A study suggests that people who are most distressed during a heart attack have higher levels of particular chemical markers in their blood.

People with an intense fear of dying during a heart attack could suffer a worse outcome, research suggests.

London-led researchers asked 208 patients to rate their levels of fear following a severe cardiac event.

People who reported they were most distressed during an attack had higher levels of chemical markers – linked to inflammation – in their blood.

Writing in the European Heart Journal, the authors say heightened inflammation may lead to poorer long-term health.

“Large inflammatory responses are known to be damaging to the heart, and to increase the risk of longer-term cardiac problems such as having another heart attack, ” said British Heart Foundation professor of psychology, Andrew Steptoe.

The research, led by a team at Imperial College, found that patients who reported an intense fear of dying had raised levels of TNF alpha – a marker that has been linked to inflammatory processes in the body.

They also measured heart rate variability and the stress hormone cortisol, three weeks after the event.

Professor Steptoe, who worked on the study, said: “Fear of dying is not just an emotional response, but is linked into the biological changes that go on during acute cardiac events.

“This is an observational study, so we do not know whether helping people overcome their fears would improve the clinical outlook.”

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “This study suggests that people who are most distressed during a heart attack have higher levels of particular chemical markers in their blood, which are associated with greater inflammation in the body.

“Inflammation has previously been linked with an increased risk of heart attack but we don’t yet fully understand why.

“What we need to know now is whether we can allay people’s fears at the time of a heart attack and whether this actually translates into better outcomes in the long term.”

Read more on the Heart Attack Fear Study here ».

Free medical advice online published by Dr Vivienne Balonwu. Categorised medical advice.

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A stroke is when a part of the brain suddenly becomes unable to function. This is due to a lack of oxygen, and so all strokes have the common factor of disease affecting the blood supply to the brain. This usually occurs with little or no warning, and causes weakness and paralysis of any part of the body depending on the part of the brain affected. In the United Kingdom, someone has a stroke every 5 minutes.

What Causes Stroke?

The main cause of a stroke is a blockage to the blood flow, or the bursting of an artery to the brain. When an artery is blocked, this is called a cerebral infarction. When there is bleeding into the brain, it is called a cerebral haemorrhage. There is a third kind of stroke, called an embolic stroke. This is where a blood clot travels through the body and blocks an artery in the brain to form a plug, or embolism.
The diseases which cause strokes to occur are similar to those which cause heart disease. Arteries in the brain may block due to them being furred up by fatty material in the same way that heart arteries become blocked and cause heart attacks. Blood clots can arise from heart diseases where the heart has an irregular rhythm, or where there is damage to the valves of the heart. When a cerebral haemorrhage occurs, the commonest cause is due to a weakness in the wall of an artery – called an aneurysm. These are sometimes present in people from birth as an inherited weakness, but more commonly are the result of high blood pressure.

What Are The Signs And Symptoms Of Stroke?

Any symptoms that occur after a stroke are immediate, and depend both on the area of the brain involved and the degree of damage caused. The commonest symptom is weakness or paralysis of one side of the body. There may be loss of sensation and movement of part of an arm or leg, or complete loss of any function along one side of the body. Speech is often affected, along with facial weakness and tingling or numbness of the face. If the stroke affects the base of the brain, there may be problems with swallowing, breathing and consciousness.
Some patients have a warning attack some time before a major stroke. This is often in the form of a short-lived weakness or numbness down one side, or a temporary problem with speaking. These are called TIAs – transient ischaemic attacks – and are usually completely better within 24 hours.

Will I Have Any Tests Or Investigations For Stroke?

The main test of use if a stroke is suspected is called a CT scan. This will not only rule out any other possible causes for a patients symptoms, but is also able to confirm whether a stroke is due to a clot or bleeding. If it is due to a clot, the heart will be tested for any source of these such as valve problems. It may also be necessary to perform a soundwave test called a carotid ultrasound, which looks at the arteries in the neck to see if there is any kind of blockage to the blood flow there. A neurologist – a doctor specialising in brain disorders – may assist in the diagnosis and management of stroke patients. The main care of patients who have had a stroke however remains good nursing care.

What Treatment Might I Need?

Initially, if the blood pressure is found to be high, this will be lowered by medication. If a clot is the cause, aspirin is started and if it is found there are problems with the heart valves, warfarin – a blood thinning drug – will be used. Any rise in the blood sugar level, which often occurs after a stroke, will be closely controlled, and oxygen may be needed in the early stages to try to minimise the brain damage.

What Course Will The Illness Follow?

This entirely depends on the severity of the stroke and how much damage it has caused. In the early stages there may be problems with swallowing, which in turn can lead to breathing difficulties or chest infections. Once a patient’s condition has settled however, attention is turned to maximising the function that remains. This involves intensive treatment by physiotherapists to improve mobility, occupational therapists (who use a wide variety of activities to help regain dexterity), and speech therapy. The aim is always for the patient to resume as many of their pre-stroke activities as possible, but a total return to their previous condition is the exception rather than the rule. Physical therapy may continue following discharge home, but some stroke patients cannot be cared for adequately at home and so need residential or nursing home care long-term.

Can I Do Anything To Help Myself?

The main factor is to identify and treat high blood pressure – this alone reduces the risk of stroke considerably. Just as important is stopping smoking since the furring up of arteries in the brain and neck is greatly speeded up by smoking. If there is any diabetes, a good control of the body’s sugar level is very important as is controlling the level of cholesterol in the blood, either by diet or tablets. Should the heart be beating irregularly, tablets such as digoxin should control this. This is often used in combination with aspirin or warfarin as blood thinning medicines to reduce the risk of any further strokes.

Tell Your Doctor

1. Did your symptoms occur suddenly?
2. Do you smoke?
3. Does anyone else in your family have similar problems?
4. Have you been treated for high blood pressure in the past?
5. Have you ever had what have seemed like stroke symptoms, but which have disappeared after 24 hours?

Ask Your Doctor

1. Am I at risk of a further stroke?
2. How often will I need my blood pressure checked?
3.What help can I get at home to help me with mobility and my daily activities?
4. If I am able to do them, will activity or exercise hurt me?
5. Will I need to stay on Aspirin or other tablets for life?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free Medical Advice Online, Published by Dr Vivienne Balonwu. Get advice, further information and help from The Stroke Association.

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A heart attack (sometimes called a coronary, a coronary thrombosis, or a myocardial infarction or ‘MI’) is when part of the heart muscle stops working because not enough oxygen is able to reach it through the heart’s blood supply – the coronary arteries. Any heart tissue that stops working during a heart attack is replaced by scar tissue that is unable to work again and will not heal. Therefore the more heart tissue that is starved of oxygen, the less well the heart can function after a heart attack.

What Are The Causes Of Heart Attack?

The blood supply to the heart is usually stopped by a blood clot in the coronary arteries, causing the heart attack. The arteries are narrowed in places due to ‘plaques’ – a build-up of the fatty substance cholesterol over many years. As this build-up of cholesterol increases, the arteries narrow – a process known as atherosclerosis. This process is speeded up by many other things, including smoking, high blood pressure, too much fat in the diet and diabetes. Being at risk of having a heart attack may also be passed down a family, as having parents or other relatives who have had a heart attack can incease the risk of having a heart attack. Most heart attacks occur in middle-aged men, and are rare under the age of 35. Women tend to have their heart attacks after their menopause.

What Are The Signs And Symptoms Of Heart Attack?

The main symptom is a dull, ‘heavy’ type of chest pain, usually in the centre of the chest. This is often described as a ‘pressure’ or ‘like someone sitting on my chest’ or an indigestion-like symptom. Pain may be felt in the jaw. There is usually some sweating and a feeling of being sick, or actual vomiting. The patient looks unwell, with a greyish colour and may be short of breath. However, up to a quarter of all heart attacks either have no symptoms – a ‘silent’ heart attack – or very mild symptoms which may be ignored by the patient. The most common time for heart attacks to occur is in the early morning, from 5 am to 10am.

Will I Have Any Tests Or Investigations?

The medical history and appearance of the patient will suggest to the doctor a diagnosis of a heart attack. This diagnosis is confirmed by an electrocardiogram (ECG) which shows the heart beat and electrical pattern of the heart. This shows up any non-working tissue in the heart as well as any heart muscle which is short of oxygen. A heart attack will produce very characteristic changes on an ECG tracing. If the ECG appears normal, or if the changes are only mild or borderline, then blood tests carried out some hours later can confirm whether there has been damage to the heart muscle or not. These tests pick up proteins which are released into the blood from heart muscle that has stopped working.

What Treatment Might I Need?

The aim of treatment is to restore the blood supply to the heart as quickly as possible this will stop a heart attack. The best way to do this is to dissolve the blood clot in the artery – a process called thrombolysis. The simplest way to do this is to give the person a dissolvable aspirin tablet under their tongue if they are conscious since this will begin thinning the blood immediately. Once in hospital, ‘clot-busting’ drugs can be given to continue this treatment, and these will open the majority of blocked blood vessels within 90 minutes.

These drugs are usually given on a coronary care ward which specialises in dealing with heart attacks. Speed is important here as most of the permanent muscle damage caused by a heart attack has taken place by 6 hours after the start of the attack. In specialised centres, patients may be given an angioplasty which is where a tiny balloon (known as a catheter) is pushed into the artery under X-ray guidance and to the site of the blockage before being inflated. This pushes the clot and plaque out of the way and so restores the circulation in the heart to normal again. Tablets may be given to prevent any complications. These include:

ß-blockers – which reduce the strain on the heart. These drugs may need to be taken for life.

ACE inhibitors – another class of drugs – which improve the heart muscle healing process.

What Course Will The Illness Follow?

Most patients admitted to a coronary care unit will spend several days there being monitored before being transferred to a general ward. They will be encouraged to begin walking around after a few days and will be monitored for any problems with the heart rhythm, shortness of breath or further chest pain. If a patient continues to suffer with any of the above problems, they may need further treatment, such as a change in medication, angioplasty or heart surgery. Provided there are no complications, most patients are allowed home after 5 to 8 days, and recovery is gradual. The time needed to return to normal activities depends on the size of the heart damage, with most patients being able to resume normal daily and sexual activity within 3-4 weeks. During this recovery period, vigorous exertion should be avoided such as heavy lifting or any work which causes sweating or shortness of breath.

Can I Do Anything To Help Myself?

As well as continuing to take regular medicines such as aspirin and ß-blockers, there are a number of ways to prevent the chances of a further heart attack:
1. The most important one is to stop smoking and never start again.
2. Losing weight reduces the strain on the heart, as does controlling any high blood pressure.
3. A low-fat diet will reduce the amount of cholesterol in the blood, and regular steady exercise will strengthen the heart muscle.
4. Try to reduce the amount of stress you may be under, which may mean taking a long look at your job and pace of life in general.

Tell Your Doctor

1. What symptoms do you have?
2. What type of pain is it?
3. When did the symptoms begin?
4. What were you doing at the time?
5. Does anyone in your family have heart problems?
6. Do you smoke?
7. Have you had any similar symptoms before?
8. Are your symptoms getting worse or better?

Ask Your Doctor

1. Is my heart beating regularly?
2. Will I recover normally?
3. Do I need to stay on treatment for life?
4. Are any of my family at increased risk of heart problems?
5. Will I be able to return to my usual work?

By Roger Henderson, MB BS, LMSSA

Free Online Medical Advice published by Viv Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Cholesterol Plague In Blood Vessel

Cholesterol is one of the fats present in the body. It is essential for life, and is found in all human and animal tissues. It is carried around the body by the blood. Some cholesterol comes directly from food, and some is made by the liver.

High blood cholesterol is usually due to eating too much fat. It can also be caused by not getting enough exercise. Occasionally, high cholesterol runs in the family, and in these circumstances it is due to the body not coping well with normal amounts of cholesterol being eaten.

Why Are High Levels Of Cholesterol A Problem?High blood cholesterol can cause health problems. The most important of these is heart disease, including heart attacks. High cholesterol levels cause fatty deposits to build up inside blood vessels. Eventually the vessels can block and blood cannot flow through them. This is particularly likely to happen in the narrow vessels which supply blood to the muscle of the heart (the coronary arteries). This may cause damage to the heart and can cause a heart attack. If you have high blood cholesterol, whatever the cause, it is possible to do something about it and so reduce your risk of developing heart disease.

What else causes heart disease?

High blood cholesterol is only one of several things which can lead to heart disease. Other things include smoking, high blood pressure, stress and lack of exercise. These are called ‘risk’ factors because they increase the risk of heart disease.

The more risk factors you have, the more likely you are to develop heart disease. To reduce your risk of heart disease, it is important to identify and control as many of your risk factors as possible. High blood cholesterol is only one of the risk factors to consider. Your doctor will be able to assess and advise you on all your risk factors.

Healthy levels of blood cholesterol

Your doctor or nurse will take a blood sample to measure your cholesterol level. Measurements can vary slightly, so it may be necessary to take more than one sample to be certain of the real level. Your doctor might also want to measure the levels of different types of cholesterol in the blood. These are HDL (high-density lipoprotein) cholesterol and LDL (low-density lipoprotein) cholesterol. They affect how likely it is that a high cholesterol level will lead to heart disease. Knowing about these will help your doctor to assess your risk of heart disease.

High Cholesterol Levels – What Can Be Done?

There are three main ways of reducing cholesterol levels: 1. to change what you eat; 2. increase the amount of exercise you take; and 3. take medication.

For most people, the doctor will recommend trying the first two approaches. This is often enough to get levels down to normal. If this doesn’t work, your doctor may prescribe a tablet. You are more likely to need medication if your cholesterol level is very high, if you have a lot of other risk factors, or if you have already had a heart attack.

Foods High In Cholesterol – Eating Habits

Changing what you eat can lower your cholesterol level. The main aim is to cut down the amount of fat you eat. However, the type of fat you eat is also important. Saturated fats (such as butter) tend to raise cholesterol. Cutting down saturated fats can lower your blood cholesterol by 20 per cent. Changes in your eating habits have to be long-term to be effective.

So you need to find a healthier eating pattern which you are happy with and can stick to. You can still enjoy your favourite food in moderation, and you don’t have to feel guilty about indulging yourself now and then.

What About Exercise?

Regular exercise can reduce cholesterol and so the risk of heart disease. Exercise also helps other risk factors for heart disease, including high blood pressure, stress and being overweight. The best activity is one that you enjoy. It does not have to be particularly strenuous. Walking, swimming, cycling and gentle jogging are all effective.

Try to take regular, moderate exercise, preferably every day. If possible, make it part of your daily routine. For example, walk short distances rather than take the bus or the car, or walk up stairs instead of using the lift. The more you do, the better, but any exercise beats none at all. If you are not fit, start gradually and build up your activity level over several weeks. Vigorous exercise can be dangerous. If you plan to do vigorous exercise, it is wise to see your doctor first if you:

Medication For High Cholesterol

Medication can be an effective way of lowering very high cholesterol levels. If you need medication, it usually needs to be taken long term. Your doctor will tell you whether or not you should consider taking medication.

By Dr Scott Lennox, MB, ChB, MRCG.

Free medical advice online published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Measurement Of Blood Pressure

High blood pressure is not a disease, but it is a major cause of heart disease and strokes. If you have high blood pressure and you also smoke, have high blood cholesterol or are generally unfit, the risk of you having a stroke or heart attack increases.

How Is Blood Pressure Measured?

Blood pressure is quoted as two numbers, for example, 140/85mmHg. The top number is the pressure in the arteries as the heart is pumping the blood around the body. The bottom number is the pressure when the heart is being filled with blood before it next beats and pumps blood. Blood pressure levels are normal or high as follows:

Blood pressure varies considerably throughout the day and is affected by your thoughts and actions. So your doctor should take at least three readings at different times to confirm you have high blood pressure.

What Causes High Blood Pressure?

In about 10 per cent of cases, the cause of high blood pressure can be related to another medical condition – this can be confirmed by your doctor. However, for most people, there is no specific cause for their high blood pressure, and it’s likely to be affected by a combination of things including:

Making changes to your lifestyle to address some of those factors can lower your blood pressure and reduce the need for medications.

Should You Change Your Eating Habits?

Don’t feel guilty about indulging yourself now and then – it’s OK to enjoy your favourite foods in moderation. Just remember that your diet plays a vital role in managing and reducing your blood pressure. One of the most important things you could do is to lose weight (if you are overweight). For every kilogram of body fat you lose, you can reduce your blood pressure by two points. To lose weight, you need to reduce your fat intake and increase physical activity. Some simple tips for improving your eating habits are listed below.

Try To Do The Following To Help You Cut Down On salt And Fat:

How Exercise Can Help

Regular exercise lowers blood pressure by about 5 to 10 points in people who haven’t been active before. Your blood pressure can be most effectively lowered by exercises such as walking, swimming, cycling and running. The ideal activity is one that you enjoy, so take the time to decide what you like best. There is no need to puff and sweat to benefit from exercise. Simply try to do regular, moderate exercise, preferably every day. The more exercise you do the better, but remember that any exercise (such as walking up the stairs instead of taking the lift) is better than none at all. If you’re on medication, be sure to discuss your exercise plan with your doctor. If you’re planning to do vigorous exercise, see your doctor if you:

Safety Tips

Stress

Too much physical and emotional stress can raise your blood pressure, so find out what’s causing your stress (both at work and at home), think positively to work out your priorities and goals, and try to relax both mentally and physically.

Medication

Many people need medication to keep blood pressure under control. There are a number of medications available, so discuss the choices with your doctor. If you’re on medication, take it as prescribed and be sure to discuss any problems with your doctor.

By Dr Michael Colquhoun, BSc, MB BS, FRCP,MRCGP, DRCOG.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.