Myocardial-infarction

It would mean a lot to me if you guys can pray for my Dad. He had an MI last night due to a complete blockage in one of his arteries and is currently in the ICU. Had my mom not fought with him to take aspirin and go to the Hospital when she did, he most likely would have died sometime last night. It’s a really trying time and we could use the support.

One of the complications is sudden death. Now the problem with sudden death is, for a lack of a better term, sudden. This means you usually never catch it early enough to treat and prevent it.
—  Lecturer explaining the complications of myocardial infarction, where about half of all cardiac deaths are sudden, occurring with one hour of symptoms.
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Heartburn Drugs Linked to Heart Attacks | NYTimes Well Blog

The widely used drugs known as proton pump inhibitors, or P.P.I.’s — gastric reflux preventives like Prilosec and Prevacid — may increase the risk for heart attack, according to analysis of data involving almost three million people.

Previous studies have found that P.P.I.’s are associated with poor outcomes for people with heart disease, probably because of an interaction with clopidogrel [Plavix], a drug commonly prescribed after a heart attack. This new study examines the heart attack risk in otherwise healthy people.

The researchers used data-mining, a mathematical method of looking at trends in large amounts of data, to analyze the use of the drugs over time. Evidence that they were increasing the risk for heart attack was clear as early as 2000.

“This is the kind of analysis now possible because electronic medical records are widely available,” said the lead author, Nigam H. Shah, an assistant professor of medicine at Stanford. “It’s a benefit of the electronic records system that people are always talking about.”

There was no association of heart attack with another class of drugs used to treat gastric reflux, H2 blockers like Zantac, Tagamet and Pepcid. The researchers suggest that P.P.I.’s promote inflammation and clots by interfering with the actions of protective enzymes.

A significant limitation of the study, in PLOS One, is that P.P.I. usage may be a marker of a sicker patient population, more subject to heart disease in any case.

Long-term PPI use is widespread, though the drugs are only supposed to be used for a few weeks at a time. In 2009, worldwide PPI sales totaled $13.6 billion USD. There are other effective approaches to GERD available, including dietary changes and weight loss, both of which can lower heart attack risk and help resolve reflux without the use of PPIs. This drug class contributes to magnesium wasting as well as low microbial diversity in the gut, which raises risk for gut infections like traveler’s diarrhea.

T-tubule Tempo

If a heart attack doesn’t kill a person, it’s likely subsequent heart failure ultimately will. A heart attack, or myocardial infarction, damages some heart cells so much that they never fully resume proper activity, causing the heart to eventually fail. Examining the nature of such damage may help researchers find ways to prevent, reverse, or circumvent the problems. One recently identified way in which infarction causes damage is via the destruction of T-tubules – structures that transmit electrical impulses across the cell to coordinate its contraction with that of its neighbours. State-of-the-art electron microscopy has revealed that while T-tubules are arranged radially in healthy heart cells (like the one pictured on the right), in a damaged cell (left) the T-tubules are largely lost and those that remain are clumped together. Finding a way to restore proper T-tubule function in damaged hearts could ensure they keep a regular rhythm for longer.

Written by Ruth Williams

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Heart: microscopic section of a 3 day old acute myocardial infarction
Unlike the previous slide, which showed the early stages of coagulation necrosis, this slide depicts a heavy neutrophilic infiltrate with destruction of the cardiac fibers. The neutrophils came into the area of the infarct from the periphery, so this should not be confused with liquefactive necrosis. Macrophages will eventually replace the neutrophils and then collagen tissue will be deposited in the area of infarction.

allnurses.com
Aspirin As Primary Prevention Strategy Investigated

According to a study conducted by Alfred A. Bartolucci, Ph.D. and colleagues from the University of Alabama at Birmingham, aspirin is effective as a preventive medication regiment against “nonfatal myocardial infarction and decreasing total cardiovascular events,” but not against “risk of stroke, CV mortality, and all-cause mortality.”

This topic is particularly alarming to me since both my parents are on a prophylactic (aka preventive) aspirin regime as a way to prevent the onset of stroke. It scares me that the results of this study conclude that aspirin does not effectively reduce the onset of stroke.  I am interested in reading the actual study (the link is provided in the article cited above) and deciphering just how the researchers conducted the study. Something that I’m glad I gained from the UCI Program in Nursing Science is the ability to investigate, question, and develop a curiosity for solid evidence

How does a stroke work? In a nutshell, a stroke is when your brain lacks the oxygen and energy it needs to function and thus begins shutting down. There are two ways this can happen: clogged brain vessels and bleeding brain vessels.

Another name for stroke caused by clogged brain vessels is ischemic stroke. The word “ischemia” comes from the Greek word "iskhein“, meaning ”to restrict". With a clogged blood vessel, the blood is restricted from moving anywhere–particularly, your brain. The majority of all strokes are ischemic.

Another name for stroke caused by bleeding brain vessels is hemorrhagic stroke. That means that a brain vessel popped and thus bled all over the inside of the brain. When there is too much volume in the brain from all the bleeding, more pressure builds up inside the brain and limits normal brain cell activity. It’s similar to how the organs in an obese person are compressed in the abdomen and thus limited in function when there is too much fat buildup in the belly.

Risk factors:

  • high blood pressure
  • blood disorders
  • aneurysms
  • arteriovenous malformations 
  • age and gender
  • race and ethnicity
  • family history of stroke
  • smoking
  • heart conditions

Signs and symptoms:

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(Images from: http://www.ninds.nih.gov/disorders/stroke/knowstroke.htm)

If you notice someone with signs and symptoms of stroke, they must be treated within 3 hours. However, it is ideal for the patient to arrive at the hospital within 60 minutes for evaluation. 

Remember FAST as an easy way to remember the signs/symptoms and you can save a life:

FACE – Face droops on one side (when asked to smile)

ARMS – One arm “drifts” downward when asked to raise both arms

SPEECH – Speech is slurred when asked to repeat a sentence

TIME – If you notice any of these signs and symptoms, call 9-1-1 immediately

Here’s a link to a FAST wallet card, created by the National Stroke Association, so you remember what to look for in stroke: http://www.stroke.org/site/DocServer/FAST_walletCard_2011.pdf?docID=8342!

Sources: 
http://www.nlm.nih.gov/medlineplus/stroke.html 
http://www.nhlbi.nih.gov/health/dci/Diseases/stroke/stroke_what.html
http://www.stroke.org/site/PageServer?pagename=symp  

Heart Attack Symptoms: Men vs. Women

Today I had an appointment with my primary care provider (PCP). As I waited to be seen, I saw an issue of WebMD magazine beckoning me to grab it from the shelf. Of the several articles I read (it was a long wait, I might add), a particular one stood out to me–the differences in heart attack symptoms between men and women

“What is a heart attack, and how is it caused?”

Heart attack, also known as myocardial infarction (MI), occurs when a blood vessel (or vessels), which usually delivers oxygen, energy, and nutrients to the heart, is blocked or occluded by deposits known as plaque

Plaque can consist of fat, cholesterol, protein, cells used for inflammation, and other substances. As you can see in the photo above, plaque deposits collect along the inner tissue lining of the blood vessel, thus restricting the amount of blood that can flow forward into the heart (this is what you call coronary heart disease).

If the plaque buildup is left untreated, it can eventually burst. The damage on the fibrous cap that surrounds the plaque will trigger the body’s clotting system to produce a blood clot inside the vessel, thus completely blocking the flow of blood.

When the heart is not receiving the blood (thus the oxygen and energy it needs) to function, heart muscle begins to die and becomes too weak to pump blood to the body (this is what you call a heart attack). As a result, you’re losing blood flow to vital organs like the brain.

Once you have heart disease or damage to the heart vessels, you will have that damage for life. Surgery cannot completely cure someone with heart disease.

(For an in-depth photo slideshow on how heart attacks work, check this out.)

So we’re down to the most important bit: how do you recognize a heart attack?

The “typical signs” are often seen in both men and women:

- Pain/discomfort in the chest (can be described as “an elephant crushing my chest”)
- Pain/discomfort that extends to the arm, jaw, shoulder, or back
- Sweating, nausea, feeling light-headed
- Difficulty breathing

Women, however, more often experience the following signs and symptoms that can also be indicative of heart attack:

- Indigestion or gas-like pain
- Dizziness or nausea
- Unexplained weakness or fatigue
- Pain/discomfort between the shoulder blades 
- Recurring chest discomfort
- Sense of impending doom 

The bottom line: Do not “tough it out”, ignore symptoms, or wait to get treatment, especially if you or someone you know is experiencing the symptoms listed above. They say that “time is muscle” and that every minute counts toward saving someone from an MI. 

“How can I become healthy and reduce my chances of getting a heart attack?”

Seven simple rules, according to the American Heart Association. These seven rules, known as “Life’s Simple 7” consist of:

1. Get Active
2. Control Cholesterol
3. Eat Better
4. Manage Blood Pressure
5. Lose Weight
6. Reduce Blood Sugar
7. Stop Smoking 



To learn more, click on the photo above to visit the AHA website!

Sources:
http://www.webmd.com/heart-disease/guide/heart_disease_heart_attacks
http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html
http://www.nlm.nih.gov/medlineplus/heartattack.html
http://women.webmd.com/news/20050118/womens-heart-attack-undiagnosed
http://www.webmd.com/heart-disease/news/20080502/younger-women-miss-heart-attack-signs
http://women.webmd.com/guide/womens-heart-attacks-how-they-differ
http://mylifecheck.heart.org/
http://www.nhlbi.nih.gov/health/public/heart/other/hhw/hdbk_wmn.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1424049