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)
At one time, hormone replacement therapy (HRT) was routinely prescribed to any woman reaching menopause and asking for it, in an effort to prevent fractures,osteoporosis, dementia and other chronic diseases.
That was fine but recent developments have advocated the reverse – only women with severe symptoms of menopause like flushing,headaches and excessive sweating are given a short course to relieve the symptoms. Otherwise, HRTs are now not advised at all.
What is the evidence for the change in stance? The US funded Women’s Health Initiative, known as WHI, was halted in 2002 when initial results showed women taking a combination of estrogen and progestin had a higher risk of breast cancer, heart disease and stroke than women who received a placebo( or ‘dud’ pill). This marked a drastic shift in opinion, so that now, these combination pills are no longer advocated. Indeed, even oestrogen-only pills are now taboo.
You can find more facts about HRT here:
For alternatives to hormone therapy, see here: http://www.nhlbi.nih.gov/health/women/pht_facts.pdf
The fact that the Mediterranean Diet has led to lower rates of heart disease, stroke and cancer has been known for decades; and the latest study highlighted over the media recently (see here) is on the back of several similar studies done over the years. I had written about one such study in an earlier blog posting in 2008 (see here).
So how many more studies do we need before the guidelines on healthy eating habits are changed by governments from the low-fat high carbohydrate that is so widely advocated? Even in those countries where a greater awareness of what constitutes healthy eating exists, the end-product may not be what the consumer paid for – olive oil is adulterated and/or filtered, garlic is taken as a pill than a freshly-crushed clove and even red wine is not aged and commercially processed so that it is lacking in polyphenols.
The Mediterranean Diet – low in saturated fat and high in fiber and monounsaturated fat – includes vegetables, whole grains, fish, legumes, fruit, and moderate red wine, if so inclined. The main cooking fat is olive oil – pure unfiltered virgin olive oil is preferable, although the quality varies quite a bit commercially.
It is interesting to note that this oil has been around since time immemorial and its benefits mentioned by most of the world’s major religions, whether its the Muslim Hadith (“Consume olive oil and anoint it upon your bodies since it is of the blessed tree”), the Catholic church (“Oil of the Sick”) or the Jewish Talmud which states that frequent consumption of olive oil is good for one’s memory.
But behind the benefits of this diet, a more stark message is revealed: that the typical ‘Western Diet’ is the antithesis, with processing, additives and chemical substitutes causing many of the lifestyle diseases it is supposed to prevent.
- Mediterranean diet proven to reduce risk of heart disease (newsfixnow.com)
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.
Its been speculated for some time..that eating red meat leads to an increased incidence of heart disease and cancer. And an analysis, published in Archives of Internal Medicine, using data from two studies that involved 121,342 men and women, further confirms the fact that consuming red meat is associated with a sharply increased risk of death from cancer and heart disease; and the more of it you eat, the greater the risk.
People who ate more red meat were less physically active and more likely to smoke and had a higher body mass index, researchers found. Still, after controlling for those and other variables, they found that each daily increase of three ounces of red meat was associated with a 12 percent greater risk of dying over all, including a 16 percent greater risk of cardiovascular death and a 10 percent greater risk of cancer death.
The increased risks linked to processed meat, like bacon, were even greater: 20 percent over all, 21 percent for cardiovascular disease and 16 percent for cancer.
You might say that you had suspected this all along, but the new results suggest a surprisingly strong link and further reinforce this conclusion.
The modus operandi for red meats and heart disease is quite clear-cut: the high saturated fats content leads to cholesterol deposition in the walls of the arteries. In the case of cancer, the mode of action is less clear-cut. Some postulated causes include:
- the presence of conjugated linoleic acid (CLA) in grass-fed meat which has anti-cancer properties.
- the mode of cooking, with preference to ‘low and slow’ and doneness.
- chemicals (nitro compounds) used in preservation of processed meats.
- breakdown of blood components like haem to harmful cancer-causing chemicals (read more here).
This probably why meat-eating countries like Argentina do not report high incidences of gut cancer..
The Pill for diabetes, Avandia, had been the subject of several investigations with regards to its side-effects for many years. I had written about it a week or two ago Your Sugar or Your Heart. Its baffling though that the nation that consumes this medication the most fell short of a total ban.
The British Heart Foundation as well as the respected British Medical Journal(BMJ) have called for its ban and the European Union’s European Medical Agency have introduced an outright ban. This drug has been blamed by research studies as far back as 2007 to cause heart problems when taken by diabetic patients, but attempts to ban it have been painfully slow. While the FDA acknowledged that the drug led to a higher incidence of heart attacks since 2007, its advisory panel in July this year stopped short of banning it with a split decision.
Why is the FDA reluctant to impose a ban? One can speculate, but the FDA statement on the matter claimed that there wasn’t enough data to kill a drug which it had already approved for sale. And ordering further studies to boost the data would be unethical, if not criminal. Anyway, the FDA is not known for banning a drug quickly, requiring watertight evidence before doing so (remember Cylert and Fen-Phen?).
For the public, the choice is simple. Stop using Avandia and switch to the myriad of other diabetic medications which are available and much less controversial.
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So, is red wine good for you?
The good part relates of course to the much-publicised high content of polyphenols which originate from the skins, seeds, and vine stems of red grapes. This anti-oxidant comes in two main forms: flavonoids and nonflavonoids, the latter being the one well-known for resveratrol, the substance known to be the found in the skin of the red grape (or for that matter, any of the colored berries, like raspberry,cranberry,blueberry,etc).
One of most well-documented benefits of red wine is the heart protective effect. Moderate consumption of red wine on a regular basis may be a prevent coronary heart disease, as well as increasing the levels of the good HDL-cholesterol. It is believed the polyphenols as anti-oxidants also prevent plaque formation and clogging of the arteries in the heart, besides having an anti-clotting effect that causes ‘thinning’ of the blood.
And what’s moderate consumption? 2 glasses (1 glass=5 oz=150 cc) for men and 1 glass for women daily.
And what about the bad? Even the Bard knew about this –
‘Alcohol provokes the desire, but takes away the performance.’
(Shakespeare (1564-1616), Macbeth; Act II, Scene 3)
Also, apart from migraine and dehydration (the thirst the morning after), the alcohol in the wine interacts with a lot of medications – special warning to those taking tranquillizers and sedatives because alcohol is a downer which adds on to the effects of these pills to cause, in extreme cases, inability to breathe, coma and death. Impairment of attention and skills, including delayed reaction times is a well-known danger for drivers, a fact well-known in causing serious accidents on the road. Temporary amnesia is well-known among boozers, and is best exemplified by UB40’s Red Red Wine:
Red, red wine
Goes to my head
Makes me forget that I
Still need you so
- mis-pronounciation: saying Pinot Noir and pronouncing the ‘T’. Saying Semillion as it is spelt instead of ‘Seh-Mee-Yhon’.
- Ignorance: complaining that the waiter didn’t pour them enough wine, when the intention was for them to taste it. Or making it a point that the red wine was too warm.
- Misplaced beliefs: ordering a bottle of expensive wine just so it looks like they know their wine, when they haven’t a clue what they’re actually drinking.
- Misplaced practices: vigorously swilling the wine around in the glass to allow it to breathe but then embarrassingly spilling it over themselves. Or (this one takes the cake) complaining to the waiter that the wine was corked, not realising it came from a screw-top bottle.
At the end of the day, it might help, especially to those who do not touch alcohol, to note that the beneficial effects of red wine comes not from the alcohol but from the skin of the red grape, so it is believed that fresh juices from coloured berries, like raspberry,cranberry,blueberry,etc, may confer a similar effect. Cheers!
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