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Chest Pain is almost always considered an emergency. Aside from
Heart Attacks,
Pulmonary Embolus (blood clot in the lung) and aortic dissection or tear can be fatal causes of
Chest Pain.
Some
Heart Attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most
heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a
heart attack is happening:
• Chest discomfort. Most
heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the
back,
neck, jaw or stomach.
• Shortness of
breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat,nausea or lightheadedness
As with men, women's most common
heart attack symptom is
chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of
breath, nausea/vomiting, and back or jaw pain.
Learn the signs, but remember this: Even if you're not sure it's a
heart attack, have it checked out. Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call emergency
Calling emergency is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. Patients with
chest pain who arrive by ambulance usually receive faster treatment at the hospital, too
Doctors and nurses in Emergency Departments take chest pain very seriously. You are not wasting anybody's time, and you are not bothering anybody when you seek care for
chest pain.
Many people die before they present for medical care because they ignore their symptoms out of fear that something bad is happening. It is much better to seek care if you are unsure whether your symptoms are related to heart disease and find that all is well than to die at home.
If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away. If you're the one having symptoms, don't drive yourself, unless you have absolutely no other option.
Cardiac arrest strikes immediately and without warning. Here are the signs:
• Sudden loss of responsiveness (no response to tapping on shoulders).
• No normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds).
If these signs of cardiac arrest are present, tell someone to call emergency and get an AED (if one is available) and you begin CPR immediately.
If you are alone with an adult who has these signs of cardiac arrest, call emergency and get an AED (if one is available) before you begin CPR.
Use an AED as soon as it arrives.
Self-Care at Home
The first step
to take when
chest pain occurs is to call emergency and activate the Emergency Medical System. First responders, EMTs and paramedics can begin treating a
heart attack enroute to the hospital, alert the Emergency Department that the patient is on the way, and treat some of the complications of a
heart attack should they occur.
Step two is to take an aspirin. Aspirin makes platelets less sticky and can minimize blood clot formation and prevent further blockage of the artery. If you are a known case of angina or coronary artery disease and you have nitroglycerine spray, sorbitrate or angised with you, take it immediately under the tongue as prescribed by your doctor and wait for the things to settle down
Step three is to
rest. When the body does work, the heart has to pump blood to supply oxygen to the muscles and clear the waste products of metabolism. When heart function is limited because it doesn't have an adequate blood supply itself, asking it to do more work may cause more damage and risk further complications.
Follow-up
Regular follow-up visits with your health care provider are essential. Coronary heart disease is a chronic (long-term, ongoing), relentlessly progressive disease.
Reducing risk factors may only slow its pace.
Even angioplasty or bypass surgery only reduces the severity of the disease. It does not cure the disease.
It often comes back and gets worse, requiring further treatment for people with previous
heart attacks or bypass, especially if the patient has not corrected the abnormal risk factors.
Your health care provider will usually monitor you for the following conditions:
New symptoms or signs of disease progression (periodic physical exams and ECGs or stress tests)
Silent ischemia (periodic treadmill or radionuclide stress tests or stress echocardiography)
Your health care provider will also monitor your progress in risk reduction and how well treatment is working. Keep track of your own numbers. This is your life.
Checking weight and activity levels
Checking blood lipid levels, including the bad
LDL, the good
HDL, and triglycerides, another fat frequently elevated in overweight patients, especially if diabetic - LDL should be less than 100
Checking blood pressure, which should be less than 130/80 mm Hg
If
diabetic, checking
blood sugar and A1C (should be less than 7.0%)
Checking progress with quitting
smoking
He or she will monitor how well your
medications, making adjustments as necessary. Side effects of
medications will also be monitored and treated if necessary.
Prevention
Risk refers to the odds that something will occur, but there are no guarantees.
Having one or more risk factors does not mean
heart disease is inevitable.
Similarly, absence of risk factors does not guarantee you will not have
heart disease.
Monitoring and modifying certain risk factors is the best way to prevent
coronary heart disease.
If possible, adopt a healthy lifestyle early in life.
Because risk factors are interrelated, many are present together in the same person.
Thus, moderate changes in one area of your life often reduce other risk factors at the same time.
You can't change some risk factors.
Age: Men older than 45 years and women older than 55 years are at increased risk for
coronary heart disease.
Family history: If someone in your immediate family has had
coronary heart disease,
angina, or
heart attack by age 55 years, your risk of developing heart disease is increased. If heart disease runs in the family, seek medical attention.
Your health care provider may recommend screening tests and preventive measures
You can change the following risk factors:
High blood fats, the bad LDL,good HDL,and triglycerides
Diet
Smoking
Diabetes
High blood pressure
Obesity
Inactivity
Emotional stress
High total cholesterol: Know your total cholesterol level and take measures to control it with diet and exercise if your levels are high. Your health care provider will check your levels and compare them with guidelines from the National Cholesterol Education Program (NCEP). Your total cholesterol levels are measured in your blood after a 9- to 12-hour fast. The following subtypes of cholesterol are important:
LDL cholesterol
Less than 100 - Optimal
100-129 - Near optimal/above optimal
130-159 - Borderline high
160-189 - High
190 or higher - Very high
Total cholesterol
Less than 200 - Desirable
201-239 - Borderline high
240 or higher - High
HDL cholesterol (the good cholesterol)
Less than 40 - Low
60 or higher - High (desirable)
Diet : A balanced, low-fat diet is good not just for people with high cholesterol but for everyone.
The American Heart Association recommends that maximum calories from fat be less than 30% of total calories in any meal.
Each day, try to eat 6-8 servings of bread, cereal, or rice; 2-4 servings of fresh fruit; 3-5 servings of fresh or frozen vegetables; 2-3 servings of nonfat milk, yogurt, or cheese; and 2-3 servings of lean meat, poultry, fish, or dry beans.
Use olive or canola oils for cooking. These oils contain monounsaturated fats known to lower cholesterol.
Eat 2 servings of fish each week. Eat fish such as salmon, mackerel, lake trout, herring, sardines, and albacore tuna. All of these fish are high in omega-3 fatty acids, which lower levels of certain fats in the blood and help prevent irregular
heartbeats and blood clots that cause
heart attacks.
Research suggests that alcohol can help protect against
coronary heart disease, but limit your intake to 1-2 drinks per day. Higher amounts can increase
blood pressure, cause
heart rhythm disorders (arrhythmias), and damage your heart muscle and liver directly.
Avoiding fast food may not be pleasant or convenient, but it may provide significant benefit in the long run.
Smoking: Quitting smoking is the single best change you can make.
Quitting can be difficult, so seek your health care provider's help.
Passive smoking (breathing in tobacco smoke), smoking cigars, or chewing tobacco are equally dangerous to your health.
Physical inactivity:
Exercise helps to lower your
blood pressure, increase your level of good cholesterol (
HDL), and control your weight.
Try to complete an endurance exercise of at least 30 minutes, 3-5 times a week. But just brisk walking alone will improve cardiovascular survival.
Exercise can include walking, swimming, biking, or aerobics.
Before beginning an exercise program, talk to your health care provider.
Obesity: Excess weight puts extra strain on your heart and blood vessels by increasing
blood pressure, plus frequently associated with
diabetes,
high cholesterol and triglycerides, and low HDL.
A high-fiber, low-fat diet and regular exercise can help you
lose weight and keep it off.
Fad diet programs may be unsafe. Seek your health care provider's advice before starting any
weight loss program.
Don't rely on drugs to lose weight. Certain medicines used for weight loss—for example,
Fen-Phen—have been associated with dangerous heart valve damage and other serious medical conditions in some users.
High blood pressure: If you have high blood pressure, your health care provider should treat it aggressively.
Proper
diet, low salt intake, regular exercise, reduction in alcohol intake, and weight reduction are of paramount importance.
If your health care provider prescribes medications, take them faithfully.
Diabetes: Diabetes causes blockage and hardening (
atherosclerosis) of blood vessels everywhere in the body, including coronary arteries. Controlling diabetes significantly reduces coronary risk.
Viagra and coronary
heart disease: If you intend to use sildenafil (Viagra) for erectile dysfunction, contact your doctor to make sure it is safe for you.
If you have a significant coronary blockage,
angina or
heart attack may occur with use of Viagra.
Also, you must avoid taking nitroglycerin in any form—pill, patch, or spray—within 48 hours of taking Viagra. Using Viagra with nitroglycerin may cause dangerously
low blood pressure.
Ways to prevent it
If you have
coronary heart disease, following the recommendations of your health care provider is very important if you wish to improve your condition or prevent it from getting worse. If you notice any change in your condition, you may need further diagnosis or treatment.
The most important ways to reduce the risk of
heart disease are in your control, not in the control of your health care provider.
Lifestyle changes are the most powerful way to prevent
heart disease from getting worse or of reducing the risk of getting heart disease in the first place.
The phenomenal drop in the
heart disease death rate over the past 30 years has been due more to reducing risk factors than to advances in treatment.
Everyone should take the following measures to lower the risk of
heart disease:
Eat a heart-healthy
diet: This is the most important step you can take in lowering your risk.
Lower your fat intake: Calories from fat should be less than 30% of your total calorie intake every day. This translates to less than 60 grams of fat per day for an adult.
Lower your blood cholesterol to the recommended level, especially the
LDL cholesterol: This keeps plaque from building up within your coronary arteries.
Engage in regular exercise: This can reduce your risk of
heart disease. Exercise strengthens the heart, makes it more efficient, and lowers your
blood pressure and bad cholesterol (
LDL), yet raises you good cholesterol (
HDL). Check with your health care provider before beginning an exercise program. The American Heart Association recommends at least 30 minutes of exercise 3-5 times a week.
Quit
smoking: This also provides a very striking benefit. After only 3 years of not smoking, your risk of
heart disease drops to that of a nonsmoker. Your health care provider can help you quit smoking by providing guidance on changing your behavior. Certain
medications have been shown to help some people quit smoking.
Control high
blood pressure and
diabetes: If you have diabetes, keep your blood sugar under control every day. You should know the value of your HbA1c, a measure of how your blood sugar is controlled; it should be less than 7.0.
Take a low-dose aspirin daily: This can reduce your risk of
heart attack. With aspirin, there is some risk of bleeding, so ask your health care provider before taking aspirin daily.
No scientific
clinical trial in humans has shown a beneficial effect of vitamins on the heart.
Note that hormone replacement therapy (HRT) was used for many years to prevent coronary
heart disease and
heart attack in women who had gone through
menopause.
Replacing certain hormones was thought to provide a heart-protective effect enjoyed by women before
menopause.
A research study that ended in 2002 found, however, that women who took HRT actually had higher rates of
heart disease and stroke than women who did not take
HRT.
HRT is no longer recommended for prevention of
heart disease.
Heart-healthy diet: This is the diet recommended by the American Heart Association.
Begin the day with whole-grain bread or cereal and fruit.
For lunch and dinner, make whole grains and vegetables the main course. Add a salad or vegetables if your meal is mainly meat. Add leafy salads, pasta salads, chickpeas, beans, and soy products, all of which help reduce
LDL cholesterol.
Eat a fruit plate or low-fat yogurt for dessert. Cut sweets and sugars to a minimum.
Cook foods in olive oil or canola oil, which are high in monounsaturated fats. These fats decrease LDL and total cholesterol levels.
Eat 1 or 2 servings of fish or seafood each week.
Eat nuts that are rich in monounsaturated fats, such as hazelnuts, almonds, pecans, cashews, walnuts, and macadamia nuts. These nuts are healthful but high in fats. They should be eaten in small amounts.
Cooking foods with garlic, which may have a slight cholesterol-lowering effect.
Alcohol may be taken in moderation.
No more than 2 drinks per day for men and 1 drink per day for women is recommended to raise the good cholesterol (HDL).
However, some people should not use alcohol. People who have liver or kidney problems, certain other medical problems, problems with alcohol abuse, or who are taking certain
medications should not use alcohol.
If you do not use alcohol, most medical professionals would recommend that you not start just for the benefits to your heart.
If you have any questions about alcohol's positive and negative effects on your health, ask your health care provider.
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