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g∞ QÆ∞O_≥ QÆ∞iOz`≥Å∞ã¨∞H˘O_ç

''QÆ∞O_≥—— QÆ∞iOz ™ê=∂#º „Ñ¨[Å‰õΩ

`≥eÜ«∞KÕÜ«∞\ÏxH˜ D Ñ¨Ùã¨ÎHÍxfl „Ñ¨K«∞iOKåO

_®II ~å=∞Hõ Nx"åãπ ZO._ç.,_ç.Ü«∞O.

QÆ∞O_≥ "åº èŒ∞Å xÑ¨Ù∞Å∞

Nx"åã¨ Ç¨~üì ÃãO@~üÇ¨Ï#‡H˘O_», =~°OQÆÖò. (PO.„Ñ¨.)

=∞# â◊s~åxH˜

''QÆ∞O_≥——

ã¨~°fiã¨fi=Ú J#∞‰õΩ<Õ

Ñ¨„u"åiH˜ D Ñ¨Ùã¨ÎHõ=Ú

JOH˜ «=Ú

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QÆ∞O_≥ =∞iÜ«Ú QÆ∞O_≥ [|∞ƒÅ QÆ∞iOz™ê=∂#º „Ñ¨[Å∞ ≥Å∞ã¨∞HÀ=Åã≤# =ÚYº q+¨Ü«∂Å∞

1) QÆ∞O_≥ x~å‡=Ú

– QÆ∞O_≥Ö’x ÉèÏQÍÅ∞

– =∂#= ~°HõÎ „Ñ¨ã¨~° =º=ã÷

– Hõ~À#s ~°HõÎ <åàÏÅ∞

– QÆ∞O_≥Ö’x "åÇ¨ÏHõ =º=ã÷

2) QÆ∞O_≥ Ñ¨xKÕ¿ã q è•#=Ú

3) QÆ∞O_≥ [|∞ƒ ÅHõ∆ÏÅ∞

4) QÆ∞O_≥ [|∞ƒ x~åú~°‰õΩ KÕÜ«∞=Åã≤# Ñ¨sHõ∆Å∞

5) QÆ∞O_≥ [|∞ƒ#∞ „¿Ñˆ~Ñ≤OKÕ Ñïã≤÷ «∞Å∞

6) QÆ∞O_≥ [|∞ƒÅ ~°HÍÅ∞

7) QÆ∞O_≥ PyáÈ~Ú ãÊ $ÇÏ «Ñ≤Ê# =∞x+≤H KÕÜ«∞=Åã≤# „Ñ äŒ=∞ zH «û

8) QÆ∞O_≥ [|∞ƒ zH˜ åû Ñ¨ Œú «∞Å∞

9) QÆ∞O_≥ [|∞ƒ ~å‰õΩO_® fã≤H˘#=Åã≤# *Ï„QÆ «ÎÅ∞

1. QÆ∞O_≥ x~å‡=Ú

QÆ∞O_≥Ö’x ÉèÏQÍÅ∞ :

QÆ∞O_≥ â◊O‰õΩ PHÍ~°OÖ’, HõO_»~°O`À U~°Ê_ç# J=Ü«∞==Ú.

=∂#= â◊s~°OÖ’ QÆ∞O_≥ Ô~O_»∞ TÑ≤iu «∞ÎÅ =∞ èŒº á⁄ky LO_ç,KèåuÖ’ Z‰õΩ¯=ÉèÏQÆO Z_»=∞ "≥·Ñ¨Ù‰õΩ LO@∞Ok.

ã¨QÆ@∞# =∞x+≤ QÆ∞O_≥ |~°∞=Ù :–

=∞QÆ"åiÖ’ 325 ± 75 gms

P_»"åiÖ’ 275 ± 75 gms

QÆ∞O_≥ QÀ_»Ö’ =¸_»∞ á⁄~°Å∞ LO\Ï~Ú.

– |Ü«∞\˜ á⁄~°–~°Hõ∆ Hõ=K«"≥∞ÿ# ÃÑiHÍi¤Ü«∞O–PERICARDIUM

– =∞ èŒº á⁄~° =∞Ü≥∂HÍi¤Ü«∞O - MYOCARDIUM

– Ö’Ñë á⁄~° ZO_ÀHÍi¤Ü«∞O – ENDOCARDIUM.

ÃÑiHÍi¤Ü«∞OÖ’x Ô~O_»∞ á⁄~°Å =∞ èŒº ™ê è•~°=ÚQÍ 10–20 q∞.b.„ Œ==Ú LO@∞Ok.

QÆ∞O_≥Ö’ <åÅ∞QÆ∞ QÆ Œ∞Å∞ LO\Ï~Ú. ÃÑ·# L#fl "å\˜x ATRIA Jx,„HÕk QÆ Œ∞Å#∞ VENTRICLES Jx JO\Ï~°∞.

Z_»=∞ =∞iÜ«Ú ‰õΩ_ç U„\Ü«∞O =∞ èŒº =∞iÜ«Ú „HOk Z_»=∞ =∞iÜ«Ú‰õΩ_ç "≥O„\˜HõÖòû =∞ èŒº L#fl QÀ_» Z_»=∞"≥·Ñ¨Ù L#fl =∞Oz ~°HõÎ=Ú,‰õΩ_ç"≥·Ñ¨Ù#fl K≥_»∞ ~°HõÎ=Ú HõÅ=‰õΩO_® KÕã¨∞ÎOk.

QÆ∞O_≥Ö’x <åÅ∞QÆ∞ Hõ"å\ÏÅ∞ :

1. MITRAL VALVE : Wk LEFT ATRIUM =∞iÜ«Ú LEFT

VENTRICLES =∞ èŒº LO_»∞#∞.

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2. AORTIC VALVE : Wk LEFT VENTRICLE =∞iÜ«Ú QÆ∞O_≥ #∞O_ç"≥Å∞=_»∞ =ÚYº ~°HõÎ<åà◊"≥∞ÿ# Aorta =∞ èŒº LO_Õ Hõ"å\=Ú.

3. TRICUSPID VALVE : Wk RIGHT ATRIUM =∞iÜ«Ú RIGHT

VENTRICLE =∞ èŒº LO_Õ Hõ"å@=Ú.

4. PULMONARY VALVE : Wk RIGHT VENTRICLE =∞iÜ«ÚTÑ≤iu «∞ÎÅ`À ãO|O èŒ=Ú#fl PULMONARY ARTERY =∞ èŒº#∞#flHõ"å@=Ú.

=∂#= ~°HõÎ „Ñ¨ã¨~° =º=ã÷(CIRCULATORY SYSTEM)

=∂#= â◊s~°OÖ’x ~°HõÎ „Ñ¨ã¨~°=º=ã÷Ö’ =ÚYº"≥∞ÿ# ÉèÏQÆ=Ú QÆ∞O_≥.

QÆ∞O_≥ xifi~å=∞OQÍ Ñ¨x KÕÜ«∞_»O^•fi~å â ◊s~ °OÖ’x q∞Q Æ`åJ=Ü«∞"åÅ‰õΩ =ÚYºOQÍ "≥∞ Œ_»∞,=¸„ «Ñ≤O_®Å‰õΩ Arteries =∞iÜ«ÚCapillaries ^•fi~å =∞Oz ~°HõÎOã¨~°Ñ¶¨~å J=Ù`«∞Ok.

â◊s~° ÉèÏQÍÅÖ’x K≥_»∞ ~°Hõ ÎOVenules =∞iÜ«Ú Veins ^•fi~åQ Æ∞O_ ≥#∞ K Õi, Q Æ ∞O_ ≥ #∞OzTÑ≤iu «∞ÎÅ‰õΩ KÕi, JHõ _» =∞Oz~°HõÎOQÍ =∂i uiy QÆ∞O_≥ ^•fi~åq∞QÆ`å J=Ü«∞"åÅ‰õΩ ã¨~°Ñ¶ ¨~åJ=Ù «∞Ok.

Aorta Z_»=∞ "≥O„\HõÖò #∞Oz =KÕÛ=ÚYº"≥∞ÿ# ~°HõÎ<åà◊O. nx #∞O_ç" ≥Å∞=_ Õ W` «~ ° ~ °H õ Î<åàÏÅ∞â◊s~°OÖ’x W`«~° J=Ü«∞"åÅ‰õΩ=ÚYºOQÍ " ≥ ∞^ Œ_ » ∞‰ õ Ω ,=¸„ «Ñ≤O_®Å‰õΩ, KÕ «∞Å‰õΩ, HÍà◊¡‰õΩ~°HõÎO ã¨~°Ñ¶¨~å KÕã¨∞ÎOk.

â◊s~° J=Ü«∞"åÅ #∞Oz K≥_»∞ ~°HõÎ=Ú QÆ∞O_≥ ‰õΩ_ç ÉèÏQÆ=Ú KÕi,JHõ _ç #∞O_ç TÑ≤i u «∞ÎÅ‰õΩ Ñ¨ÖÁ‡#i P~°ìi ^•fi~å KÕ~°∞ «∞Ok.

TÑ≤iu «∞ÎÅÖ’ Wk =∞Oz ~°HõÎOQÍ =∂i ÑÖÁ‡#i "Õ<£û •fi~å QÆ∞O_≥Z_»=∞ ÉèÏQÍxH˜ KÕ~°∞ «∞Ok.

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QÆ∞O_≥ x~å‡=Ú

Aorta

Left atrium

Left ventricle

Right atrium

Right ventricle

Interatrial septum

Interventricularseptum

Mitral valve

Aortic valve

Tricuspid valve

Pulmonary valve

Superior venacava

Pulmonary veinsPulmonary artery

Inferior venacava

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Right atrial branch ofRight coronary artery

Right coronary artery

Left main coronary artery

Left circumflex artery

Left anterior descendingartery

Aorta

Hõ~À#s ~°HõÎ <åàÏÅ∞ :– Wq JÜ≥∂~åì #∞O_ç "≥Å∞=_»∞`å~Ú.

– Hõ~À#s ~°HõÎ<åàÏÅ∞ QÆ∞O_≥ HõO_»~åxH˜ ~°HÍÎxfl ã¨~°Ñ¶~å KÕ™êÎ~Ú.

– g\˜ Ñ¨i=∂=Ú 2–3.5 q∞.g∞.

QÆ∞O_≥ "åÇ¨ÏHõ =º=ã÷ :QÆ∞O_≥ "ÕQÆ=Ú =∞iÜ«Ú ÅÜ«∞ QÆ∞O_≥ "åÇ¨ÏHõ =º=ã÷ (HõO_»Hõ∆<£ ã≤ãì"£∞)

^•fi~å xÜ«∞O„uOK«|_»∞`«∞Ok.

"åÇ¨ÏHõ =º=ã÷Ö’x ÉèÏQÍÅ∞ ÉÁ=∞‡Ö’ K«∂Ñ≤# =∂kiQÍ LO\Ï~Ú.

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Right coronaryartery

Left main coronaryartery

Left circumflexartery

Left anteriordescending artery

Aorta

Obtusemarginals

SeptalBranch

DiagonalBranches

Posteriordescending artery

Sino atrial node

Atrio ventricular node

Common bundle

Atrial muscle

Ventricular muscle

Bundle branches

Purkinje fibers

QÆ∞O_≥ Œ_» =∂#ã≤Hõ PO^Àà◊# =Å#<Õ HÍHõ, H˘xfl™ê~°∞¡ QÆ∞O_≥ "ÕQÆOÖ’

=∞iÜ«Ú ÅÜ«∞Ö’ =∂~°∞ÊÅ =Å# =ã¨∞ÎOk.

"åÇ¨ÏHõ =º=ã÷Ö’x =∂~°∞ÊÅ =Å# "åºkè ã¨OÉèíqOz, H˘xfl™ê~°∞¡

ã¨Ê $Ç¨Ï HÀÖ’Ê=_»O ‰õÄ_® [~°∞QÆ∞ «∞Ok.

QÆ∞O_≥ "ÕQÍxfl, ÅÜ«∞#∞ x~åúiOKÕ „H˜Ü«∞ "åÇ¨ÏHõ =º=ã÷Ö’ Sino

Atrial Node Ö’ „áê~°OÉèí=∞=Ù «∞Ok. JO Œ∞ˆH nxx Pacemaker of

the Heart JO\Ï~°∞.

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2. QÆ∞O_≥ Ñ¨xKÕÜ«Ú q^è•#=Ú CARDIAC CYCLE Ö’ QÆ∞O_≥ HõO_»~°=Ú SYSTOLE (ãOHÀzOK«∞@– =Ú‰õΩjÉèÏ==Ú) =∞iÜ«Ú DIASTOLE (=Ú‰õΩà◊#=Ú ÖËHõ"åºHÀK«=Ú) „Hõ=∞OQÍ [~°∞QÆ∞ «∞Ok.

CARDIAC CYCLE =º=kè 0.8 ÃãHõ#∞

QÆ∞O_≥ ã¨OHÀzOK«∞#Ñ¨Ù_»∞ "≥Å∞=_Õ ~°HõÎO - 70ml. - 80ml.

xq∞ëêxH˜ QÆ∞O_≥ #∞Oz "≥Å∞=_Õ ~°Hõ ÎO 70x72 = (5050ml)

(CARDIAC OUTPUT) 5 b@~°∞¡.

QÆO@‰õΩ 5x60=300 Liters. ~ÀA‰õΩ - 300x24=7200 Liters

â◊s~°OÖ’ ~°HõÎ=Ú =∞x+≤ |~°∞=ÙÖ’ 8 âß «O (ã¨∞=∂~°∞ 5,600ml)

™ê è•~°OQÍ CORONARY BLOOD FLOW (Hõ~À#s ~°HõÎ<åàÏÅÖ’~°HõÎ„Ñ¨ã¨~° 70-90 ml/100gm/min.)

QÆ∞O_≥ HõO_»~°=Ú 8-10ml/100gm/min. PH˜û[<£ LÑ¨Ü≥∂yã¨∞ÎOk.

ÃÑ·# ¿Ñ~˘¯#fl qÅ∞=Åhfl ~°Hõ~°HÍÅ Ñiã≤÷ «∞ÅÖ’, "åº èŒ∞ÅÖ’ =∂~°∞ «∂LO\Ï~Ú.

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â◊s~° ÉèÏQÍÅ #∞O_ç

TÑ≤i u`«∞ÎÅ‰õΩ

â◊s~° ÉèÏQÍÅ‰õΩ

Left atrium

Left ventricle

Right atrium

Right ventricle

TÑ≤i u`«∞ÎÅ #∞O_ç

TÑ≤i u`«∞ÎÅ‰õΩ

TÑ≤i u`«∞ÎÅ #∞O_ç

â◊s~° ÉèÏQÍÅ #∞O_çâ◊s~° ÉèÏQÍÅ‰õΩ

g∞‰õΩ ≥Å∞™ê ?

™ê è•~°=ÚQÍ QÆ∞O_≥ xq∞ëêxH 70 ™ê~°∞¡ H˘@∞ì‰õΩO@∞Ok. HEART

RATE 100 ÃÑ· L#fl@¡~Ú`Õ TACHYCARDIA Jx, 60 Ö’Ñ¨ÙL#fl@¡~Ú Õ BRADY CARDIA Jx JO\Ï~°∞.

QÆ∞O_≥ CARDIAC CYCLE ^•fi~å Ü«∂O„uHõOQÍ Ñ¨xKÕã¨∞ÎOk.

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3. QÆ∞O_≥ [|∞ƒ ÅHõ∆ÏÅ∞(SYMPTOMS OF HEART DISEASE)

1. PÜ«∂ã¨=Ú ÖËHõ Œ=Ú‡ – BREATHLESSNESS.

2. Kèåu<˘Ñ≤Ê – CHEST PAIN.

3. ã¨Ê $Ç¨Ï HÀÖ’Ê=Ù@ – UNCONSCIOUSNESS.

4. JÅã¨@ – UNDUE FATIGUE.

5. QÆ∞O_≥ Œ_» – PALPITATIONS

6. HÍà◊¡ "åÑ¨Ù ÖËHõ â◊s~°O "åÑ¨Ù – SWELLING OF LEGS OR BODY.

1. PÜ«∂ã¨=Ú ÖËHõ Œ=Ú‡ :PÜ«∂ã=Ú, Œ=Ú‡ ÖËHõ TÑ≤i fã≤HÀ=@OÖ’ Hõ+ì=Ú : SHORTNESS

OF BREATH : ≥·#Ok# HÍ~°º=ÚÅ∞ KÕÜ«Ú#ÑC_»∞, ™ê è•~° #_»HõÖ’HÍx,"≥∞@∞¡ ZH¯#ÑC_»∞HÍx, |~°∞=ÙÅ∞ ZuÎ#ÑC_»∞HÍx, PÜ«∂ã=Ú =zÛ#@¡~Ú ÕWk QÆ∞O_≥ [|∞ƒ‰õΩ ã¨∂K«# HÍ=K«∞Û#∞.

PHõã≤‡HõOQÍ Œ=Ú‡QÍx, PÜ«∂ãÖ =zÛ#@¡~Ú Õ TÑ≤iu «∞ÎÅ "åºkèHÍHõ, QÆ∞O_≥ ãÖ|O èŒ"≥∞ÿ# "åºkèH˜ „Ñ¨=∂ Œ ã¨∂K«# HÍ=K«∞Û#∞. WkHeart Failure ÅHõ∆O.

2. Kèåu <˘Ñ≤Ê (CHEST PAIN) :Kèåu <˘Ñ≤Ê J#QÍ<Õ QÆ∞O_≥ [|∞ƒ L#fl\Ï¡? HÍ Œ∞ !

– Kèåu <˘Ñ≤ÊH ~°Hõ~°HÍÅ HÍ~°ÏÅ∞. JO Œ∞Ö’ „Ñ=∂ ŒHõ~°"≥∞ÿ#k QÆ∞O_≥[|∞ƒ.

– Kèåu<˘Ñ≤Ê L#fl@¡~Ú`Õ, =ÚYºOQÍ =∞^èŒº =Ü«∞ã¨∞¯Å∞, RISK

FACTORS – =∞^èŒ∞"Õ∞Ç¨Ï "åºkè, ~°HõÎáÈ@∞, á⁄QÆ„`åQÆ∞"å~°∞QÆ∞O_≥[|∞ƒ QÆ∂iÛ Ñ¨sHõ∆ KÕ~ÚOK«∞H˘#_»O =∞Ozk.

‘ANGINA’ J#QÍ <Õq∞ ?

Kèåu =∞ èŒºÖ’ <˘Ñ≤ÊQÍx, Z_»=∞ KÕu Ö’Ñë ÉèÏQÍ# HÍx, Ô~O_»∞KÕ «∞Å∞ Ö’Ñë ÉèÏQÍ# <˘Ñ≤ÊHÍx, Q˘O «∞ aQÆ|\ì#@∞¡ HÍx, „HÕkŒ=_» <˘Ñ≤Ê HÍx LO>Ë ‘ANGINA’ HÍ=K«∞Û#∞.

QÆ∞O_≥ HõO_»~åxH˜ ~°HõÎO ã¨~°Ñ¶~å KÕ¿ã Hõ~À#s ~°HõÎ <åàÏÅÖ’ ~°HõÎ„Ñ ¨ã ¨~ °‰ õ Ω JO` «~åÜ « ∞O (MYOCARDIAL ISCHEMIA)

U~°Ê_ç#@¡~Ú`Õ,‘ANGINA’ ~å=K«∞Û#∞. D ~°Hõ"≥∞ÿ# Kèåu <˘Ñ≤Ê™ê^è•~°OQÍ #_»Hõ`ÀHÍx, |~°∞=ÙÅ∞ ZuÎ#@¡~Ú`ÕHÍx, "≥∞@∞¡ZH˜ #Ñ¨C_»∞ Z‰õΩ¯= JÜÕ∞º J=HÍâ◊O LO_»∞#∞.

– ANGINA - ISCHEMIC HEART DISEASE ÅHõ∆O.

– HEART ATTACK JO>Ë Uq∞\˜ ?

Hõ~À#s ~°Hõ Î<åàÏÅÖ’ ~°Hõ Î „Ñ¨ã¨~°‰õΩ Ñ¨ÓiÎQÍ JO`«~åÜ«∞OU~°Ê_ç#@¡~Ú Õ QÆ∞O_≥ HõO_»~åxH˜ JHõ™ê‡ «∞ÎQÍ ~°HõÎ ã¨~°Ñ¶~å xezáÈ=@O =¸ÖÏ# Heart Attack J#QÍ QÆ∞O_≥ áÈ@∞ ãÖÉèíqã¨∞ÎOk.

3. ã¨Ê $Ç¨Ï HÀÖ’Ê=@=Ú (UNCONSCIOUSNESS) :PHõã≤‡HõOQÍ ã¨Ê $Ç¨Ï HÀÖ’Ê=@=Ú QÆ∞O_≥ Ñ¨xKÕÜ«Ú "ÕQÆOÖ’ =∂~°∞ÊÅ=Å# (Irregularity in Heart Beat - ARRHYTHMIA) HÍ=K«∞Û#∞.H˘xfl Hõ"å@ ãÖ|O^èŒ"≥∞ÿ# "åº^èŒ∞ÅÖ’ ‰õÄ_® (L^• : AORTIC

STENOSIS) ã¨Ê $Ç¨Ï HÀÖ’Ê=@O ÅHõ∆O.

4. JÅã¨@ (UNDUE FATIGUE) :QÆ∞O_≥ ãO|O èŒ"≥∞ÿ# JÅã@ QÆ∞O_≥ HõO_»~°=Ú |ÅÇ‘Ï#Ñ_»_»O =¸ÖÏ#~å=K«∞Û#∞.

5. QÆ∞O_≥ Œ_» (PALPITATIONS) :QÆ∞O_≥ Ñ¨xKÕÜ«Ú "ÕQÆOÖ’ =∂~°∞ÊÅ =Å#– (ARRHYTHMIA) =Å# ~å=K«∞Û#∞.

6. HÍà◊¡"åÑ¨Ù ÖËHõ â◊s~°O "åÑ¨Ù K≥O Œ∞@– Swelling of legs or Body D ÅHõ∆O QÆ∞O_≥ HõO_»~°O ≥|ƒu#_»O

=¸ÖÏ# HEART FAILURE Ö’<Õ HÍHõ, HÍÖËÜ«∞ ãÖ|O èŒ"≥∞ÿ#"åº èŒ∞Å∞, =¸„ «Ñ≤O_» "åº èŒ∞Å∞, ~°HõÎ „Ñ¨ã¨~°Ö’ JO «~åÜ«∞O=Å# ‰õÄ_® ~å=K«∞Û#∞.

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4. QÆ∞O_≥ [|∞ƒ x~åú~°QÆ∞O_≥ [|∞ƒÅ x~åú~° âßG „Ñ¨HÍ~°=Ú XHõ „Hõ=∞OÖ’ „HÕk q èŒOQÍ

[~°∞QÆ∞ «∞Ok.

1. [|∞ƒ ÅHõ∆ÏÅ∞ : SYMPTOMS OF HEART DISEASE.

2. „áê äŒq∞Hõ QÆ∞O_≥ ÑsHõ∆ : EXAMINATION OF THE CARDIOVASCULAR

SYSTEM

3. ~°HõÎ Ñ¨sHõ∆Å∞ : BIOCHEMICAL INVESTIGATIONS

4. E.C.G. ZÅ„HÀìHÍi¤Ü≥∂„QÍO

5. X-RAY CHEST : Kèåu ZHõûˆ~

6. DHÀHÍi ¤Ü ≥∂„QÍO – H õÅ~ ü _®Ñ ¨ ¡~ ü 2–DIMENSIONAL

ECHOCARDIOGRAM - COLOUR DOPPLER.

7. TREADMILL TEST OR EXERCISE TEST (OR) STRESS TEST :

8. CORONARY ANGIOGRAM, CARDIAC CATHETERISATION

H˘xfl Ju „Ñ¨`ÕºHõ Ñ¨sHõ∆Å∞ :

24 HOURS HOLTER

ELECTROPHYSIOLOGICAL STUDIES

STRESS THALLIUM

C.T. SCAN, MRI

POSITRON EMISSION TOMOGRAPHY

1. [|∞ƒ ÅHõ∆ÏÅ∞ : (SYMPTOMS OF HEART DISEASE)"≥Ú Œ@ „Ñü =∞x+≤ ÅHõ∆ÏÅ∞ ≥Å∞ã¨∞H˘x, "åi =Ü«∞ã¨∞û#∞ |\ì,Ñïã≤÷ «∞Å#∞ =∞iÜ«Ú QÆ∞O_≥ [|∞ƒ#∞ „¿Ñˆ~Ñ≤OKÕ "åº èŒ∞Å#∞, (RISK

FACTORS L^•! á⁄QÆ„`åQÆ∞@, =∞ èŒ∞"Õ∞Ç¨Ï "åºkè, ~°HõÎáÈ@∞, ~°HõÎOÖ’JkèHõOQÍ H˘Öˇ„™êìÖò LO_»∞@, =Oâ◊áê~°OÑ¨~°º "åºkè) ^Œ$+≤ìÖ’LOK«∞H˘x Ñ¨sHõ∆ KÕÜ«Ú@ KåÖÏ =ÚYº=Ú.

2. „áê^äŒq∞Hõ QÆ∞O_≥ Ñ¨sHõ∆ :nx ^•fi~å =∞x+≤ <å_ç (PULSE), BLOOD PRESSURE =∞iÜ«ÚSTETHOSCOPE ^•fi~å QÆ∞O_≥ Ñ¨sHõ∆ KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.

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Blood pressure apparatus or Sphygmomanometer ^•fi~å ~°HõÎáÈ@∞#∞ Hõ#∞Q˘#=K«∞Û#∞.

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3. ~°HõÎ Ñ¨sHõ∆Å∞ :g\˜Ö’ =ÚYº"≥∞ÿ#k – ~°HõÎOÖ’ H˘Öˇ„™êìÖò =∞iÜ«Ú qq èŒ ~°HÍÅH˘Öˇ„™êìÖò âß «O ≥Å∞ã¨∞H˘#∞@.

~°HõÎOÖ’ LDL H˘Öˇ„™êìÖò, TRIGLYCERIDES (K≥_»∞ H˘Öˇ„™êìÖò) âß «OÃÑiy<å, ÖËHõ HDL H˘Öˇ„™êìÖò (=∞Oz H˘Öˇ„™êìÖò) âß «O «yæ<å,QÆ∞O_≥ [|∞ƒ =KÕÛ J=HÍâ◊O LO@∞Ok. JO Œ∞ˆH 20 Uà◊√§ ÃÑ·|_ç#"å~°∞ D Ñ¨sHõ∆ KÕ~ÚOK«∞H˘x, H˘Öˇ„™êìÖò âß «O „Ñ¨HÍ~°=Ú, PÇ¨~°xÜ«∞=∂Å#∞ áê\OK«_»O QÍx, H˘Ö„™êìÖò âß «O «yæOK«∞@‰õΩ "≥· Œ∞ºxã¨ÅÇ¨"Õ∞~°‰õΩ =∞O Œ∞Å∞ "å_»@O =∞Ozk.

=∞x+≤ ÅHõ∆ÏÅ`À, „áê äŒq∞Hõ ÑsHõ∆ «~åfi « [|∞ƒ#∞ QÆ∞iÎOz, x~åú~°QÆ∞iOz „Ñ¨ ÕºHõ Ñ¨sHõ∆Å∞ KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.

E.C.G. ZÅ¢HÀìHÍi¤Ü≥∂„QÍO nx ^•fi~å QÆ∞O_≥ ELECTRICAL ACTIVITY x x~åúiOK«=K«∞Û#∞.

nx •fi~å Kèåu <˘Ñ≤Ê QÆ∞O_≥ [|∞ƒ‰õΩ ãÖ|OkèOz#k J=Ù<å HÍ^•Jx ≥Å∞ã¨∞H˘#=K«∞Û#∞. « •fi~å QÆ∞O_≥áÈ@∞ x~åúiOK«=K«∞Û#∞.

WO Õ HÍ‰õΩO_® ~°HõÎáÈ@∞, =∞ èŒ∞"Õ∞ÇÏ "åºkè, Hõ"å@ ãO|Okè « "åº èŒ∞Å=Å# QÆ∞O_≥ g∞ Œ „Ñ¨ÉèÏ==Ú ECG ^•fi~å ≥Å∞ã¨∞H˘#=K«∞Û#∞.

ECG =Å# QÆ∞O_≥ ÑxKÕÜ«Ú "ÕQÆO =∞iÜ«Ú ÅÜ«∞ ≥Å∞ã∞H˘#=K«∞Û#∞.

Kèåu X-RAY :

X-ray Chest Kèåu X-RAY ^•fi~å QÆ∞O_≥ Ñïq∞ux `≥Å∞ã¨∞H˘#=K«∞Û#∞.

Kèåu X-RAY ^•fi~å Q Æ∞O_≥ [|∞ƒ L#fl^Œx J#∞=∂x¿ãÎEchocardiogram KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.

12 13

2 - DIMENSIONAL ECHOCARDIOGRAM&

COLOUR DOPPLER

DHÀHÍi¤Ü≥∂„QÍO ^•fi~å QÆ∞O_≥x~å‡=Ú, Ñ¨xKÕÜ«Ú q^è•#=Ú,Ñ¨Ù@∞ìHõ À =KÕÛ "åº èŒ∞Å∞ –CONGENITAL HEART DISEASE,

Hõ"å@ ãÖ|O^è Œ" ≥∞ ÿ# "åº^è Œ ∞Å∞VALVULAR HEART DISEASE

QÆ∞O_≥ HõO_»~°=Ú#‰õΩ ãÖ|OkèOz#W «~° "åº èŒ∞Å∞ x~åúiOK«=K«∞Û#∞.

HõÅ~ü _®Ñ¨¡~ü`À – (COLOUR

DOPPLER) QÆ∞O_≥ JO «~åƒùQÍ# ~°HõÎ„Ñ¨ã¨~° QÆ∂iÛ ≥Å∞ã¨∞H˘#=K«∞Û.

9

24 HOURS HOLTER

J#QÍ 24 QÆO@Å∞ ECG RECORDING : D Ñ¨sHõ∆ ^•fi~å XHõxs‚ « 24 QÆO@Å HÍÅOÖ’ QÆ∞O_≥ Ñ¨xKÕÜ«Ú q è•<åxfl, "ÕQÍxfl ECG

~°∂áê# `≥Å∞ã¨∞H˘# =K«∞Û#∞. `«^•fi~å QÆ∞O_≥ ÅÜ«∞|^Œ ú=ÚQÍÑxKÕÜ«ÚK«∞#fl^• ÖË •, ARRHYTHMIAS (RHYTHM DISTURBANCES

OF HEART) QÆ∞iOz ≥Å∞ã¨∞H˘#=K«∞Û#∞.

TREADMILL TEST : (TMT)

nx ^•fi~å Kèåu <˘Ñ≤Ê QÆ∞O_≥ [|∞ƒ‰õΩ ã¨O|OkèOz# Õ<å, HÍ^•Jx x~åúiOK« =K«∞Û#∞. „>ˇ_£q∞Öò Ñ¨sHõ∆ ^•fi~å QÆ∞O_≥Ö’ Ö’Ñ¨=Ú#fl ŒxJ#∞=∂x¿ãÎ, ANGIOGRAM KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.

POlÜ≥∂„QÍ"£∞ (ANGIOGRAM) =∞iÜ«ÚCARDIAC CATHETERISATION

nx =Å# QÆ∞O_≥‰õΩ ~°HõÎO ã¨~°Ñ¶¨~å KÕ¿ã Hõ~À#s ~°HõÎ <åàÏÅ#∞

K«∂_»=K«∞Û#∞. Hõ~À#s POlÜ≥∂„QÍ"£∞ ^•fi~å QÆ∞O_≥ HõO_»~°=Ú#‰õΩ ~°HõÎ

„Ñ¨ã¨~° QÆ∂iÛ ≥Å∞ã¨∞H˘#=K«∞Û#∞. POlÜ≥∂„QÍ"£∞ ^•fi~å QÆ∞O_≥ ~°HõÎ

„Ñã~° QÆ∞iOKÕ HÍHõ, â◊s~°OÖ’ q∞QÆ å J=Ü«∞"åÅ‰õΩ ~°HõÎ „Ñã~° =º=ã÷

QÆ∞iOz ‰õÄ_® ‰õ∆Ω‚OQÍ ≥Å∞ã¨∞H˘#=K«∞Û#∞.

W Õ „Ñ¨„H˜Ü«∞`À QÆ∞O_≥Ö’ =∞iÜ«Ú =ÚYº ~°HõÎ <åàÏÅÖ’ ~°HõÎ„Ñ¨ã¨~°,

^•x „Hõ=∞=Ú ≥Å∞ã¨∞H˘#=K«∞Û#∞. =ÚYºOQÍ Ñ¨Ù@∞ìHõ À LO_»∞ "åº èŒ∞Å∞,

Hõ"å@ ã¨O|O èŒ "åº èŒ∞Å x~åú~°Ö’ CARDIAC CATHETERISATION

LÑ¨Ü≥∂QÆÑ¨_»∞ «∞Ok.

14 15

10

5. QÆ∞O_≥ [|∞ƒ#∞ „¿Ñˆ~Ñ≤OKÕ HÍ~°ÏÅ∞RISK FACTORS

1) DIABETES MELLITUS - =∞ èŒ∞"Õ∞Ç¨Ï "åºkè

2) HYPERTENSION - JkèHõ ~°HõÎáÈ@∞

3) SMOKING - á⁄QÆ„`åQÆ∞@

4) FAMILY HISTORY - =Oâ◊áê~°OÑ¨~°ºOQÍ QÆ∞O_≥ [|∞ƒ ~å=@O

5) HYPERCHOLESTEROLEMIA - ~°HõÎOÖ’ K≥_»∞ H˘Å„™êìÖò âß`«O

ÃÑ~°∞QÆ∞@.

=∞ èŒ∞"Õ∞Ç¨Ï "åºkè

– =∞ èŒ∞"Õ∞Ç¨Ï "åºkè L#fl"åiH˜ QÆ∞O_≥ [|∞ƒ ~°Hõ ~°HÍÅ∞QÍ =ã¨∞ÎOk.

=∞ èŒ∞"Õ∞Ç¨Ï "åºkè =Å# QÆ∞O_≥ HõO_»~°=Ú ≥|ƒux Ç¨~üì ÃÑ¶~ÚÅ∂º~ü

~å=K«∞Û#∞.

– =∞^èŒ∞"Õ∞Ç¨Ï "åºkè =Å# Hõ~À#s ~°HõÎ <åàÏÅÖ’ ~°HõÎ „Ñ¨ã¨~°‰õΩ

JO «~åÜ«∞O U~°Ê_»=K«∞Û#∞.

– QÆ∞O_≥ [|∞ƒ ÅHõ∆ÏÅ∞ ÖË‰õΩO_® =∞ èŒ∞"Õ∞Ç¨Ï "åºkè „Ñ¨„H˜Ü«∞ =Å#

QÆ∞O_≥áÈ@∞ ~å=K«∞Û#∞. JO Œ∞ˆH D "åºkè L#fl"å~°∞ QÆ∞O_≥ Ñ¨sHõ∆

KÕã¨∞HÀ=_»O =∞Ozk.

JkèHõ ~°HõÎáÈ@∞ :

– JkèHõ ~°HõÎáÈ@∞ =Å# QÆ∞O_≥ [|∞ƒ HÍ‰õΩO_® "≥∞ Œ_»∞, =¸„ «Ñ≤O_®Å∞

=∞iÜ«Ú HõO\˜ [|∞ƒÅ∞ ~å=K«∞Û#∞. HÍ=Ù# „Ñü"å~°∞ ~°HõÎáÈ@∞#∞

J èŒ∞Ñ¨ÙÖ’ LOK«∞@‰õΩ Ñ¨sHõ∆ KÕ~ÚOK«∞H˘x zH˜ «û á⁄O Œ∞@ =∞Ozk.

á⁄QÆ „`åQÆ∞@

g∞‰õΩ ≥Å∞™ê ?

WHO „Ñ¨HÍ~°=Ú á⁄QÍ‰õΩ =Å# „Ñ¨ÑÖK« "åºÑÎOQÍ ÃÑ ŒÌ LÑ¨„ Œ==ÚãÖÉèíqOK«QÆÅ Œ∞.

„Ñü U_®k 4 q∞eÜ«∞#¡ „Ñ¨[Å∞ á⁄QÍ‰õΩ ãÖ|OkèOz# "åº èŒ∞Å=Å# =∞~°˜™êÎ~°x JOK«<å.

2030 =~°‰õΩ D q èŒOQÍ =∞~°ÕKÕ "åi ãÖYº 10 q∞eÜ«∞#¡‰õΩÃÑ~°QÆQÆÅ Œ∞.

á⁄QÍ‰õΩ "å_Õ "åiÖ’ QÆ∞O_≥ [ÉËƒ HÍHõ âßfiã¨HÀâ◊, r~°‚HÀâ◊ =∞iÜ«Ú=¸„ «HÀâ◊ HÍ#û~ü =KÕÛ J=HÍâ◊=Ú LO@∞Ok.

2020 =~°‰õΩ 70% á⁄QÍ‰õΩ ãÖ|OkèOz# =∞~°ÏÅ∞ ¿Ñ Œ =∞iÜ«ÚJaè=$kú K≥O Œ∞ «∞#fl ÕâßÖ’¡ ãÖÉèíq™êÎÜ«∞x JOK«<å.

„Ñ¨ÑÖK« "åºÑ¨ÎOQÍ 48% =∞Ok =∞QÆ"å~°∞ 12% P_»"å~°∞á⁄QÆ„`åQÆ∞`å~°x JOK«<å.

á⁄QÍ‰õΩ "å_»@O =Å# QÆ∞O_≥ [|∞ƒ J=HÍâ◊O 3 Ô~@∞¡ ÃÑ~°∞QÆ∞ «∞Ok.

Ñ¶≤Åì~°∞¡ HÍx, q∞QÆ å =∂~°∞ÊÅ =Å# D [|∞ƒ J=HÍâ◊O U =∂„ «=Ú`«QÆæ^Œ∞.

"Second-Hand Smoke" =Å# á⁄QÆ „`åQÆ∞"åi K«∞@∞ì „Ñ[Å‰õΩ ‰õÄ_®D Ç¨xÖ’ Uq∞ Õ_® LO_» Œ∞.

á⁄QÆ„`åQÆ@O =Å# QÆ∞O_≥ [|∞ƒ ~å=\ÏxH˜ HÍ~°ÏÅ∞ :

1. â◊s~°OÖ’ OXIDATION PRODUCTS ÃÑ~°QÆ@=Ú.

2. á⁄QÆ„`åQÆ@O =Å# "≥Å∞=_Õ HÍ~°ƒ<£ "≥∂<åÔH· û_£ =∞iÜ«Ú á⁄QÍ‰õΩÖ’xxHÀ\ ˜<£ (Nicotine)–â◊s~°OÖ’x, =ÚYºOQÍ ~°Hõ Î<åà◊OÖ’xENDOTHELIUM #∞ ≥|ƒfã¨∞ÎOk. JO ÕHÍHõ H˘xfl ~°HõÎ HõÏÅ∞ŒQÆæ~°QÍ KÕi, QÆ_»¤Hõ\˜ì, « •fi~å ~°HõÎ „Ñã~°‰õΩ JO «~åÜ«∞=Ú U~°Ê_»∞ «∞Ok.

á⁄QÆ „`åQÆ@O =∂x"Õã≤# «~åfi « QÆ∞O_≥ [|∞ƒ J=HÍâ◊=Ú «QÆæQÆÅ Œxã¨∂K«#.

NO SMOKING

16 17

11

~°HõÎOÖ’ H˘Öˇ„™êìÖò ~°HÍÅ∞ :Total Cholesterol

LDL Cholesterol - 'K≥_»∞— H˘Öˇ„™êìÖò

Triglycerides HDL Cholesterol - '=∞Oz— H˘Öˇ„™êìÖò

ÃÑ· Risk Factors L#fl"å~°∞ =∞iÜ«Ú =∞ èŒº =Ü«∞ã¨∞ûÃÑ· L#fl"å~°∞QÆ∞O_≥ Ñ¨sHõ∆ KÕ~ÚOK«∞H˘#_»O =∞Ozk.

=Oâ◊áê~°O Ñ¨~°ºOQÍ QÆ∞O_≥[|∞ƒ L#fl"å~°∞ QÆ∞O_≥ Ñ¨sHõ∆

KÕ~ÚOK«∞H˘#_»O „âıÜ«∞ã¨ ~°O.

"åºÜ«∂=∞ ÖËq∞, =∂#ã≤Hõ PO^Àà◊# =∞iÜ«Ú ã¨∂÷ÅHÍÜ«∞=Ú QÆ∞O_≥[|∞ƒ ~å=\ÏxH˜ HÍ~°=Ú HÍ=K«∞Û#∞.

6. QÆ∞O_≥ [|∞ƒÅ∞1. CONGENITAL HEART DISEASE - Ñ¨Ù@∞ìHõ À LO_Õ [|∞ƒÅ∞.

2. RHEUMATIC HEART DISEASE - ACUTE RHEMATIC FEVER

«~åfi « =ÚYºOQÍ QÆ∞O_≥ Hõ"å\ÏÅ∞ ≥|ƒu#@O •fi~å =KÕÛ "åºkè.

3. ISCHEMIC HEART DISEARSE : QÆ∞O_≥ HõO_»~åxH ~°HõÎ „Ñã~°Ö’JO «~åÜ«∞O U~°Ê_»_»O =Å# =KÕÛ "åºkè.

4. CARDIOMYOPATHY : QÆ∞O_≥, HõO_»~°=Ú#‰õΩ ãÖ|OkèOz# [|∞ƒ.

5. PERICARDIAL DISEASE : QÆ∞O_≥ K«∞@∂ì LO_Õ ~°Hõ∆ Hõ=KåxH˜PERICARDIUM #‰õΩ =KÕÛ "åºkè.

6. ARRHYTHMIAS : CONDUCTION DISORDERS : QÆ∞O_≥ "ÕQÆOÖ’=∂~°∞ÊÅ∞.

QÆ∞O_≥ «‰õΩ¯=QÍ H˘@∞ìHÀ=_»O – Complete Heart Block HÍx, QÆ∞O_≥Ju"ÕQÆOQÍ H˘@∞ìHÀ=@O – VENTRICULAR TACHYCARDIA HÍxãÖÉèíqOK«∞#∞.

7. TUMORS OF THE HEART.

CONGENITAL HEART DISEASES :

Ñ≤O_» Œâ◊Ö’ QÆ∞O_≥ x~å‡OÖ’ Ö’ÑÖ [iy Õ =KÕÛ qq èŒ ~°HÍÅ"åº èŒ∞Å∞.

QÆ∞O_≥Ö’ ~°O„ èŒO LO_»@O q<åfl~å ?

– QÆ∞O_≥ J~°Å =∞ èŒº LO_Õ SEPTUM – QÀ_» x~å‡OÖ’ Ö’ÑO [iy ÕATRIA =∞ èŒº ATRIAL SEPTAL DEFECT HÍx VENTRICLES =∞ èŒº#VENTRICULAR SEPTAL DEFECT =K«∞Û#∞.

– QÆ∞O_≥ ~°HõÎ „Ñ¨ã¨~° =º=ã÷Ö’x =ÚYº ~°HõÎ<åàÏÅ∞ AORTA =∞iÜ«ÚPULMONARY ARTERY =∞ èŒº# L#fl DUCTUS ARTERIOSUS

J#∞ ÉèÏQÆ=Ú Ñ≤O_» Œâ◊Ö’<Õ =¸ã¨∞H˘x áÈ=ÅÜ«Ú#∞.

– JÖÏ HÍ#@¡~Ú Õ PATENT DUCTUS ARTERIOSUS J#∞ "åºkè=K«∞Û#∞.

18 19

12

Ñ¨Ù@∞ìHõ À LO_»∞ "åº èŒ∞Å ÅHõ∆ÏÅ∞ :

– Ñ¨Å∞=∂~°∞¡ âßfiã¨HÀâ◊HÍx, TÑ≤iu «∞ÎÅ "åºkè ~å=@O.

– Ñ¨Å∞=∂~°∞¡ [Å∞|∞ KÕÜ«∞@O.

– áêÑ¨ áêÅ∞ „`åQÆ@OÖ’ Hõ+ìÑ¨_»@O.

– áêÑ¨ ÃÑ~°∞QÆ∞ ŒÅÖ’ Ö’Ñ¨O.

H˘xfl H˜¡+¨ì"≥∞ÿ# "åº^èŒ∞Å∞ – L^• : Cyanotic Congenital Heart

Diseases Ö’ ÃÑ Œ=ÙÅ∞HÍx, <åÅ∞HõQÍx, KÕ «∞Å∞, HÍà◊¡ QÀà◊√¡ he~°OQÆ∞Ö’ LO_»@O – Cyanosis "åºkè ÅHõ∆O. gix Blue Babies

Jx JO Œ∞~°∞.

– ™ê^è•~°OQÍ D "åº^è Œ∞Å∞ Ñ≤Å¡Å "åºkè xÑ¨Ù∞Å Ñ¨sHõ ∆Ö’|Ü«∞@Ñ¨_»∞#∞.

RHEUMATIC HEART DISEASE :

Wk =∞# Õâ◊OÖ’ ã¨~°fi ™ê è•~°"≥∞ÿ# QÆ∞O_≥ [|∞ƒ.

QÆ∞O_≥ Hõ"å\ÏÅ#∞ ^≥|ƒf¿ã D "åºkè ™ê^è•~°OQÍ ACUTE

RHEUMATIC FEVER `À "≥Ú ŒÅ HÍ=K«∞Û#∞.

ACUTE RHEUMATIC FEVER ÅHõ∆ÏÅ∞ :

– Wk ™ê è•~°OQÍ 5–15 Uà◊¡ =Ü«∞ã¨∞û Ñ≤Å¡ÅÖ’ =K«∞Û#∞.

– H©à◊¡ <˘Ñ¨CÅ∞, [fi~°=Ú, Q˘O «∞<˘Ñ≤Ê, nx ™ê è•~° ÅHõ∆ÏÅ∞.

B - HEMOLYTIC STREPTOTOCCAL BACTERIAL INFECTION

`À Q˘O «∞ <˘Ñ≤Ê`À "≥Ú ŒÅ~Ú, BACTERIA K«∞@∂ì Hõ=K«OÖ’x„áÈ\©<£ =∞iÜ«Ú QÆ∞O_≥Ö’ LO_Õ „áÈ\©<£ „HÍãπ iÜ«∂Hõ∆<£ J=Ù «∞Ok.

D q èŒOQÍ ACUTE RHEUMATIC FEVER =Å# QÆ∞O_≥ Hõ"å\ÏÅ∞^≥|ƒu#@O =Å# ~°Hõ~°HÍÅ VALVULAR HEART DISEASES

ã¨OÉèíqOK«∞#∞.

L^• :MITRAL STENOSIS. MITRAL REGURGITATION.

AORTIC STENOSIS. AORTIC REGURGITATION.

ISCHEMIC HEART DISEASE(OR)

CORONARY ARTERY DISEASE

HEART ATTACK (QÆ∞O_≥áÈ@∞) ZÖÏ =ã¨∞ÎOk ?

QÆ∞O_≥ HõO_»~°=Ú xifi~å=∞OQÍ Ñ¨x KÕ¿ãO^Œ∞‰õΩ Hõ~À#s ~°HõÎ<åàÏÅ

^•fi~å ~°HõÎ „Ñ¨ã¨~° [~°∞QÆ∞`«∞Ok. Hõ~À#s ~°HõÎ<åàÏÖ’¡ PLAQUE,

THROMBUS U~°Ê_ç, ~°HõÎ<åà◊ ~°O„ èŒ=Ú qã‘Î~°‚=Ú «QÆæ\Ïxfl CORONARY

STENOSIS JO\Ï~°∞.

nx ^•fi~å QÆ∞O_≥ HõO_»~åxH˜ =∞Oz ~°HõÎO ã¨~°Ñ¶~å «yæáÈ=@=Ú#∞

MYOCARDIAL ISCHEMIA JO\Ï~°∞. `«^•fi~å =KÕÛ Kèåu <˘Ñ≤Êx

‘ANGINA’ JO\Ï~°∞. Hõ~À#s èŒ=∞#∞ÅÖ’ U ≥·<å XHõ •xÖ’ #∂~°∞ âß «O

~°HõÎ „Ñ¨ã¨~°‰õΩ P@OHõ=Ú U~°Ê_ç Õ, QÆ∞O_≥ HõO_»~°=Ú ≥|ƒu#_»O =Å#

HEART ATTACK (QÆ∞O_≥áÈ@∞) =ã¨∞ÎOk.

ATHEROSCLEROSIS J#QÍ <Õq∞ ?

"ATHERO" - PORRIDGE – zHõ x Ñ¨ •~°÷=Ú.

"SCLEROSIS" - HARDENING – QÆ\ì Ñ¨_»@=Ú.

™ê è•~°=ÚQÍ ARTERY ( èŒ=∞#∞Å) QÀ_»ÅÖ’ HÍe¬Ü«∞O, H˘=Ùfi

Ñ¨ •~å÷Å∞ LO_»=Ù. ~°HõÎ<åàÏÅÖ’, "å\˜ QÀ_»ÅÖ’, JO «~åƒùQÍ# H˘=Ùfi

Ñ¨ •~å÷Å∞, HÍe¬Ü«∞O, ~°HõÎ HõÏÅ∞ QÆ_»¤ Hõ\ì PLAQUE QÍ U~°Ê_ç, á⁄~°Å∞

á⁄~°Å∞QÍ KÕi THROMBUS QÍ =∂i, ~°HõÎ „Ñã~°‰õΩ JO «~åÜ«∞O HõeyOKÕ

"åºkè „Ñ¨„H˜Ü«∞<Õ ATHEROSCLEROSIS JO\Ï~°∞. « •fi~å P ARTERY

( èŒ=∞x) U ÉèÏQÍxH =∞Oz ~°HÍÎxfl ã~°Ñ¶~å KÕã∞ÎO^À P J=Ü«∞= ÉèÏQÍxH

~°HõÎ „Ñ¨ã¨~° «yæáÈ «∞Ok.

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13

=∂#= ~°HõÎ „Ñ¨ã¨~° =º=ã÷ ~°HõÎ<åàÏÅÖ’ ~°HõÎ„Ñ¨ã¨~°‰õΩJO «~åÜ«∞=Ú U~°Ê_»∞ q è•#=Ú

22 23

14

HÍi¤Ü≥∂=∞Ü≥∂Ñü :HÍi¤Ü≥∂=∞Ü≥∂Ñu J#QÍ QÆ∞O_≥ HõO_»~°=Ú#‰õΩ ãO|OkèOz# "åºkè.

QÆ∞O_≥áÈ@∞ Ñ≤ ŒÑ¨, =∞ èŒ∞"Õ∞Ç¨Ï "åºkè, JkèHõ ~°HõÎáÈ@∞ =Å# Wk ~å=K«∞Û.

H˘xfl =∂~°∞¡ "≥·~°ãπ =Å# QÆ∞O_≥ HõO_»~°=Ú g∞ Œ „Ñ¨ÉèÏ==Ú =Å#=∞Ü≥∂HÍÔ~Â¤\ ˜ãπ J#∞ PÑ¨ « ~° "åºkè ~å=K«∞Û#∞.

Z~Ú_£û =Å# ‰õÄ_® QÆ∞O_≥[|∞ƒ ~å=K«∞Û#∞.

JuQÍ =∞^ŒºO ¿ãqOK«∞@ =Å# QÆ∞O_≥ HõO_»~°=Ú ^≥|ƒu#_»"Õ∞HÍ‰õΩO_®, ~°HõÎOÖ’x K≥_»∞ H˘Öˇ„™êìÖò âß`«O ÃÑiy QÆ∞O_≥ [|∞ƒ~å=K«∞Û#∞.

H˘xfl =∂~°∞¡ ÕÅ∞ ‰õΩ@ì_»O =Å#, q Œ∞º^•… «=Ú =Å#, H˘xfl =∞O Œ∞Å=Å# (HÍº#û~ü "åºkèH˜ "å_Õ =∞O Œ∞Å∞ =∞iÜ«Ú =∂#ã≤Hõ "åº èŒ∞Å‰õΩLÑ¨Ü≥∂yOKÕ =∞O Œ∞Å =Å#) QÆ∞O_≥ g∞ Œ „Ñ¨ÉèÏ==Ú LO_»∞#∞.

QÆ∞O_≥ K«∞@∂ì LO_Õ ÃÑiHÍi¤Ü«∞O‰õΩ =KÕÛ [|∞ƒ =∞#^Õâ◊OÖ’™ê è•~°OQÍ Hõ∆Ü«∞ "åºkè =Å#<Õ HÍHõ, "≥·~°ãπ =Å# ‰õÄ_® =K«∞Û#∞.

QÆiƒù˜ ¢ã‘ÎÅÖ’ QÆ∞O_≥ [|∞ƒ(HEART DISEASE IN PREGNANCY)

QÆiƒù© ¢ã‘ÎÅÖ’ QÆ∞O_≥ [|∞ƒ‰õΩ ãÖ|OkèOz# ÅHõ∆ÏÅ∞ L#fl@¡~Ú Õ,QÆ∞O_≥ Ñ¨sHõ∆ KÕ~ÚOK«∞H˘#_»O =∞Ozk.

QÆiƒù© ¢ã‘ÎÅÖ’ QÆ∞O_≥ [|∞ƒ L#fl Œx x~å÷~° J~Ú Õ, „Ñã= ã=∞Ü«∞=Ú=~°‰õΩ "≥· Œ∞ºx Ñ¨~°º"ÕHõ∆Ö’ LO_»@O =∞Ozk.

HTN – ~°HõÎáÈ@∞, VALVULAR HEART DIEASES – Hõ"å@ ãO|O èŒ"åº èŒ∞Å∞, QÆiƒù© ¢ã‘ÎÅÖ’ =K«∞Û ™ê è•~° QÆ∞O_≥ [|∞ƒÅ∞.

H˘xfl QÆ∞O_≥ [|∞ƒÅ∞ L#fl@¡~Ú Õ L^•! PERIPARTUM

CARDIOMYOPATHY, PRIMARY PULMONARY

HYPERTENSION, =∞m¡ QÆ~°ƒùO ^•ÅÛ@O „âıÜ«∞ã¨ ~°O HÍ Œ∞.

QÆiƒù© ¢ã‘ ÎÅÖ’ ~°Hõ ÎáÈ@∞HÍx, QÆ∞O_≥ [|∞ƒHÍx, `«e¡H˜HÍx,Ñ≤O_»=Ú#‰õΩQÍx Ç¨xHõ~°=Ú. HÍ=Ù#, "≥· Œ∞ºx ã¨ÅÇ¨ áê\ÕK«_»O=∞Ozk.

HEART FAILURE :

~°Hõ~°HÍÅ QÆ∞O_≥ [|∞ƒÅ =Å# QÆ∞O_≥ ãïQÍæ Ñ¨xKÕÜ«∞Hõ áÈ=_»O=¸ÖÏ#, q∞QÆ å J=Ü«∞"åÅ‰õΩ – =ÚYºOQÍ "≥∞ Œ_»∞‰õΩ, =¸„ «Ñ≤O_®Å‰õΩ~°HõÎ„Ñ¨ã¨~° ≥|ƒux, ~°HõÎOÖ’ PH˜û[<£ âß «O «QÆæ_»O (HYPOXEMIA)

=Å#, CARDIORESPIRATORY ARREST =Å# =∞~°O ãOÉèíqOK«∞#∞.

Ç¨~üì ÃÑ¶~ÚÅ∂º~ü ÅHõ∆ÏÅ∞ :– `˘O Œ~°QÍ JÅã¨@ K≥O Œ∞@

– PÜ«∂ã¨=Ú ÖËHõ Œ=Ú‡

– HÍà◊¡ "åÑ¨Ù

QÆ∞O_≥ HõO_»~°=Ú ~°Hõ~°HÍÅ "åº èŒ∞Å =Å# ≥|ƒu#_»O =¸ÖÏ#,QÆ∞O_≥ Ñ¨xKÕ¿ã â◊HÎ «QÆ∞æ «∞Ok. « •fi~å W «~° J=Ü«∞"åÅ‰õΩ ~°HõÎ „Ñ¨ã¨~°«Qæ J=HÍâ◊O LO@∞Ok.

D Ñïã≤÷uH˜ =ÚYº HÍ~°ÏÅ∞ :– QÆ∞O_≥áÈ@∞

– JkèHõ ~°HõÎáÈ@∞

– =∞ èŒ∞"Õ∞Ç¨Ï"åºkè

– HÍi¤Ü≥∂=∞Ü≥∂Ñü

24 25

15

QÆ∞O_≥ [|∞ƒ`À PHõã≤‡Hõ =∞~°ÏÅ‰õΩ HÍ~°ÏÅ∞ :rq «OÖ’ "≥Ú@ì"≥Ú Œ\˜ ™êiQÍ QÆ∞O_≥ [|∞ƒ ÅHõ∆ÏÅ∞ =ÚYºOQÍ

Kèåu <˘Ñ≤Ê "≥Ú ŒÅ~Ú# QÆO@ Ö’ÑÅ =∞~°=Ú ãOÉèíqOz#@¡~Ú Õ nxx

SUDDEN CARDIAC DEATH QÍ ¿Ñ~˘¯O Œ∞~°∞.

SUDDEN CARDIAC DEATH ‰õΩ HÍ~°ÏÅ∞ :1) QÆ∞O_≥ Ju "ÕQÆOQÍ H˘@∞ìH˘#_»O VENTRICULAR TACHYCARDIA

2) QÆ∞O_≥ „Hõ=∞O «Ñ≤Ê Ñ¨x KÕÜ«∞_»O VENTRICULAR FIBRILLATION

3) COMPLETE HEART BLOCK (QÆ∞O_≥ «‰õΩ¯=QÍ H˘@∞ìHÀ=_»O)

4) CARDIAC ASYSTOLE & CARDIAC ARREST QÆ∞O_≥ PyáÈ=_»O.

D „Ñ¨=∂ Œ Ñ¨iã≤÷ «∞Å#∞ H˘xfl=∂~°∞¡ ã¨iÜ≥ÿ∞# suÖ’ QÆ∞iÎOz##∞,

H˘xfl™ê~°∞¡ =∂„ «"Õ∞ „áêÏáêÜ«∞O #∞Oz HÍáê_»=K«∞Û#∞.

QÆ∞O_≥ PyáÈ~Ú ã¨Ê $Ç¨Ï «Ñ≤Ê# =∞x+≤H˜ KÕÜ«Ú „Ñ„H˜Ü«∞

1

2 3

4 5 6

7 8

26 27

16

8. QÆ∞O_≥ [|∞ƒÅ∞ – zH˜ åû Ñ¨ Œú «∞Å∞ QÆ∞O_≥ [|∞ƒ x~åú~° [iy# «~åfi « zH˜ «û =ÚYº=Ú.

zH˜ åû Ñ¨ Œú «∞Å∞ :

– =∞O Œ∞Å∞ "å_»@O (MEDICAL MANAGEMENT)

– INTERVENTIONAL METHODS.

– SURGICAL MANAGEMENT (â◊¢ãÎ zH˜ «û)

zH˜ åû Ñ¨ Œú «∞Å∞ "åºkè «~°Ç¨ =∞iÜ«Ú "åºkè Œâ◊#∞ |\ì LO_»∞#∞.

Ñ¨Ù@∞ìHõ À LO_»∞ "åº èŒ∞Å‰õΩ zH˜ åû Ñ¨ Œú «∞Å∞(TREATMENT METHODS FOR CONGENITAL HEART DISEASE)

– Ñ¨Ù@∞ìHõ À LO_»∞ "åº èŒ∞ÅÖ’ JxflO\˜H˜ â◊„ãÎ zH˜ «û J=ã¨~°=∂?ÖË Œ∞.

– H˘xfl Ñ¨Ù@∞ìHõ`À LO_»∞ "åº^èŒ∞Å∞ (ATRIAL SEPTAL DEFECT,

VENTRICULAR SEPTAL DEFECT) – ''QÆ∞O_≥ J~°Å =∞ èŒºQÆÅQÀ_»ÅÖ’ ~°O„ èŒ=Ú——:–

D Ö’Ñ=ÚÅ∞ H˘O « =∞Ok Ñ≤Å¡ÖÖ’ HÍÅ„Hõ"Õ∞Ï Ñ Õà◊§ =Ü«∞ã∞ûÖ’ÑÙ=¸#∞H˘x áÈ=Ù#∞.

– ~°O„ èŒ=Ú ÖË • Ö’Ñ¨=Ú Ñïq∞ux |\ì, "åºkè ÅHõ∆ÏÅ∞, f„= «|\ì, z#fl «#OÖ’<Õ â◊„ãÎ zH˜ «û J=ã¨~°O Ñ¨_»∞ «∞Ok.

(ASD CLOSURE, VSD CLOSURE, PDA LIGATION).

– P^èŒ∞xHõOQÍ, D Ö’Ñ¨=Ú#∞ â◊„ã¨Î zH˜`«û J=ã¨~°=Ú ÖË‰õΩO_®–DEVICE CLOSURE J#∞ „Ñ¨ „H ˜Ü«∞ ^•fi~å ãïKÕÜ«Ú@[~°∞QÆ∞K«∞#flk.

– H˘xfl H˜¡+¨ì"≥∞ÿ# "åº^èŒ∞ÅÖ’ COMPLEX CONGENITAL HEART

DISEASES Œ∞~° Œ$+ì=âß «∞Î, =∞O Œ∞Å∞HÍx, â◊„ãÎ zH˜ «û=Å##∞„Ñ¨Ü≥∂[#=Ú LO_»Hõ, "åºkè J"åO «~° Ñïã≤÷ «∞Å‰õΩ ^•ifÜ«Ú#∞.

7. g∞ =ÚO^Œ∞ Z=Ô~·# JHõ™ê‡`«∞ÎQÍ ã¨Ê $Ç¨Ï`«Ñ≤ÊÑ¨_çáÈ`Õ Uq∞ KÕÜ«∂e ?

(CARDIO PULMONARY RESUSCITATION)

QÆ∞O_≥ JHõ™ê‡ «∞ÎQÍ PyáÈ Õ,

– "≥∞ Œ_»∞‰õΩ ~°HõÎ „Ñ¨ã¨~° Py "å~°∞ ≥eq «Ñ¨C`å~°∞.

– <å_ç, TÑ≤i PyáÈ «∞Ok.

– g∞~°∞ D Ñïã≤÷ux Z Œ∞~˘¯#fl@¡~Ú Õ, «Hõ∆O J «º=ã¨~° zH˜ åû

qÉèÏQÍxH˜ «~°eOK«=Öˇ#∞. DÖ’Ñ¨Ù g∞~°∞ KÕÜ«∞=Åã≤# „Ñ¨„H˜Ü«∞<Õ

Cardio Pulmonary Resuscitation (CPR) JO\Ï~°∞.

– ~Àyx XHõ ã¨=∂O «~° ã÷ÅOÃÑ· Ñ¨_»∞HÀÉˇ@ì=Öˇ#∞. HÍà◊¡#∞ H˘kÌQÍ ÃÑ·H˜

ÖËÑ¨=Öˇ#∞.

– Kèåu =∞^èŒºÉèÏQÍ# Ñ≤_çH˜e`À XHõ\ ˜, Ô~O_»∞=∂~°∞¡ Ñ≤_çQÆ∞^Œ∞ÌÅ∞

"ÕÜ«∞=Öˇ#∞.

– ÉÁ=∞‡Ö’ K«∂Ñ≤# =∂ki xq∞ëêxH˜ 80–100 =∂~°∞¡ Kèåux =∞~°ú#

KÕÜ«∞=Öˇ#∞.

– ~Àyx „Ñ¨Hõ "≥∂HÍà◊¡ g∞ Œ g∞~°∞ LO_ç, XHõKÕ~Ú J~°KÕu ÉèÏQÍxfl

Kèåu „HÕk ÉèÏQÍ# LOz, WOH˘Hõ KÕu J~°KÕu "≥Ú Œ\˜ •x g∞ Œ

LOz =∞~°Ì# KÕÜ«∞=Öˇ#∞.

WÖÏ KÕã¨∞‰õΩO@∂, <À\˜Ö’x „ Œ= Ñ¨ •~å÷Å#∞ fã≤"Õã≤, ~Ày<À\˜x

g∞ <À\˜ À =¸ã≤"Õã≤, TÑ≤ix JOkOK«=Öˇ#∞.

ÃÑ· Ñ¨ Œúux «fi~°QÍ áê\Õz <å_ç =zÛ# Ñ≤ ŒÑ¨, TÑ≤i =zÛ# Ñ≤ ŒÑ¨,

J «º=ã¨~° zH˜ åû qÉèÏQÍxH˜ «~°eOK«=Öˇ#∞.

28 29

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TREATMENT OF VALVULAR HEART DISEASES

Hõ"å@ ãO|O èŒ "åº èŒ∞ÅÖ’ RHEUMATIC HEART DISEASE =Å#=KÕÛ MITRAL STENOSIS. =∞# Õâ◊OÖ’ ™ê è•~°=Ú. D "åºkèÖ’MITRAL VALVE Ñiq∞u «QÆ∞æ «∞Ok. â◊„ãÎzH «û, P èŒ∞xHõ Ñ Œú «∞Ö·#PERCUTANEOUS BALLOON VALVOTOMY ^•fi~å nx zH˜ «ûKÕÜ«∞=K«∞Û#∞.

H˘xfl Hõ"å@ ãÖ|OkèOz# "åº^èŒ∞ÅÖ’ â◊„ã¨Î zH˜`«û – Hõ"å@OÉÏQÆ∞Ñ¨~°Û_»O – (VALVEREPAIR) ÖËHõ Hõ"å@O =∂iÊ_ç (VALVE

REPLACEMENT KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.VALVE REPLACEMENT J#QÍ â◊„ãÎ zH «û •fi~å Hõ$„u=∞ Hõ"å@O(ARTIFICIAL VALVE) J=∞~°Û@O [~°∞QÆ∞ «∞Ok.

Hõ~À#s "åºkè zH˜ åû Ñ¨ Œú «∞Å∞(TREATMENT OF ISCHEMIC HEART DISEASE)

Hõ~À#s "åºkè „áê~°OÉèí Œâ◊Ö’ =∞O Œ∞Å`À zH˜ «û "≥Ú ŒÅ=Ù «∞Ok.D "åºkèÖ’ ™ê è•~°OQÍ "å_Õ =∞O Œ∞Å∞ NITRATES, ASPIRIN.

Hõ~À#s "åºkè ÅHõ∆ÏÅ∞ f„==∞~Ú Õ, UNSTABLE ANGINA J#∞"åºkè Œâ◊‰õΩ KÕ~°∞#∞. D Ñïã≤÷ «∞ÅÖ’ – "≥· Œ∞ºx ã¨ÅÇ¨ "Õ∞~°‰õΩ"åºkè„QÆã¨∞Îx INTENSIVE CORONARY CARE UNIT (ICCU) Ö’KÕ~°Û@O L «Î=∞=Ú. ZO Œ∞HõO>Ë, UNSTABLE ANGINA, QÆ∞O_≥áÈ@∞(HEART ATTACK) ~å=\ÏxH˜ XHõ ÃÇÏK«ÛiHõ.

QÆ∞O_≥áÈ@∞– zH˜ åû Ñ¨ Œú «∞Å∞ Hõ~À#s ~°HõÎ<åà◊=ÚÖ’ #∂~°∞âß`«O ~°HõÎ „Ñ¨ã¨~°‰õΩ JO`«~åÜ«∞O

U~°Ê_ç#@¡~Ú Õ, QÆ∞O_≥áÈ@∞ ~å=K«Ûx ≥Å∞ã¨∞‰õΩ<åflO Hõ •! J~Ú ÕD JO «~åÜ«∂xfl ÖËHõ Thrombus (CLOT #∞) HõiyOKÕ „Ñ¨„H˜Ü«∞#∞THROMBOLYSIS JO^Œ∞~°∞. D „Ñ¨„H˜Ü«∞Ö’ ™ê^è•~°OQÍSTREPTOKINASE, UROKINASE J#∞ =∞O^Œ∞Å#∞ "å_≥^Œ~°∞.(THROMBOLYTIC AGENTS).

QÆ∞O_≥áÈ@∞ Jx x~åúiOz# «~åfi « ZO « «fi~°QÍ ÃÑ· =∞O Œ∞Å∞"å_ç#KÀ, QÆ∞O_≥ HõO_»~°O ≥|ƒu#\Ïxfl «yæOK«=K«∞Û.

P èŒ∞xHõOQÍ,PRIMARY ANGIOPLASTY J#∞ "åºkè „Ñ„HÜ«∞ ‰õÄ_®QÆ∞O_≥áÈ@∞ «~åfi « KÕÜ«∞_»O [~°∞QÆ∞ «∞Ok.

QÆ∞O_≥áÈ@∞ `«~åfi`« Z^Œ∞~°ÜÕ∞º ~°Hõ~°HÍÅ „Ñ¨=∂^Œ Ñïã≤÷`«∞Å(Complications) ^Œ$ëêì º 5–7 ~ÀAÅ∞ Pã¨∞Ñ¨„uÖ’ "≥·^Œ∞ºxÑ¨~°º"ÕHõ∆Ö’ LO_»=Åã≤ =ã¨∞ÎOk.

Hõ~À#s POlÜ≥∂„QÍO •fi~å JO «~åÜ«∞O Hõ#∞Q˘#fl «~åfi « J=ã~°O|\˜ì ÉÅ∂<£ POlÜ≥∂áê¡ã≤ì, Ããì<£ì ÃÑ@∞ì@ ÖËHõ É·áêãπ â◊GzH «û KÕÜ«∞_»O[~°∞QÆ∞ «∞Ok.

É·áêãπ â◊GzH˜ «û J#QÍ â◊s~°OÖ’x W «~° ÉèÏQÍÅ #∞O_ç fã≤# Vein

ÖËHõ Artery x JO «~åÜ«∞O U~°Ê_ç# Hõ~À#s ~°HõÎ <åàÏxH [ «Ñ~°∞Û@.

¿Ñãπ"Õ∞Hõ~ü (PACEMAKER ) J#QÍ <Õq∞?QÆ∞O_≥ ÅÜ«∞Ö’ =∂~°∞Ê=zÛ#KÀ, QÆ∞O_≥ H˘@∞ìH˘#∞ Ñ¨^Œ úux

xÜ«∞O„uOK«∞@‰õΩ Hõ$„u=∞OQÍ K«~°‡OQÍ „HO Œ â◊„ãÎ zH «û •fi~å ¿Ñãπ"Õ∞Hõ~üJ#∞ ÑïHõ~åxfl J=∞Ô~Û Œ~°∞. H˘xfl =∂~°∞¡ QÆ∞O_≥ ÅÜ«∞Ö’, QÆ∞O_≥ "ÕQÆOÖ’ =∂~°∞ÊÅ∞ QÆ∞O_≥Ö’

q Œ∞º «∞Î „Ñ¨ã¨~° ABNORMAL PATHWAYS ^•fi~å [iy#Ñ¨C_»∞ãÖÉèíqOK«∞#∞.D ABNORMAL OR ACCESSORY PATHWAYS #∞

ELECTROPHYSIOLOGICAL STUDIES ^•fi~å Hõ#∞‰õΩ¯x "å\ ˜xx~°∂‡eOKÕ "åºkè „Ñ„HÜ«∞#∞ RADIOFREQUENCY ABLATION JO Œ∞~°∞.

g∞‰õΩ QÆ∞O_≥ [|∞ƒ L#fl@¡~Ú Õ1. =∞O Œ∞Å "å_»HõO QÆ∞iOz =∞iÜ«Ú W «~° ã¨ÅÇ¨Å#∞ g∞ "≥· Œ∞º_»∞

K≥Ñ≤Ê# q èŒOQÍ áêiîOK«O_ç.2. g∞ [|∞ƒ‰õΩ ãO|OkèOz# x~åú~° Ñ„`åÅ∞ =∞iÜ«Ú zH`åû Ñ„`åÅ∞

ÕnÅ "åiQÍ *Ï„QÆ «ÎQÍ Éèí„ ŒÑ¨~°K«O_ç.3. g∞~°∞ „Ñ¨Ü«∂ÕK«∞#Ñ¨Ù_»∞QÍx, "≥· Œ∞ºx ãÖ„Ñ¨kOK«∞ ã¨=∞Ü«∂#, g∞

"≥O@ XHõix fã≤H˘x "≥à◊¡QÆÅ~°∞.

4. g∞~°∞ "å_Õ =∞O Œ∞Å QÆ∞iOz g∞‰õΩ Ñ¨ÓiÎ J=QÍÇ¨Ï# LO_®e.

5. g∞~°∞ "åºkè =Å# x~°∞`åûÇ¨Ï Ñ¨_»#Hõ ~°ÖË Œ∞. g∞ "≥· Œ∞ºx`À "åºkèzH˜ «û QÆ∞iOz ã¨ÅÇ¨Å∞ á⁄O ŒQÆÅ~°∞.

6. PÑ¨ Œ ã¨=∞Ü«∞OÖ’, ã¨=∞Ü«∞O =$ è• KÕÜ«∞‰õΩO_® g∞‰õΩ ŒQÆæ~°QÍ L#fl"≥· Œ∞ºxfl ãÖ„Ñ¨kOK«QÆÅ~°∞.

30 31

1832

9. QÆ∞O_≥ [|∞ƒ ~å‰õΩO_® fã¨∞H˘#=Åã≤# *Ï„QÆ`åÎÅ∞1. =∞^èŒ∞"Õ∞Ç¨Ï=Ú, ~°HõÎáÈ@∞ =∞iÜ«Ú JkèHõ H˘Öˇ„™êìÖò#∞ J^Œ∞Ñ¨ÙÖ’

LOK«∞HÀ=_»O.

2. QÆ∞O_≥‰õΩ ãÖ|OkèOz# U ÅHõ∆=Ú`À ÉÏ èŒÑ¨_ç<å, QÆ∞O_≥ "åº èŒ∞Å

xÑ¨Ù∞x ãÖ„Ñ¨kOK«∞@ =∞Ozk.

3. á⁄QÆ‰õΩ U ~°∂ÑÖÖ’ <≥·<å "å_»@O Ç¨xHõ~°O.

4. „Hõ=∞=Ú «Ñ¨ÊHõ "åºÜ«∂=∞=Ú K≥Ü«∂ºe.

5. |~°∞=Ù «yæOK«∞H˘#_»O (Weight Reduction).

6. =∂#ã≤Hõ XuÎ_çx «yæOK«∞H˘#_»O.

"åºÜ«∂=∞O :â◊s~° "åºÜ«∂=∞O QÆ∞O_≥‰õΩ =∞Ozk. "å~åxH J~Ú Œ∞™ê~°∞¡ 20–30

xq∞ëêÅ áê@∞ #_»Hõ "åºÜ«∂=∞O, QÆ∞O_≥ [|∞ƒ =KÕÛ J=HÍâ◊O#∞

«yæã¨∞ÎOk.

– â◊s~° "åºÜ«∂=∞O ~°HõÎOÖ’x =∞Oz H˘Öˇ„™êìÖò âß`åxfl ÃÑOK«∞ «∞Ok.

– ~°HõÎáÈ@∞ `«yæã¨∞ÎOk.

– "åºÜ«∂=∞O =Å# â◊s~° |~°∞=Ù «QÆ∞æ#∞.

– "åºÜ«∂=∞O TÑ≤iu «∞ÎÅ‰õΩ =∞Ozk.

– "åºÜ«∂=∞O =∂#ã≤Hõ Ñïã≤÷ux "≥∞~°∞QÆ∞Ñ¨~°∞K«∞#∞.




Nx"åã¨ Ç¨~üì ÃãO@~üx"åã¨=Ú :

''N è•„u——, WO\˜ <≥O. 2–4–617/4,~åO#QÆ~ü, Ç¨Ï#‡H˘O_», =~°OQÆÖò. (PO.„Ñ¨.)

Mobile : 93901 05045e-mail : [email protected]


Mobile : 0870-3105045e-mail : [email protected]


Mobile : 0870-3105045e-mail : [email protected]




Nx"åã¨ Ç¨~üì ÃãO@~üx"åã¨=Ú :

''N è•„u——, WO\˜ <≥O. 2–4–617/4,~åO#QÆ~ü, Ç¨Ï#∞=∞H˘O_», =~°OQÆÖò. (PO.„Ñ¨.)

Mobile : 93901 05045e-mail : [email protected]

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08719-25338808719-253233

NRAFORD

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