Tag Archives: Myocardial infarction

Straight, No Chaser: High Blood Pressure (Hypertension)

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , , , , , , ,

hypertension-34

High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
bloodpressureThe vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)

blood_pressure_5_treat-img_1280x720-jpg

Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Cardiology/Heart, Head/Eyes/Ears/Nose/Throat, Dental, , , , , , , , , ,

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Heart Attack Recognition – Time is Tissue

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , ,

 MIrecog

Heart Attacks. Myocardial Infarctions. Acute Coronary Syndromes. Coronary Artery Disease. Unstable Angina. There are many names to describe one main phenomenon. Heart attacks are the most common manifestation of heart disease, the #1 cause of death in the United States. Today’s post is to heighten your sensitivity to risk factors and symptoms of a heart attack, because we’ve gotten very good at treating them—especially if you get to us in time.
Risk Factors
Who’s at risk of having a heart attack? If any of the following considerations look or sound like you, you should be especially sensitive to the symptoms I describe below. Please understand these are the rules. I also see the exceptions nearly every day.

  • Age: especially men over 45 and women over 55
  • Cocaine or amphetamine (meth) use
  • Family history of heart attacks: sibling, parents, or grandparents if their heart attacks occurred by age 65
  • High blood pressure: higher risk with obesity, smoking, diabetes, or high cholesterol.
  • High cholesterol or triglyceride levels
  • Obesity/inactivity: especially due to associations with high blood pressure, diabetes, and high cholesterol
  • Smoking: including prolonged exposure to second-hand smoke

Again, if you have any of the above risk factors, your symptoms are more likely to be attributable to a heart attack. You may still have a heart attack without any of these risks.
Symptoms
How do you know if you’re having a heart attack? There’s no one-answer-fits-all response (like using FAST for strokes, which we’ll discuss in the next post). Heart attack pain comes in many varieties and is usually associated with other symptoms. What you should be aware of are the pain patterns that should prompt you to get evaluated. These may include the following:

  • Chest discomfort like pressure (something sitting on your chest), squeezing, fullness, indigestion, or just pain
  • Radiation of chest discomfort or just pain in other areas, such as one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath
  • Nausea or vomiting
  • Breaking out in a sweat
  • Racing, fluttering, or forceful beating of the heart
  • Lightheadedness up to or including blacking out

Again, you may have all of these symptoms or none of these symptoms in the face of a heart attack. We evaluate you based on the combination of your risk factors and your symptoms.
Bottom Line 1: If you have risks, symptoms and/or concerns, I’d much rather give you good news and education than give your family condolences. Get evaluated.
Bottom Line 2: I’m not discussing specific treatment options today (that’s for a future post), but remember two things:

  • Time is tissue, so the sooner you get to the Emergency Room, the more treatment options we have and the better your outcome is likely to be. This is not the disease to think, “It’ll just go away.” We can do our absolute best for you if you get to us within three hours of the start of your symptoms.
  • If and when something like this happens to me, the first thing I’m doing on my way the hospital is taking an aspirin.

As per routine, the combination of adequate prevention and prompt symptom recognition are key. I hope you share this with your families, especially those at immediate risk.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Cardiology/Heart, Head/Eyes/Ears/Nose/Throat, , , , , , , , , ,

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Should I Take a Daily Aspirin?

Cardiology/Heart, Medical Treatment, Health Prevention, , , , , , ,

asaheart

So… I’m stuck on a desert island, and I’m allowed to take two medications. I’m pretty sure aspirin is going to be one of them. This begs the question “Who should take a daily aspirin?”
The answer is actually easy: anyone and only anyone whose physician recommends it. The better question is when will your physician recommend it?
The benefits of aspirin in reducing heart attack risk have been known and well described for quite a while now, and you should check this list to see if you’d benefit from taking a daily aspirin. Truth be told, it’s of such importance that if you’re of a certain age, you should have this conversation with your physician at your next physical exam. Here’s a partial list that will get you a daily aspirin or very strongly considered for one.

  • If you’ve previously had a heart attack
  • If you’ve had a coronary artery stent or surgery
  • If you’ve previously had a stroke (caused by a blood clot) or TIA (transient ischemia attack, aka ‘mini-stroke’).
  • You’re a male over 50.
  • You’re a female over 60.
  • You have a bad risk factor profile (i.e. You smoke, have diabetes, high blood pressure or high cholesterol levels, are overweight, don’t exercise or have a personal or family history of heart disease)

The above list actually isn’t exhaustive but is sufficient for most individuals’  ability to remember to start a conversation with their physician.  These considerations will be measured against others that would suggest you shouldn’t be taking a daily aspirin (e.g. allergy, bleeding ulcers, a bleeding disorder or if you’re taking certain other medications).
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Heart Attack Recognition – Time is Tissue

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , ,

 MIrecog

Heart Attacks. Myocardial Infarctions. Acute Coronary Syndromes. Coronary Artery Disease. Unstable Angina. There are many names to describe one main phenomenon. Heart attacks are the most common manifestation of heart disease, the #1 cause of death in the U.S. Today’s post is to heighten your sensitivity to risk factors and symptoms of a heart attack, because we’ve gotten very good at treating them—especially if you get to us in time.
Risk Factors
Who’s at risk of having a heart attack? If any of the following considerations look or sound like you, you should be especially sensitive to the symptoms I describe below. Please understand these are the rules. I also see the exceptions nearly every day.

  • Age: especially men over 45 and women over 55
  • Cocaine or amphetamine (meth) use
  • Family history of heart attacks: sibling, parents, or grandparents if their heart attacks occurred by age 65
  • High blood pressure: higher risk with obesity, smoking, diabetes, or high cholesterol[J1]
  • High cholesterol or triglyceride levels
  • Obesity/inactivity: especially due to associations with high blood pressure, diabetes, and high cholesterol
  • Smoking: including prolonged exposure to second hand smoke

Again, if you have any of the above risk factors, your symptoms are more likely to be attributable to a heart attack. You may still have a heart attack without any of these risks.
Symptoms
How do you know if you’re having a heart attack? There’s no one-answer-fits-all response (like using FAST for strokes[J2] ). Heart attack pain comes in many varieties and is usually associated with other symptoms. What you should be aware of are the pain patterns that should prompt you to get evaluated. These may include the following:

  • Chest discomfort like pressure (something sitting on your chest), squeezing, fullness, indigestion, or just pain
  • Radiation of chest discomfort or just pain in other areas, such as one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath
  • Nausea or vomiting
  • Breaking out in a sweat
  • Racing, fluttering, or forceful beating of the heart
  • Lightheadedness up to or including blacking out

Again, you may have all of these symptoms or none of these symptoms in the face of a heart attack. We evaluate you based on the combination of your risk factors and your symptoms.
Bottom Line 1: If you have risks, symptoms and/or concerns, I’d much rather give you good news and education than give your family condolences. Get evaluated.
Bottom Line 2: I’m not discussing specific treatment options today (that’s for a future post), but remember two things:

  • Time is tissue, so the sooner you get to the Emergency Room, the more treatment options we have and the better your outcome is likely to be. This is not the disease to think, “It’ll just go away.” We can do our absolute best for you if you get to us within three hours of the start of your symptoms.
  • If and when something like this happens to me, the first thing I’m doing on my way the hospital is taking an aspirin.

As per routine, the combination of adequate prevention and prompt symptom recognition are key. I hope you share this with your families, especially those at immediate risk.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: High Blood Pressure

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , , , ,

bp_chartbloodpressure
High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
The vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)
Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Your Questions on When Fainting is Fatal

Neurology, , , , , , ,

fainting
1. So are faints deadly?

  • Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death.
  • The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain.
  • Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.

2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?

  • If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.

3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
faintinggoats