I want to thank everyone for your interest in and comments about my first series addressing health issues.
This will be the last of the series on Heart Disease. Again, if there is a health issue that you would like to see addressed, leave a comment or e-mail me and I will see what I can come up with.


TREATMENT AND CARE

CPR

Heart disease is the number 1 killer in the United States. Each year, almost half a million Americans die from a heart attack. Half of these, or one quarter of a million people, will die suddenly, outside of the hospital, because their heart stops beating.

* The most common cause of death from a heart attack in adults is a disturbance in the electrical rhythm of the heart called ventricular fibrillation.

o Ventricular fibrillation can be treated, but it requires applying an electrical shock to the chest called defibrillation.

o If a defibrillator is not readily available, brain death will occur in less than 10 minutes.

* One way of buying time until a defibrillator becomes available is to provide artificial breathing and circulation by performing cardiopulmonary resuscitation, or CPR.

o The earlier you give CPR to a person in cardiopulmonary arrest (no breathing, no heartbeat), the greater the chance of a successful resuscitation.

o By performing CPR, you keep oxygenated blood flowing to the heart and brain until a defibrillator becomes available.

* Because up to 80% of all cardiac arrests occur in the home, you are most likely to perform CPR on a family member or loved one.

* CPR is one link in what the American Heart Association calls the "chain of survival." The chain of survival is a series of actions that, when performed in sequence, will give a person having a heart attack the greatest chance of survival.

o When an emergency situation is recognized, the first link in the chain of survival is early access. This means activating the emergency medical services, or EMS, system by calling 911 (check your community plan, some communities require dialing a different number).

o The next link in the chain of survival is to perform CPR until a defibrillator becomes available.

o In some areas of the country, simple, computerized defibrillators, known as automated external defibrillators, or AEDs, may be available for use by the lay public or first person on the scene. If available, early defibrillation becomes the next link in the chain of survival.

o Once the EMS unit arrives, the next link in the chain of survival is early advanced life support care. This involves administering medications, using special breathing devices, and providing additional defibrillation shocks if needed.

NOTE: This reference is only intended to serve as a guideline for learning about CPR. It is not intended to be a replacement for a formal CPR course. If you are interested in taking a CPR course contact the American Heart Association at (800) AHA-USA1, or the American Red Cross by phoning your local chapter. Never practice CPR on another person, because bodily damage can occur.

Learn CPR for a loved one.

How to Take Heart Medication

Your doctor may prescribe a variety of heart medications you can take to treat or prevent heart disease. These drugs may help lower your blood pressure, reduce the level of cholesterol in your blood, or help your body get rid of excess fluids that put a strain on your heart's ability to pump blood.

Heart medication needs vary for each person. Whatever the treatment protocol prescribed to you, it is a good idea to keep the following guidelines in mind when you're taking heart disease medication.

Here are some tips for taking drugs for your heart disease:

* Know the names of your heart medications and how they work. Know the generic and brand names, dosages, and side effects of your medications. Always keep a list of your medications with you.
* Take your heart medications as scheduled, at the same time every day. Do not stop taking or change your medications unless you first talk with your doctor. Even if you feel good, continue to take your medications. Stopping your medications suddenly can make your condition worse.
* Have a routine for taking your heart medications. Get a pillbox that is marked with the days of the week. Fill the pillbox at the beginning of each week to make it easier for you to remember.
* Keep a medicine calendar and note every time you take a dose. Your prescription label tells you how much to take at each dose, but your doctor may change your dosage periodically, depending on your response to the medication. On your medication calendar, you can list any changes in your drug dosages as prescribed by your doctor.
* Do not decrease your drug dosage to save money. You must take the full amount to get the full benefits. Talk with your doctor about ways you can reduce the costs of your medications.
* Do not take any over-the-counter drugs or herbal therapies unless you ask your doctor first. Some drugs, such as antacids, salt substitutes, antihistamines (including Benadryl and Dimetapp), and nonsteroidal anti-inflammatory agents (NSAIDs, such as Advil, Motrin, and Indocin), can worsen heart failure symptoms.
* If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, ask your doctor about skipping versus making up the missed dose.
* Regularly fill your prescriptions and ask your pharmacist any questions you have. Do not wait until you are completely out of medication before filling your prescriptions. If you have trouble getting to the pharmacy, have financial concerns, or have other problems that make it difficult for you to get your heart drugs, let your doctor know.
* When traveling, keep your medications with you so you can take them as scheduled. On longer trips, take an extra week's supply of medications and copies of your prescriptions, in case you need to get a refill.
* Before having surgery with a general anesthetic, including dental surgery, tell the doctor or dentist in charge what heart drugs you are taking. An antibiotic may need to be prescribed prior to your surgical or dental procedure.
* Some heart drugs may alter your heart rate, so take your pulse regularly.
* Medications that relax constricted blood vessels may cause dizziness. If you experience dizziness when standing or getting out of bed, sit or lie down for a few minutes, then get up more slowly.



Heart Disease: Living with Heart Disease

Coronary artery disease is a chronic disease with no cure. When you have coronary artery disease, it is important to take good care of your heart for the rest of your life. This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart. Procedures do not cure coronary artery disease. It is up to you to take steps to stop the disease from progressing.

Here are some steps you can take to make living with heart disease easier:

* Recognize the symptoms. Call your doctor if symptoms become more frequent or severe. Call for emergency assistance if rest and/or medications do not relieve symptoms after 15 minutes. DO NOT WAIT TO GET HELP!
* Reduce your risk factors. The more risk factors you have, the greater your risk for future heart problems.
* Take your medications. Your medications are used to control your symptoms and help your heart work more efficiently. Follow your doctor's instructions when you take your medications.
* See your doctor for regular check-ups. Schedule regular appointments with your primary doctor and/or your heart doctor (even if you have no symptoms). Your appointments may be spaced once a year or more often if your doctor feels you need to be followed more closely.

How Can I Reduce My Risk Factors?

Making the necessary lifestyle changes is not easy. It takes dedication and discipline to quit smoking, eat right, and master techniques to ease stress. The following tips may help get you started. But, it's a good idea to seek help from dieticians, doctors and support groups to keep you on track.

Regardless of the lifestyle change you are trying to make:

* Have a plan before starting.
* Create realistic goals for yourself.
* Master one change at a time (for example, quit smoking before changing your diet).
* Write a formal or informal contract to strengthen your commitment to make the necessary lifestyle changes.
* Prepare for lapses and relapses. Don't be too hard on yourself when this happens.
* Be sure to reward yourself when you do well (this doesn't mean treating yourself to a hamburger and fries).
* Make sure you have plenty of support from your friends and family. Seek the help of support groups. Also, talk to your doctor about participating in a cardiac rehabilitation program.

Heart Disease and the Doctor's Exam

Some standard and simple exam techniques provide your doctor with the first clues to how well your heart functions and whether you have heart disease. During your visit, your doctor will listen to your heart, take your heart rate, and check your blood pressure.

Heart Rate

Your doctor feels your pulse in order to check your heart's rate, rhythm, and regularity. Each pulse matches up with a heartbeat that pumps blood into the arteries. The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of your body.

You can tell how fast your heart is beating (heart rate) by feeling your pulse. Your heart rate is the amount of times your heart beats in one minute.

To measure your pulse, all you need is a watch with a second hand.

* Place your index and middle finger of your hand on the inner wrist of the other arm, just below the base of the thumb. You should feel a tapping or pulsing against your fingers.
* Count the number of taps you feel in 10 seconds.
* Multiply that number by 6 to find out your heart rate for one minute (pulse in 10 seconds x 6 = ____ beats per minute)

When feeling your pulse, you can also tell if your heart rhythm is regular or not.

Heartbeat

Your doctor listens to your heartbeat with the aid of a stethoscope. The opening and closing of your valves make a "lub dub" sound known as the heart sounds. The doctor can evaluate your heart and valve function and hear your heart's rate and rhythm by listening to your heart sounds.

Blood Pressure

Blood pressure is the force or pressure exerted in the arteries by the blood as it is pumped around the body by the heart. It is recorded as two measurements:

* Systolic blood pressure. Pressure in the arteries during the period of the heart's contraction (the higher number).
* Diastolic blood pressure. Pressure in the arteries when the heart is relaxed, between heartbeats (the lower number).

Blood pressure is measured in millimeters of mercury (mm Hg), which refers to how high the pressure in the arteries can raise a column of mercury in a sphygmomanometer, a device for measuring blood pressure.

Normal blood pressure for an adult, relaxed at rest, is less than or equal to 120 over 80. The 120 is the systolic pressure; the diastolic pressure is 80. Blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take. One high reading does not mean you have high blood pressure. It is necessary to measure your blood pressure at different times while resting to find out your typical value.

Physical Exam

Your doctor can also tell about your heart's function by examining other parts of your body such as your eyes, arms, legs, and skin.

Blood Tests

Your doctor may recommend a blood test to check your cholesterol and other markers that may indicate heart disease.

Heart Disease, Electrocardiogram, and Specialized EKGs

An electrocardiogram (also called EKG or ECG) is a test that records the electrical activity of your heart through small electrode patches attached to the skin of your chest, arms, and legs. An EKG may be part of a routine physical exam or it may be used as a test for heart disease. An EKG can be used to further investigate symptoms related to heart problems.

EKGs are quick, safe, painless, and inexpensive tests that are routinely performed if a heart condition is suspected.

Your doctor uses the EKG to:

* Assess your heart rhythm.
* Diagnose poor blood flow to the heart muscle (ischemia).
* Diagnose a heart attack.
* Evaluate certain abnormalities of your heart, such as an enlarged heart.

How Should I Prepare for an EKG?

To prepare for an EKG:

* Avoid oily or greasy skin creams and lotions the day of the test. They interfere with the electrode-skin contact.
* Avoid full-length hosiery, because electrodes need to be placed directly on the legs.
* Wear a shirt that can be easily removed to place the leads on the chest.

What Happens During an EKG?

During an EKG, a technician will attach 10 electrodes with adhesive pads to the skin of your chest, arms, and legs. Men may have chest hair shaved to allow a better connection. You will lie flat while the computer creates a picture, on graph paper, of the electrical impulses traveling through your heart. This is called a "resting" EKG. This same test may also be used to monitor your heart during exercise.

It takes about 10 minutes to attach the electrodes and complete the test, but the actual recording takes only a few seconds.

Your EKG patterns will be kept on file for later comparison with future EKG recordings.

If you have questions, be sure to ask your doctor.

In addition to the standard EKG, your doctor may recommend other specialized EKG tests, including a holter monitor or a signal-averaged electrocardiogram.

What Is a Holter Monitor?

A holter monitor is a portable EKG that monitors the electrical activity of a freely moving person's heart generally for one to two days, 24-hours a day. It is most often used when the doctor suspects an abnormal heart rhythm or ischemia (not enough blood flow to the heart muscle).

It is a painless test; electrodes from the monitor are taped to the skin. Once the monitor is in place, you can go home and perform all of your normal activities (except showering). You will be asked to keep a diary of your activities and any symptoms you experience and when they occur.

What Is an Event Monitor?

If your symptoms are infrequent your doctor may suggest an event monitor. This is a device that, when you push a button, will record and store the heart's electrical activity for a few minutes. Each time you develop symptoms you should try to get a reading on the monitor. They are used for weeks to months, typically one month. This information can later by transmitted by telephone to the doctor for interpretation.

What Is a Signal-Averaged Electrocardiogram?

This is a painless test used to assess whether a person is at high risk of developing a potentially fatal heart arrhythmia. It is performed in a similar manner to the EKG, but uses sophisticated technology to look for heart arrhythmias.

After a discuss with Mrs. Betsy from Tennessee, she brought up an interesting fact, that heart attacks in women are not always the same as in men.
So, I visited the Women's Heart Foundation (www.womensheart.org) and this is what they said:

Heart Attack Symptoms: An Action Plan for Women

A Healthy Hearts Guide

Heart disease is our nation's number one killer.

Getting treatment quickly –at the first sign of distress –is critical for lifesaving medicines and treatments to work.

Newer blood tests are being used to diagnose a heart attack more quickly and accurately.

There are about 500,000 heart attack deaths in the U.S. each year. At least 250,000 people die before they even get to the hospital. Many of these deaths could be prevented by acting quickly and by getting treatment right away, especially within the first hour of having chest pain

Women account for nearly half of all heart attack deaths. Between the ages of 40 and 60, as many women die of heart disease as breast cancer. Over a lifetime, heart disease kills five times as many women as breast cancer. Heart disease is our nation's number one killer. Newer blood tests are being used to diagnose a heart attack more quickly and accurately. Getting treatment quickly –at the first sign of distress –is critical for lifesaving medicines and treatments to work.

Place a checkmark next to the heart disease risk factors that apply to you

_ Smoking or daily exposure to second-hand smoke (at home or at work)
_ Past heart attack or known coronary artery disease
_ Family history
_ Elevated lipids (over 240 mg/dL. or HDL less than 35 mg/dL)
_ Abnormal heartbeat
_ High blood pressure
_ Birth control pills (in combination with smoking)
_ Overweight (by 20 or more pounds)
_ Post-menopausal (and without estrogen replacement therapy)
_ Sedentary lifestyle


The Warning

A Heart Attack may cause some or all of these symptoms:

Pain, pressure, fullness, discomfort or squeezing in the center of the chest

Shortness of breath or difficulty breathing

Stabbing chest pain

Radiating pain to shoulder(s), neck, back, arm(s) or jaw

Pounding heartbeats (palpitations) or feeling extra heartbeats

Upper abdominal pain

Nausea, vomiting or severe indigestion

Sweating for no apparent reason

Dizziness with weakness

Sudden extreme fatigue

Panic with feeling of impending doom

A note about women's milder symptoms - About a third of women experience no chest pain at all when having a heart attack and 71% of women report flu-like symptoms for two weeks to a month prior to having more acute chest discomfort or severe shortness of breath. These milder symptoms are under-reported to emergency room staff.


If you suspect a heart attack, call 9-1-1

Say “I am having a heart attack”.

Chew an uncoated aspirin right away as this can reduce damage to the heart muscle.

Go to the nearest medical facility with 24-hour emergency cardiac care. Don't drive yourself. If you're not sure that the pain you are experiencing is serious, it is best to go to the emergency room to find out.

Get treatment quickly. Clot buster medicine and coronary angioplasty work best if provided after the first signs of distress, so don’t wait. Get to the emergency room without delay. Every Minute Counts!.

Symptoms

Heart Disease: Symptoms

Coronary artery disease, heart attack -- each type of heart disease has different symptoms, although many heart problems have similar symptoms. The symptoms you experience depend on the type and severity of your heart condition. Learn to recognize your symptoms and the situations that cause them. Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

Coronary Artery Disease

The most common symptom is angina. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling in your chest. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the shoulders, arms, neck, throat, jaw or back.

Other symptoms that can occur with coronary artery disease include:

* Shortness of breath
* Palpitations (irregular heart beats, skipped beats or a "flip-flop" feeling in your chest)
* A faster heartbeat
* Weakness or dizziness
* Nausea
* Sweating

Heart Attack (Myocardial Infarction or MI)

Symptoms can include:

* Discomfort, pressure, heaviness, or pain in the chest, arm or below the breastbone
* Discomfort radiating to the back, jaw, throat or arm
* Fullness, indigestion or choking feeling (may feel like heartburn)
* Sweating, nausea, vomiting or dizziness
* Extreme weakness, anxiety or shortness of breath
* Rapid or irregular heartbeats

During a heart attack, symptoms typically last 30 minutes or longer and are not relieved by rest or oral medications (medications taken by mouth). Initial symptoms can start as a mild discomfort that progresses to significant pain.

Some people have a heart attack without having any symptoms (a "silent" MI). A silent MI can occur among all people, though it occurs more often among diabetics.

If you think you are having a heart attack, DO NOT DELAY. Call for emergency help (dial 911 in most areas). Immediate treatment of a heart attack is very important to lessen the amount of damage to your heart.

Arrhythmias

When symptoms of arrhythmias are present, they may include:

* Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops," or feeling that your heart is "running away").
* Pounding in your chest.
* Dizziness or feeling light-headed.
* Fainting.
* Shortness of breath.
* Chest discomfort.
* Weakness or fatigue (feeling very tired).

Atrial Fibrillation

Atrial fibrillation (AF) is a type of arrhythmia. Most people with AF experience one or more of the following symptoms:

* Heart palpitations (a sudden pounding, fluttering, or racing feeling in the heart).
* Lack of energy; tired.
* Dizziness (feeling faint or light-headed).
* Chest discomfort (pain, pressure, or discomfort in the chest).
* Shortness of breath (difficulty breathing during activities of daily living).

Some patients with atrial fibrillation have no symptoms. Sometimes these episodes are briefer.

Heart Valve Disease

Symptoms of Heart valve disease can include:

* Shortness of breath and/or difficulty catching your breath. You may notice this most when you are active (doing your normal daily activities) or when you lie down flat in bed.
* Weakness or dizziness.
* Discomfort in your chest. You may feel a pressure or weight in your chest with activity or when going out in cold air.
* Palpitations (this may feel like a rapid heart rhythm, irregular heartbeat, skipped beats or a flip-flop feeling in your chest).
* If valve disease causes heart failure, symptoms may include:
* Swelling of your ankles, feet or abdomen. Swelling may also occur in your belly, which may cause you to feel bloated.
* Quick weight gain (a weight gain of two or three pounds in one day is possible).

Symptoms do not always relate to the seriousness of your valve disease. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show minor valve disease.

Heart Failure

Symptoms of Heart failure can include:

* Shortness of breath noted during activity (most commonly) or at rest, especially when you lie down flat in bed.
* Cough that is productive of a white mucus.
* Quick weight gain (a weight gain of two or three pounds in one day is possible).
* Swelling in ankles, legs and abdomen.
* Dizziness.
* Fatigue and weakness.
* Rapid or irregular heartbeats.
* Other symptoms include nausea, palpitations and chest pain.

Like valve disease, heart failure symptoms may not be related to how weak your heart is. You may have many symptoms, but your heart function may be only mildly weakened. Or you may have a severely damaged heart, with little or no symptoms.

Congential Heart Disease

Congenital heart defects may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all. Sometimes it can be diagnosed because of a heart murmur on physical exam or an abnormal EKG or chest X-ray in an asymptomatic person.

In adults, if symptoms are present, they may include:

* Shortness of breath.
* Limited ability to exercise.
* Symptoms of heart failure (see above) or valve disease (see above).

Congenital Heart Disease in Infants and Children

Symptoms can include:

* Cyanosis (a bluish tint to the skin, fingernails and lips).
* Fast breathing and poor feeding.
* Poor weight gain.
* Recurrent lung infections.
* Inability to exercise.

Heart Muscle Disease (Cardiomyopathy)

Many people with heart muscle disease have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as heart function worsens.

Symptoms can occur at any age and may include:

* Chest pain or pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals).
* Heart failure symptoms (see above).
* Swelling of the lower extremities.
* Fatigue.
* Fainting.
* Palpitations (fluttering in the chest due to abnormal heart rhythms).

Some people also have arrhythmias. These can lead to sudden death in a small number of people with cardiomyopathy.

Pericarditis

When present, symptoms of pericarditis may include:

* Chest pain. This pain is different from angina (pain caused by coronary artery disease). It may be sharp and located in the center of the chest. The pain may radiate to the neck and occasionally, the arms and back. It is made worse when lying down, taking a deep breath in, coughing or swallowing and relieved by sitting forward.
*

Low-grade fever.
* Increased heart rate.

Because many of the symptoms associated with each type of heart disease are similar, it is important to see your doctor so that you can receive a correct diagnosis and prompt treatment.