Science For Health Care » blood

Heart Attack Treatment

admin — Thu, 06 Aug 2009 18:59:24 +0000

If the EKG (Electrocardiography) shows that there is an acute heart attack (myocardial infarction), then the goal is to open the blocked artery as soon as possible and restore blood supply to the heart muscle.

When a heart attack strikes, the key thing to remember is that time equals muscle. The longer the delay in seeking medical care, the more heart muscle will be damaged. There is a window of opportunity to restore blood supply to the heart muscle by unblocking the affected heart artery. Treatments must be done in a hospital and include administration of clot-busting drugs to dissolve the clot at the site of the ruptured plaque and heart catheterization and angioplasty (in which the blood vessel is opened by balloon, often with adjunctive placement of a stent), or both.

Emergency Medical Treatment

Hospitals have established treatment plans to minimize the time to diagnose and treat people with heart attack. National guidelines suggest that an electrocardiogram (EKG) be done within 10 minutes of the patient’s arrival in the ER.

Many things will occur at the same time as the EKG being completed. The doctor will take a history and complete a physical exam while the nurses start an intravenous line, place heart monitor lines on the chest, and administer oxygen.

Medications are used to try to restore blood supply to the heart muscle. If it wasn’t taken prior to arrival in the ER, aspirin will be used for its anti-platelet action. Nitroglycerin will be used to dilate blood vessels. Heparin or enoxaparin (Lovenox) will be used to thin the blood. Morphine can also be used for pain control.

There are two options (depending on the resources at the hospital) if the EKG shows an acute heart attack (myocardial infarction), and if there are no contraindications.

Heart catheterization

The favored treatment is heart catheterization. Tubes are threaded through the femoral artery in the groin or through the brachial artery in the elbow, into the coronary arteries, and the area of blockage is identified.

Angioplasty

Angioplasty (angio= artery + plasty=repair) is then considered if possible. A balloon is placed at the blockage site and as it opens, it squashes the plaque into the blood vessel wall. Afterwards, a stent or a mesh cage is placed across the angioplasty site to keep it from closing down. Guidelines recommend that the time from the time the patient presents to the hospital to having the blood vessel open be less than 90 minutes.

Not all hospitals have the capabilities of doing heart catheterizations 24 hours a day, and may transfer the patient with an acute heart attack to a hospital that has that technology available. If the transfer time will delay angioplasty treatment beyond the 90 minute window recommendation, clot-busting drugs may be considered to dissolve the blood clot that has obstructed the coronary artery. Tissue plasminogen activator (TPA or TNK) can be used intravenously. After TPA infusion, the patient may still be transferred for heart catheterization and further care.

If the EKG is normal but the history is suggestive of an heart attack or angina, the evaluation will continue with the blood tests described above. However, the patient will likely be treated as if the heart attack was happening with aspirin, oxygen, nitroglycerin and blood thinning medications until the presence of heart damage is proven not to be present. The treatment presumes heart disease until proven otherwise.

Heart Attack Complications

When a heart attack occurs, part of the heart muscle dies and is ultimately replaced with scar tissue. This leaves the heart weaker and less able to meet the needs of the body. This will lead to exercise intolerance including early fatigue or shortness of breath on exertion. The amount of disability is dependent on the amount of muscle pumping function lost.

Muscle that loses its blood supply becomes electrically irritable. This may cause a short circuit of the electrical conduction system of the heart. This may cause ventricular fibrillation, a situation where the ventricles do not beat in a coordinated function. Instead, they jiggle like a bowl of Jello and cannot pump blood to the body. Sudden death occurs. Patients are kept in the ER or admitted to the hospital while assessing chest pain to monitor their heart rhythm and hopefully prevent sudden death from acute heart attack or unstable angina which may result in ventricular fibrillation.

If this rhythm occurs while monitored in the hospital, it can be rapidly treated with no adverse sequelae.

Heart attack & symptoms

admin — Thu, 06 Aug 2009 18:52:48 +0000

The heart is a muscle like any other in the body. It needs blood flow to supply oxygen to allow it to do work. When there isn’t enough oxygen, the muscle starts to suffer, and when there is no oxygen, the muscle starts to die.

Heart muscle gets its blood supply from arteries that start in the aorta and run on the surface of the heart, known as the coronary arteries. The right coronary artery supplies the right ventricle of the heart and the inferior (lower) portion of the left ventricle. The left anterior descending coronary artery supplies the majority of the left ventricle, while the circumflex artery supplies the back of the left ventricle.

Heart Attack Causes

Over time, cholesterol buildup can occur in these blood vessels in the form of plaque. This narrows the artery and can restrict the amount of blood that can flow through it. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed. Just like arm muscles that begin to hurt if you lift too much, or legs that ache when you run too fast; the heart muscle will ache if it doesn’t get adequate blood supply. This ache is called angina.

If the plaque ruptures, a small blood clot can form within the blood vessel and acutely block the blood flow. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI – a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

Heart Attack Symptoms

Classic symptoms of a heart attack may include:

chest pain associated with shortness of breath,
profuse sweating, and
nausea.

The chest pain may be described as tightness, fullness, a pressure, or an ache.

Unfortunately, many people do not have these classic signs. Other presentations of heart attack may include:

indigestion,
jaw ache,
pain only in the shoulders or arms,
shortness of breath, or
nausea and vomiting.

This list is not complete, since many times people can experience a heart attack with minimal symptoms. In women and the elderly, heart attack symptoms can be atypical and sometimes so vague as to be easily missed. The only complaint may be extreme weakness or fatigue.

Cancer Symptoms

admin — Thu, 06 Aug 2009 13:55:46 +0000

Cancer Signs and Symptoms

Cancer gives you no symptoms or signs that exclusively indicate the disease. Every complaint for cancer can explain a harmless condition as well. If you have symptoms, however, you should see a doctor for further evaluation. Some common symptoms are as follows:

Persistent cough or blood-tinged saliva

These symptoms usually represent simple infections such asbronchitis or sinusitis.
They could be symptoms of cancer of your lung, head, and neck. Anyone with a cough that lasts more than a month or with blood in the mucus that is coughed up should see a doctor.

A change in bowel habits

Doctors sometimes see pencil-thin stools with colon cancer.
Occasionally, cancer exhibits continuous diarrhea.
Some people with cancer feel as if they need to have a bowel movement and still feel that way after they have had a bowel movement. If any of these abnormal bowel complaints last more than a few days, they require evaluation.

Blood in your stool

A doctor always should investigate blood in your stool.
Hemorrhoids frequently cause rectal bleeding, but because hemorrhoids are so common, they may exist with cancer. Therefore, even when you have hemorrhoids, you should have a doctor examine your entire intestinal tract when you have blood in your bowel movements.
- X-rays may be enough.
- Sometimes, when the source of your bleeding is entirely clear, these studies may not be needed.

Unexplained anemia

Anemia is a condition in which you have fewer than the expected number ofred blood cells in your blood. Anemia should be investigated.
There are many kinds of anemia, but blood loss almost always causes iron deficiency anemia. Unless there is an obvious source of ongoing blood loss, as there is for menstruating women, this anemia needs to be explained.
Many cancers can cause anemia, but bowel cancers most commonly causeiron deficiency anemia. Evaluation should include endoscopy or x-raystudies of your upper and lower intestinal tracts.

Breast lump or breast discharge

Most breast lumps are noncancerous tumors such as fibroadenomas orcysts. But all breast lumps need to be thoroughly investigated.
- A negative mammogram result is not sufficient to evaluate a breast lump.
- Generally, diagnosis requires a needle aspiration or biopsy (a small tissue sample).
- Discharge from a breast is common. But some forms of discharge may be signs of cancer. If discharge is bloody or from only 1 nipple, further evaluation is recommended.
Women are advised to conduct monthly breast self-examinations.

Lumps in the testicles

Most men (90%) with cancer of the testicle have a painless or uncomfortable lump on a testicle.
Some men have an enlarged testicle.
Other conditions, such as infections and swollen veins, can also cause changes in your testicles, but you should have any lump evaluated.
Men are advised to conduct monthly testicular self-examinations.

A change in urination

Urinary symptoms can include frequent urination, small amounts of urine, and slow urine flow.
These symptoms can be caused by urinary infections or, in men, by an enlarged prostate gland.
- Most men will suffer from harmless prostate enlargement as they age, and will often have these urinary symptoms.
- These symptoms may signal prostate cancer.
- Men experiencing urinary symptoms need a bit of investigation, probably including a specific blood test called a PSA and a digital rectal exam.
Cancer of the bladder and pelvic tumors can also cause irritation of the bladder and urinary frequency.

Blood in the urine

Hematuria or blood in the urine can be caused by urinary infection, kidney stones, or other causes.
For some people, it is a symptom of cancer of the bladder or kidney.
Any episode of blood in the urine should be investigated.

Hoarseness

Hoarseness not caused by a respiratory infection or that lasts longer than 3-4 weeks should be evaluated.
Hoarseness can be caused by simple allergy or by vocal cord polyps, but it could also be the first sign of cancer of the throat.

Persistent lumps or swollen glands

Lumps most frequently represent harmless conditions. But your doctor should examine any new lump or a lump that won’t go away.
Lumps may represent cancer or a swollen lymph gland related to cancer.
Lymph nodes swell from infection and other causes and may take weeks to shrink again.
A lump or gland that remains swollen for 3-4 weeks should be evaluated.

Obvious change in a wart or a mole

Multicolored moles that have irregular edges or bleed may be cancerous.
Larger moles are more worrisome.
Removing a mole is simple. You should remove any suspicious mole. The doctor will send it for examination under a microscope for skin cancer.

Indigestion or difficulty swallowing

Most people with chronic heartburn do not have serious problems.
People who suffer from chronic or lasting symptoms despite using over-the-counter antacids may need to have an upper GI endoscopy.
A condition called Barrett esophagus, which can lead to cancer of the esophagus, can be treated with medication and then monitored by a doctor.
Difficulty swallowing is a common problem, especially in elderly people, and has many causes.
- Swallowing problems need to be investigated, because nutrition is always important.
- Difficulty swallowing solids can be seen with cancer of the esophagus.

Unusual vaginal bleeding or discharge

Unusual vaginal bleeding or bloody discharge may be an early sign of cancer of the uterus. Women should be evaluated when they have bleeding after intercourse or bleeding between periods.
Bleeding that comes back, that lasts 2 or more days longer than expected, or that is heavier than usual also merits medical examination.
Postmenopausal bleeding, unless expected on hormone therapy, is also worrisome and should be evaluated.
Usually, the evaluation will include an endometrial biopsy, in which a doctor takes a small tissue sample from inside the uterus for testing.

Unexpected weight loss, night sweats, or fever

These nonspecific symptoms might be present with several different types of cancer.
Various infections can lead to similar symptoms.

Continued itching in your anus or genitals

Precancerous or cancerous conditions of the skin of the genital or anal areas can cause persistent itching.
You may notice skin color changes.
Several infections or skin conditions also can cause these symptoms. If itching does not stop with over-the-counter topical medications, your doctor should inspect the area.

Nonhealing sores

Sores generally heal quickly. If an area fails to heal, you may have cancer and should see a doctor.
Nonhealing sores in your mouth or persistent white or red patches on your gums, tongue, or tonsils are also should raise concerns.

Headaches

Headaches have many causes, but cancer is not a common one.
A severe unrelenting headache that feels different from usual can be a sign of cancer.
If your headache fails to improve with over-the-counter medications, see a doctor promptly.

Back pain, pelvic pain, bloating, or indigestion

These are common symptoms of daily life. But they also can be seen inovarian cancer.
This cancer is particularly difficult to treat, because it is frequently diagnosed late in the course of the disease.
The American Cancer Society and other organizations have been trying to make both patients and physicians more aware and consider this diagnosis if the classic symptoms are present.