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Heart Attacks
Coronary heart
disease (CHD) is the leading cause of death for both men and women
in the United States. CHD is caused by a narrowing of the coronary
arteries that supply blood to the heart, and often results in a
heart attack.
Each year, about 1.1 million Americans
suffer a heart attack. About 460,000 of those heart attacks are
fatal. About half of those deaths occur within 1 hour of the start
of symptoms and before the person reaches the hospital.
Fortunately, everyone can take steps to
protect their heart–and their life or that of someone else. The key
is seeking medical care as soon as possible.
This Web page tells you about heart attack
and the steps you can take to increase your chances of survival.
You’ll learn why a fast response to the signs of a heart attack is
crucial to save lives and limit heart damage. |
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Who's At
Risk?
Heart attacks strike both
men and women. However, some persons are more likely than others to have
a heart attack because of their "risk factors." Risk factors are
behaviors or conditions that increase the chance of a disease. Some of
the risk factors for heart attack are beyond your control, but most can
be modified to help you lower your risk of having a first–or
repeat–heart attack.
Factors that increase the risk of a heart attack
are:
Factors you cannot control
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Pre-existing coronary
heart diseases, including a previous heart attack, a prior
angioplasty or bypass surgery, or angina
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Age-In men, the risk
increases after age 45; in women, the risk increases after age 55.
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Family history of
early heart disease-a father or brother diagnosed before age 55; or
a mother or sister diagnosed before age 65.
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Factors you can control
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Smoking. |
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High blood pressure. |
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High blood
cholesterol. |
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Overweight and
obesity. |
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Physical inactivity. |
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Diabetes. |
Risk factors do not add their effects in a simple
way. Rather, they multiply each other’s effects. So, it is very
important to prevent or control risk factors that can be modified.
If you have one or more of these factors, see your health care provider
to find out how to reduce your risk of having a first or repeat heart
attack.
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Limiting
Heart Muscle Damage
Treatments for a heart
attack work to open the blocked artery to restore blood flow as fast as
possible to prevent or limit damage to the heart muscle, and to lessen
the chance of a repeat attack. The main treatments are thrombolytic
("clot-busting") therapy, other medications, and special procedures,
such as angioplasty and coronary artery bypass surgery.
To be most effective, these treatments must be
given fast–within 1 hour of the start of heart attack symptoms.
Acting fast can save your life and limit damage to your heart. |
Heart
Attack Warning Signs
A heart attack is a
frightening event, and you probably don't want to think about it. But,
if you learn the signs of a heart attack and what steps to take, you can
save a life–maybe your own.
What are the signs of a heart attack? Many
people think a heart attack is sudden and intense, like a "movie" heart
attack, where a person clutches his or her chest and falls over.
The truth is that many heart attacks start
slowly, as a mild pain or discomfort. If you feel such a symptom, you
may not be sure what's wrong. Your symptoms may even come and go. Even
those who have had a heart attack may not recognize their symptoms,
because the next attack can have entirely different ones.
Women may not think they're at risk of having a
heart attack–but they are. Learn more about
women and
heart attack.
It's vital that everyone learn the warning
signs of a heart attack. These are:
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Chest
discomfort. Most heart attacks involve discomfort in
the center of the chest that lasts for more than a few minutes,
or goes away and comes back. The discomfort can feel like
uncomfortable pressure, squeezing, fullness, or pain.
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Discomfort
in other areas of the upper body. Can include pain
or discomfort in one or both arms, the back, neck, jaw, or
stomach.
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Shortness
of breath. Often comes along with chest discomfort.
But it also can occur before chest discomfort.
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Other
symptoms. May include breaking out in a cold sweat,
nausea, or light-headedness.
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Learn the signs–but also remember: Even if
you're not sure it's a heart attack, you should still have it checked
out. Fast action can save lives-maybe your own.
After you learn more about heart attack, try a
brief quiz
to see if you know what to do if you or someone else has warning signs. |
Surviving
a Heart Attack
How do you survive a
heart attack? Fast action is your best weapon against a heart attack.
Why? Because
clot-busting drugs and other
artery-opening treatments can stop a heart attack in its tracks.
They can prevent or limit damage to the heart–but they need to be given
immediately after symptoms begin. The sooner they are started, the more
good they will do–and the greater the chances are for survival and a
full recovery. To be most effective, they need to be given ideally
within 1 hour of the start of heart attack symptoms.
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Uncertainty Is Normal
Expectations often
don't match reality when it comes to heart attack. People expect a
heart attack to happen as it does in the movies, where someone
clutches his or her chest in pain and falls over. Because of this
expectation, people often are not sure if they're having a heart
attack. As a result, people often take a wait-and-see approach
instead of seeking care at once. This even happens to people who
have already had a heart attack. They may not recognize the
symptoms, because their next heart attack can have entirely
different symptoms.
Learn the
warning
signs of a heart attack. But, always remember: Even if you're
not be sure it's a heart attack, you should still have it checked
out. |
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Delay Can Be Deadly
Most persons having
a heart attack wait too long to seek medical help–and that can be a
fatal mistake. Patient delay–rather than transport or hospital
delay–is the biggest cause of not getting rapid care for
heart attacks.
People often take a wait-and-see approach, delaying because they:
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Do not understand the symptoms of a
heart attack and think that what they are feeling is due to
something else.
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Are afraid or unwilling to admit that
their symptoms could be serious.
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Are embarrassed about "causing a
scene," or going to the hospital and finding out it is a false
alarm.
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Do not understand the importance of
getting to the hospital right away. |
Some patients are more likely than others to delay. For instance,
women, older persons, and minorities are more likely to delay
getting help.
As a result, most heart attack victims wait 2 hours or more
after their symptoms begin before they seek medical help. This
delay can result in death or permanent heart damage–damage that can
greatly reduce the ability to do everyday activities |
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Call
9-1-1
The first step to
take when a heart attack happens is to call 9-1-1. Call whether
you're sure you're having a heart attack or not.
Anyone showing heart attack warning signs
needs to receive medical treatment right away. Don't wait more than
a few minutes—5 minutes at most—to call 9-1-1.
Calling 9-1-1 for an ambulance is the best
way to get to the hospital because:
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Emergency
medical personnel (also called EMS, for emergency medical
services) can begin treatment immediately–even before arrival at
the hospital.
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The heart may
stop beating during a heart attack. This is called sudden
cardiac arrest. Emergency personnel have the equipment needed to
start the heart beating again.
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Heart attack
patients who arrive by ambulance tend to receive faster
treatment on their arrival at the hospital.
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If for some reason, you are having heart
attack symptoms and cannot call 9-1-1, have someone
else drive you at once to the hospital. Never drive yourself to the
hospital, unless you absolutely have no other choice. |
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Reducing
Heart Attack Risk
You can reduce your
risk of having a heart attack—even if you already have coronary heart
disease (CHD) or have had a previous heart attack. The key is to take
steps to prevent or control your heart disease risk factors.
Six Key Steps To Reduce Heart Attack Risk
Taking these steps will reduce your risk of
having a heart attack:
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Stop
Smoking Cigarettes
Cigarette smoking
greatly increases the risk of fatal and nonfatal heart attacks in both
men and women. It also increases the risk of a second heart attack among
survivors. Women who smoke and use oral contraceptives have an even
greater risk than smoking alone. The good news is that quitting smoking
greatly reduces the risk of heart attack. One year after quitting, the
risk drop to about one-half that of current smokers and gradually
returns to normal in persons without heart disease. Even among persons
with heart disease, the risk also drops sharply one year after quitting
smoking and it continues to decline over time but the risk does not
return to normal.
(Note: This following links open a second
browser window. Simply close that window to return to this page.)
The
Virtual
Office of the Surgeon General is a Web site of the U.S. Surgeon
General. It contains information to help smokers quit. The U.S. Food and
Drug Administration has approved five medications to help you stop
smoking and lessen the urge to smoke. They are:
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Bupropion SR -
available by prescription |
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Nicotine gum -
available over-the-counter |
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Nicotine inhaler -
available by prescription |
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Nicotine nasal
spray - available by prescription |
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Nicotine patch -
available by prescription and over-the-counter |
All of these medicines will more or less double
your chances of quitting and quitting for good. You will find details on
this information and more at the
Virtual
Office of the Surgeon General. |
Lower
High Blood Pressure
High blood pressure makes the heart work
harder. It increases the risk of developing heart disease, as well as
kidney disease and stroke.
Also called hypertension, it usually has no
symptoms. Once developed, it typically lasts a lifetime.
Blood pressure is recorded as two numbers–the
systolic pressure (as the heart beats) over the diastolic pressure (as
the heart relaxes). For example, a measurement would be written as
120/80 mm Hg (millimeters of mercury).
Normal blood pressure is less than 130 mm Hg
systolic and less than 85 mm Hg diastolic. An optimal blood pressure is
less than 120 mm Hg systolic and less than 80 mm Hg diastolic. A
consistent blood pressure reading of 140/90 mm Hg or higher is
considered high blood pressure. If the systolic and diastolic pressures
fall into different categories, the higher category is used to classify
blood pressure status.
To help prevent or control high blood pressure,
you should: lose excess weight; become physically active; follow a heart
healthy eating plan, including foods lower in salt and sodium; limit
alcohol intake; and, if you are prescribed a medication, take it as
directed.
The main types of high blood pressure
medications are: diuretics, beta-blockers, angiotensin converting enzyme
(ACE) inhibitors, angiotensin antagonists, calcium channel blockers,
alpha blockers, alpha-beta blockers, nervous system inhibitors, and
vasodilators. It’s important that you take medication as prescribed and
control your blood pressure to below 140/90 mm Hg.
To learn more about high blood pressure:
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Reduce High Blood Cholesterol
The level of cholesterol in the bloodstream
greatly affects the risk of developing heart disease. The higher the
level of blood cholesterol, the greater the risk for heart disease
or heart attack.
Why? When there is too much cholesterol (a
fat-like substance) in the blood, it builds up in the walls of
arteries. Over time, this buildup causes arteries to become
narrowed, and blood flow to the heart is slowed or blocked. If the
blood supply to a portion of the heart is completely cut off, a
heart attack results.
Various factors affect cholesterol levels:
diet, weight, physical activity, age and gender, and heredity.
High blood cholesterol itself does not
cause symptoms. You may not know your blood cholesterol level is too
high. So, it’s important to have your cholesterol measured. Adults
age 20 or older should have their cholesterol checked at least once
every 5 years. It best to have a blood test called a lipoprotein
profile. This test measures total cholesterol, "good" and "bad"
cholesterol, as well as triglycerides, another form of fat in the
blood.
High cholesterol is treated with lifestyle
changes–a heart healthy eating plan, physical activity, and loss of
excess weight–and, if those do not lower it enough, medication.
Medications include statins, bile acid sequestrants, nicontinic
acid, and fibric acids.
To learn more about high cholesterol:
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Aim for
a Healthy Weight
A healthy weight is crucial for a long, healthy
life. In 1999, almost 108 million-or 61 percent of-adults in the United
States were overweight or obese. Being overweight or obese increases
your risk of heart attack. And, it increases your risk of developing
high blood cholesterol, high blood pressure, and diabetes-each of which
also increases your chance of having a heart attack. If you are
overweight, even a small weight loss-just 10 percent of your current
weight-will help to lower your risk of developing those diseases.
Two of the measures that assess whether or not
a person is overweight are body mass index (BMI) and waist
circumference. BMI is a measure of weight relative to height. To check
your BMI, choose this
online calculator.
Waist circumference measures abdominal fat. The risk for developing
heart and other diseases increases with a waist measurement of more than
40 inches in men and more than 35 inches in women.
To be at their best, adults need to avoid
gaining weight and many need to lose weight. Losing weight and keeping
it off depends on a change of lifestyle that combines sensible eating
with regular physical activity, not a temporary effort to drop pounds
quickly. If you need to lose excess weight, talk with your health care
provider about developing an action plan, which includes a
hearty-healthy, low-calorie, nutritious eating plan and physical
activity.
To learn more about weight control:
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Be
Physically Active Each Day
Being physically active reduces the risk of
heart-related problems, including heart attack. Physical activity can
improve cholesterol levels, help control high blood pressure and
diabetes, and manage weight. It also increases physical fitness,
promotes psychological well-being and self-esteem, and reduces
depression and anxiety.
Those who have already had a heart attack also
benefit greatly from being physically active. Many hospitals have a
cardiac (or heart) rehabilitation program. A health care provider can
offer advice about a suitable program.
To protect your heart, you only need to do 30
minutes of a moderate-intensity activity on most and, preferably, all
days of the week. If 30 minutes is too much at one time, you can break
it up into periods of at least 10 minutes each.
If you have been inactive, you should start
slowly to increase your physical activity.
If you have coronary heart disease, check with
you health care provider before starting a physical activity program.
This is especially important if you are over age 55, have been inactive,
or have diabetes or another medical problem. Your health care provider
can give you advice on how rigorous the exercise should be.
To learn more about physical activity:
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Manage Diabetes
Diabetes mellitus affects more than 16 million Americans. It
damages blood vessels, including the coronary arteries of the heart. Up
to 75 percent of those with diabetes develop heart and blood vessel
diseases. Diabetes also can lead to stroke, kidney failure, and other
problems.
Diabetes occurs when the body is not able to use sugar as it
should for growth and energy. The body gets sugar when it changes food
into glucose (a form of sugar). A hormone called insulin is needed for
the glucose to be taken up and used by the body.
Symptoms of diabetes include: increased thirst and urination,
weight loss, and blurred vision, hunger, fatigue, frequent infections,
and slow healing of wounds or sores.
There are two main types of diabetes: insulin-dependent, or type
1, and noninsulin-dependent, or type 2. Type 1 usually appears suddenly
and most commonly in those under age 30. Type 2 diabetes occurs
gradually and most often in those over age 40. Up to 95 percent of those
with diabetes have type 2. You’re more likely to develop type 2 if you
are overweight or obese, especially with extra weight around the middle,
over age 40, have high blood pressure, or have a family history of
diabetes. Diabetes is particularly prevalent among African Americans,
Asians, and Native Americans.
Because of the link with heart disease, it’s important for those
with diabetes to prevent or control heart disease and its risk factors.
Besides diabetes, major risk factors for heart disease include smoking,
high blood pressure, high blood cholesterol, physical inactivity, and
overweight and obesity.
Fortunately, new research shows that the same steps that reduce
the risk of heart disease also lower the chance of developing type 2
diabetes. And, for those who already have diabetes, those steps, along
with taking any prescribed medication, also can delay or prevent the
development of complications of diabetes, such as eye disease and nerve
damage.
According to the research, a 7 percent loss of body weight and 150
minutes of moderate-intensity physical activity a week can reduce the
chance of developing diabetes by 58 percent in those who are at high
risk. The lifestyle changes cut the risk of developing type 2 diabetes
regardless of age, ethnicity, gender, or weight.
To reduce the risk of developing diabetes, as well as heart
disease, you should:
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Follow a heart healthy eating plan,
which is low in saturated fat and cholesterol, and moderate in total
fat. |
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Aim for a healthy weight. |
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Be physically active each day–try to
do 30 minutes of moderate-intensity physical activity such as brisk
walking on most and, preferably, all days of the week. |
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Don’t smoke. |
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Prevent or control high blood
pressure. |
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Prevent or control high blood
cholesterol. |
If you already have diabetes, you can delay its progression, or
prevent or slow the development of heart, blood vessel, and other
complications by following the steps given above and these:
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Eat your meals and snacks at around
the same times each day. |
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Check with your doctor about physical
activities that are best for you. |
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Take your diabetes medicine at the
same times each day. |
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Check your blood sugar every day. Each
time you check your blood sugar, write the number in your record
book. Call your doctor if your numbers are too high or too low for 2
to 3 days. |
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Check your feet every day for cuts,
blisters, sores, swelling, redness, or sore toenails. |
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Brush and floss your teeth and gums
every day. |
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Take any prescribed medication for
other conditions, such as coronary heart disease. |
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Check with your doctor about taking
aspirin each day if you have heart disease. |
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nitrogliceriegn, nitloglycereign, nitroglyceleign, netrogricerin,
nitrogycerin, netloglyceriegn, nitrogliceliegn, nitloglyceleign,
nitrogrycereign, netroglycelin, nitroglcerin, netroglyceriegn,
nitlogrycereign, nitloglicelin, nitroglycelin, nitlogrycelin,
nitroglicelin, nitrogrycelin, nitrogricelin, nitloglycerin,
nitloglicerin, nitlogrycerin, nitroglicerin, nitlogricerin,
nitrogrycerin, nitloglycelin, nitrogricerin, n1trog1ycer1n,
n1troglycer1n, mitroglycerin, nitroglycerni, nitroglyceirn,
nitroglycrein, nitroglyecrin, nitroglcyerin, nitrogylcerin,
nitrolgycerin, nitrgolycerin, nitorglycerin, nirtoglycerin, |
Heart
Disease And Medications
Sometimes, medications
may be needed to help prevent or control coronary heart disease (CHD)
and so reduce the risk of a first or repeat heart attack. But, if
medications are needed, lifestyle changes still must be undertaken.
If prescribed, take medications as directed by
your health care provider.
Drugs used to treat CHD include:
Drugs can cause side effects. If side effects
occur, report them to your doctor. Often, a change in the dose or type
of a medication, or the use of a combination of drugs can stop the side
effect. |
|
|
Frequently Asked Questions About Heart Attack
Heart
Attack Warning Signs—
Q: How would I know if I
were having a heart attack?
Often, it is not easy to
tell. But there are symptoms people may have. These are: an
uncomfortable pressure, squeezing, fullness, or pain in the center
of the chest that lasts more than a few minutes, or goes away and
comes back; discomfort in other areas of the upper body, which may
be felt in one or both arms, the back, neck, jaw, or stomach;
shortness of breath, which often occurs with or before chest
discomfort; and other symptoms such as breaking out in a cold sweat,
nausea, or light-headedness. When in doubt, check it out! Call
9-1-1. Don’t wait more than a few minutes–5 at most. Call right
away!
Q: What is angina and how is
it different from a heart attack?
An episode of angina is NOT
a heart attack. However, people with angina report having a hard
time telling the difference between angina symptoms and heart attack
symptoms. Angina is a recurring pain or discomfort in the chest that
happens when some part of the heart does not receive enough blood
temporarily. A person may notice it during exertion (such as in
climbing stairs). It is usually relieved within a few minutes by
resting or by taking prescribed angina medicine. People who have
been diagnosed with angina have a greater risk of a heart attack
than do other people.
Prehospital Delay Time—
Q: I’d rather wait until I’m
sure something’s really wrong. What’s the rush anyway?
Clot-busting drugs and
other artery-opening treatments work best when given within the
first hour after a heart attack starts. The first hour also is the
most risky time during a heart attack–it’s when your heart might
stop suddenly. Responding fast to your symptoms really increases
your chance of surviving.
Q: So how quickly should I
act?
If you have any heart
attack symptoms, call 9-1-1 immediately. Don’t wait for more than a
few minutes–5 at most–to call 9-1-1.
Q: Why should I bother? If
I’m going to die, there’s not much I can do about it anyway, is
there?
That’s not true. There is
something that can be done about a heart attack. Doctors have
clot-busting drugs and other artery-opening procedures that can stop
or reverse a heart attack, if given quickly. These drugs can limit
the damage to the heart muscle by removing the blockage and
restoring blood flow. Less heart damage means a better quality of
life after a heart attack.
Given that these new
therapies are available, it’s very sad to know that so many people
cannot receive these treatments because they delay too long before
seeking care. The greatest benefits of these therapies are gained
when patients come in early (preferably within the first hour of the
start of their symptoms).
The
Role of Emergency Medical Personnel—
Q: Emergency medical personnel cause
such a commotion. Can’t I just have my wife/husband/friend/coworker
take me to the hospital?
Emergency medical
personnel—also called EMS, for emergency medical services—bring
medical care to you. For example, they bring oxygen and medications.
And they can actually restart someone’s heart if it stops after they
arrive. Your wife/husband/friend/coworker can’t do that, or help you
at all if they are driving. In the ambulance, there are enough
people to give you the help you need and get you to the hospital
right away.
Steps
to Survival—
Q:
I’m not sure I can remember all this. What can I do to make it
easier for me?
You can make a plan and
discuss it in advance with your family, your friends, your coworkers
and, of course, your doctor. Then you can rehearse this plan, just
like a fire drill. Keep it simple. Know the warning signs. Keep
information–such as what medications you’re taking–in one place. If
you have any symptoms of a heart attack for a few minutes (no more
than 5), call the EMS by dialing 9-1-1 right away.
Q: I carry nitroglycerin
pills all the time for my heart condition. If I have heart attack
symptoms, shouldn’t I try them first?
Yes, if your doctor has
prescribed nitroglycerin pills, you should follow your doctor’s
orders. If you are not sure about how to take your nitroglycerin
when you get chest pain, check with your doctor.
Q: What about taking an
aspirin like we see on television?
You should not delay
calling 9-1-1 to take an aspirin. Studies have shown that people
sometimes delay seeking help if they take an aspirin (or other
medicine). Emergency department personnel will give people
experiencing a heart attack an aspirin as soon as they arrive. So,
the best thing to do is to call 9-1-1 immediately and let the
professionals give the aspirin |
|
What Is a Heart
Attack?
A heart attack occurs when the supply of blood and oxygen to an area of
heart muscle is blocked, usually by a clot in a coronary artery. Often,
this blockage leads to
arrhythmias (irregular heartbeat or rhythm) that cause a severe
decrease in the pumping function of the heart and may bring about sudden
death. If the blockage is not treated within a few hours, the affected
heart muscle will die and be replaced by scar tissue.
A heart attack is a life-threatening event. Everyone should know the
warning signs of a heart attack and how to get emergency help. Many
people suffer permanent damage to their hearts or die because they do
not get help immediately.
Each year, more than a million persons in the U.S. have a heart attack
and about half (515,000) of them die. About one-half of those who die
do so within 1 hour of the start of symptoms and before reaching the
hospital.
Emergency personnel can often stop arrhythmias with emergency CPR
(cardiopulmonary resuscitation), defibrillation (electrical shock), and
prompt advanced cardiac life support procedures. If care is sought soon
enough, blood flow in the blocked artery can be restored in time to
prevent permanent damage to the heart. Yet, most people do not seek
medical care for 2 hours or more after symptoms begin. Many people wait
12 hours or longer.
A heart attack is an emergency. Call
9-1-1 if you think you (or someone else) may be having a heart attack.
Prompt treatment of a heart attack can help prevent or limit lasting
damage to the heart and can prevent sudden death.
What is a heart attack?
A heart attack (also known as a myocardial
infarction) is the death of heart muscle from the sudden blockage of a
coronary artery by a blood clot. Coronary arteries are blood vessels
that supply the heart muscle with blood and oxygen. Blockage of a
coronary artery deprives the heart muscle of blood and oxygen, causing
injury to the heart muscle. Injury to the heart muscle causes chest pain
and pressure. If blood flow is not restored within 20 to 40 minutes,
irreversible death of the heart muscle will begin to occur. Muscle
continues to die for 6-8 hours at which time the heart attack usually is
"complete." The dead heart muscle is replaced by scar tissue.
Approximately one million Americans suffer a
heart attack each year. Four hundred thousand of them die as a result of
their heart attack.
|
What causes a heart attack?
Atherosclerosis
Atherosclerosis is a gradual process in which plaques (collections) of
cholesterol are deposited in the walls of arteries. Cholesterol plaques
cause hardening of the arterial walls and narrowing of the inner channel
(lumen) of the artery. Arteries that are narrowed by atherosclerosis
cannot deliver enough blood to maintain normal function of the parts of
the body they supply. For example, atherosclerosis of the arteries in
the legs causes reduced blood flow to the legs. Reduced blood flow to
the legs can lead to pain in the legs while walking or exercising, leg
ulcers, or a delay in the healing of wounds to the legs. Atherosclerosis
of the arteries that furnish blood to the brain can lead to vascular
dementia (mental deterioration due to gradual death of brain tissue
over many years) or
stroke (sudden death of brain tissue).
In many people, atherosclerosis can remain
silent (causing no symptoms or health problems) for years or decades.
Atherosclerosis can begin as early as the teenage years, but symptoms or
health problems usually do not arise until later in adulthood when the
arterial narrowing becomes severe. Smoking cigarettes,
high blood pressure, elevated cholesterol, and
diabetes mellitus can accelerate atherosclerosis and lead to the
earlier onset of symptoms and complications, particularly in those
people who have a family history of early atherosclerosis.
Coronary atherosclerosis (or coronary artery
disease) refers to the atherosclerosis that causes hardening and
narrowing of the coronary arteries. Diseases caused by the reduced blood
supply to the heart muscle from coronary atherosclerosis are called
coronary heart diseases (CHD). Coronary heart diseases include heart
attacks, sudden unexpected death, chest pain (angina),
abnormal heart rhythms, and heart failure due to weakening of the heart
muscle.
Atherosclerosis and angina
pectoris
Angina pectoris (also referred to as angina) is chest pain or pressure
that occurs when the blood and oxygen supply to the heart muscle cannot
keep up with the needs of the muscle. When coronary arteries are
narrowed by more than 50 to 70 percent, the arteries cannot increase the
supply of blood to the heart muscle during exercise or other periods of
high demand for oxygen. An insufficient supply of oxygen to the heart
muscle causes angina. Angina that occurs with exercise or exertion is
called exertional angina. In some patients, especially diabetics,
the progressive decrease in blood flow to the heart may occur without
any pain or with just shortness of breath or unusually early fatigue.
Exertional angina usually feels like a
pressure, heaviness, squeezing, or aching across the chest. This pain
may travel to the neck, jaw, arms, back, or even the teeth, and may be
accompanied by shortness of breath, nausea, or a cold sweat. Exertional
angina typically lasts from 1 to 15 minutes and is relieved by rest or
by placing a
nitroglycerin tablet under the tongue. Both resting and
nitroglycerin decrease the heart muscle's demand for oxygen, thus
relieving angina. Exertional angina may be the first warning sign of
advanced coronary artery disease. Chest pains that just last a few
seconds rarely are due to coronary artery disease.
Angina also can occur at rest. Angina at rest
more commonly indicates that a coronary artery has narrowed to such a
critical degree that the heart is not receiving enough oxygen even at
rest. Angina at rest infrequently may be due to spasm of a coronary
artery (a condition called Prinzmetal's or variant angina). Unlike a
heart attack, there is no permanent muscle damage with either exertional
or rest angina.
Atherosclerosis and heart attack
Occasionally the surface of a cholesterol plaque in a coronary artery
may rupture, and a blood clot forms on the surface of the plaque. The
clot blocks the flow of blood through the artery and results in a heart
attack (see diagram below). The cause of rupture that leads to the
formation of a clot is largely unknown, but contributing factors may
include cigarette smoking or other nicotine exposure, elevated LDL
cholesterol, elevated levels of blood catecholamines (adrenaline), high
blood pressure, and other mechanical and biochemical forces.
Unlike exertional or rest angina, heart muscle dies during a heart
attack, and loss of the muscle is permanent.
While heart attacks can occur at any time, most
heart attacks occur between 4:00 A.M. and 10:00 A.M. because of the
higher blood levels of adrenaline released from the adrenal glands
during the morning hours. Increased adrenaline, as previously discussed,
may contribute to rupture of cholesterol plaques.
Approximately 50% of patients who develop heart
attacks have warning symptoms such as exertional angina or rest angina
prior to their heart attacks. |
What are the symptoms of a heart
attack?
Although chest pain or pressure is the most common symptom of a heart
attack, heart attack victims may experience a diversity of symptoms that
include:
- Pain, fullness, and/or squeezing sensation
of the chest
- Jaw pain,
toothache,
headache
- Shortness of breath
- Nausea, vomiting, and/or general epigastric
(upper middle abdomen) discomfort
- Sweating
- Heartburn and/or indigestion
- Arm pain (more commonly the left arm, but
may be either arm)
- Upper back pain
- General malaise (vague feeling of illness)
- No symptoms (Approximately one quarter of
all heart attacks are silent, without chest pain or new symptoms.
Silent heart attacks are especially common among patients with
diabetes mellitus)
Even though the symptoms of a heart attack at
times can be vague and mild, it is important to remember that heart
attacks producing no symptoms or only mild symptoms can be just as
serious and life-threatening as heart attacks that cause severe chest
pain. Too often patients attribute heart attack symptoms to
"indigestion," "fatigue," or "stress,"
and consequently delay seeking prompt medical attention. One cannot
overemphasize the importance of seeking prompt medical attention in the
presence of symptoms that suggest a heart attack. Early diagnosis and
treatment saves lives, and delays in reaching medical assistance can be
fatal. A delay in treatment can lead to permanently reduced function of
the heart due to more extensive damage to the heart muscle. Death also
may occur as a result of the sudden onset of arrhythmias such as
ventricular fibrillation.
What are the
complications of a heart attack?
Heart failure
If a large amount of heart muscle dies, the ability of the heart to pump
blood to the rest of the body is diminished, and this can result in
heart failure. The body retains fluid, and organs, for example, the
kidneys, begin to fail
Ventricular fibrillation
Injury to heart muscle also can lead to ventricular fibrillation.
Ventricular fibrillation occurs when the normal, regular, electrical
activation of heart muscle contraction is replaced by chaotic electrical
activity that causes the heart to stop beating and pumping blood to the
brain and other parts of the body. Permanent brain damage and death can
occur unless the flow of blood to the brain is restored within five
minutes.
Most of the deaths from heart attacks are
caused by ventricular fibrillation of the heart that occurs before the
victim of the heart attack can reach an emergency room. Those who reach
the emergency room have an excellent prognosis; survival from a heart
attack with modern treatment should exceed 90%. The 1% to 10% of heart
attack victims who die later include those victims who suffer major
damage to the heart muscle initially or who suffer additional damage at
a later time.
Deaths from ventricular fibrillation can be
avoided by cardiopulmonary resuscitation (CPR) started within five
minutes of the onset of ventricular fibrillation. CPR requires breathing
for the victim and applying external compression to the chest to squeeze
the heart and force it to pump blood. When paramedics arrive,
medications and/or an electrical shock (cardioversion) can be
administered to convert ventricular fibrillation back to a normal heart
rhythm and allow the heart to pump blood normally. Therefore, prompt CPR
and a rapid response by paramedics can improve the chances of survival
from a heart attack. In addition, many public venues now have
defibrillators that provide the electrical shock needed to restore a
normal heart rhythm even before the paramedics arrive. This greatly
improves the chances of survival.
|
|
Can 'Cough CPR' Save Your Life During a
Heart Attack? From Urban Legends Report. |
 |
|
Netlore Archive: Self-CPR? According to this 1999 email rumor, you
can save your own life during a heart attack ... by coughing
|
Description:
Email rumor Circulating since: 1999 Status: Disputed by experts
Analysis
|
| This one is serious...
Let's say it's 4:17 p.m. and you're driving home, (alone of
course) after an unusually hard day on the job. Not only was the
work load extraordinarily heavy, you also had a disagreement with
your boss, and no matter how hard you tried he just wouldn't see
your side of the situation. You're really upset and the more you
think about it the more up tight you become.
All of a sudden you start experiencing severe pain in your
chest that starts to radiate out into your arm and up into your jaw.
You are only about five miles from the hospital nearest you home,
unfortunately you don't know if you'll be able to make it that far.
What can you do? You've been trained in CPR but the guy that
taught the course neglected to tell you how to perform it on
yourself.
HOW TO SURVIVE A HEART ATTACK WHEN ALONE
Since many people are alone when they suffer a heart attack,
this article seemed in order.) Without help the person whose heart
stops beating properly and who begins to feel Faint, has only about
10 seconds left before losing consciousness. However, these victims
can help themselves by coughing repeatedly and very vigorously. A
deep breath should be taken before each cough, and the cough must be
deep and prolonged, as when producing sputum from deep inside the
chest. A breath and a cough must be repeated about every two seconds
without let up until help arrives, or until the heart is felt to be
beating normally again. Deep breaths get oxygen into the lungs and
coughing movements squeeze the heart and keep the blood circulating.
The squeezing pressure on the heart also helps it regain
normal rhythm. In this way, heart attack victims can get to a phone
and, between breaths, call for help.
Tell as many other people as possible about this, it could
save their lives!
from Health Cares, Rochester General Hospital via Chapter
240's newsletter AND THE BEAT GOES ON... (reprint from The Mended
Hearts, Inc. publication, Heart Response)
|
Comments:
This message gives the impression that the technique described has
the endorsement of Rochester General Hospital and Mended Hearts, Inc., a
heart attack victims' support group. It does not. Although the text was
first published in a Mended Hearts newsletter, the organization has
since retracted it. Rochester General Hospital played no part in the
creation or dissemination of the message, nor does it endorse its
contents.
According to the best information I can find, "cough CPR"
(referred to in some variants as "self-CPR") is a
real procedure occasionally used in emergency situations under
professional supervision. It is not, however, taught in standard CPR
courses, nor do most medical professionals presently recommend it as a
"life-saving" measure for people who experience the most common types of
heart attack while alone (note: see update below).
One doctor I contacted — a heart specialist — had never even heard
of the procedure.
Other doctors say they're aware of the "cough CPR" technique but
would only advise it under very specific circumstances. For example, in
certain cases where a patient has abnormal heart rhythms, coughing can
help normalize them, according to Dr. Stephen Bohan of Brigham and
Women's Hospital in Boston. However, most heart attacks are not of this
type. Dr. Bohan says the best course of action for a typical heart
attack victim is to immediately take an aspirin (which helps dissolve
blood clots) and call 911.
This is a case where a nugget of truth has apparently been
misunderstood and misrepresented to the public, though not
intentionally. A chapter of Mended Hearts published it without proper
research. It was then reprinted by other chapters and eventually found
its way into email form.
Darla Bonham, the organization's executive director, issued a
statement afterward which read, in part:
I've received email from people
all across the country wanting to know if it is a valid medically
approved procedure. I contacted a scientist on staff with the American
Heart Association Emergency Cardiac Care division, and he was able to
track a possible source of the information. The information comes from
a professional textbook on emergency cardiac care. This procedure is
also known as "cough CPR" and is used in emergency situations by
professional staff. The American Heart Association does not recommend
that the public use this method in a situation where there is no
medical supervision.
As with all medical rumors, the most prudent course of action is
to verify the information with your own doctor or other medical
professional before acting upon it or sharing it with others.
2003 update:
In September 2003, four years after this email rumor began circulating,
Polish physician Tadeusz Petelenz presented the
results of a study which he said demonstrates that cough CPR can
indeed save the lives of some heart attack victims. While not
immediately embraced by all the members attending the European Society
of Cardiology meeting where Petelenz spoke, the findings were
characterized by some as "interesting." At least one heart specialist,
Dr. Marten Rosenquist of Sweden, found fault with the study, objecting
that Petelenz had presented no evidence that the subjects had actually
experienced cardiac arythmias. He called for further research.
Further reading:
American Heart Association Statement
"The American Heart Association does not endorse 'cough CPR,' a
coughing procedure widely publicized on the Internet."
Mended Hearts, Inc. Statement
"It is not a recommended procedure for the general public."
Doctor: Cough CPR Good for Cardiac Arrest
Associated Press, 2 September 2003
|
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Heart
Attack
Information and Frequently Asked Questions |
3/4
|
Welcome my compendium website on
Heart Attack Information and
Frequently Asked Questions. I hope you will find the answers here to
some of your questions on having a heart attack.
Some topics included below are:
Limiting Heart Muscle Damage
Heart Attack Warning Signs
Surviving a Heart Attack
Delay Can Be Deadly
Emergency
Medical Personnel
Testing For A Heart Attack
Key heart attack tests
Reducing
Heart Attack Risk
Stop
Smoking Cigarettes
Lower High Blood Pressure
Reduce High Blood
Cholesterol
Aim for a Healthy Weight
Be Physically Active Each Day
Manage Diabetes
Heart
Disease And Medications
How would I know if I were having a heart attack?
What is angina and how is it different from a heart attack?
Prehospital Delay Time
So how
quickly should I act?
The Role of Emergency
Medical Personnel
Steps to
Survival
I carry nitroglycerin pills
all the time for my heart condition.
What about taking an aspirin like we see on television?
What Is a heart attack?
What causes a
heart attack?
Atherosclerosis
Atherosclerosis and angina pectoris
Atherosclerosis and heart
attack
What are the
symptoms of a heart attack?
What are the
complications of a heart attack?
Heart failure
Ventricular fibrillation
You can find this site again by
typing in the Google search engine the unique word " 1kcattAtraeH
" which is OR " HeartAttack1 "
backwards.
|
4/4
|
If after you scan to the
bottom of this website and still can't find the
information
you are looking for try another Google search here.
|
Contact information for this
Website:
Brian Nelson, Webpage Marketing Consultant
31 Gessner Rd. Houston, TX
09/03/2008 05:44 AM -0500
713-467-3025 Fax 713-467-3192 Click:
E-mail me |
You are at:
http://www.NewMedicalDirectories.com/Heart-Attack/Information-FAQ.html
ud
09/03/2008 05:44 AM -0500
Bookmark
this page now!
|
Misspelled words used to
find this page 1 of 3 .
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cohlesterol, hcolesterol, cholestero, holesterol, |
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Heart Attacks
Coronary
heart disease (CHD) is the leading cause of death for both men
and women in the United States. CHD is caused by a narrowing of
the coronary arteries that supply blood to the heart, and often
results in a heart attack.
Each year, about 1.1 million Americans
suffer a heart attack. About 460,000 of those heart attacks are
fatal. About half of those deaths occur within 1 hour of the
start of symptoms and before the person reaches the hospital.
Fortunately, everyone can take steps to
protect their heart–and their life or that of someone else. The
key is seeking medical care as soon as possible.
This Web page tells you about heart
attack and the steps you can take to increase your chances of
survival. You’ll learn why a fast response to the signs of a
heart attack is crucial to save lives and limit heart damage. |
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Who's At Risk?
Heart attacks strike
both men and women. However, some persons are more likely than
others to have a heart attack because of their "risk factors." Risk
factors are behaviors or conditions that increase the chance of a
disease. Some of the risk factors for heart attack are beyond your
control, but most can be modified to help you lower your risk of
having a first–or repeat–heart attack.
Factors that increase the risk of a heart
attack are:
Factors you cannot control
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Pre-existing
coronary heart diseases, including a previous heart attack, a
prior angioplasty or bypass surgery, or angina
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Age-In men, the
risk increases after age 45; in women, the risk increases after
age 55.
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Family history of
early heart disease-a father or brother diagnosed before age 55;
or a mother or sister diagnosed before age 65.
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Factors you can control
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Smoking. |
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High blood
pressure. |
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High blood
cholesterol. |
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Overweight and
obesity. |
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Physical
inactivity. |
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Diabetes. |
Risk factors do not add their effects in a
simple way. Rather, they multiply each other’s effects. So, it
is very important to prevent or control risk factors that can be
modified. If you have one or more of these factors, see your
health care provider to find out how to reduce your risk of having a
first or repeat heart attack.
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Limiting Heart Muscle Damage
Treatments for a
heart attack work to open the blocked artery to restore blood flow
as fast as possible to prevent or limit damage to the heart muscle,
and to lessen the chance of a repeat attack. The main treatments are
thrombolytic ("clot-busting") therapy, other medications, and
special procedures, such as angioplasty and coronary artery bypass
surgery.
To be most effective, these treatments must
be given fast–within 1 hour of the start of heart attack
symptoms. Acting fast can save your life and limit damage to your
heart. |
Heart Attack Warning Signs
A heart attack is
a frightening event, and you probably don't want to think about it.
But, if you learn the signs of a heart attack and what steps to
take, you can save a life–maybe your own.
What are the signs of a heart attack? Many
people think a heart attack is sudden and intense, like a "movie"
heart attack, where a person clutches his or her chest and falls
over.
The truth is that many heart attacks start
slowly, as a mild pain or discomfort. If you feel such a symptom,
you may not be sure what's wrong. Your symptoms may even come and
go. Even those who have had a heart attack may not recognize their
symptoms, because the next attack can have entirely different ones.
Women may not think they're at risk of
having a heart attack–but they are. Learn more about
women
and heart attack.
It's vital that everyone learn the warning
signs of a heart attack. These are:
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Chest
discomfort. Most heart attacks involve
discomfort in the center of the chest that lasts for more
than a few minutes, or goes away and comes back. The
discomfort can feel like uncomfortable pressure, squeezing,
fullness, or pain.
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Discomfort in other areas of the upper body. Can
include pain or discomfort in one or both arms, the back,
neck, jaw, or stomach.
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Shortness of breath. Often comes along with
chest discomfort. But it also can occur before chest
discomfort.
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Other
symptoms. May include breaking out in a cold
sweat, nausea, or light-headedness.
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Learn the signs–but also remember: Even if
you're not sure it's a heart attack, you should still have it
checked out. Fast action can save lives-maybe your own.
After you learn more about heart attack,
try a brief
quiz
to see if you know what to do if you or someone else has warning
signs. |
Surviving a Heart Attack
How do you
survive a heart attack? Fast action is your best weapon against a
heart attack. Why? Because
clot-busting drugs and other
artery-opening treatments can stop a heart attack in its tracks.
They can prevent or limit damage to the heart–but they need to be
given immediately after symptoms begin. The sooner they are started,
the more good they will do–and the greater the chances are for
survival and a full recovery. To be most effective, they need to be
given ideally within 1 hour of the start of heart attack symptoms.
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Uncertainty Is Normal
Expectations
often don't match reality when it comes to heart attack. People
expect a heart attack to happen as it does in the movies, where
someone clutches his or her chest in pain and falls over.
Because of this expectation, people often are not sure if
they're having a heart attack. As a result, people often take a
wait-and-see approach instead of seeking care at once. This even
happens to people who have already had a heart attack. They may
not recognize the symptoms, because their next heart attack can
have entirely different symptoms.
Learn the
warning signs of a heart attack. But, always remember: Even
if you're not be sure it's a heart attack, you should still have
it checked out. |
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Delay
Can Be Deadly
Most persons
having a heart attack wait too long to seek medical help–and
that can be a fatal mistake. Patient delay–rather than transport
or hospital delay–is the biggest cause of not getting
rapid care for heart attacks.
People often take a wait-and-see approach, delaying because
they:
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Do not understand the symptoms of
a heart attack and think that what they are feeling is due
to something else.
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Are afraid or unwilling to admit
that their symptoms could be serious.
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Are embarrassed about "causing a
scene," or going to the hospital and finding out it is a
false alarm.
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Do not understand the importance
of getting to the hospital right away. |
Some patients are more likely than others to delay. For
instance, women, older persons, and minorities are more likely
to delay getting help.
As a result, most heart attack victims wait 2 hours or
more after their symptoms begin before they seek medical help.
This delay can result in death or permanent heart damage–damage
that can greatly reduce the ability to do everyday activities |
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Call 9-1-1
The first step
to take when a heart attack happens is to call 9-1-1. Call
whether you're sure you're having a heart attack or not.
Anyone showing heart attack warning
signs needs to receive medical treatment right away. Don't wait
more than a few minutes—5 minutes at most—to call 9-1-1.
Calling 9-1-1 for an ambulance is the
best way to get to the hospital because:
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Emergency
medical personnel (also called EMS, for emergency medical
services) can begin treatment immediately–even before
arrival at the hospital.
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The heart
may stop beating during a heart attack. This is called
sudden cardiac arrest. Emergency personnel have the
equipment needed to start the heart beating again.
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Heart
attack patients who arrive by ambulance tend to receive
faster treatment on their arrival at the hospital.
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If for some reason, you are having
heart attack symptoms and cannot call 9-1-1, have
someone else drive you at once to the hospital. Never drive
yourself to the hospital, unless you absolutely have no other
choice. |
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Reducing Heart Attack Risk
You can reduce
your risk of having a heart attack—even if you already have coronary
heart disease (CHD) or have had a previous heart attack. The key is
to take steps to prevent or control your heart disease risk factors.
Six Key Steps To Reduce Heart Attack
Risk
Taking these steps will reduce your risk of
having a heart attack:
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Stop Smoking Cigarettes
Cigarette smoking
greatly increases the risk of fatal and nonfatal heart attacks in
both men and women. It also increases the risk of a second heart
attack among survivors. Women who smoke and use oral contraceptives
have an even greater risk than smoking alone. The good news is that
quitting smoking greatly reduces the risk of heart attack. One year
after quitting, the risk drop to about one-half that of current
smokers and gradually returns to normal in persons without heart
disease. Even among persons with heart disease, the risk also drops
sharply one year after quitting smoking and it continues to decline
over time but the risk does not return to normal.
(Note: This following links open a second
browser window. Simply close that window to return to this page.)
The
Virtual Office of the Surgeon General is a Web site of the U.S.
Surgeon General. It contains information to help smokers quit. The
U.S. Food and Drug Administration has approved five medications to
help you stop smoking and lessen the urge to smoke. They are:
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Bupropion SR -
available by prescription |
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Nicotine gum -
available over-the-counter |
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Nicotine
inhaler - available by prescription |
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Nicotine nasal
spray - available by prescription |
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Nicotine patch
- available by prescription and over-the-counter
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All of these medicines will more or less
double your chances of quitting and quitting for good. You will find
details on this information and more at the
Virtual Office of the Surgeon General. |
Lower High Blood Pressure
High blood pressure makes the heart work
harder. It increases the risk of developing heart disease, as well
as kidney disease and stroke.
Also called hypertension, it usually has no
symptoms. Once developed, it typically lasts a lifetime.
Blood pressure is recorded as two
numbers–the systolic pressure (as the heart beats) over the
diastolic pressure (as the heart relaxes). For example, a
measurement would be written as 120/80 mm Hg (millimeters of
mercury).
Normal blood pressure is less than 130 mm
Hg systolic and less than 85 mm Hg diastolic. An optimal blood
pressure is less than 120 mm Hg systolic and less than 80 mm Hg
diastolic. A consistent blood pressure reading of 140/90 mm Hg or
higher is considered high blood pressure. If the systolic and
diastolic pressures fall into different categories, the higher
category is used to classify blood pressure status.
To help prevent or control high blood
pressure, you should: lose excess weight; become physically active;
follow a heart healthy eating plan, including foods lower in salt
and sodium; limit alcohol intake; and, if you are prescribed a
medication, take it as directed.
The main types of high blood pressure
medications are: diuretics, beta-blockers, angiotensin converting
enzyme (ACE) inhibitors, angiotensin antagonists, calcium channel
blockers, alpha blockers, alpha-beta blockers, nervous system
inhibitors, and vasodilators. It’s important that you take
medication as prescribed and control your blood pressure to below
140/90 mm Hg.
To learn more about high blood
pressure:
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Reduce High Blood
Cholesterol
The level of cholesterol in the
bloodstream greatly affects the risk of developing heart
disease. The higher the level of blood cholesterol, the greater
the risk for heart disease or heart attack.
Why? When there is too much cholesterol
(a fat-like substance) in the blood, it builds up in the walls
of arteries. Over time, this buildup causes arteries to become
narrowed, and blood flow to the heart is slowed or blocked. If
the blood supply to a portion of the heart is completely cut
off, a heart attack results.
Various factors affect cholesterol
levels: diet, weight, physical activity, age and gender, and
heredity.
High blood cholesterol itself does not
cause symptoms. You may not know your blood cholesterol level is
too high. So, it’s important to have your cholesterol measured.
Adults age 20 or older should have their cholesterol checked at
least once every 5 years. It best to have a blood test called a
lipoprotein profile. This test measures total cholesterol,
"good" and "bad" cholesterol, as well as triglycerides, another
form of fat in the blood.
High cholesterol is treated with
lifestyle changes–a heart healthy eating plan, physical
activity, and loss of excess weight–and, if those do not lower
it enough, medication. Medications include statins, bile acid
sequestrants, nicontinic acid, and fibric acids.
To learn more about high
cholesterol:
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Aim for a Healthy Weight
A healthy weight is crucial for a long,
healthy life. In 1999, almost 108 million-or 61 percent of-adults in
the United States were overweight or obese. Being overweight or
obese increases your risk of heart attack. And, it increases your
risk of developing high blood cholesterol, high blood pressure, and
diabetes-each of which also increases your chance of having a heart
attack. If you are overweight, even a small weight loss-just 10
percent of your current weight-will help to lower your risk of
developing those diseases.
Two of the measures that assess whether or
not a person is overweight are body mass index (BMI) and waist
circumference. BMI is a measure of weight relative to height. To
check your BMI, choose this
online
calculator. Waist circumference measures abdominal fat. The risk
for developing heart and other diseases increases with a waist
measurement of more than 40 inches in men and more than 35 inches in
women.
To be at their best, adults need to avoid
gaining weight and many need to lose weight. Losing weight and
keeping it off depends on a change of lifestyle that combines
sensible eating with regular physical activity, not a temporary
effort to drop pounds quickly. If you need to lose excess weight,
talk with your health care provider about developing an action plan,
which includes a hearty-healthy, low-calorie, nutritious eating plan
and physical activity.
To learn more about weight control:
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Be Physically Active Each
Day
Being physically active reduces the risk of
heart-related problems, including heart attack. Physical activity
can improve cholesterol levels, help control high blood pressure and
diabetes, and manage weight. It also increases physical fitness,
promotes psychological well-being and self-esteem, and reduces
depression and anxiety.
Those who have already had a heart attack
also benefit greatly from being physically active. Many hospitals
have a cardiac (or heart) rehabilitation program. A health care
provider can offer advice about a suitable program.
To protect your heart, you only need to do
30 minutes of a moderate-intensity activity on most and, preferably,
all days of the week. If 30 minutes is too much at one time, you can
break it up into periods of at least 10 minutes each.
If you have been inactive, you should start
slowly to increase your physical activity.
If you have coronary heart disease, check
with you health care provider before starting a physical activity
program. This is especially important if you are over age 55, have
been inactive, or have diabetes or another medical problem. Your
health care provider can give you advice on how rigorous the
exercise should be.
To learn more about physical activity:
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Manage Diabetes
Diabetes mellitus affects more than 16 million Americans. It
damages blood vessels, including the coronary arteries of the heart.
Up to 75 percent of those with diabetes develop heart and blood
vessel diseases. Diabetes also can lead to stroke, kidney failure,
and other problems.
Diabetes occurs when the body is not able to use sugar as it
should for growth and energy. The body gets sugar when it changes
food into glucose (a form of sugar). A hormone called insulin is
needed for the glucose to be taken up and used by the body.
Symptoms of diabetes include: increased thirst and urination,
weight loss, and blurred vision, hunger, fatigue, frequent
infections, and slow healing of wounds or sores.
There are two main types of diabetes: insulin-dependent, or
type 1, and noninsulin-dependent, or type 2. Type 1 usually appears
suddenly and most commonly in those under age 30. Type 2 diabetes
occurs gradually and most often in those over age 40. Up to 95
percent of those with diabetes have type 2. You’re more likely to
develop type 2 if you are overweight or obese, especially with extra
weight around the middle, over age 40, have high blood pressure, or
have a family history of diabetes. Diabetes is particularly
prevalent among African Americans, Asians, and Native Americans.
Because of the link with heart disease, it’s important for
those with diabetes to prevent or control heart disease and its risk
factors. Besides diabetes, major risk factors for heart disease
include smoking, high blood pressure, high blood cholesterol,
physical inactivity, and overweight and obesity.
Fortunately, new research shows that the same steps that
reduce the risk of heart disease also lower the chance of developing
type 2 diabetes. And, for those who already have diabetes, those
steps, along with taking any prescribed medication, also can delay
or prevent the development of complications of diabetes, such as eye
disease and nerve damage.
According to the research, a 7 percent loss of body weight and
150 minutes of moderate-intensity physical activity a week can
reduce the chance of developing diabetes by 58 percent in those who
are at high risk. The lifestyle changes cut the risk of developing
type 2 diabetes regardless of age, ethnicity, gender, or weight.
To reduce the risk of developing diabetes, as well as heart
disease, you should:
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Follow a heart healthy eating
plan, which is low in saturated fat and cholesterol, and
moderate in total fat. |
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Aim for a healthy weight. |
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Be physically active each day–try
to do 30 minutes of moderate-intensity physical activity such as
brisk walking on most and, preferably, all days of the week. |
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Don’t smoke. |
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Prevent or control high blood
pressure. |
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Prevent or control high blood
cholesterol. |
If you already have diabetes, you can delay its progression,
or prevent or slow the development of heart, blood vessel, and other
complications by following the steps given above and these:
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Eat your meals and snacks at
around the same times each day. |
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Check with your doctor about
physical activities that are best for you. |
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Take your diabetes medicine at the
same times each day. |
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Check your blood sugar every day.
Each time you check your blood sugar, write the number in your
record book. Call your doctor if your numbers are too high or
too low for 2 to 3 days. |
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Check your feet every day for
cuts, blisters, sores, swelling, redness, or sore toenails. |
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Brush and floss your teeth and
gums every day. |
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Take any prescribed medication for
other conditions, such as coronary heart disease. |
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Check with your doctor about
taking aspirin each day if you have heart disease. |
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Heart Disease And
Medications
Sometimes,
medications may be needed to help prevent or control coronary heart
disease (CHD) and so reduce the risk of a first or repeat heart
attack. But, if medications are needed, lifestyle changes still must
be undertaken.
If prescribed, take medications as directed
by your health care provider.
Drugs used to treat CHD include:
Drugs can cause side effects. If side
effects occur, report them to your doctor. Often, a change in the
dose or type of a medication, or the use of a combination of drugs
can stop the side effect. |
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Frequently Asked
Questions About Heart Attack
Heart Attack Warning
Signs—
Q: How would I know if I
were having a heart attack?
Often, it is not easy
to tell. But there are symptoms people may have. These are: an
uncomfortable pressure, squeezing, fullness, or pain in the
center of the chest that lasts more than a few minutes, or goes
away and comes back; discomfort in other areas of the upper
body, which may be felt in one or both arms, the back, neck,
jaw, or stomach; shortness of breath, which often occurs with or
before chest discomfort; and other symptoms such as breaking out
in a cold sweat, nausea, or light-headedness. When in doubt,
check it out! Call 9-1-1. Don’t wait more than a few minutes–5
at most. Call right away!
Q: What is angina and
how is it different from a heart attack?
An episode of angina is
NOT a heart attack. However, people with angina report having a
hard time telling the difference between angina symptoms and
heart attack symptoms. Angina is a recurring pain or discomfort
in the chest that happens when some part of the heart does not
receive enough blood temporarily. A person may notice it during
exertion (such as in climbing stairs). It is usually relieved
within a few minutes by resting or by taking prescribed angina
medicine. People who have been diagnosed with angina have a
greater risk of a heart attack than do other people.
Prehospital Delay Time—
Q: I’d rather wait until
I’m sure something’s really wrong. What’s the rush anyway?
Clot-busting drugs and
other artery-opening treatments work best when given within the
first hour after a heart attack starts. The first hour also is
the most risky time during a heart attack–it’s when your heart
might stop suddenly. Responding fast to your symptoms really
increases your chance of surviving.
Q: So how quickly should
I act?
If you have any heart
attack symptoms, call 9-1-1 immediately. Don’t wait for more
than a few minutes–5 at most–to call 9-1-1.
Q: Why should I bother?
If I’m going to die, there’s not much I can do about it anyway,
is there?
That’s not true. There
is something that can be done about a heart attack. Doctors have
clot-busting drugs and other artery-opening procedures that can
stop or reverse a heart attack, if given quickly. These drugs
can limit the damage to the heart muscle by removing the
blockage and restoring blood flow. Less heart damage means a
better quality of life after a heart attack.
Given that these new
therapies are available, it’s very sad to know that so many
people cannot receive these treatments because they delay too
long before seeking care. The greatest benefits of these
therapies are gained when patients come in early (preferably
within the first hour of the start of their symptoms).
The Role of Emergency
Medical Personnel—
Q: Emergency medical personnel
cause such a commotion. Can’t I just have my
wife/husband/friend/coworker take me to the hospital?
Emergency medical
personnel—also called EMS, for emergency medical services—bring
medical care to you. For example, they bring oxygen and
medications. And they can actually restart someone’s heart if it
stops after they arrive. Your wife/husband/friend/coworker can’t
do that, or help you at all if they are driving. In the
ambulance, there are enough people to give you the help you need
and get you to the hospital right away.
Steps to Survival—
Q: I’m not sure I can
remember all this. What can I do to make it easier for me?
You can make a plan and
discuss it in advance with your family, your friends, your
coworkers and, of course, your doctor. Then you can rehearse
this plan, just like a fire drill. Keep it simple. Know the
warning signs. Keep information–such as what medications you’re
taking–in one place. If you have any symptoms of a heart attack
for a few minutes (no more than 5), call the EMS by dialing
9-1-1 right away.
Q: I carry nitroglycerin
pills all the time for my heart condition. If I have heart
attack symptoms, shouldn’t I try them first?
Yes, if your doctor has
prescribed nitroglycerin pills, you should follow your doctor’s
orders. If you are not sure about how to take your nitroglycerin
when you get chest pain, check with your doctor.
Q: What about taking an
aspirin like we see on television?
You should not delay
calling 9-1-1 to take an aspirin. Studies have shown that people
sometimes delay seeking help if they take an aspirin (or other
medicine). Emergency department personnel will give people
experiencing a heart attack an aspirin as soon as they arrive.
So, the best thing to do is to call 9-1-1 immediately and let
the professionals give the aspirin |
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What Is a Heart Attack?
A heart attack occurs when the supply of blood and oxygen to an area
of heart muscle is blocked, usually by a clot in a coronary artery.
Often, this blockage leads to
arrhythmias (irregular heartbeat or rhythm) that cause a severe
decrease in the pumping function of the heart and may bring about
sudden death. If the blockage is not treated within a few hours, the
affected heart muscle will die and be replaced by scar tissue.
A heart attack is a life-threatening event. Everyone should know the
warning signs of a heart attack and how to get emergency help.
Many people suffer permanent damage to their hearts or die because
they do not get help immediately.
Each year, more than a million persons in the U.S. have a heart
attack and about half (515,000) of them die. About one-half of
those who die do so within 1 hour of the start of symptoms and
before reaching the hospital.
Emergency personnel can often stop arrhythmias with emergency CPR
(cardiopulmonary resuscitation), defibrillation (electrical shock),
and prompt advanced cardiac life support procedures. If care is
sought soon enough, blood flow in the blocked artery can be restored
in time to prevent permanent damage to the heart. Yet, most people
do not seek medical care for 2 hours or more after symptoms begin.
Many people wait 12 hours or longer.
A heart attack is an emergency.
Call 9-1-1 if you think you (or someone else) may be having a heart
attack. Prompt treatment of a heart attack can help prevent or limit
lasting damage to the heart and can prevent sudden death.
What is a heart attack?
A heart attack (also known as a
myocardial infarction) is the death of heart muscle from the sudden
blockage of a coronary artery by a blood clot. Coronary arteries are
blood vessels that supply the heart muscle with blood and oxygen.
Blockage of a coronary artery deprives the heart muscle of blood and
oxygen, causing injury to the heart muscle. Injury to the heart
muscle causes chest pain and pressure. If blood flow is not restored
within 20 to 40 minutes, irreversible death of the heart muscle will
begin to occur. Muscle continues to die for 6-8 hours at which time
the heart attack usually is "complete." The dead heart muscle is
replaced by scar tissue.
Approximately one million Americans suffer
a heart attack each year. Four hundred thousand of them die as a
result of their heart attack.
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What causes a heart attack?
Atherosclerosis
Atherosclerosis is a gradual process in which plaques (collections)
of cholesterol are deposited in the walls of arteries. Cholesterol
plaques cause hardening of the arterial walls and narrowing of the
inner channel (lumen) of the artery. Arteries that are narrowed by
atherosclerosis cannot deliver enough blood to maintain normal
function of the parts of the body they supply. For example,
atherosclerosis of the arteries in the legs causes reduced blood
flow to the legs. Reduced blood flow to the legs can lead to pain in
the legs while walking or exercising, leg ulcers, or a delay in the
healing of wounds to the legs. Atherosclerosis of the arteries that
furnish blood to the brain can lead to vascular
dementia (mental deterioration due to gradual death of brain
tissue over many years) or
stroke (sudden death of brain tissue).
In many people, atherosclerosis can remain
silent (causing no symptoms or health problems) for years or
decades. Atherosclerosis can begin as early as the teenage years,
but symptoms or health problems usually do not arise until later in
adulthood when the arterial narrowing becomes severe. Smoking
cigarettes,
high blood pressure, elevated cholesterol, and
diabetes mellitus can accelerate atherosclerosis and lead to the
earlier onset of symptoms and complications, particularly in those
people who have a family history of early atherosclerosis.
Coronary atherosclerosis (or coronary
artery disease) refers to the atherosclerosis that causes hardening
and narrowing of the coronary arteries. Diseases caused by the
reduced blood supply to the heart muscle from coronary
atherosclerosis are called coronary heart diseases (CHD). Coronary
heart diseases include heart attacks, sudden unexpected death, chest
pain (angina),
abnormal heart rhythms, and heart failure due to weakening of the
heart muscle.
Atherosclerosis and angina pectoris
Angina pectoris (also referred to as angina) is chest pain or
pressure that occurs when the blood and oxygen supply to the heart
muscle cannot keep up with the needs of the muscle. When coronary
arteries are narrowed by more than 50 to 70 percent, the arteries
cannot increase the supply of blood to the heart muscle during
exercise or other periods of high demand for oxygen. An insufficient
supply of oxygen to the heart muscle causes angina. Angina that
occurs with exercise or exertion is called exertional angina.
In some patients, especially diabetics, the progressive decrease in
blood flow to the heart may occur without any pain or with just
shortness of breath or unusually early fatigue.
Exertional angina usually feels like a
pressure, heaviness, squeezing, or aching across the chest. This
pain may travel to the neck, jaw, arms, back, or even the teeth, and
may be accompanied by shortness of breath, nausea, or a cold sweat.
Exertional angina typically lasts from 1 to 15 minutes and is
relieved by rest or by placing a
nitroglycerin tablet under the tongue. Both resting and
nitroglycerin decrease the heart muscle's demand for oxygen, thus
relieving angina. Exertional angina may be the first warning sign of
advanced coronary artery disease. Chest pains that just last a few
seconds rarely are due to coronary artery disease.
Angina also can occur at rest. Angina at
rest more commonly indicates that a coronary artery has narrowed to
such a critical degree that the heart is not receiving enough oxygen
even at rest. Angina at rest infrequently may be due to spasm of a
coronary artery (a condition called Prinzmetal's or variant angina).
Unlike a heart attack, there is no permanent muscle damage with
either exertional or rest angina.
Atherosclerosis and heart attack
Occasionally the surface of a cholesterol plaque in a coronary
artery may rupture, and a blood clot forms on the surface of the
plaque. The clot blocks the flow of blood through the artery and
results in a heart attack (see diagram below). The cause of rupture
that leads to the formation of a clot is largely unknown, but
contributing factors may include cigarette smoking or other nicotine
exposure, elevated LDL cholesterol, elevated levels of blood
catecholamines (adrenaline), high blood pressure, and other
mechanical and biochemical forces.
Unlike exertional or rest angina, heart muscle dies during a heart
attack, and loss of the muscle is permanent.
While heart attacks can occur at any time,
most heart attacks occur between 4:00 A.M. and 10:00 A.M. because of
the higher blood levels of adrenaline released from the adrenal
glands during the morning hours. Increased adrenaline, as previously
discussed, may contribute to rupture of cholesterol plaques.
Approximately 50% of patients who develop
heart attacks have warning symptoms such as exertional angina or
rest angina prior to their heart attacks. |
What are the symptoms of a
heart attack?
Although chest pain or pressure is the most common symptom of a
heart attack, heart attack victims may experience a diversity of
symptoms that include:
- Pain, fullness, and/or squeezing
sensation of the chest
- Jaw pain,
toothache,
headache
- Shortness of breath
- Nausea, vomiting, and/or general
epigastric (upper middle abdomen) discomfort
- Sweating
- Heartburn and/or indigestion
- Arm pain (more commonly the left arm,
but may be either arm)
- Upper back pain
- General malaise (vague feeling of
illness)
- No symptoms (Approximately one quarter
of all heart attacks are silent, without chest pain or new
symptoms. Silent heart attacks are especially common among
patients with diabetes mellitus)
Even though the symptoms of a heart attack
at times can be vague and mild, it is important to remember that
heart attacks producing no symptoms or only mild symptoms can be
just as serious and life-threatening as heart attacks that cause
severe chest pain. Too often patients attribute heart attack
symptoms to "indigestion," "fatigue," or "stress,"
and consequently delay seeking prompt medical attention. One cannot
overemphasize the importance of seeking prompt medical attention in
the presence of symptoms that suggest a heart attack. Early
diagnosis and treatment saves lives, and delays in reaching medical
assistance can be fatal. A delay in treatment can lead to
permanently reduced function of the heart due to more extensive
damage to the heart muscle. Death also may occur as a result of the
sudden onset of arrhythmias such as ventricular fibrillation.
What are the complications
of a heart attack?
Heart failure
If a large amount of heart muscle dies, the ability of the heart to
pump blood to the rest of the body is diminished, and this can
result in heart failure. The body retains fluid, and organs, for
example, the kidneys, begin to fail
Ventricular fibrillation
Injury to heart muscle also can lead to ventricular fibrillation.
Ventricular fibrillation occurs when the normal, regular, electrical
activation of heart muscle contraction is replaced by chaotic
electrical activity that causes the heart to stop beating and
pumping blood to the brain and other parts of the body. Permanent
brain damage and death can occur unless the flow of blood to the
brain is restored within five minutes.
Most of the deaths from heart attacks are
caused by ventricular fibrillation of the heart that occurs before
the victim of the heart attack can reach an emergency room. Those
who reach the emergency room have an excellent prognosis; survival
from a heart attack with modern treatment should exceed 90%. The 1%
to 10% of heart attack victims who die later include those victims
who suffer major damage to the heart muscle initially or who suffer
additional damage at a later time.
Deaths from ventricular fibrillation can be
avoided by cardiopulmonary resuscitation (CPR) started within five
minutes of the onset of ventricular fibrillation. CPR requires
breathing for the victim and applying external compression to the
chest to squeeze the heart and force it to pump blood. When
paramedics arrive, medications and/or an electrical shock (cardioversion)
can be administered to convert ventricular fibrillation back to a
normal heart rhythm and allow the heart to pump blood normally.
Therefore, prompt CPR and a rapid response by paramedics can improve
the chances of survival from a heart attack. In addition, many
public venues now have defibrillators that provide the electrical
shock needed to restore a normal heart rhythm even before the
paramedics arrive. This greatly improves the chances of survival.
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Can 'Cough CPR' Save Your Life
During a Heart Attack? From Urban Legends Report. |
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Netlore Archive: Self-CPR? According to this 1999 email
rumor, you can save your own life during a heart attack ... by
coughing
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Description: Email rumor Circulating since: 1999 Status:
Disputed by experts Analysis
|
| This one is serious...
Let's say it's 4:17 p.m. and you're driving home, (alone
of course) after an unusually hard day on the job. Not only was
the work load extraordinarily heavy, you also had a disagreement
with your boss, and no matter how hard you tried he just
wouldn't see your side of the situation. You're really upset and
the more you think about it the more up tight you become.
All of a sudden you start experiencing severe pain in your
chest that starts to radiate out into your arm and up into your
jaw. You are only about five miles from the hospital nearest you
home, unfortunately you don't know if you'll be able to make it
that far.
What can you do? You've been trained in CPR but the guy
that taught the course neglected to tell you how to perform it
on yourself.
HOW TO SURVIVE A HEART ATTACK WHEN ALONE
Since many people are alone when they suffer a heart
attack, this article seemed in order.) Without help the person
whose heart stops beating properly and who begins to feel Faint,
has only about 10 seconds left before losing consciousness.
However, these victims can help themselves by coughing
repeatedly and very vigorously. A deep breath should be taken
before each cough, and the cough must be deep and prolonged, as
when producing sputum from deep inside the chest. A breath and a
cough must be repeated about every two seconds without let up
until help arrives, or until the heart is felt to be beating
normally again. Deep breaths get oxygen into the lungs and
coughing movements squeeze the heart and keep the blood
circulating.
The squeezing pressure on the heart also helps it regain
normal rhythm. In this way, heart attack victims can get to a
phone and, between breaths, call for help.
Tell as many other people as possible about this, it could
save their lives!
from Health Cares, Rochester General
Hospital via Chapter 240's newsletter AND THE BEAT GOES ON...
(reprint from The Mended Hearts, Inc. publication, Heart
Response) |
Comments: This
message gives the impression that the technique described has the
endorsement of Rochester General Hospital and Mended Hearts, Inc., a
heart attack victims' support group. It does not. Although the text
was first published in a Mended Hearts newsletter, the organization
has since retracted it. Rochester General Hospital played no part in
the creation or dissemination of the message, nor does it endorse
its contents.
According to the best information I can find, "cough CPR"
(referred to in some variants as "self-CPR") is a
real procedure occasionally used in emergency situations under
professional supervision. It is not, however, taught in standard CPR
courses, nor do most medical professionals presently recommend it as
a "life-saving" measure for people who experience the most common
types of heart attack while alone (note: see
update below).
One doctor I contacted — a heart specialist — had never even
heard of the procedure.
Other doctors say they're aware of the "cough CPR" technique
but would only advise it under very specific circumstances. For
example, in certain cases where a patient has abnormal heart
rhythms, coughing can help normalize them, according to Dr. Stephen
Bohan of Brigham and Women's Hospital in Boston. However, most heart
attacks are not of this type. Dr. Bohan says the best course of
action for a typical heart attack victim is to immediately take an
aspirin (which helps dissolve blood clots) and call 911.
This is a case where a nugget of truth has apparently been
misunderstood and misrepresented to the public, though not
intentionally. A chapter of Mended Hearts published it without
proper research. It was then reprinted by other chapters and
eventually found its way into email form.
Darla Bonham, the organization's executive director, issued a
statement afterward which read, in part:
I've received email from people all
across the country wanting to know if it is a valid medically
approved procedure. I contacted a scientist on staff with the
American Heart Association Emergency Cardiac Care division, and he
was able to track a possible source of the information. The
information comes from a professional textbook on emergency
cardiac care. This procedure is also known as "cough CPR" and is
used in emergency situations by professional staff. The American
Heart Association does not recommend that the public use this
method in a situation where there is no medical supervision.
As with all medical rumors, the most prudent course of action
is to verify the information with your own doctor or other medical
professional before acting upon it or sharing it with others.
2003
update: In September 2003, four years after this email rumor
began circulating, Polish physician Tadeusz Petelenz presented the
results of a study which he said demonstrates that cough CPR can
indeed save the lives of some heart attack victims. While not
immediately embraced by all the members attending the European
Society of Cardiology meeting where Petelenz spoke, the findings
were characterized by some as "interesting." At least one heart
specialist, Dr. Marten Rosenquist of Sweden, found fault with the
study, objecting that Petelenz had presented no evidence that the
subjects had actually experienced cardiac arythmias. He called for
further research.
Further reading:
American Heart Association Statement
"The American Heart Association does not endorse 'cough CPR,' a
coughing procedure widely publicized on the Internet."
Mended Hearts, Inc. Statement
"It is not a recommended procedure for the general public."
Doctor: Cough CPR Good for Cardiac Arrest
Associated Press, 2 September 2003
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Heart Attack Symptoms and Warning Signs
( Spanish
version: Sintomas del ataque cardiaco/signos de
alerta
)
A blockage in the heart's arteries may
reduce or completely cut off the blood supply to a
portion of the heart. This can cause a blood clot
to form and totally stop blood flow in a coronary
artery, resulting in a heart attack (also called
an acute myocardial infarction or MI).
Irreversible injury to the heart muscle
usually occurs if medical help is not received
promptly. Unfortunately, it is common for people
to dismiss heart attack symptoms.
The American Heart Association and other
medical experts say the body likely will send one
or more of these warning signals of a heart
attack:
-
Uncomfortable
pressure, fullness, squeezing or pain in the
center of the chest lasting more than a few
minutes.
-
Pain spreading to
the shoulders, neck or arms. The pain may be
mild to intense. It may feel like pressure,
tightness, burning, or heavy weight. It may be
located in the chest, upper abdomen, neck, jaw,
or inside the arms or shoulders.
-
Chest discomfort
with lightheadedness, fainting, sweating, nausea
or shortness of breath.
-
Anxiety,
nervousness and/or cold, sweaty skin.
-
Paleness or
pallor.
-
Increased or
irregular heart rate.
-
Feeling of
impending doom.
Not all of these signs occur in every
attack. Sometimes they go away and return. If some
occur, get help fast. IF YOU NOTICE ONE OR MORE OF
THESE SIGNS IN YOURSELF OR OTHERS, DON'T WAIT.
CALL EMERGENCY MEDICAL SERVICES (9-1-1) RIGHT
AWAY! In the event of cardiopulmonary arrest (no
breathing or pulse), call 9-1-1 and begin
cardiopulmonary resuscitation (CPR) immediately.
The actual diagnosis of a heart attack must
be made by a doctor who has studied the results of
several tests. The doctor may:
-
Review the
patient's complete medical history.
-
Give a physical
examination.
-
Use an
electrocardiogram (or EKG) to discover any
abnormalities caused by damage to the heart.
-
Use a blood test
to detect abnormal levels of certain enzymes in
the bloodstream.
What does heart-related chest pain feel like?
By William R. Ladd, M.D., Director of Nuclear
Cardiology, Cardiovascular Institute of the South
If you suffer chest pain, particularly while
exercising, you will almost certainly wonder
whether it might be heart-related - and well you
should. Heart muscle pain - angina - is likely to
be the first warning of blocked coronary arteries,
the cause of most heart attacks.
While there are no infallible guidelines
about whether a chest pain is heart-related, it
generally takes a particular form. Heart
discomfort is rarely a sharp, stabbing pain. The
textbook description of angina is a feeling of
heaviness, pressure, tightness or aching in the
chest, usually accompanied by shortness of breath.
The pain generally goes away when you stop
exerting yourself, and it frequently isn't
especially severe, which is, perhaps, unfortunate.
Even a heart attack may not be unbearably
painful at first, permitting its victim to delay
seeking treatment for as much as four to six hours
after its onset. By then, the heart may have
suffered irreversible damage. It is not unknown
for patients to drive themselves to emergency
rooms with what proved to be very serious and even
fatal heart attacks.
Angina is a protest from the heart muscle
that it isn't getting enough oxygen because of
diminished blood supply. A heart attack is simply
the most extreme state of oxygen deprivation, in
which whole regions of heart muscle cells begin to
die for lack of oxygen. If the blockage in the
arteries serving the heart muscle can be cleared
quickly enough - within the first few hours of the
onset of the attack - the permanent damage can be
held to a minimum.
That's why it is so vital to seek medical
attention quickly if you feel the sort of pressing
pain or heaviness described above. There is a 90
percent probability that pain of this type is
angina. And even if it goes away, the artery
blockages that caused it are still there and will
grow progressively worse.
Ignoring this sort of pain because it is not
unbearable or because it goes away is the worst
thing you can do. It is the only warning you are
likely to get of a potentially lethal condition.
Heed it! Consult a cardiologist immediately.
You can have a heart attack without knowing it
By William R. Condos, Jr., M.D., Medical
Director, Cardiovascular Institute of the
South/Lake Charles
The nation's longest-running heart study
suggests that about one heart attack in four
produces no symptoms - or at least none that the
victim associates with a heart problem.
These so-called "silent heart attacks,"
however, are only the most extreme case of a still
more prevalent condition called "silent ischemia"
- a chronic shortage of oxygen - and
nutrient-bearing blood to a portion of the heart.
Both conditions put their victims at significant
risk.
The cause of ischemia, silent or otherwise,
is almost always atherosclerosis - the progressive
narrowing of the heart's arteries from
accumulations of cholesterol plaque. In most
instances, this reduction in blood supply
generates a protest from the heart - the crushing
pain called angina. But in perhaps 25 to 30
percent of heart attack victims, there were no
previous symptoms of these gradually developing
blockages. The Framingham Heart Study, which
followed 4,000 Massachusetts men for more than 40
years, found that 25 percent of their subjects'
heart attacks go unnoticed until their annual EKGs
detect their after-effects.
The absence of pain, however, doesn't mean
an absence of damage. The heart has a built-in
reserve capacity, allowing it to suffer a certain
amount of scarring and weakening from a heart
attack and continue to meet the body's needs. But
further ischemia or another heart attack, even a
mild to moderate one, may prove fatal because that
reserve capacity is no longer there. Even those
who survive another heart attack are at increased
risk of becoming cardiac cripples, disabled by
congestive heart failure or arrhythmias heartbeat
irregularities.
There is no way of predicting absolutely who
is a candidate for silent ischemia, but
statistically, the greater the number of risk
factors for coronary artery disease that you have,
the more likely you are to be a candidate. Those
risk factors include some you can't control - your
age, sex and genetic predisposition to
atherosclerosis - and those you can influence,
like diabetes, high blood pressure, high blood
cholesterol, smoking, lack of exercise and
obesity.
As a rule of thumb, I would urge you to
undergo a screening for silent ischemia if you
have any three of these factors working against
you - a man over age 50 who smokes, or a
post-menopausal woman with a ten-year history of
diabetes and chronic unfavorable blood cholesterol
levels, for instance.
The screening for undetected ischemia is a
medical history and physical examination and a
cardiac stress test - a workout on a treadmill
while your heart function is monitored.
It's a simple, painless and inexpensive way
to learn whether the beating of your heart is
accompanied by the inaudible ticking of an
atherosclerosis time bomb that could kill you. |
|
|
Heart
Attack, Part One: A Patient Guide
Introduction
The Heart Attack Patient Guide is a simple explanation of what
a person is likely to experience when having a heart attack. The
guide describes how a person is treated immediately during the
attack, upon arrival at the hospital, to months and years later. The
first part of the guide discusses the basics of heart function,
heart attack symptoms, emergency care, medications, tests and
treatments performed in the hospital. The
second part is a comprehensive
guide that covers short-term recovery in the cardiac care unit of
the hospital, including details about bypass and angioplasty
recovery, discharge from the hospital, cardiac rehabilitation,
exercise, long-term recovery, medication, depression, and lifestyle
modification.
I. Heart function
The heart works like a large pump and
consists of a bag comprised of muscle with blood vessels leading in
and out. The blood flows from your lungs, where it picks up oxygen,
into your heart and gets pmped out to the rest of your body. Once
the blood has delivered its oxygen to the tissues, it returns to
your heart and gets pumped back out to the lungs.
Blood flow
during a heart attack
The heart requires oxygen to function
properly. The blood inside your heart does not supply oxygen to the
heart muscle. Special blood vessels on the outside of the heart,
called coronary arteries, feed the heart muscle. Three major vessels
and many smaller vessels do this job. When one or more of the major
vessels is obstructed (usually due to blood clot formation in the
blood vessel lumen), blood cannot reach the heart muscle beneath the
block, restricting the supply of oxygen to the heart
(see
accompanying animation NOTE:
requires
Macromedia Flash Player).
Within 20 minutes of not receiving blood and oxygen, the heart
muscle begins to die, leading to a heart attack. A heart attack
results in the loss of function or contractility of the damaged
portion of the heart.
Symptoms of a heart
attack
The symptoms of a heart attack can be
greatly varied. Some heart attacks are blatantly obvious, with
affected people describing an intense, vice-like squeezing chest
pressure or a feeling of a heavy weight having been placed on their
chest. Other heart attacks are much more subtle, often beginning
slowly as a mild chest discomfort or dull ache. Some individuals may
report a stabbing, knifelike, or burning sensation. The pain is
usually prolonged and typically lasts for at least 30 minutes. The
pain, however, may also greatly fluctuate in intensity during the
period of a heart attack, and at times, appear to nearly completely
dissipate. The intensity of heart attack-related chest pain does not
usually alter with changes in body position. Even rest will not
typically relieve this type of chest pain. Finally, some patients
may not experience any chest pain.
Some patients describe pain radiating
down the arms (usually the left arm) with a tingling sensation in
the wrists, hands, and fingers. Others report pain in the shoulders,
neck, and jaw. The pain can also radiate to the teeth and back.
Additional symptoms include indigestion, nausea, vomiting,
palpitations, cold perspiration, weakness, dizziness, cough,
fainting, dry mouth, anxiety, or a sense of impending doom.
In general, men and women experience the
same symptoms of a heart attack. Although many heart attack victims
report some form of chest pain, others may report none at all. While
individuals who are elderly or have diabetes are generally at
highest risk for experiencing no chest pain during a heart attack
(this is known as a silent heart attack), all persons should
recognize this risk. In particular, individuals with unexplainable
new onset indigestion, nausea, or shortness of breath should
consider seeking prompt medical attention.
Finally, acute heart attack is a major
cause of sudden death in adults and may occur with absolutely no
warning signs at all.
II. Emergency Care
Prehospital care
If you are experiencing chest discomfort
and any of the aforementioned symptoms, you or someone close to you
should call an ambulance immediately. Use 911 or your local
emergency number. If you are not sure if you are having a heart
attack, call your doctor immediately. There is a strong tendency to
deny the possibility of a heart attack. Denial and delaying medical
treatment can cost you your life. Research shows that one in three
people die from a heart attack within the first few hours of
experiencing chest pain. Making the decision to get to a hospital as
early as possible is often the single most important factor in
determining your likelihood of survival.
If your doctor has previously prescribed
nitroglycerin tablets for you, put one under your tongue when the
symptoms begin and repeat at five-minute intervals for a total of
three doses. If the symptoms have not disappeared within 15 minutes,
call an ambulance immediately. Do not take nitroglycerin tablets
unless directed by a doctor. In patients with a condition known as
aortic stenosis, taking nitroglycerin tablets can precipitate death.
If you do have this condition, clearly understand from your doctor
how you should respond in the event that you do develop worrisome
chest pain.
As soon as you think you are having a
heart attack, take one aspirin, unless you have a specific allergy
to it or a condition that makes taking aspirin highly risky. While
perhaps the most inexpensive of all heart attack related therapies,
aspirin is also one of the most effective.
Unlike a heart attack, if you believe you
are having a stroke, aspirin may not be beneficial and may even
prove harmful. This is because not all strokes are due to blood
clots. Some are due to bleeding. Aspirin may worsen a stroke if, in
fact, it is due to bleeding.
If you are with someone whose heart has
stopped beating, call 911 or your local emergency number. Administer
cardiopulmonary resuscitation (CPR) immediately. CPR will supply
oxygen to parts of the body until the ambulance arrives. It is
important to have a family member or caretaker trained in CPR,
especially when there is diagnosed heart disease in the family.
Local community centers and hospitals can provide information on CPR
training.
In the emergency department
Treatment goals at the emergency
department (emergency room) are to decrease the demands on your
heart and prevent and treat complications. An IV (intravenous
catheter) will be placed in a vein. This is usually the best way to
administer fluids and medications. Even if blood levels of oxygen
are normal, oxygen is generally administered to decrease the
workload of the heart and make oxygen readily available to the body.
A urinary catheter might be inserted to help monitor the input and
output of fluid from the body.
Your doctor will use the following
information to determine the severity of your condition and
treatment of choice: previous medical history, physical examination,
an electrocardiogram (ECG or EKG), and the level of pertinent
chemicals in your blood.
Physicians will want to know what type of
chest pain you may have experienced previously. They will also want
to know whether you have had a heart attack in thepast, surgeries,
and if you take any medications. (It is useful if a family member
has knowledge of medication dosages.) This information will help
physicians determine whether the pain you are feeling is due to a
heart attack.
If you are having a heart attack, a rapid
pulse, changes in blood pressure, crackles in lungs, and abnormal
heart sounds might be found on physical examination. The ECG (or
EKG) is a test that records the electrical rhythm of your heart.
Wires (or leads) are attached to the chest, arms, and legs using
pads with gel or tape. This procedure is not painful. Specific
changes in the ECG alert the physician that a heart attack is
occurring. EKG monitoring is generally started immediately since
life threatening dysrhythmias (defective rhythm) are the leading
cause of death during the first several hours following an acute
heart attack.
Blood tests provide an indication of
heart muscle damage. When some of the heart muscle dies, the dead
cells release chemicals into the blood. One chemical that is
routinely evaluated is creatinine phosphokinase (CPK), specifically
the MB isoform. Another set of chemicals belong to the troponin
family of proteins (troponin I and troponin T). All of these
chemicals have high specificity for heart muscle and when they are
significantly elevated, confirm a heart attack diagnosis. The CPK MB
and troponins provide important information about the extent and
severity of your heart attack, when your heart attack might have
occurred, and your prognosis.
Medicines
If ECG results determine that you are
having a heart attack, your doctor will try to use medications to
help the heart. Several of these drugs are specifically designed to
prevent further blood vessel obstruction (aspirin, heparin,
low-molecular weight heparin, glycoproteins 2b/3a inhibitors, and
clopidogrel). Others, such as oxygen and beta blockers, improve
oxygen utilization by the heart and decrease the heart's workload.
Nitrogylcerin and morphine decrease chest pain and reduce heart
strain. If you have an arrhythmia during the course of your heart
attack, you may also be placed on an antiarrhythmic (other than beta
blockers which are, by themselves, effective antiarrhythmics).
Diuretics such as lasix may be prescribed if you have fluid
accumulation in your lungs. Cholesterol-lowering agents such as
statins and antihypertensive, anti-remodeling agents such as
angiotensin-converting enzyme inhibitors (ACE inhibitors) are
important adjunctive therapies that may also be used early in the
course of your therapy.
If your doctor finds enough convincing
evidence that you are having a heart attack, then you will be
prescribed some form of reperfusion therapy. Reperfusion therapy
refers to using intravenous medication (thrombolytics), a
percutaneous catheterization-based technique (angioplasty), or
surgery to reestablish blood flow to an occluded artery. The
decision to receive one of these therapies is dependent upon a
number of important factors including how long ago your heart attack
started, the severity and instability of your heart attack, and the
available resources and experience of the cardiovascular specialists
at the hospital where you are being treated. Each of these therapies
has their own unique advantages and disadvantages that will be
discussed with you during the very initial phases of your
hospitalization. If the caring emergency team has decided during
your en route trip to the hospital that you will receive
thrombolytics, you may be started on such medication in the
ambulance. Along with reperfusion therapy, heparin and/or 2b/3a
inhibitors may be prescribed to reduce the clotting tendency of your
blood.
III. Tests and Treatments
The following tests and treatments are
usually not performed in the emergency room. Patients are usually
admitted at this point.
Cardiac
catheterization
Your physician may request a cardiac
catheterization. A thin catheter (plastic tube) is inserted through
a vein or artery in the arm or leg and is guided into the coronary
arteries of the heart. This test can accurately measure how much
oxygen is in your blood, your blood pressure, and can provide
information about functioning of the heart muscles, valves and
arteries. A skilled doctor usually injects dye through the catheter
into the origins of the coronary arteries and identifies arterial
obstructions by observing dye flow.
Angioplasty
As briefly mentioned, your doctor may
decide to treat you with angioplasty to establish reperfusion when
he/she feels that thrombolytic therapy is either not primarily
indicated or was ineffective in relieving your heart attack
symptoms. Angioplasty can be performed during a cardiac
catheterization. The technique consists of a small balloon being
placed at the site of the coronary blockage and blown up with air.
This causes the material forming the blockage to be compressed along
the wall of the vessel. The inflated balloon can also cause the
vessel to stretch, making it wider so more blood can flow through.
It can also cause cracks in the blockage that will allow more blood
to flow through.
You will be mildly sedated during
angioplasty, and most people report feeling only minor discomfort.
Like a catheterization, your doctor will inject dye into your
arteries that will allow him/her to monitor your blood flow and
determine the site(s) of blockage. The tube carrying the balloon,
regarded as the catheter, is inserted at the site of artery access,
usually in the groin area. The catheter is moved along the artery
until it reaches the blockage. The balloon is then inflated for a
period of a few seconds to a few minutes and then deflated. Blood
flow is monitored to ensure adequate reperfusion or restoration of
blood flow. Sometimes the balloon will be reinflated at the same
site or at another site.
Usually a stent is placed at the site of
the balloon. A stent is a rigid tube which prevents the vessel from
collapsing or a blood clot from forming at the site of the blockage.
Great advances in stent technology have led to markedly improved
outcomes for people who undergo angioplasty at the time of their
heart attack, or shortly thereafter.
Bypass surgery
If angioplasty proves unsuccessful, the
position of the block is too difficult to access by angioplasty, or
you have severe blockages in multiple major vessels, the doctors may
recommend bypass surgery. In this procedure, a piece of vein taken
from the leg or an artery taken from the chest is used to form a
bypass conduit to enable blood to go around the blockage. Several
blocks can be bypassed at the time of surgery.
Bypass surgery is a major operation. If
you undergo this operation, you will receive general anesthesia, and
thus be completely asleep during the surgery. Pre-operative
medications are often administered to bypass patients by mouth,
muscular or subcutaneous injection, or IV. During bypass surgery,
the chest bone is separated, and the ribs are spread apart to allow
visible and physical access to the heart. During surgery, blood
circulation and breathing functions will be taken over by a
heart-lung machine. The operation usually lasts between two and six
hours. A bypass graft is performed to reroute blood flow around the
blockage. Veins used in bypass surgery are usually taken from one of
the legs or an artery is usually taken from the chest wall (internal
mammary artery), or forearm (radial artery) to complete the graft.
A newer technique, minimally invasive bypass surgery, requires a
much smaller incision in the chest (only three inches) instead of
sawing through the chest bone. An artery from the chest is used to
bypass the blockage. While fewer patients are candidates for this
type of surgery, the technique is less painful and leads to a
shorter hospital stay than the usual bypass surgery. |
Heart Attack, Part Two: A Patient Guide
Introduction
The Heart Attack
Patient Guide describes what you are likely
to experience when having a heart attack, as
well as your recovery and treatment. This
guide describes the various stages of
recovery, from the first few days in the
cardiac care unit to months and years later.
Details about bypass and angioplasty
recovery, discharge from the hospital,
cardiac rehabilitation, exercise, long-term
recovery, medication, depression, and
lifestyle modifications are included.
Part One
of the guide reviews basics of heart
function, heart attack symptoms, emergency
care, medications, tests, and treatments
performed in the hospital.
I. Recovery
The cardiac care unit (CCU)
If you have had or
are suspected of having a heart attack, you
will usually be taken from the emergency
room (ER) to the cardiac care unit (CCU).
Within the first day of your CCU stay, you
may be ordered not to receive anything to
eat by mouth (i.e., made fasting) or placed
on a clear liquid diet. The reason for these
dietary restrictions is to reduce the risk
of vomiting and nausea after the heart
attack. More importantly, you must be made
fasting to empty the upper gastrointestinal
tract prior to the performance of any urgent
invasive cardiac procedures (i.e., cardiac
catheterization). Once it is deemed safe for
you to resume eating solid food, you will be
prescribed a diet that is low in saturated
fats, cholesterol, sodium, and processed
sugars (if diabetes is present). Diets might
consist of fish or lean chicken (protein),
fruits and vegetables (fiber and
carbohydrates, antioxidants), and breads and
light pastas (carbohydrates). Bananas,
orange juice, and grapefruit juice might be
used because they serve as plentiful sources
of potassium and magnesium and are low in
sodium.
Anxiety is common
during the first 24 to 48 hours and may be
treated with benzodiazepines (e.g.,
lorazepam or oxazepam), low-dose narcotics
(e.g., morphine), or haloperidol. While
these medications overall are very safe,
each has its own set of side effects or
adverse reactions that could occasionally
dissuade its use in particular groups of
patients. You may become temporarily
confused and disoriented to time (termed
delirium, or ICU psychosis) in the CCU
because you are receiving multiple new
medications, severely sleep-deprived, or
unaccustomed to your new surrounding.
Patients with multiple complex medical
problems and the elderly are at greatest
risk for this condition. Fortunately, ICU
psychosis is usually tempered with
medications (e.g. haloperidol),
discontinuation of problematic medications,
or discharge from the CCU to a quieter
floor. You may also be given sleeping pills
to maintain as normal a day-night schedule
as possible. Stool softeners are used to
prevent constipation and straining.
In the absence of
complications, patients who have had a heart
attack are not confined to bed for more than
12 hours. You can participate in progressive
daily activity depending on your vital signs
(blood pressure and heart rate), age, and
physical capacity. The following stages are
used as general guidelines for activity
following a heart attack. Actual practice
may vary significantly from these
guidelines, depending on your health status
and progress.
Stage one (days 1 and 2)
During the first
day, you may use a bedpan or bedside
commode. You may feed yourself from a tray
with arm and back support. Complete
assistance will be given for bathing. The
nurse will move your arms and legs to assess
range of motion. You may be asked to push
your foot against a footboard as a first
step in active motion. You are encouraged to
concentrate on relaxing and taking deep
breaths.
On the second day,
with back support, you may partially bathe
your upper body. You should try to move from
the bed to the chair for one to two hours
per day. You should actively move your arms
and legs five to 10 times during the day.
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