Archive for November, 2013

Heart Attack

[This post written with Jeanne Schulz, RN, MSN]

A myocardial infarction, or MI, is commonly known as a heart attack.  An MI is damage to an area of the heart muscle caused by a lack of blood supply.

CAUSES — Almost all cases of MI occur in someone who has an underlying condition called coronary heart disease (CHD), which is due to a narrowing or blockage in the coronary arteries, due to what is known as plaque. An MI occurs when the plaque ruptures and causes a blood clot (thrombus) to form in one of the coronary arteries.  Some studies have shown that an emotional or stressful event occurs in a certain percentage of people in the days or hours before an MI.  In addition, an increase in the incidence of MIs has been noted in populations where a disaster has occurred.  Because mental stress is known to cause increases in heart rate and blood pressure as well as other changes in the cardiovascular system, it has been suggested that, in some cases, mental stress can affect the stability of a coronary artery plaque and “trigger” an MI.

SYMPTOMS — The “typical” complaint of a person having an MI is persistent chest discomfort, resulting from ischemia (lack of oxygen supply) involving an area of heart muscle. But there is wide variability in the symptoms a person can have when an MI is occurring. Some patients have no symptoms at all. Others, particularly women, the elderly, diabetics, and individuals with a prior diagnosis of heart failure, may have other symptoms but not report chest discomfort. Still others have a combination of chest discomfort and other complaints. Some people having an MI will experience sudden death, also known as cardiac arrest.

Many different conditions can cause pain in the chest. The ischemic chest discomfort of an MI can range from mild to severe, and typically has the following characteristics:

  • Felt as a pressure, constriction, tightness, or squeezing, versus a sharp or stabbing pain
  • Is not limited to a small area, but rather spreads through the chest
  • May radiate to other areas of the body, including the upper abdomen, shoulders, arms, neck and throat, or lower jaw and teeth
  • Comes on gradually and lasts more than a few seconds
  • Is usually not made worse by pressing on the area of the chest that is affected, by taking a deep breath or by a particular position; however, lying down may make it worse, while sitting up may produce some reduction in intensity
  • Is not relieved by antacids or food

Other symptoms of MI — A number of other symptoms can occur in the setting of an MI. They may occur in a patient with or without chest discomfort. These include:

  • Shortness of breath
  • Nausea, vomiting, or belching
  • Sweating
  • Palpitations
  • Lightheadedness
  • Fatigue
  • Fainting
  • Cardiac arrest (sudden cardiac death)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.   Online resources include, but are not limited to the National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov) and the American Heart Association (www.americanheart.org).

Colonoscopy

This test sounds much worse than it is! This test is recommended for anyone 50 and older.

This office procedure lasts about 20-30 minutes whereby a scope is inserted into the large intestine. With a colonoscopy your physician may detect and remove colon polyps, mushroom-like growths that transform into cancer over several years.

You can have this test as an outpatient.  You can’t eat or drink for about 8 hours before the test and you will have to take a liquid diet and laxative packages the night prior to the test, so that your intestines are empty before the test. Your doctor will give you written instructions about this beforehand, or they may arrive with your appointment letter.  It is important to follow the instructions completely in order for the test to be successful.

When you get to the Colonoscopy Suite, you will be asked to take your clothing off and put on a hospital gown.  Once you are ready, you get onto the bed or a stretcher.  Right before the procedure you will receive pain medicine and a sedative to help you relax during the exam.

Because you will be sedated, you will need to rest at the colonoscopy facility for 1 to 2 hours until the medication wears off, before being able to go home. You should also bring someone with you or arrange to be picked up.

It is suggested that people have a colonoscopy every ten years; for patients with a family history of previous polyps detection, it is recommended every five years. When caught early, colon cancer survival is over 90% and after surgical removal no chemotherapy or radiation is needed. You’re done. See you back in 5 years.