How to tell if you're having a heart attack, and what to do next
Is it a heart attack? A guide
Date published: 1/28/2007

Heart disease is the leading cause of death in the United States, and heart attack, the sudden blockage of blood flow to the heart, is one way that heart disease reveals itself.

Each year about 1.2 million Americans suffer a heart attack. If you become one of them, here's some information that could save your life.

Is it a heart attack?
The first thing that a person having a heart attack must do is acknowledge that it's happening, said Lisa Lucas, director of cardiac services for Mary Washington Hospital.

"They delay a lot," Lucas said. "It's hard for them to imagine that they're having a heart attack. When they realize that they need to go to the emergency room, it's hours and hours after they've had this pain."

This admission is even more critical for those at increased risk of heart attack, such as those who smoke or have diabetes, hypertension or a family history of heart disease.

So how do you recognize a heart attack? There are a couple of important indicators, Lucas said.

Pressure in the chest: With most heart attacks, there is an uncomfortable pressure, squeezing, fullness or pain in the center of the chest.

"It could be a heaviness, a pressure, radiating down one of their arms," Lucas said.

Discomfort in other areas: Symptoms also can include pain that moves to the back, neck, jaw or stomach. Shortness of breath that lasts for more than a few seconds is common, as are sweating, nausea and lightheadedness.

Women's symptoms: Women can have some of the same symptoms as men, such as shortness of breath, nausea and back or jaw pain. But their symptoms are likely to be different.

"A common symptom that differs from men is 'lingering tiredness'," said Diana R. Louder, coordinator for cardiovascular research and community programs at Mary Washington. Women usually don't get the crushing "elephant sitting on your chest" symptom, Louder said.

"Women's symptoms are usually a little more vague," Lucas said. "Sometimes they can't describe it."

What to do: Call 911. Patients who call an ambulance can get treatment up to an hour sooner, compared with those who go to the hospital by car.

"They think the rescue squad is just a ride to the hospital, and it's not," Lucas said. "The rescue squad is central to the care you receive on the way."

Up to one-fourth of heart-attack patients die before reaching the hospital.

"Sudden death is a high probability for those patients when they wait at home," Lucas said. "If they're driving themselves, there's no way to provide emergency care on the way."

While waiting for the ambulance, the patient should chew one regular aspirin tablet

Los Angeles Times Brief: Depression drug aids heart patients
From Times wire reports
January 29, 2007

A drug can combat depression common among patients with severe heart disease, but psychological counseling doesn't seem to work, a study has found.

The report from the University of Montreal Hospital Center said there have been few studies looking at how much antidepressants help heart disease patients with depression, even though as many as 27% may suffer from it. Doctors believe that treating the depression may also slow the deterioration of patients' health.

The Canadian study, published in the Jan. 25 issue of the Journal of the American Medical Assn., involved 284 patients variously given the drug citalopram — sold as Celexa — a placebo or short-term psychotherapy. The patients had previously suffered a heart attack or major blockage of arteries.

Citalopram is one of a class of antidepressants called SSRIs.

The study found that the drug worked to combat depression by easing its most common symptoms, with the effect apparent within six weeks. But, it concluded, counseling did not have an effect.

To read the study, go to jama.ama-assn.org/cgi/content/full/297/4/367

Victims of heart attacks, strokes need quick treatment
By: BRADLEY J. FIKES - Staff Writer

Someone's been hit by a car and is bleeding profusely. A child falls down a flight of stairs and is knocked unconscious.

Of course, you dial 911 immediately to get an ambulance.

But what if you feel prolonged pain and pressure in your chest? What if someone suddenly has trouble speaking, or becomes partially paralyzed? These, too, are life-threatening emergencies. And you need to dial those three numbers right away.

However, people aren't taking these warning signs of a heart attack or stroke seriously enough, says the American Heart Association and the local medical community.

Half of people who need emergency treatment are driving themselves or being driven to the hospital, said Shelley Berthiaume, quality improvement initiative director for the American Heart Association.

As a result, people die or become permanently injured who could make a full recovery ---- if they had been treated quickly.

If only they had made that call.

When to call
Medical emergencies that demand a 911 call include unconsciousness, heavy bleeding or very intense pain, said Dr. Mark Olcott, an urgent care physician with ScrippsHealth. But heart attack and stroke are the biggest concerns, Olcott said, because they are so common and the damage from delaying treatment can be so severe.

"We're assuring people not to be worried in the emergency room for using the system in the face of any of these conditions," Olcott said. Lesser matters, such as a sprain or a persistent cold or cough not accompanied by significant chest pain, are best treated at urgent care centers, he said.

Berthiaume said people may not want to think about being in a life-threatening situation.

"They may not want to admit that their lives could change forever," she said. But by delaying, they make matters worse.

Dennis Leahy, an interventional cardiologist at Palomar Medical Center in Escondido, said people can gauge the significance of their symptoms by taking into account their medical history.

For a 60-year-old male who is overweight and has a family history of heart disease, severe chest pains and shortness of breath should be considered a heart attack until proven otherwise, Olcott said. But in a 20-year-old man who has just completed a strenuous task, with no personal or family history of heart disease, those symptoms are probably harmless.

"You make it easier for us all if you came to us early," said Berthiaume, a registered nurse who was formerly a hospital coordinator at Palomar Medical Center.

Berthiaume helped Palomar comply with the heart association's Get With the Guidelines program to teach the most up-to-date medical-care methods for heart attack and stroke patients. Palomar Medical Center is the only hospital in San Diego or Riverside counties recognized for meeting the guidelines for two or more years. (MORE)

Expertise Essential for Coronary Intervention Without Surgical Backup - CME Teaching Brief® - MedPage Today

TEMPLE, Tex., Feb. 5 -- Only high-volume cardiac interventionalists with meticulous track records should consider performing percutaneous coronary procedures without onsite surgical backup, according to a consensus statement.

Without endorsing the use of such procedures without onsite surgical backup, the Society for Coronary Angiography and Interventions said that only cardiologists who perform a minimum of 100 interventions annually -- including at least 18 of them primary -- should be eligible to intervene without a surgical safety net.

Moreover, no cardiologists should begin working at such a facility until "they have a lifetime experience of more than 500 percutaneous coronary interventions as primary operator after completing fellowship."

Gregory J. Dehmer, M.D., of the Texas A & M School of Medicine, and SCAI president, said that by spelling out those requirements the society "has defined 'expert' interventionalist." Only experts, he said, should be working without a safety net.

The consensus statement was published in the February issue of Catheterization and Cardiovascular Interventions and a shorter version was published on the journal's website.
Although the SCAI statement sets forth minimum volume requirements, Dr. Dehmer said the statement gives equal emphasis to quality, noting that it recommends that free-standing percutaneous coronary intervention centers and interventionalists at those centers should also meet quality benchmarks. [MORE]

Hypertension During Pregnancy Linked to Later Heart Disease - CME Teaching Brief® - MedPage Today

Although hypertension during pregnancy usually subsides after delivery, a postmenopausal second act may await, found researchers here.

The postmenopausal course of women with a history of hypertension during pregnancy may be marked by coronary calcification and an increased risk of coronary artery disease, said Michiel Bots, M.D., Ph.D., of the Julius Center for Health Sciences and Primary Care here, and colleagues.

They found women with mild elevations of blood pressure from preeclampsia had a 57% increased risk of coronary calcification several decades later compared with women who were normotensive during pregnancy, they reported in the February issue of Hypertension.

"To the best of our knowledge, the present study is the first to show that a history of high blood pressure during pregnancy is related to coronary calcification later in life," they said.

Many women who have had preeclampsia exhibit the phenotype of the metabolic syndrome and impaired endothelial function three to 12 months postpartum, the researchers said. In addition, preeclampsia is associated with an increased risk of cardiovascular events and death later in life.

The findings of this study are in line with these observations, they said, and expand the evidence to an increased risk of atherosclerosis, a significant predictor of subsequent cardiovascular disease and total mortality.

The study population included 491 healthy postmenopausal women selected from participants enrolled in the PROSPECT study from 1993 to 1997. PROSPECT was one of two Dutch cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Information on high blood pressure during pregnancy was obtained by questionnaire. Of the women, 151 (30.7%) reported having had high blood pressure in pregnancy.

The high prevalence of hypertension was most likely the result of a definition of "hypertension during pregnancy" that included not only brief and modest elevations during pregnancy but also women with preeclampsia, the researchers said. Unfortunately, they added, blood pressure levels for women with nonproteinuric hypertension or mild elevations were not available. [MORE]

"PRESS RELEASE FROM JOHNS HOPKINS UNIVERSITY: CALL MADE FOR CHANGES IN WOMEN'S HEART DISEASE RISK-FACTOR LIST"
-- Family history and blood C-reactive protein should be added to traditional risk factors for all older women

Johns Hopkins cardiologists are calling for an expansion of the criteria widely used by physicians to detect and assess a postmenopausal woman's chances of developing cardiovascular disease, the leading cause of death among women in the United States.

In an editorial appearing in the Journal of the American Medical Association (JAMA) online Feb. 14, Roger Blumenthal, M.D., and colleagues say that a family history of heart disease and blood levels of a protein tied to vessel inflammation, C-reactive protein, should quickly be added to traditional assessments of women's risk of suffering a heart attack, stroke or severe chest pain (angina).

"Physicians should incorporate these factors into their testing and decision-making about which women are most likely to develop cardiovascular disease," says Blumenthal, an associate professor and director of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine and its Heart Institute. "And physicians should intervene with lifestyle changes and drug treatment before symptoms start to appear," he adds. "Our best means of prevention is through early identification of those most at risk."

Blumenthal says these changes could help ameliorate the discrepancy between the death rate for men and women from cardiovascular disease, which has steadily declined for men over the last 20 years, but has remained relatively the same for women.

The new risk-factor list would strengthen existing assessment tools, including the Framingham Risk Estimate, which gauges how likely a person is to suffer a fatal or nonfatal heart attack within 10 years and calculates risk based on a summary score of such factors as age, blood pressure, cholesterol levels and smoking.

The Johns Hopkins experts base their editorial call on research conducted elsewhere and published in the same issue of JAMA, which looked at the predictive value of more than 35 risk factors not included in the Framingham score but reported to play a role in heart disease and stroke.

They found clear evidence that only family history and C-reactive protein, or hsCRP for short, had significant, additional predictive value in determining women really at moderate or high risk of future cardiovascular disease. The new method changed risk scores for at least 20 percent of the women studied.

"These are the best data yet to show how we should be assessing our female patients," says Blumenthal, whose own research showed in 2005 that the gold standard Framingham tool failed to identify approximately one-third of women over age 60 who had advanced hardening and narrowing of the arteries for their age and sex.

The latest findings are not surprising, the Johns Hopkins team says. Family history - where either a parent or a sibling suffered a coronary event - doubles a woman's own chances of arterial disease. High blood levels of C-reactive protein, in excess of 3 milligrams per liter, also double the risk. And the effects are multiplied if both factors are present, with a woman's risk rising almost fourfold.

Also in 2005, Blumenthal and his team suggested additional screening, using CT scans of the arteries and calcium scoring to better find women who would likely benefit from aspirin and statin therapy. Such additional tests, he says, should still be considered for those women with no symptoms and at least two traditional risk factors who are also undergoing lifelong drug therapy with aspirin and lipid-lowering drugs.

But, he notes, the latest analysis, which was funded by the Donald W. Reynolds Foundation, provides a thorough review of many potential risk factors and should be applied for all postmenopausal women. Results are available online at http://www.reynoldsriskscore.org/

Evaluation of the women in the current study included analysis of race, age, body mass index, menopause status, frequency of exercise, alcohol use, postmenopausal hormone use and dietary supplements of vitamin E, other multivitamins and aspirin. Blood factors studied were equally varied and included levels of homocysteine, creatinine, fibrinogen and hemogloblin A1C levels.

The information came from the U.S. Women's Health Study, which tracked for a decade more than 24,000 healthy women to see who developed coronary heart disease and who didn't. All women were over age 45.

"Our goal is to make heart attacks less likely to occur, and to do so by strongly considering therapies such as aspirin, cholesterol-lowering medications and, possibly, blood pressure medications for individuals at higher risk," says editorial co-author and cardiologist Erin Michos, M.D., a clinical fellow at Johns Hopkins.

In addition to researchers' call for change, Michos says that existing treatment guidelines, the 2001 National Cholesterol Education Program Adult Treatment Panel, which currently emphasize the Framingham score, should be revised to incorporate family history and hsCRP.

Assistance with the Johns Hopkins editorial was provided by Khurram Nasir, M.D., M.P.H.

Air Pollution Linked to Increased Cardiovascular Events and Death in Postmenopausal Women - CME Teaching Brief® - MedPage Today

Fine-particulate air pollution over time significantly increased the risk of first heart attack or stroke, as well as cardiac mortality, in postmenopausal women, researchers here reported.

Moreover, the risk increased as pollution worsened so that for every 10 µg per cubic meter increase in fine-particulate matter the risk of a cardiovascular event rose by 24% and the risk of death jumped by 76%, found Kristin A. Miller, M.S., of the University of Washington, and colleagues, in an observational study. (MORE...)

BREAKING NEWS: 18 MILLION U.S. MEN AFFECTED BY ER*CT*LE DYSFUNCTION - Lifestyle Changes Could Improve Male Sexu*l Function
(PRESS RELEASE FROM: Johns Hopkins University)

From: Johns Hopkins University
Date: February 1, 2007 3:00:00 AM MST
Johns Hopkins University Bloomberg School of Public Health
Office of Communications and Public Affairs

NOTE: Due to its subject matter, some words in this release have been edited to avoid its being captured by spam filters

FOR IMMEDIATE RELEASE
18 MILLION U.S. MEN AFFECTED BY ER*CT*LE DYSFUNCTION
- Lifestyle Changes Could Improve Male Sexu*l Function
More than 18 million men in the United States over age 20 are affected by er*ct*le dysfunction, according to a study by researchers from the Johns Hopkins Bloomberg School of Public Health.
The prevalence of er*ct*le dysfunction was strongly linked with age, cardiovascular disease, diabetes and a lack of physical activity. The findings also indicate that lifestyle changes, such as increased physical activity and measures to prevent cardiovascular disease and diabetes, may also prevent decreased er*ct*le function. The study is published in the Feb. 1, 2007, issue of the American Journal of Medicine.

"Physicians should be aggressive in screening and managing middle-aged and older patients for er*ct*le dysfunction, especially among patients with diabetes or hypertension," said Elizabeth Selvin, PhD, MPH, lead author of the study and a faculty member in the Bloomberg School of Public Health's Department of Epidemiology. "The associations of er*ct*le dysfunction with diabetes and cardiovascular risk factors may serve as powerful motivators for men who need to make changes in their diet and lifestyle."

For the study, the research team analyzed data from 2,126 men who participated in the National Health and Nutrition Examination Survey (NHANES). Men who reported being "sometimes able" or "never able" to get and keep an er*ct*on were categorized as having er*ct*le dysfunction, while men who reported being "always or almost always able" or "usually able" were not.

The overall prevalence of er*ct*le dysfunction among men in the United States was 18 percent. Men aged 70 and older were much more likely to report having er*ct*le dysfunction compared to only 5 percent in men between the ages of 20 and 40. Nearly half of all men in the study with diabetes also had er*ct*le dysfunction. And, almost 90 percent of all men with er*ct*le dysfunction had at least one risk factor for cardiovascular disease, including diabetes, hypertension, having poor cholesterol levels or being a current smoker. Men with er*ct*le dysfunction were also less likely to have engaged in vigorous physical activity within the month prior to participation in the study.

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"Prevalence and Risk Factors for Er*ct*le Dysfunction in the U.S." was written by Elizabeth Selvin, PhD, MPH, Arthur L. Burnett, MD, and Elizabeth A. Platz, ScD, MPH. Selvin and Platz are with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Platz and Burnett are with the James Buchanan Brady Urological Institute at Johns Hopkins Hospital.