risk factors for heart attacks. It is the biggest risk factor for strokes.

To avoid high blood pressure, you need to stay active, maintain a healthy body weight, and eat a healthy diet. A healthy diet includes lots of fruits and vegetables. Limit the amount of salt in your diet, and do not drink too much alcohol. If you make all of these changes to your lifestyle, but you still cannot lower your blood pressure, there are medicines that can help.

High blood sugar (diabetes):
The body produces a hormone called insulin, which helps body cells to use sugar from the blood to produce energy. When the body does not produce enough insulin, or cannot use it properly, as in diabetes, sugar builds up in the blood. The high blood sugar levels speed up the development of atherosclerosis
– the narrowing and hardening of the arteries. This greatly increases the risk of heart attacks and strokes.

Treating diabetes involves changing your diet and lifestyle. Sometimes, medicines that lower blood sugar are needed.

High blood fats (hyperlipidaemia):
Blood fats include substances such as cholesterol and triglycerides. When there are too many of these fats in the blood, they cause fatty deposits to build up in arteries leading to atherosclerosis (the narrowing and hardening of the arteries). This greatly increases the risk of heart attacks and strokes.

If you have high cholesterol or triglyceride levels in your blood, you need to eat less fat, stay active, and control your body weight. If these measures are not enough, you may also need medicine to lower your blood fats.

Combined risk factors:
If a person has two or more of the three risk factors – high blood pressure, high blood sugar, and high blood fats – the risk of heart attacks and strokes is greatly increased. The more risk factors, the higher the risk.

Other important risk factors
Metabolic syndrome:
When a person has central obesity (too much weight around the waist), abnormal blood fat levels (e.g. high triglyceride level or low HDL cholesterol;high blood pressure and high blood sugar at the same time,
this is known as metabolic syndrome. People with metabolic syndrome are at high risk of developing diabetes or having a heart attack or stroke, and require careful medical attention.

Chronic stress:
Feeling lonely, isolated, or anxious for a long time can combine with other risk factors to make a person more likely to have a heart attack or stroke.

Certain medicines:
Some oral contraceptives and hormone treatments can increase the risk of heart attacks. Check with your doctor for details.

Irregular heartbeat (atrial fi brillation):
With irregular heartbeat, or atrial fi brillation, the heart does not contract as strongly as it should. This can cause blood to pool in the heart and form clots. When the blood clots dislodge, they may move to the brain, where they can become trapped in a narrow brain artery, blocking the blood fl ow and causing a stroke. Up to 20% of strokes may be caused by atrial fi brillation.

Many people are unaware that their heartbeat is irregular. If you are concerned about this, your doctor can easily check by listening to your heartbeat. If necessary your doctor may arrange for an electrocardiogram. If your heartbeat is irregular, medicines (like warfarin or in some cases aspirin) can signifi cantly reduce the risk of strokes. Sometimes, an irregular heartbeat can be returned to normal with medicines or special medical procedures.

How To Prevent Heart Attack And Strokes?

 The Risk Factors Of Heart Attack:

Nearly two-thirds of people who have a heart attack die before they can reach medical care. Even when stroke patients have access to modern, advanced treatment, 60% die or become disabled. So it is important to know the warning signs and to act fast.

But it is even better to prevent a heart attack or stroke from ever happening. Prevention is always better than treatment, and most heart attacks and strokes can be prevented.

Research shows that a number of things make us more likely to have a heart attack or stroke. These are called risk factors. Some risk factors are linked to choices we make in the way we live. The three most important lifestyle factors are:

• smoking and other tobacco use;
• unhealthy diet; and
• lack of physical activity.

Poor lifestyle choices can lead to three serious physical problems:
• high blood pressure (hypertension);
• high blood sugar (diabetes);
• high blood fats (hyperlipidaemia).

These are the most important risk factors for heart attacks and strokes. Throughout large parts of the world, tobacco use is on the rise. People are also becoming overweight in many countries as a result of being less active and eating more food that is high in fat and sugar. More and more young people and children are getting diabetes because they are overweight. We owe it to our children to change these lifestyle choices.