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There are a number of myths about heart care and more specifically about heart attack that really need to be dispelled once and for all. We obviously want to stay clear of heart ailments so we carry with us a number of beliefs about things that we consider will either keep us safe from or make us more prone to a heart attack. But many of these may be misguiding or downright wrong. So let us do away with the unnecessary fears and learn what will actually help our hearts.
Below are some common misconceptions about heart attacks:
Most of doctors these days in the heightened reality of nutrition and well being stress the fact that those who are overweight, eat out a lot, or do not exercise and lead a sedentary lifestyle are more susceptible to heart attacks. While they are not wrong, those who are thin, do regular exercise and eat a proper healthy diet are not safe from heart attacks either. This is because cholesterol deposits which are the most common cause of clogging of arteries can be present in thin people too. Physical appearance can many times mask an underlying health problem.
Moreover heart problems and heart attacks are also genetic. So if you have a history of heart issues in your family you are more likely to have a hereditary link. There are also factors like diabetes, high cholesterol or high blood pressure that put you at a risk, no matter your weight. Gender and age also matter. So in spite of how healthy you look or feel, get a check up to ascertain your heart’s health!
While we are pretty used to watching men, in the typical hollywood movies, clutching their chests and falling down from what is apparently a heart attack, it usually isn’t so obvious in real life. The classic symptoms of a heart attack include a heavy feeling in the chest that may be painful. But the heaviness or pain may spread to the left arm, neck, or jaw. Another often ignored symptom is indigestion or heart burn, it may just be something you ate or it could be a heart attack.
Symptoms include:
Chest painPressure, heaviness or tightness in the chestPain or pressure in the neck or jawPain or pressure in one or both arms (especially the left)Shortness of breathSweatingNauseaPain or throbbing between the shoulder bladesMany people suffer from heart attacks but assume it is only heartburn or fatigue. When it comes to your heart, it’s important to consult a doctor rather than to self diagnose!
Most of us believe that if we were having a heart attack, it would involve having chest pain. But as mentioned above recognizing a heart attack isn’t that easy. The classic signs include chest pain but it needn’t really cause chest pain. According to CNN, 40 to 60 percent of all heart attacks are unrecognized by their victims. If you’re having some sort of unusual discomfort in your back, chest or upper arms, whether or not it is in the middle of your back or the middle of your chest, don’t wait until your heart stops, call an ambulance. Never drive yourself to the hospital if you think you are having a heart attack as you might kill yourself and others doing so.
Since women in movies do not clutch at their hearts and collapse to the floor it is assumed that women do not suffer from heart attacks. True, women are less prone to heart attacks before menopause due to the presence of estrogen, which protects them from heart attacks, but post menopause women are just as prone to heart attacks as men are. In fact, probably moreso.
According to statistics: [courtesy Women's Heart Foundation]
Worldwide, 8.6 million women die from heart diseases each year (including heart attacks), accounting for a third of all deaths in women.Women are twice as likely as men to die within the first few weeks after suffering a heart attack.38% of women and 25% of men die within one year of a first recognized heart attack.Women do not usually experience the commonly expected chest pain as men do when they suffer from heart attacks. 71% of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like the flu – often with no chest pain at all. Nearly two-thirds of the deaths from heart attacks in women occur among those who have no history of chest pain at all. Even if they do experience mild chest discomfort they simply do not perceive it to be a heart attack like men do. So they must get any abnormal pain checked out.
Here are some of the symptoms of female heart attack:
Shortness of breathWeaknessUnusual fatigueNauseaDizzinessAbdominal discomfort that may seem like indigestionMedical professionals are challenged to respond to women’s milder symptoms, due to insufficient information and often times when women present in the emergency room with a heart attack they are initially misdiagnosed.
If you have a pain in your chest, you must not sit around and wait to see if it goes away. If you’re having significant chest discomfort, shortness of breath, or any other symptoms that suggest a heart attack, call a 911 or any clinic’s emergency number. If you delay treatment when you are having a heart attack you could cause irreparable damage to your heart and it could also prove to be fatal.
It is possible to die of fright, or for that matter grief, anger, joy, or just about any other intense emotion. Though usually victims are older and likely to be in unstable health conditions, even younger people could be so affected. It is possible for a terrifying event to trigger a fatal heart attack.
Multiple scientific studies show that important mind and body connections exist for health in general and cardiovascular health in particular. Your levels of stress and wellbeing are extremely important for your cardiovascular health. Higher stress levels or negative emotions like anger or depression could burden your heart pumping due to release of certain hormones in our blood stream like adrenalin. You should therefore look for ways and means to reduce stress and negative emotions in your lives.
Though predominantly those who are older are more prone to having a heart attack, it is possible to start developing coronary artery disease as a teenager especially these days with fast food and junk food being a primary source of nutrition for many young people. People in their 20s and 30s have suffered from heart attacks. A heart-healthy lifestyle needs to begin in the childhood, so that kids don’t develop bad habits that they carry to adulthood. Parents should encourage their kids to exercise, limit time spent in front of the television or computer screen, and partake healthy, well-balanced meals.
Children, who are obese, have high blood pressure or a family history of heart disease are at a higher risk. Also, although rare, some children (usually due to genetic differences) can have unusually high cholesterol and thus an increased risk for heart disease.
Another problem today is the kind of lifestyle that we live. Especially the young working population today lives an unbalanced life with no exercise, a lot of junk food and high stress levels. Not to mention overexposure to technology and the sedentary lifestyle it promotes that is proving to harm our lives. For the young it is especially necessary to have regular checkups and a conscious effort to maintain a well balanced life.
An ECG (electrocardiogram) is a graphic which shows the electrical activity of the heart. The heart muscles create electrical waves by working. These waves can be measured by electrodes that are in contact with the human body.
Accurate ECG interpretation is dependent on recognition and analysis of each of the components of the tracing. In this article, the wave forms which contribute to the ECG are reviewed briefly.
When analyzing any ECG deflection, it is important to point out that the size and configuration of the deflection are affected by the direction from which the electrical events are viewed. Accordingly, points of observation along the electrical axis of a deflection will yield waves which are larger (in either a positive or negative direction) than deflections viewed from observation points more nearly perpendicular to the axis of the wave form.
Some leads are more useful than others for the diagnosis of atrial enlargement and ventricular hypertrophy. It also makes it essential that more than one lead be viewed in the analysis of cardiac arrhythmias, as wave form patterns that are obvious in one lead may be obscure, absent, or uninterpretable in other leads.
The ECG tracing is recorded usually at a rate of 25 mm/sec. Occasionally 50 mm/sec is used to facilitate interval measurement or wave form interpretation.
The P Wave (Atrial Depolarization)
The P wave originates normally from the sinus node, which lies at the junction of the superior vena cava and the right atrium, and proceeds from right to left across the atria. In the coronal plane, right atrial forces are directed anteriorly and left atrial forces both posteriorly and to the left. The P wave is a “composite” wave form, consisting of components originating from both the right and left atria.
The right atrial deflection precedes the left, as one would expect from the discussion above. The P wave, then, is the electrical summation of these two component parts.
The QRS Complex (Ventricular Depolarization)
The QRS complex reflects depolarization of the interventricular septum and both ventricles. Normally, the electrical activation of this portion of the heart proceeds from the AV node to the inferior and left side of the interventricular septum. The septal depolarization from left to right, in a superior direction, is the first (earliest) event in the QRS complex; it represents the Q wave seen in the left precordial (chest) leads of the normal ECG. The remainder of the QRS deflection reflects depolarization of the right and left ventricles.
The nomenclature of this wave form can be confusing:
A Q wave refers to an initial negative deflection.
An R wave is the first positive deflection.
An S wave is a negative deflection following a positive deflection.
The size, axis, and configuration of the QRS complex are useful for the diagnosis of ventricular hypertrophy.
The T Wave (Ventricular Repolarization)
Normally, the T wave axis is similar to the QRS axis because of two cellular electrical factors: cellular repolarization causes a deflection opposite in direction to cellular depolarization, but ventricular repolarization occurs in a sequence opposite to that of depolarization. Therefore, although the direction of repolarization is opposite to that of depolarization, the cellular (and, therefore, ECG) electrical forces are reversed, resulting in a T wave axis similar to that of the QRS complex.
The PR Interval
The interval in time between the onset of the P wave and the onset of the QRS complex is termed the PR interval.
The PR interval varies with both age and heart rate. The higher the heart rate, the shorter the PR interval; for a given rate, the younger the age, the shorter the PR interval. A short PR interval suggests aberrant atrial to ventricular conduction.
The QT Interval
The interval between the onset of the QRS complex and the end of the T wave is referred to as the QT interval.
The QT interval is affected by heart rate, shortening normally at more rapid rates and lengthening at slower rates. For this reason, the QT interval is best “corrected” for rate, by referencing it to a rate of 60 bpm. This is done by dividing the absolute QT interval by the square root of the interval in seconds between R waves (that is, the cycle length).
The QT interval is modulated by the autonomic nervous system, and affected by a variety of electrolyte, mineral, and acid-base disorders.
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Drug eluting stents (also called medicated or drug-coated stents) were invented in response to a common side effect of balloon angioplasty surgery in which the coronary artery became weak and prone to collapse. Stents are a metallic metal “scaffold” or tube that is inserted into the coronary artery in order to prevent collapse. Further developments in stent technology led to drug-coating in which the stent was coated with a pharmacological agent designed to prevent re-blocking (restenosis) through the delivery of time-released drugs into the bloodstream.
Drug eluting stent therapy is accompanied by antiplatelet drugs designed to prevent clotting of the blood within the arteries for at least six months. Common drugs include Ticlid and Plavix, which help to ensure that restenosis does not occur during the time in which the heart’s cells are growing over the stent and allowing it to “grow” into the anatomy of the coronary artery.
The first stents were used in France in 1986, and the first FDA approval for a metal stent occurred in 1994. Drug eluting stents were first introduced in the 1990s and have since grown into a multi-billion dollar business with over six million prescriptions in America and over $5 billion in revenues per year. American manufacturers include Medtronic, Boston Pharmaceuticals and Cordis, and the drug is also manufactured and marketed in Europe.
Despite their growing popularity, drug-eluting stents have been linked with severe side effects including allergic reactions, increased risk for cardiac-related deaths and heart attacks, and thromobosis (blood clotting). The FDA warned United States patients about the Cordis CYPHER stent in 2003 after use of the CYPHER stent led to deaths in some patients due to sub-acute thrombosis, in which blood cells gather and clot around the stent, preventing the passage of blood through the artery.
In addition, a 2006 study conducted in Switzerland found that patients with drug eluting stents are up to 40 percent more likely to die of a cardiac event, or experience a heart attack after insertion of a DES device.
In addition, increased incidence of non-cardiac conditions such as lung disease, cancer and stroke were found in some stent patients. Stent thrombosis, a condition in which blood clots in the artery and prevents blood flow, is among the most dangerous side effects of DES treatment. The risk also exists with non-medicated metal stents, but a disturbing trend has appeared in coated stents in which patients experience a linear and cumulative rate of thrombosis over time.
The release of medication from the stent can lead to delayed healing and actually increase the likelihood of thrombosis at the stent site. In fact, in June 2006, Boston Scientific itself admitted that its own studies showed a higher increase in late stent thrombosis with its medicated stent product, implying that all drug-eluting stents might have this effect (a claim which was vigorously denied by its competitor companies).
Another drug eluting stent side effect is dependence on antiplatelet drugs over the long-term. Since patients are usually put on Plavix and similar antithrombosis drugs after stent insertion, they are subject to the side effects of those drugs, which include a myriad of symptoms such as gastrointestinal bleeding, strokes, rashes, chest pain, flu-like symptoms, allergic reactions, and inability to have surgery in life-threatening conditions due to the drugs’ blood-thinning and anti-clotting effects. This is in addition to the cost of long-term Plavix use: while the minimum antiplatelet drug therapy averages around six months, some patients are prescribed Plavix for life.
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Congestive heart failure (CHF) is the inability of the heart to pump blood effectively to the body. congestive heart failure does not mean that the heart has stopped working completely, but does mean that the heart is not pumping as strongly as it should. As a result, some of the blood that is normally pumped out of the heart backs up into the lungs and other parts of the body, causing a build-up of fluids in the body (resulting in swelling), shortness of breath and fatigue. While prevention of congestive heart failure is optimal, it’s important that those who are diagnosed, along with their family members, know how to maintain quality of life and provide proper care.
The seriousness of congestive heart failure usually determines the impact on a person’s life. “The type of assistance that patients with heart failure need is directly dependent on the degree of severity of the congestive heart failure,” Dr. Douglas Mann, Lewin Professor and Chief of the Cardiovascular Division at Washington University School of Medicine, and the Cardiologist-in-Chief of Barnes-Jewish Hospital, explains. Mild heart failure may have little effect, while severe congestive heart failure can interfere with even simple activities of daily living, such as bathing and dressing. “One symptom of heart failure is shortness of breath, so someone with class three or four [more severe] congestive heart failure may need help getting groceries, even help getting up the stairs and going to the bathroom, or they could be bed-bound,” Dr. Marrick Kukin, Director of the Heart Failure Program at St. Luke’s-Roosevelt Hospital Center in New York City, and Professor of Clinical Medicine at the Columbia University College of Physicians & Surgeons, notes.
In cases of moderate to severe congestive heart failure, support from loved ones is essential to creating a home health routine. According to Dr. Mann, “The great majority of patients with severely advanced congestive congestive heart failure will require assistance ambulating.” In order to cope and help in the best way possible, Dr. Kukin suggests family care givers practice patience when assisting their loved one with heart failure. “They [patients] need to be encouraged to try some activities, but also to rest,” Dr. Kukin explains. “If they walk three steps and have to catch their breath, that’s OK.” Assuring your loved one that s/he can indeed make it to the kitchen table for lunch, no matter how long it takes, gives them confidence and strength (both mental and physical).
Medications, such as diuretics (water pills used to reduce swelling and congestion), ACE (angiotension-converting enzyme) inhibitors and beta-blockers, can also support the day-to-day life of a heart failure patient. “Both ACE inhibitors and beta blockers have been shown in clinical trials to reduce hospitalization, lower mortality, and make patients with heart failure feel better,” Dr. Kukin notes. He encourages both the person living with heart failure and the family care giver to ensure that the prescribed home health and medication regime is followed.
Upon diagnosis of heart failure, a person’s diet and exercise routine must be tailored to ensure optimal home health and well-being. If you’re the family member responsible for caring for your loved one, don’t worry about having to cook two meals, or engage in different exercise programs — the following suggestions are great preventative measures for your heart health, as well, so join in!
Perhaps the most important dietary guideline to follow is reducing sodium. Salt increases blood pressure, putting further strain on the heart, and also causes fluid retention by the kidneys. “It’s essential that the person who has heart failure follow a low-sodium diet (two grams per day), which means no saltshaker, and avoiding foods that have high sodium concentration, such as canned soups, hard cheeses, pizza, and processed meat,” Dr. Kukin explains. Begin reducing sodium intake by using other spices to flavor food, limiting the consumption of processed foods and fast food — and increasing the amount of fruits, vegetables and fresh foods in your refrigerator.
Dr. Kukin also suggests that those living with heart failure limit the amount of fluids they consume, as excess fluids can cause fluid retention (and swelling), and also often result in decreased serum (blood) sodium. However, “It is extremely difficult to keep patients from drinking water if they are thirsty,” Dr. Mann notes. He suggests patients restrict fluid to less than two liters per day if they have moderate hyponatrenia (lower than normal serum sodium), and follow more strict limitations when severe hyponatrenia is present.
Having congestive heart failure doesn’t mean dining out is out of the picture, either — it just means you and your loved one will have to be more aware of your choices. Avoiding restaurants that only serve fried or fast food, asking that food be prepared without salt or MSG, and planning meals around busy schedules will ensure a heart-healthy diet.
Physical activity strengthens muscles — and the heart is a muscle — so exercise is also a very important part of maintaining health in the wake of congestive heart failure. “Once a patient gets a diagnosis of heart failure, we don’t want them to become couch potatoes,” Dr. Kukin explains. “We want them to be physically active within their means.” He recommends swimming and walking — even if rest is needed in between laps, or even steps. ” … the family care giver has to encourage the patient to walk, even if it’s half a block, then rest and walk some more. Try to increase it [exercise] by a few feet each day.” According to Dr. Kukin, the only exercise that should really be avoided is extreme weight lifting.
“In general, the goal of exercise should be 30 minutes of moderate activity 5 days a week, for a total of 150 minutes per week,” Dr. Mann adds. According to Dr. Mann, the only time exercise should really be avoided is in the most severe cases of congestive heart failure, or when an exercise-induced arrhythmia is present.
Although those diagnosed with congestive heart failure can live fulfilling and enjoyable lives, there is no cure for heart failure — which oftentimes leaves patients and their family care givers living with stress or depression. In fact, people with heart failure and their family care givers have depression at much higher rates than the general public. According to Dr. Mann, rates of depression have been reported in 15 percent to 35 percent of heart failure patients, depending on the methodology used for the diagnosis of depression. It’s essential that both parties — the family care giver and their loved one living with congestive heart failure heart failure — commit to being aware of mood changes and emotions in themselves and each other.
Stress takes its toll on the body, decreasing the physical health and emotional well-being of both the family care giver and his/her loved one with heart failure. To reduce stress, take walks together, talk about your feelings and emotions (or jot them down in a journal), and take time each day to be in peace (meditation or yoga are great options).
In order to reduce the stress that comes with a diagnosis, Dr. Kukin suggests both the patient and the family care giver educate themselves about heart failure. “Knowledge is freedom. Knowing a little bit more about the heart’s pumping, heart function, why the patient is taking various medications, why they’re being restricted in sodium, and why they’re being encouraged to exercise is all very important.”
Depression is associated with increased risk of cardiovascular disease, so it goes without saying that treatment is essential. In addition, ” … depression can impact the quality of life for patients with heart failure, and has been associated with a four-fold increase in overall mortality,” Dr. Mann notes. “Depression can also impact cognitive function, which makes it more difficult to instruct patients on medication use, as well as dietary restriction.” Dr. Mann stresses the importance of the family care giver role in diagnosing depression. He suggests being aware of changes in mood, or mental status, and seeking treatment when necessary. While it can be difficult to talk about depression — whether about your own depressed feelings or the feelings of the person in your care — it is important to reach out to a health care provider and discuss a treatment plan.
While it’s completely feasible to cope with the symptoms of congestive heart failure and live a safe, satisfying life at home (especially with the help of a loved one or professional in home caregiver, there are certain warning signs that indicate medical help is a necessity.
Dr. Kukin cites the following as indications of heart failure worsening: difficulty lying in bed (orthopnea), swelling in the calves or ankles (edema), early satiety (feeling full quickly), and waking up in the middle of the night to catch breath. Excessive weight gain (3 pounds in one day, or 5 pounds in one week) can also point to problems, so Dr. Kukin suggests those living with congestive heart failure keep a scale handy and weigh themselves daily, with the help of an in home caregiver if necessary.
Depending on the prognosis, there are treatment options for certain heart failure patients. Electrical devices, like defibrillators and mechanical heart assistance can provide life-prolonging therapy, Dr. Kukin notes — but are expensive and involve surgical procedures.
In home care giving, home health nursing care, or hospice care can also be options for those living with congestive health failure and their loved ones. Home care can provide assistance with activities of daily living, transportation services, and companion care. I can’t say enough about home hospice care as we had in home hospice care for my mother when she was in the final stages of congestive heart failure and they were an absolute god send.
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