Tag Archives: heart attack

Some NSAIDs potentially dangerous for heart attack survivors

When heart attack survivors or those with heart disease take certain pain relievers it puts them at higher risk for heart attack or death according to a new study in Circulation, a journal of the American Heart Association. Continue reading

Cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs)

I’m surprised how many of my patients are NOT aware of the potential cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve). If you’re in their camp, don’t miss this report: Continue reading

The ABCs of CPR Rearranged to “CAB”

Every shopping season we all hear a wrenching story or two of someone who dies of a heart attack at a mall with people standing around but NOT offering help. I think it’s not only because so many have not had CPR training, and don’t know what  to do, but that the definitely do NOT want to do mouth-to-mouth resuscitation on someone they do not know. Well, now even untrained observers can do CPR, except it’s now called “CAB.” Here are the details from MedScape:

Chest compressions should be the first step in addressing cardiac arrest. Therefore, the American Heart Association (AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of cardiopulmonary resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

So, if you see someone collapse and they are not breathing and do not have a pulse, (1) have someone call 9-1-1, (2) have another person locate a portable defibralator (all malls and stores have them) or call store security who will bring one, and then you begin chest compressions. No need to do mouth-to-mouth resuscitation at the beginning.

If you remember the Bee Gee’s hit song, Staying Alive, you can time your compressions to the beat as you hum it. Just push down hard (you can NOT push too hard) and fast at a point half way between the top and bottom of the sternum (chest bone). Once 9-1-1 is on the line, the dispatcher will be able to give you further instructions.

Here are the details from MedScape:

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which were published in Circulation: Journal of the American Heart Association and represent an update to previous guidelines issued in 2005.

“The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published,” note the authors in the executive summary. The new research includes information from “356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions (‘webinars’) during the 36-month period before the 2010 Consensus Conference.”

According to the AHA, chest compressions should be started immediately on anyone who is unresponsive and is not breathing normally. Oxygen will be present in the lungs and bloodstream within the first few minutes, so initiating chest compressions first will facilitate distribution of that oxygen into the brain and heart sooner. Previously, starting with “A” (airway) rather than “C” (compressions) caused significant delays of approximately 30 seconds.

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” noted Michael R. Sayre, MD, coauthor and chairman of the AHA’s Emergency Cardiovascular Care Committee, in an AHA written release. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body,” he added.

The new guidelines also recommend that during CPR, rescuers increase the speed of chest compressions to a rate of at least 100 times a minute. In addition, compressions should be made more deeply into the chest, to a depth of at least 2 inches in adults and children and 1.5 inches in infants.

Persons performing CPR should also avoid leaning on the chest so that it can return to its starting position, and compression should be continued as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers instruct untrained lay rescuers to provide Hands-Only CPR (chest compression only) for adults who are unresponsive, with no breathing or no normal breathing.

Other key recommendations for healthcare professionals performing CPR include the following:

  • Effective teamwork techniques should be learned and practiced regularly.
  • Quantitative waveform capnography, used to measure carbon dioxide output, should be used to confirm intubation and monitor CPR quality.
  • Therapeutic hypothermia should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
  • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.

Pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of continuous CPR. The new guidelines also discuss resuscitation of infants and children with various congenital heart diseases and pulmonary hypertension.

The 2010 AHA guidelines for CPR and emergency cardiovascular care are available here.

Can Calcium Supplements Cause Heart Attacks?

Calcium supplements are coming under scrutiny due to concerns that they might increase heart attacks. A new study shows that patients over 40 who take 500 mg/day or more of calcium have an increased risk of heart attack.

And, the theory is plausible as too much calcium might lead to vascular calcification and atherosclerosis.

But it is WAY, WAY, WAY  too soon to jump to any conclusions for at least a couple of reasons:

  • The analysis only looked at people taking calcium supplements alone.
  • It doesn’t address the role of dietary calcium or taking vitamin D along with calcium. Especially since some research suggests that taking calcium plus vitamin D does not significantly affect coronary artery calcification.

The Doctors of Pharmacology at the Natural Medicines Comprehensive Database tell prescribers this:

Continue to advise people to use calcium supplements if needed, but not to exceed recommended amounts.

Advise patients to consider their TOTAL calcium intake from supplements PLUS foods. Recommend aiming for calcium 1000 mg/day for adults under 50 and 1200 mg/day for adults over 50. Many people get about half this amount in their diet.

To this I add, if you’re going to take a calcium supplement (and, I do), then be sure to take it with vitamin D (and consider having your doctor test your vitamin D level).

To figure out dietary calcium intake, I have my patients count 300 mg/day from NON-dairy foods plus 300 mg/cup of milk, fortified orange juice, etc.

I also recommend vitamin D (based upon the new guidelines from Osteoporosis Canada) 1000 IU/day for adults under age of 50 and up to 2000 IU/day for adults over 50, to maintain adequate levels and help prevent fractures. I recommend using vitamin D3 (cholecalciferol) because it’s more active, but vitamin D2 (ergocalciferol) is also fine for increasing vitamin D levels. And, I do not recommend sunlight exposure for increasing vitamin D levels. You can read my reasons here.

Keep in mind, as I’ve told you before, the Institute of Medicine will come out with new calcium and vitamin D recommendations later this fall.

Too many women experiencing heart attack symptoms fail to call 911

In the USA Today Your Health column, Kim Painter points out that an American Heart Association survey reveals that “just over half of” the female respondents “said they would” call 911 in the event of heart attack symptoms.

“Instead, many women would call their doctors, take an aspirin, or get to a hospital on their own, says study author Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center.”

This trend is not gender exclusive, as “many men also respond to ominous symptoms with denial, says Angela Gardner, president of the American College of Emergency Physicians.”

A cardiologist with Harvard’s Health Line says this:

Here is what I recommend about chest pain and calling 911: If the discomfort (pain, pressure, squeezing) is severe, felt in the midchest area, occurs when you’re at rest, lasts at least five minutes, or is accompanied by lightheadedness, a sudden sweat, or unusual shortness of breath, make the call. If you have known coronary artery disease, and it feels like your typical angina, and it’s not relieved by three nitroglycerin pills, make the call.

When none of these is true, but the chest pain keeps recurring with exertion, exposure to cold, or psychological stress, or if you have been diagnosed with angina and the pain has gotten more severe or lasts longer, you don’t need to call 911, but you do need to call your doctor — pronto.

I tell my patients who are having symptoms of a heart attack (or, for that matter, a brain attack — stroke symptom) NOT to drive to the ER. ALWAYS call 911. Why?

  • 911 can get to you faster than you can get to the ER.
  • 911 can get to you safer than you can drive or be driven to the ER.
  • If you try driving to the ER (or being driven to the ER) and become weak or unconscious, you then become a danger to others.
  • 911 carries oxygen and medications that can increase your odds of survival.
  • And, last but not least, when 911 takes you to the ER, you see a doctor immediately — not wait required.

The bottom line? If you or someone you love is having symptoms of a heart attack or brain attack, call 911. Immediately!

Four lifestyle choices reduce risk of chronic disease 80 percent

What an interesting new study. It concludes that to dramatically reduce your healthcare costs, to lengthen your life, to improve the quality of your life, and, in short, to have a happier and more highly healthy life, you need to “only” do four things.

More Information: Continue reading

More reasons to consider having your vitamin D level checked – you may think better and have less arthritis

Low vitamin D levels may impair thinking and adequate vitamin D levels may help prevent knee osteoarthritis, according to two studies released this last week. Both of these studies, added to the others I’ve discussed in this blog in the past, may lead you to get your doctor to check your vitamin D level at your next physical exam.

More Information: Continue reading

FDA Approves Triple-Drug Antihypertensive Polypill – Should you consider a polypill?

Hidden behind all of the Swine flu news stories is this one – which I feel is significantly more important when it comes to public health. The FDA just gave its official thumbs-up to an antihypertensive polypill. Could this pave the way for a preventive medicine polypill? And, should you consider taking a polypill?

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Study indicates inexpensive polypill pill may significantly reduce risk of heart attack and stroke. Should you consider it?

On the March 30th edition of the ABC World News, Charles Gibson reported, “Some of the country’s leading heart doctors heard results” yesterday at the American College of Cardiology (ACC) conference “about … just one pill that could revolutionize the way heart disease is treated. This pill combines five commonly used medications, and new findings show it to be safe and effective.” Should you get your doctor to prescribe this to you?

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Gardening Not Only Saves Money, It’s Highly Healthy

I don’t know about your part of the world, but here in Colorado, the weather was downright balmy last week. And on Friday spring was sprung! These facts turned my and Barb’s minds toward preparing for this year’s gardening. So, I wanted to remind myself, and you, of why gardening can be highly healthy to you and those you love.

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Are multivitamins helpful or harmful when it comes to preventing chronic diseases?

According to the LA Times, “a spate of high-profile studies published in the last few years shows that a variety of popular supplements — including calcium, selenium, and vitamins A, C and E — don’t do anything to reduce the risk of developing heart disease, stroke, or a variety of cancers.” And, the New York Times is reporting, “In the past few years, several high-quality studies have failed to show that extra vitamins, at least in pill form, help prevent chronic disease or prolong life.” But what about multivitamins? Are they helpful or harmful

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Inexpensive blood test identifies people with a normal cholesterol at risk for heart attack, stroke – and a statin medicine may save lives and change preventive medicine

Whew! This is long title describing the remarkable results of a study, just announced at the American Heart Association’s meeting in New Orleans, which showed that AstraZeneca’s cholesterol fighting Crestor (rosuvastatin) slashed deaths, heart attacks, strokes, and artery-clearing procedures in apparently healthy patients who had normal cholesterol levels. The study has made a dramatic impression on some doctors who now expect an adjustment to preventive care guidelines.

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Vitamin D may protect against heart attack


In yet another study of vitamin D, Reuters is reporting a study where scientists found that low vitamin D levels are associated with a higher risk for heart attack. 

Researchers studied medical records and blood samples from 454 men aged 40-75 who had either died from heart disease or who were alive but had a heart attack. Continue reading