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Those
of us who have had the unfortunate experience of having had heart attack
with or without infractions have many question unanswered. It is not the
intention to take the place of doctor who is really managing such cases.
Generally such persons are advised rest for variable periods depending
on their medical conditions. But after the initial period of rest
certain doubts, fears, apprehensions and questions remain in the mind of
such patients, which need consideration. It may again be emphasized that
the extent to which physical, mental and emotional activity can be
permitted is a decision to be entirely taken by the attending physician.
1. Talking and
arguing - In
the early stage of recovery at least, if not always, prolonged talking
like speech making, radio talk or a T.V. appearance may be tiring and
should be avoided. These lead, to some extent to emotional involvement,
which is not conductive to rehabilitation. In no case convalescents
should enter into arguments with other, which may result in emotional
physical exercise.
2. Car Driving - After
lapse of a reasonable time after an attack one many drive but drive slow
and avoid heavy traffic areas and long continuous spells of driving.
Sudden application of breaks and other traffic hazards are definite
risks.
3. Sex life -
Heart disease does not in any way affect sex capabilities but since the
act involves some physical strain and emotional excitement, it is
advisable to undertake such activity only if allowed by the attending
physician. But within moderation there is no direct risk.
4.
Air Travel - Extreme
height mean reduced pressures and difficulty in breathing puts strain on
the lungs and the heart. However in modern pressurized planes there is
no risk involved but travel should be avoided in non-pressurized
aircraft especially if it is to fly at great heights.
5.
Fear Psychosis -
Since any heart attack is serious, the patient after his recovery tends
to fear about impending attack and any ache or twitch in chest is
considered as an onset of another attack. The development of such a
personality may even ruin the bright chances of recovery and a perfectly
normal existence. It should be remembered especially by those, who have
had the experience of a heart attack the pain in a real attack is
extreme and unbearable and it does not come as an ache, twinges,
twitches or fluttering. The fear affects generally health and impairs
recovery to normal.
6.
Employment -
There is ample evidence to show that return to work after the prescribed
period of rest has resulted in better health than it was before the
heart attack. But it must be decided by the attending physician. There
can obviously be no fixed rule. In most of the cases the patients can
return to work with a little caution and moderation. In some cases a
person may not be able to return to original work either on account of
hesitancy of the employer or the nature of work. In almost every case
some gainful occupation is not only possible for but also beneficial to
the heart patient. It should be remembered that the fright of having had
a heart attack and subsequent apprehension of the possibility of another
more so after resuming normal activity cripples more heart patients that
actual heart condition.
Conclusion
- Besides taking medicines on doctor’s advice. Regular rest, exercise, a
mind at peace, a sensible watch in weight, no smoking should be a
reasonably safe way of life for the cardiac patient.
Heart Attack
(Myocardial Infraction)
What is a heart
attack?
A
heart attack (myocardial infraction) is the death of heart muscle due to
the loss of blood supply. Usually, the loss of blood supply is caused by
a complete blockage of a coronary artery (an artery that supplies blood
to the heart muscle) by a blood clot.
What are the features
of a heart attack?
Pain:
is the cardinal symptom of a heart attack. The pain is often described
as a tightness or heaviness in the chest. It is often severe enough to
be the worst pain that can be experienced. The usual location of the
pain is in the center of the chest but it frequently radiates to the
left arm or the jaw.
Some
heart attacks though can pass unrecognized; these painless attacks are
called as ‘silent infracts’ and are particularly common in
diabetics.
Anxiety:
Fear of impending
death.
Brightlessness,
Nausea and vomiting,
Sweating, pallor and a fast pulse.
Sudden death:
Loss of blood supply disturbs the orderly transmission of electrical
impulses in the heart and as a result the heart stops to effectively
pump blood. Permanent brain damage and death can occur unless oxygenated
blood flow is restored within five minutes. Approximately 40% of people
suffering a heart attack die before reaching to the hospital.
What
causes a heart attack?
A
heart attack is almost always caused by the formation of a blood clot on
a cholesterol plaque located on the inner wall of an artery to the heart
(coronary artery). It is believed that the process of formation of these
plaques starts in the late teens. Over a period of time the accumulation
of cholesterol plaque causes thickening of the artery walls and
narrowing of the arteries; a process called atherosclerosis.
Many
factors have been found to influence this plaque formation. It can be
accelerated by smoking, high blood pressure, elevated cholesterol and
diabetes. Whereas, factors like exercise, low fat diet, avoiding stress
seem to help in retarding this process.
Ultimately,
the arteries narrow to an extent where they are unable to supply enough
blood to the heart muscle during periods of increased demand like during
exercise or excitement. This results in a condition called ischemia
which leads to chest pain called as angina.
Occasionally,
however, for unknown reasons, the surface of the cholesterol plaque can
become sticky, causing blood clotting. When a blood clot forms on top of
this plaque, the artery becomes completely blocked, causing death of the
heart muscle (heart attack).
How is heart attack
diagnosed?
The
initial diagnosis of a heart attack is made by a combination of clinical
symptoms and characteristic electrocardiogram (ECG) changes. An EKG is a
recording of the electrical activity of the heart. However, confirmation
of a heart attack can only be made hours later through detection of
elevated creatinine phosphokinase (CPK) in the blood. CPK is a muscle
protein enzyme, which is released into the blood circulation by dying
heart muscles when their surrounding membranes dissolve.
What is the early
management of a patient of a heart attack?
Most
of the patients of heart attack are managed in a dedicated heart care
unit. Following are the elements in the management:
·
Bed rest
·
Oral Aspirin
·
High flow oxygen
·
Intravenous analgesia with morphine
·
Monitoring the E.C.G.
Reperfusion:
The immediate
goal of treatment is to quickly open blocked arteries and restore blood
flow to the heart muscles; a process called “reperfusion” Early
reperfusion minimizes the extent of the heart muscle damage and
preserves the pumping function of the heart. Many drugs are available to
dissolve the clots and restore blood supply. Drugs like tissue
plasminogen-activator (t-PA) and streptokinase given intravenously can
open 80% of the blocked arteries within 90 minutes.
How can I prevent a second heart attack?
The best chances of preventing a second heart attack come from a
combination of medications and change of diet and lifestyle.
Drugs:
Aspirin and beta blockers (drugs like Tenormin), have been shown to
reduce chances of a second heart attack and improve future survival.
Diet:
Reducing weight
and dietary fat. |
Dr. Tarun
Praharaj