I was prompted to write about this when, in the last week or so, a couple of patients presented with upper back-pain in between the shoulder-blades and dismissed them off as ‘muscular aches’. In both cases, they turned out to be impending heart attacks. So what kind of symptoms are produced when the heart’s in trouble?
The reality is not all heart attacks happen suddenly and dramatically as in a TV drama where you clutch your chest in pain and fall to the ground. In many instances, the warning symptoms appear but are ignored because they appear in unusual parts of the body and may fade off after a while, only to reappear again especially when the heart is stressed.
The classical symptom is that of central chest-pain or pressure, not unlike someone standing on your chest. But sometimes, the pain can be in unusual locations include jaw or teeth pain, leading to a visit (wrongfully) to the dentist. An alert dental surgeon can recognise the differentiating features and refer the patient on to the cardiologist for urgent attention.
Another location for heart-attack pain can be the so-called interscapular area (the part between the shoulder-blades), even without chest-pain. Often, the pain can be excruciating with possible pain-free intervals, leading one to a false sense of security with disastrous consequences; because time is crucial in such circumstances : the well-known ‘golden hour‘, named because early treatment during an evolving heart attack can mean the difference between life and death.
Pain need not always be present as a heart attack develops. Especially in diabetics, breathlessness can be the only symptom. Of particular note is progressive deterioration of stamina, such as walking up a staircase.
Getting treatment within an hour of a heart attack cuts your risk of dying from it in half, so it is important to get to the nearest Emergency Department of a large hospital in double-quick time. Sometimes it may be better to rely on one’s own transport than to wait for an ambulance if that’s going to save time.
Are there any useful measures to do while waiting to receive medical attention? Anecdotally, several maneuvers have been promoted on the Internet, many without a proven basis. There’s certainly no place for home remedies! Sitting up and facilitating breathing (loosening tight clothing) and at the same time calming the patient does help as it is well-known that anxiety aggravates the heart. If aspirin is available (even the ones for headaches), putting a tablet under the tongue will help to thin out blood and prevent clots from developing.
Personally, I have encountered several instances where people hesitate to go to the hospital for fear of embarrassment in case it turns out to be a false alarm. Others deliberately neglect to call help, fearing the worst, but hoping their inner fears may be wrong. In any case, an important rule of thumb is that it is better to be proven wrong at the hospital than to miss a heart attack. No medical staff is going to chastise you, for sure, if you’re wrong.
- 20 Classic Heart Attack Signs Never To Ignore (positivelygood.net)
Its World Stroke Day..so it might be timely to reiterate what I consider the most important point in handling someone who is suspected of suffering from ‘brain attack‘ – acting FAST.
Of the four points, perhaps the last is most crucial in determining the chances of survival and the probability of recovery. Every second delayed in receiving treatment means more brain cells die . The thing about the brain is once cells die, they do not get replaced, unlike other organs in the body like the liver.
Nowadays, its possible to dissolve the clot causing the stroke (the ischemic variety, not the bleeding form) by injecting a clot-dissolving medicine into the veins; but to re-emphasize, time is of utmost importance.
One might wonder – how do you prevent stroke in the first place?
A study conducted in England by four researchers, one of whom came from Malaysia and was a classmate of mine, showed quite conclusively that one could reduce the chances of getting stroke by 50% if one adopted the following measures:
- not smoking
- being physically active
- limiting their alcohol intake to not more than 14 units a week
- fruit and vegetable intake of at least five servings a day.
Apart from the above, it is well-known that the presence of the following risk-factors also predispose to stroke: high blood pressure, diabetes, high cholesterol, atrial fibrillation (irregular heart-beats), heart disease and certain blood diseases which cause clotting.
As they say, prevention is better than cure.
- Atrial Fibrillation – Part 1 – What is it? (myheartnet.wordpress.com)
Face-masks come in many shapes and sizes. One normally associates them with surgical masks, which is meant to prevent germs from the wearer contaminating the environment. However, the haze which is affecting Southeast Asia is another story..
The Southeast Asian haze event is caused by continued uncontrolled burning from “slash and burn” cultivation in Indonesia, and affects several countries in the Southeast Asian region because the prevailing southwesterly winds carry the pollutants across the water – see below.
What are haze particles composed of? Haze particles are predominantly made up of fine particles that are 2.5 micrometers or smaller. This means using an ordinary facemask, whether single-ply, 2 ply or 3 ply, hardly protects the wearer effectively from the haze particles Its designed to keep the germs in and should be worn by those having viral illnesses like flu. Nevertheless, ordinary surgical masks will reduce the inhalation of haze particles but NOT eliminate them completely.
To eliminate haze particles completely, one needs to wear a N95 mask (so-called because these masks eliminate 95% of particles as small as 0.1 micrometers (or microns). It must be tight-fitting and is rather uncomfortable to wear over long periods as extra effort is sometimes needed to inhale.
For this reason, the N95 mask is a must for those with lung problems, those with reduced immunity and those who have to be in the open for prolonged periods (like traffic cops).
For those who are otherwise healthy and stay indoors most of the time, ordinary surgical masks may be adequate. In all cases, adequate hydration is important mainly to facilitate the removal of the haze particles which have lodged in the lungs.
- Singapore’s Great Haze exposes limits of e-commerce (sgentrepreneurs.com)
The effects of the current outbreak of the H7N9 avian influenza in China has been as varied as causing the sales of KFC to drop and causing the stock-prices of rubber-glove manufacturers to be on the uptrend..but there’s no mistaking the fact that to date, there has been 9 deaths and 28 confirmed cases (see here).
But a mystery is brewing..the first known human case was in eastern China on Feb. 19, but this was not announced to the public until March 31, some 6 weeks later. This delay in announcement is even being questioned by the heavily censored news media, such as the Communist Youth Daily, the official newspaper of the Communist Youth League.
Was there deliberate concealment by the health authorities? The answer may not be that straightforward. Possible reasons for the delay may include that the new virus strain shows unusual properties and that Chinese laboratories might have been doing tests to detect the previous H5N1 strain instead. To recap, the H5N1 outbreak struck in 2003 where a total of 247 people died. Measures instituted at that time included the controversial administration of several million vaccines to the chicken population at a significant economic cost. This could also be a reason why the news has been suppressed.
Avian influenza (also called avian flu, bird flu) is a flu virus that infects poultry but can be transmitted to man by direct or indirect exposure to infected live or dead poultry or contaminated environments. It is generally classified of low virulence (it does not spread to man easily). There is no evidence that the disease can be spread to people through properly cooked food. You can get more info from the WHO Fact Sheet here.
It doesn’t happen often, but when you’re one of the top restaurants in the world and your customers end up with food poisoning, that becomes a tsunami in the culinary world.
Given two stars by the Michelin Guide and voted byThe S Pellegrino and Acqua Panna World’s 50 Best Restaurants as the best restaurant in the world for three years running, the Noma restaurant in Denmark has been serving exotic dishes that include foraged Nordic ants, fermented grasshoppers, live shrimp and locally sourced carrots in malt soil at around 5,000 Danish krone (£580) for a 12-course set menu for two including appetisers, treats to finish, wine pairing and a tour of the kitchen to meet some of the 50 chefs.
Established in 2004,the name is a blend of the two Danish words “nordisk” (Nordic) and “mad” (food) and can only seat 40 diners on one sitting. Rumour has it that the wait-list is several months long.
The first sign of trouble started between 12 and 16 February when 63 customers who ate there developed fever, vomiting and diarrhoea. Danish health authorities have since traced the cause to a Norovirus infection, spread by an infected kitchen staff. They criticised the restaurant for not having running warm water for staff to wash their hands.
The Norovirus, which causes stomach flu and viral gastroenteritis, is spread by several ways:
- Consuming contaminated food or drinks.
- Touching surfaces or objects contaminated with norovirus and then putting hands or fingers into your mouth.
- Having direct contact with another person who is infected e.g. sharing food or eating from the same utensils as someone who is ill.
- Aerosol spread (when vomiting disperses virus particles into the air).
The virus has been responsible for several outbreaks in the last few months, as in the UK during last winter and on several cruise ships, the last one being yesterday (see here).
Such outbreaks in restaurants are nothing new. 3 years ago, I wrote about a similar Norovirus outbreak at the famed Fat Duck restaurant in the UK, where 240 people fell sick and survived the ordeal.
So will the world’s best restaurant be forced to close its doors? Highly unlikely, as the Fat Duck has showed, as it still enjoys booming business. But will it retain its title for this year when results are announced next month? We shall see..
Its the holiday season again, and many will be embarking to distant lands.. and with it comes the risk of exposure to new bugs (currently, the Norovirus virus outbreak is the vogue. Read more here.) Seasoned business travelers know that to reduce their chances of getting sick, its best to maximize the use of soap, water and hand sanitizer and minimize the number of times they touch their face.
Apart from that, what about other risks? Dehydration poses a greater risk, drying out the body’s natural defenses against germs. Avoid coffee and alcohol (no, its not a devious plan by airlines to reduce their beverage costs), which act as diuretics, and try to drink a cup of water an hour. Saline solutions can keep your nose and eyes moist, providing a barrier against germs. Dehydration makes the body’s defence mechanisms perform less efficiently and thus make the entry of germs easier.
While going around, preventing dehydration remains important, particularly in hot arid climates, where body water loss is not too obvious due to the absence of sweating.To avoid drinking contaminated water, watch out for recycled tap-water impersonating as bottled mineral water (look for a sealed cap). For that matter, possibly contaminated water could also be present in ice, uncooked salads and fruits that are eaten without peeling. These methods of reducing the odds of getting sick are important, as contaminated foods (due to agents causing infectious diseases) remain the number one killer of humans on earth.It is said that 80% of all infectious diseases are transmitted by direct or indirect human contact
Many air travellers claim they caught an infection from other passengers but, with the efficient air filtering systems of modern aircraft, where air is circulated 15-20 times per hour through efficient biofilters, chances of this happening is low unless the offending party is coughing and sneezing repeatedly within two rows of oneself.
At the hotel, I do recommend laying the bedspread aside, because it is washed rarely, and making sure the sheets are crisp and clean; if they are not, request another room. Check the mattress for bed bugs. Wipe down the telephone, night stand, remote control and bathroom with disinfectant. Disinfect the handle on the minibar fridge, and relax.
Indeed, various gadgets are available to make travelling safe – personal hand-sanitizers, personal air purifiers, UV scanners that destroy contaminants and the Silky Dreamsack, which “puts a layer between you and suspect bedding.”
All very exotic, but I would really recommend that the only cost-effective device that you will ever need is a bottle of hand-sanitiser..and refraining from touching your eyes,face or mouth. Not forgetting the ubiquitous mineral water bottle!
This being the end of another year, I thought it might be worthwhile to focus on the top game-changers in 2012, as far as the treatment of heart diseases are concerned. As a cardiologist, the rate of new advances in this field is bewildering and unless one were to update regularly, it is all too easy to fall behind..
The Polypill - the concept of a pill containing more than a single medication was first introduced in 2003, but the idea of adding several medications into one pill for people with multiple conditions have gained appeal in recent years. This year, it was shown at the American Heart Association meeting (the UMPIRE study) that a fixed-dose polypill that included aspirin, a statin (anti-cholesterol medication) and two blood pressure drugs, all rolled into one, were more efficient and improved compliance among people when compared to them taking 4 or more pills a day.
The Good Cholesterol - this year, more evidence were presented (the AIM-HIGH study)to say that increasing the good cholesterol (HDL-cholesterol) does not necessarily protect one better from a heart attack. However, it remains important to reduce the bad cholesterol (LDL-cholesterol) to reduce the risk for a heart attack.
Bypass vs BlowJob -if you’re diabetic and have multiple blockages in your heart arteries, then you’re better off going for a heart bypass surgery than subjecting yourself to multiple angioplasties.(the FREEDOM trial)
Bless the Generics -For years, clopidogrel (Plavix) , a blood-thinner pill used to prevent heart attacks and stroke among others, remained the second-most popular pill in the world..but at a premium: its high cost. Now, with the expiry of the patent, it is available at a quarter of its original cost.
Replacing a Heart Valve Without Open-Heart Surgery - replacing a diseased aortic valve in the heart via a tube inserted into the femoral artery (in much the same way as an angiogram) using an FDA-approved device offers hope for those who cannot undergo an open-heart surgery for various reasons. Transcatheter Aortic Valve Replacement (TAVR) is now an approved treatment.
New Side-Effects of Statins - many on these cholesterol-lowering drugs are familiar with the possible side-effects of muscle damage and impotence, but the FDA has issued a warning that it can increase both blood glucose and blood HBA1C levels (read: cause or worsen diabetes).
New Blood Thinners -for years, people have depended on warfarin although it is notorious for being difficult to give the correct dosage continually and requiring frequent blood tests. New blood-thinners like dabigatran and rivaroxaban are more efficient and do not need regular blood tests.
For the very first time, a supreme court has ruled that using mobile or cordless phones is directly linked to causing brain tumors, affirming what many scientists have been saying for years now about the dangers of cell phone radiation. The U.K.’s Telegraph reports that 60-year-old Innocente Marcolini, who developed a tumor in his trigeminal nerve, was ruled to have suffered this fate as a result of using his mobile handset for up to six hours every day for 12 years.
Italy’s Supreme Court in Rome, ruled that there is a “causal link” between Marcolini’s mobile phone use and the non-cancerous tumor that caused the entire left side of his face to become paralyzed. Experts provided evidence at a recent trial showing that the electromagnetic radiation emitted from mobile and cordless phones damages cells.
Though Marcolini’s brain tumor is non-cancerous, it still reportedly threatened to kill him because it had been encroaching on his carotid artery, which is the major blood vessel responsible for transporting blood to the brain. The tumor also developed directly next to where Marcolini typically held his phone next to his ear, illustrating how significantly mobile phone radiation can disrupt proper brain cell function.
In the face of repeated studies that there was no direct causative effect, this landmark ruling takes a new perspective on the possible dangers of prolonged mobile phone usage. To add fuel to the debate, last year the WHO ( World Health Organisation) urged limits on mobile use, calling them a Class B carcinogen.
International radiation biology expert Michael Repacholi said: “Studies show no evidence of cancer”. But he quickly adds : “If you are worried, use a headset, hands-free or loudspeaker.”
- Mobiles can give you a tumour, court rules (thesun.co.uk)