Symptoms

Symptoms of heart disease

The most common symptom of heart disease is chest pain but the type of nerve that innervates the heart can give the brain very different signals to indicate ‘heart pain’.  Therefore symptoms of heart disease can very from person to person.

· Chest pain is usually described as chest pressure, tightness, squeezing, or an aching discomfort.

Symptoms of heart disease can also include:
· Fatigue or a change in exercise tolerance can be a symptom of heart disease.
· Shortness of breath can also be a symptom of heart disease.
· Indigestion, heart burn and nausea can also be symptoms of heart disease which results from the fact that the same nerve that innervates the heart also goes to the stomach.
· Passing out may be a sign of heart disease.
· Palpitations; the sensation that your heart is beating forcefully or irregularly.
· Left arm discomfort or jaw pain can also be symptoms of heart disease due to nerves that enter the spine at the same location.
· Yawing is an infrequent sign of heart disease affecting the bottom of the heart.

· Symptoms of heart disease may worsen with exercise.

· Symptoms of heart disease should be evaluated by your doctor.

Read more – June 15, 2009

Treating heart disease with bone marrow cells

- An injection into the heart muscle with cells from the bone marrow can treat heart disease.  This is according to a recent study published in the Journal of the American Medical Association.

· Investigators report on a study to treat patients with chronic heart disease.  In this study, investigators used cells from the patient’s bone marrow and injected them directly into the wall of the heart.  Study authors report this technique improved heart function by three months after the procedure.

· This was a placebo controlled, double-blinded prospective study of 50 patients and took place over a three months period.

· Patients who received an injection with their bone marrow cells had a statistically significant improvement in their heart function when assessed at 3 months.

· This is an interesting and novel treatment for refractory heart disease.  The study authors do not discuss the a mechanism to explain why patient would benefit from the bone marrow injection in to their heart.
The cells of the heart do not divide and heart cells that have died do not regenerate or get replaced by new cells.  It is likely that their bone marrow contained “stem cells” which can induce the formation of a new heart cell.

· Heart disease is a common disease in the United States and current treatment for refractory chronic heart disease in unsatisfactory.  Current treatment is limited to medications and in severe cases, cardiac bypass grafting surgery.  This technique would be a big advancement in the treatment of heart disease and is a significantly easier option to traditional heart surgery.
More studies are needed to confirm these results and to determine the long term benefit of bone marrow injections.

Cristopher Geiler, MD
May 22nd, 2009

Reference
JAMA. 2009;301(19):1997-2004

Read more – May 23, 2009

Sudden cardiac death

by Cristopher Geiler, M.D.

• Definition
· Sudden cardiac death (SCD) is a sudden and unexpected cardiac arrest (heart stops beating).

• Overview
· Sudden cardiac death (SCD) affects up to 460,000 adult Americans every year.
· Sudden cardiac death most commonly affects men age 50 to 75 years
· Sudden cardiac death is likely the result of:
· heart disease (Coronary artery disease/ plaque in the arteries around the heart)
· structural heart disease
· enlarged heart

• Types
· Heart Attack
· Sudden cardiac death can result from a heart attack which leads to a serious arrhythmia and cardiac arrest.
· Sudden cardiac death can result from a spontaneous ventricular arrhythmia (electrical short-circuiting of the heart) such as ventricular fibrillation.
· Sudden cardiac death can occur from trauma to the chest (cardiac concussion) and lead to a ventricular arrhythmia.

• Treatment
· Risk factors for heart disease should be treated such as: hypertension, diabetes, high cholesterol tobacco use
· Implantable defibrillators
· Medications

References
Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995;333:337-342. [PMID: 7609749]
Sudden death due to cardiac arrhythmias. New Engl J Med 345:1473, 2001. [PMID: 11794197]
Centers for Disease Control and Prevention: State-specific mortality from sudden cardiac death-United States, 1999. MMWR 51:123-126, 2002.
Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 19:179, 1990. [PMID: 2301797]

Read more – May 2, 2009

Sudden Cardiac Death associated with stress induced rapid heart rate

-A stress-induced rapid heart rate predicts risk of Sudden Cardiac Death. This is according to a new study published in the medical journal European Heart Journal.
· Investigators found that men who had an elevated heart rate just prior to preforming a cardiac stress test had twice the risk of sudden cardiac death later in life, compared with those who did not have an increase in heart rate.

· The cardiac test was an example of a mental stressor. The people were likely nervous about the test and some expressed their nervousness with a rapid heart rate.

· Study authors report that “this study shows that the heart-rate increase during mild mental stress in preparation for exercise is a strong predictor of sudden death.

· The study was retrospective analysis of 7,746 French policemen, age 42 to 53-years-old who participated in the Paris Prospective Study that took place in 1967 to 1972.

· Individuals respond differently to emotional stress. Epinephrine released in response to emotional stress can cause in increase in heart rate. This study is very interesting in that it indicates that people who are sensitive to stress and epinephrine have a higher risk of sudden cardiac death.

The study also indicates a toxic affect that excessive stress and epinephrine can have on the heart.

Cristopher Geiler, M.D.
May 1st 2009
References
Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population. Eur Heart J. 2009 Apr 28. PMID: 19401600

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Alteplase

· Trade Name
Activase

· Generic Name
ALTEPLASE

· Drug Class
Anticoagulation medication
Thrombolytic medication

· How It Works
Medication converts plasminogen to plasmin which promotes fibrinolysis and dissolves clots

· Serious Side Effects
stroke
intracranial bleeding
bleeding
heart arrhythmias after reperfusion
allergic reations
pulmonary embolism
cholesterol embolism

· Common Side Effects
bleeding

Read more – March 29, 2009

Activase

· Trade Name
ACTIVASE

· Generic Name
Alteplase

· Drug Class
Anticoagulation medication
Thrombolytic medication

· How It Works
Medication converts plasminogen to plasmin which promotes fibrinolysis and dissolves clots

· Serious Side Effects
stroke
intracranial bleeding
bleeding
heart arrhythmias after reperfusion
allergic reations
pulmonary embolism
cholesterol embolism

· Common Side Effects
bleeding

Read more

Plavix effectiveness decreased by Heartburn Medications

· According to the Journal of the American Medical Association, the effectiveness of the medication Plavix was decreased in patients taking the stomach acid medications Proton Pump Inhibitors. According to study authors, patients who were on both Proton Pump Inhibitor medication and Plavix had a higher risk of recurrent heart attack compared with patients who were taking Plavix alone.

· The study included 8200 patients who were hospitalized with acute coronary syndrome. Recurrent heart attack or death occurred in 20% of patients who were discharged from the hospital on Plavix alone and 30% in patients who were discharged in Plavix and a Proton Pump Inhibitor medication. Therefore, the risk of recurrent heart attack or death was higher with the use of a Proton Pump Inhibitor plus Plavix compared with Plavix alone.

· Proton Pump Inhibitors(PPIs) are medications that powerfully decrease stomach acid production. They are useful in patients with acid reflux (GERD) or the stomach ulcer disease gastritis. These medications are commonly prescribed and very effectively control stomach acid. Examples of PPIs include: Protonix, Prilosec, Nexium, Aciphex, Prevacid, Omeprazole

· The medication Plavix is helpful in heart disease as it Platelets’ ability to clot and obstruct arteries. It is commonly used in patients with severe heart disease or in whom have a stent placed in a coronary artery.

· Plavix needs to be activated in the liver at the same place where PPIs are metabolized leading researchers to believe that the explanation for these results is that PPIs interfere with the activation of Plavix.

By Medicues
March 8, 2009

Read more – March 8, 2009

Zolmitriptan

· Trade Name
Zomig

· Generic Name
ZOLMITRIPTAN

· Drug Class
Migraine medication

· How It Works
Activates vascular serotonin receptors, producing vasoconstriction (constriction of blood vessels)

· Serious Side Effects
coronary vasospasm
myocardial ischemia
heart attack
ventricular tachycardia
ventricular fibrillation
arrhythmias, life-threatening
hypertension
hypertensive crisis
stroke
cerebral hemorrhage
subarachnoid hemorrhage
peripheral vascular ischemia
bowel ischemia
vision loss
hypersensitivity allergic reaction
serotonin syndrome

· Common Side Effects
nausea
dizziness
paresthesias
neck pain/pressure/tightness
jaw pain/pressure/tightness
somnolence
hot or cold sensation
dry mouth
asthenia
dyspepsia
chest pain/pressure/tightness
sweating

Read more – February 12, 2009

Sudden Cardiac Death Amongst Athletes On The Rise

· Sudden cardiac death occurs more frequently in young athletes than previously estimated, according to investigators of a study published in the journal Circulation.
· The journal article reports Sudden Cardiac Death occurred at an average rate of 66 deaths per year in the United States over the past six years- a clear decrease from a rate of 44 deaths per year between 1980 to 1993, and 108 deaths per year between 1994 to 2006.
The study does not offer an explanation as to the cause of the increase in death rate due to Sudden Cardiac Death in athletes over the past 27 years but suggests that enhanced public recognition due to increased media attention and greater awareness of Sudden Cardiac Death in Athletes may result in more diagnoses.
The study analyzed data from the Minneapolis Heart Institute Foundation.
Reference
Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes. Circulation 2009; 119: 1085-1092

February 10, 2009

Read more – February 10, 2009

Chest numbness

• Chest numbness is the symptom of the loss of sensation of the chest.

• Chest numbness can be a sign of a peripheral neuropathy (nerve damage).

• Chest numbness can result from heavy metal exposure or trauma to nerves.

• Chest numbness can be a sign of diabetes and should be evaluated by your doctor.

• Chest numbness can also be a sign of a heart attack, especially if present on the left side and should be evaluated by a doctor.

Read more – December 10, 2008

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