An Asprin-A-Day

For a drug that has been around for over a century, aspirin was hailed as a wonder drug a few years ago. Studies showed its effectiveness in preventing heart attacks, particularly when taken by people who already have coronary artery disease. The hoopla stemmed from reports which showed that dose of a daily aspirin could significantly reduce the risk of a heart attack.

How does aspirin work? A heart attack can occur when fatty plaque build up in a blood vessel ruptures. When this happens, substances within the blood vessel lining can form a blood clot, blocking blood flow through the artery to the heart muscle, and causing a heart attack. Aspirin inhibits an important enzyme in that clotting process. So although taking an aspirin will not stop the progression of coronary artery disease, it can help stop blood clots from forming, lessening the risk of heart attack.

How much aspirin should be taken? A tiny amount of aspirin can inhibit this aspect of blood clotting in a test tube. Your body, though, is not a test tube. When aspirin is in your blood stream, its effect varies, so the exact beneficial amount is difficult to establish. As little as 80 mg (a baby aspirin) may be effective. However, most cardiologists recommend taking one 325 mg pill (an adult aspirin) each day.

The least expensive type of generic aspirin that you can find will work. Many people find the enteric coated type preferable because they cause less stomach irritation. Remember, though, aspirin substitutes, such as acetaminophen (Tylenol) and ibuprofen (Advil) are not used for reducing platelet activity.

Although most people can safely take aspirin, not everyone can. If you have kidney problems, bleeding disorders such as hemophilia or low platelet count, or if you participate in hobbies or sports in which you may be injured, such as horse-riding and mountain climbing, consult a physician before taking aspirin on a regular basis to prevent heart attack. Of course, if you are allergic to aspirin, you should not take it.
In addition to preventing heart attacks, aspirin has also been known to reduce the risk of stroke. However, you should take aspirin only on your doctor's recommendation.

As important as aspirin may be in preventing heart attacks, you are only fooling yourself if you look upon it as a substitute for making other lifestyle changes, such as quitting smoking, losing excess weight, or exercising. What you can do is to ask your doctor whether you should begin a daily aspirin regimen.

CONSIDER TAKING VITAMINE

Recently, vitamin E has been heralded as the latest weapon in the arsenal against heart disease. Although all of the evidence is not yet in, current research indicates that taking a daily vitamin E supplement may be useful. Vitamin E is one of a group of vitamins called antioxidants. This means the vitamin helps counteract the effects of oxidation, the process that causes metal to rust, butter to turn rancid and, some researchers believe, that leads to the formation of fatty plaque build up in the coronary arteries. Studies have indicated that both men and women who took daily vitamin E supplements had a significantly reduced risk of heart disease.

However, these studies are not considered conclusive. Although they involved a large number of participants, the results showed only a subtle link between vitamin E and the reduced risk. This means the studies were not subjected to the rigorous double-blind technique that leads to conclusions beyond dispute. Although concrete scientific proof is still lacking, these results show promise. Remember, even though it is sold over-the-counter, vitamin E can be harmful to people with some medical conditions, or those taking some types of medications. For example, people with a rare deficiency of vitamin K can develop severe bleeding problems from large doses of vitamin E.

Many cardiologists endorse the taking of vitamin E, and some take it themselves. The optimum daily dose of 400 TU of vitamin E is safe and effective. Two other vitamins of the antioxidants group including beta carotene and vitamin C were not found to be as effective as was vitamin E.

CONSIDER HORMONES: FOR WOMEN ONLY

Since you have heart disease, you want to do everything possible to prevent if from worsening or leading to a heart attack. Many studies have shown that by taking estrogen, the female hormone, women can reduce the risk of heart disease. Although not all evidence is in yet, many cardiologists find the studies very convincing. Yet taking hormones is not completely without risk. So there are some important things to keep in mind.

As women age and their estrogen decreases, they run a higher risk of dying from heart disease. It has not yet been determined exactly how estrogen works, but it appears to positively affect a woman's cholesterol profile, lessening the narrowing of the arteries that occurs with heart disease. Estrogen also helps prevent osteoporosis, the so-called 'brittle bone' disease which afflicts older women.

But the issue is not that clear-cut. For the past half century, discussion has been centered on whether the pros of taking estrogen outweigh the cons. Estrogen therapy fell into disrepute in the 1970s, when it was found to increase the risk of a woman's developing uterine or endometrial cancer. Since then, hormone replacement therapy has undergone a major change. Scientists discovered that combining estrogen with progesterone, the other hormone produced during a woman's menstrual cycle, greatly reduced the risk. This combination is now generally known as hormone replacement therapy, or HRT.

Most studies showing the positive effects of the hormone on the heart had involved estrogen alone, but in 1994 results of a major study showed that the combination does help prevent heart disease. More research on this is underway. If you have undergone a hysterectomy, uterine cancer is no longer a threat, and you are a candidate for pure estrogen.

Another controversy surrounding both estrogen and HRT is whether they increase the risk of breast cancer and if so, to what degree extent. The studies have been contradictory, but more studies indicate that long term use of HRT does increase the risk of breast cancer. More experts contend this increase is only slight, but some differ. Again, research in this area is also • underway. If you apt for HRT, follow the American Cancer Society's recommendation for mammograms and breast examinations.

Until more research results are available, we will stop short saying that it is essential that you undertake replacement hormone therapy. However, if you are a female with coronary heart disease, we believe you should seriously consider it, taking your individual risks and benefits into consideration.

Discuss HRT with your doctor. To fully explore all your options, you may find that a second opinion is worthwhile. If you opt for replacement hormones, you can revaluate your decision as more information becomes available. Make sure you are on the lowest possible dosage considered sufficient, to help protect your heart and bones.

BE PREPARED

One of the most important things you can do for your heart is to be prepared in the event of a cardiac emergency. Since you have a heart disease, you are at increased risk of suffering a heart attack. But, instead of living in fear, empower yourself. Learn the symptoms of a heart attack. Discuss with your doctor exactly what you should do in such an event. Map an emergency plan and make your family aware of it as well.

LEARN CPR AND ENCOURAGE OTHERS TO DO SO

If you have heart disease, the people with whom you live and work could save your life. But they have to know how to perform CPR. CPR, known otherwise as Cardiopulmonary Resuscitation or Basic Life Support (BLS) is a proven lifesaver. If you are not medically trained, it is normal to doubt your capabilities in an emergency. Indeed CPR was once considered only appropriate for medical personnel. But today, most lifeguards are required to learn CPR. It is also now required for high school graduation. People in all walks of life have enthusiastically learned the technique and are proud of their ability to use it, if called upon in an emergency. If you have severe heart disease, or are frail or disabled by other illness, ask your doctor if performing CPR would be dangerous for you. If it is not, consider learning it. Encourage your family and co-workers to learn it, too. They may someday help save your life, or you may do the same for them.

CHEST PAIN

The type of chest pain caused by coronary heart disease is called angina pectoris. This chest pain occurs when your heart muscle is doing its job, but is not receiving enough oxygen, usually because of a narrowing in a coronary artery. This type of angina is directly related to physical exertion. A second type, known as vasospastic angina, occurs during periods of rest, or may even awaken you from sleep. This type of angina results from a temporary spasm of the coronary artery, not from a permanent narrowing.
Your doctor can give you guidelines to help you plan what to do in the event of chest pain due to a heart problem. Do not procrastinate. Nobody wants to face the possibility that something may be amiss. For men, it may be a 'macho' thing. Women, on the other hand, sometimes tend to delay getting help because they are too afraid of the potential impact of a heart emergency on their families. Chest pain may be your heart's warning to you that something is wrong. Do not panic, but do not ignore it, either.

What you can do is to pay attention to your chest pain. Evaluate it so you know when it occurs and whether it is more frequent or severe. Discuss with your doctor whether or not you should take nitroglycerin when you experience chest pain. If your physician has given you a prescription for rapidly acting nitroglycerin, be absolutely sure you know when and how to take it and what to do if it does not work. If the pain is new, that is, different from your earlier experiences or the pain does not respond to what your physician has prescribed, follow the emergency plan you have discussed with your doctor in advance. Create an emergency plan as follows.

HEART ATTACK - HOW TO ACT

If you suspect you are experiencing a heart attack, you need to take fast action. By acting quickly, you may be able to take advantage of new treatments that could not only save your life, but spare your heart damage. With heart disease you are at increased risk of suffering a heart attack, so it is crucial to have an 'emergency plan' mapped out and ready for use.

There are some important things you can do to prepare for an emergency. Firstly, you should discuss with your doctor the specific steps he or she would want you to take. Secondly, you should carry a copy of your EKG (ECG) printout with you at all times. This is an electronic graphing of your heartbeat. If you have heart disease, or if you have undergone heart surgery, or if you ever suffered a heart attack, these tracings may be normal for you, but appear markedly abnormal to someone who does not know your medical history. Ask your doctor for a copy of your most recent EKG. Having a copy of your EKG can be helpful, should you ever be taken to the hospital. This way, it can be quickly ascertained whether your EKG results are indeed in the normal range, or whether you may be suffering a cardiac emergency. Such an emergency plan could very well save your life.

In the old days, if you were suffering a heart attack, it was important to get to the hospital quickly, so doctors could stabilize your condition and possibly save your life by treating complications of the attack. Yet, they could do nothing except let the heart attack run its course, resulting in whatever damage to your heart muscle that occurred. Nowadays, it is possible to stop a heart attack in its tracks, and minimize the heart muscle damage. But treatment is available only if you get help quickly.

The development of a class of drugs known as thrombolytics has caused this momentous change in treatment. These are known as 'clot busters'. A heart attack usually occurs when a blood clot forms within a coronary artery and cuts off the supply of oxygen-filled blood to the heart. Clot busters are powerful drugs which act to dissolve the clot, enabling the flow to resume. But they must be administered quickly.
There are different types of clot dissolvers. Tissue plasminogen activator, tPA, is one type; another is streptokinase. What is important to remember is that if you have been given streptokinase before, you should be given tPA, because using streptokinase a second time could result in a severe allergic reaction. If you are an African American, you should know that while both drugs work for you, research shows tPA to be more effective.

If a cardiac emergency arises, you should:

• Never attempt to drive yourself to the hospital. In general, studies have found that calling the local emergency number is the quickest method to get help.
• Call up the number and tell the dispatcher that you think you are having a heart attack. Give the dispatcher your exact street location. Make sure your house is posted with a clearly visible number, and specify the floor, room or apartment number. Turn on the outside lights, if it is dark outside.
  
• Contact your cardiologist immediately. The cardiologist's number should be kept by every telephone in the house. Discuss with your cardiologist beforehand whether he or she may be best contacted at the office or at the clinic, or hospital.

If you arrive at the hospital's emergency room on your own, clearly state that you may be suffering a heart attack. This is especially important for women, since studies have shown that doctors sometimes overlook heart disease in women. If it turns out you are not having a heart attack, so much the better. But, since, as a woman with heart disease, you are at risk, emphasize that you do not want to deprive yourself of potentially life-saving treatment.

As a heart patient, you are also at increased risk for stroke as well. As with heart attacks, it used to be thought that nothing much could be done immediately for a stroke. But treatment with clot dissolvers is also being found effective for strokes. If you think you may be having a stroke, follow the same advice to get help quickly. What you can do is to know the symptoms of a heart attack. You may be having a heart attack if:

1. The pain comes on suddenly over a minute or two and increases in intensity.
2. The pain occurs near the centre of your chest.
3. The pain lasts for atleast twenty minutes and is not relieved by rest or by changing position.
4. The pain ranges from mild to  severe,  and usually accompanied by feelings of tightness or heaviness.
5. The pain radiates up into your jaw, your back, or down your left arm.
6. You experience nausea, shortness of breath, or a sense of 'impending doom'.

It is important to remember that these are the common symptoms of a heart attack in both men and women. Studies have shown, however, that women often experience more subtle symptoms such as discomfort in indigestion or difficulty in breathing.

You may be having a stroke if you experience:

• Sudden weakness or numbness of the face, arm, or leg on one side of the body.
• Sudden difficulty speaking or understanding others.
  
• Dimness or impaired vision in one eye.
  
• Loss or near loss of consciousness.
  
• Confusion.
  
• Unexplained dizziness or sudden falls, especially along with any of the above symptoms.
  

A person who is faced with an impending stroke may suffer a TLA (transient ischemic attack), or mini-stroke.

The symptoms are the same as of a stroke, but their duration is brief, usually for several minutes to half-hour. If you experience what may be a TIA, also get help immediately.

CHOOSING THE RIGHT HOSPITAL

In an emergency, you do not have the luxury of choosing a hospital; you must go to the closest available. But many times heart procedures are elective, which means they are not done on an emergency basis. You should know how to choose the right hospital in the event you need one.

If you require heart surgery, or an angioplasty-type procedure, you may select your doctor first. In doing so, you will be choosing the hospital where the physician is permitted to practice. On the other hand, you may have a particular hospital in mind; then you will be choosing among the doctors who practice there. Either way is fine, as long as you are making the best decision for yourself. Bear in mind that your future well-being may very well depend on your decision. You may be tempted to choose a hospital which is close by to minimize the inconvenience to your family. This is fine, but make sure you will be getting the best medical care there as well.

Comparing hospitals is not easy. As health care gets more competitive, hospitals are using more advertising and making more grandiose claims. Check them out carefully. Be wary of hospitals that tout themselves as 'heart centres' but really have limited cardiac offerings. There should be at least two surgical teams available, for example, in the event a member of the team becomes ill or goes on vacation. Also, if you need- to undergo cardiac catheterization, be careful about catheterization laboratories which claim to perform 'low risk' procedures. In the event of an emergency, angioplasty or surgery may become necessary, and these labs often lack the facilities to perform them.

(Experts agree that there is a minimum number of procedures that should be performed in a hospital in order for them to be competently performed).
They are:

1. Cardiac catheterization (also known as coronary angiography) - 300 per year.
   
2. Balloon angioplasty - 200 per year.
3. Coronary bypass surgery -150 per year

Bear in mind that many hospitals tout 'laser' angioplasty, giving the impression that this high-tech treatment is available for coronary artery disease when it really is not. Coronary 'laser' angioplasty is still an experimental technique, performed in only a few places in the country.

If you are higher than average risk for cardiac procedures, then you might want to consider a regional or even a national heart health centre. How do you know if you fit this description? Discuss it with your doctor.

Factors that increase risk include:

1. Whether your heart has been previously damaged by a heart attack or other cause.
   
2. You have multiple heart problems, such as both heart disease and a faulty heart valve.
   
3. You underwent open heart surgery before (particularly if you did not do well).
   
4. You have potentially complicating medical problems such as diabetes and/or high blood pressure.
   
5. You are over sixty-five years of age. Open heart surgery is now being done successfully on people in their seventies or even eighties, but the risk is higher.
   
6. You are a woman. Cardiac procedures are effective and may be life-saving for a woman, but being a female also may increase your risk of complications.
   What you need to do is to visit the hospitals in your area. Learn their area of expertise. Knowing you have selected your ideal hospital, should you ever need it, will give you peace of mind.

KNOW WHAT TO EAT

The kind of food you eat can make a difference in your fight against heart disease. That you must stick to a low fat diet probably does not come as a surprise, but it probably does not come as welcome news either. Some people do not care about what they eat and can easily adapt to a strict diet. Many of us, consider good food to be one of life's pleasures, and we fear that having heart disease will sentence us to a life of stiff food restrictions. This really is not the case at all. What you need to know is how to create a delicious eating plan that will stay within the low-fat guidelines and will help you in your fight against heart disease.