One chapter of the book Love to Live and
Live to Love, copyright 2002 by Ken Wear.
This chapter excluded from copyright; copy it freely.

I am not medically trained so anything you read here should be interpreted as the product of my years and study and experience rather than advice from a trained physician.

HEART ATTACK
Perhaps the most prevalent debilitating illness is heart attack, but most of us, if we survive it initially, can with time and effort return to an essentially normal life.

Warning signs are:
1) uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back
2) pain that spreads to the shoulders, neck or arms
3) chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath
4) unaccustomed fatigue (especially in women) can be an early warning.
Not all these warning signs occur in every heart attack, but we novices are ill-prepared to distinguish between real heart attacks and these discomforts.

Traditional advice is that, if some signs start to occur, don’t wait; heart attack is a medical emergency. Taking an aspirin, if your body allows it, may improve your chances of survival and recovery.

And conventional advice is this: Do not drive yourself to the hospital. Seek another since you don’t want to lose consciousness while driving. If you live alone, unlock your door and sit or lie down awaiting your ride to the hospital. Your fellow man will likely be sympathetic and helpful since they know that it is only by the grace of God they aren’t lying there in your place.

Discussion of Heart Attack is continued below.

STROKE
Then there is the stroke, in which a portion of the brain is damaged by restricted blood flow or leakage of blood into brain tissue; it leaves us with weakened mental faculties and possibly a resultant loss of portions of our brain function and therefore a part of our bodily function.

Warning signs are:
1) sudden numbness or weakness of the face, arm or leg, especially on one side of the body
2) sudden confusion, trouble speaking or understanding
3) sudden trouble seeing in one or both eyes
4) sudden trouble walking, dizziness, loss of balance or coordination
5) sudden, severe headache with no known cause
Note the word “sudden” in all of the warning signs. And not all these warning signs occur in every stroke.

Traditional advice is that, if some signs start to occur, don’t wait; stroke is a medical emergency.

Conventional advice is this: Do not drive yourself to the hospital. Seek assistance since your senses may be impaired; moreover, you don’t want to lose consciousness while driving.

Discussion of Stroke is continued below.

Continuing HEART ATTACK (includingANGINA). See also Heart Failure (below).

Aspirin is touted as beneficial in general, including conditions other than headache or other pain; it reduces stickiness of platelets as well as relaxing the muscles in the walls of your arteries and thereby allows blood to pass more freely. In cases of pronounced build-up of plaque, aspirin has the obvious effect of promoting blood flow, and the use of aspirin has been advertised as part of a heart-healthy regimen.

Symptoms versus time: To me advice from the medical community is confusing here. I suggest that, if you suspect you may be susceptible to angina or heart attack, you should develop a history with a doctor (or possibly also with a cardiologist). Should you experience symptoms that may be either angina or heart attack, you may not know which it is. If it is at all possible, cease physical activity, rest, and contemplate your need for medical attention. By all means, discuss it with your doctor.

If you have discussed it with your doctor, you likely carry a vial of nitroglycerin tablets. Upon recognition of symptoms use your nitroglycerin; if symptoms persist as much as five minutes use your nitroglycerin again; again, if symptoms persist as much as five minutes use your nitroglycerin a third time. If symptoms persist in spite of rest and the nitroglycerin, consider that it is a heart attack rather than angina.

Angina is of lesser severity but is also due to a heart muscle not receiving enough blood and oxygen. If symptoms are brief and resolved in a few minutes by rest or nitroglycerin plus rest, it is considered to be angina, which is not treated by the medical community as a heart attack. I suppose it is because the body responds to an insufficiency of blood by -- with time measured in weeks or months -- increasing the capacity of auxiliary blood vessels, so a partial blockage of blood is not considered of medical noteworthiness unless that blockage exceeds some 70%(?) or more. But, if your angina is becoming worse, then likely you should discuss this with your doctor.

By 'becoming worse' I mean:
(1)	developing new symptoms or
(2)	a change in your usual pattern of symptoms, such as
		(a) having symptoms after not having any for a long time,
		(b) symptoms coming on more often or during rest or sleep, or
		(c) symptoms lasting longer at a time or requiring additional nitroglycerin for relief

Traditional medical advice is that, if angina symptoms are not relieved within 15 minutes by nitroglycerin and/or rest, you have a medical emergency and should seek medical care at once.

From my own experience I would suggest this:
1) Do what you can in the way of immediate self-help (aspirin, nitroglycerin, cease activity, protection from weather, . . .)
2) Seek assistance -- 911 if available. You must decide if your chances for survival are improved by waiting for the ambulance, by riding as a passenger or by driving yourself; but you should also consider that other people may be put at risk (or, if by yourself, that you would be without assistance) should you lose consciousness.
3) Do what other steps you know of self-help while waiting for your assistance.

Because time is of the essence in treating heart attack, and a clot is so often the cause of ischemic pain (pain caused by lack of oxygen) a thrombolytic drug (“clot-buster”) may be used. I was advised there may be serious side effects but that the probability of clot is so prevalent that this is generally a wise first treatment. Time permitting, the heart arteries may be examined, by a process known as catheterization wherein a catheter (tube) is inserted into an artery some distance from the heart, guided into the heart artery, and then dye injected so X-ray pictures of blood flow can reveal restrictions.

If the blood supply to your heart muscles is near that critical level, then these activities may encourage angina or heart attack:
Exercise or exertion
A heavy meal
Walking up a hill or upstairs
Walking in very cold or in very hot and humid weather, or against a strong wind
Stress, fright, anger, or other strong emotions
Higher altitude than normal for you

I have read this claim dealing with a suspected heart attack: Without help, the person whose heart begins to beat improperly or erratically so he begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. I understand the American Heart Association does not recommend that the public use this method in a situation where there is no medical supervision. My personal opinion is that it is better to spend effort rather than meekly allow yourself to slip into unconsciousness, especially if you are caught alone with little hope of expeditiously reaching a medical facility. But you assuredly would not rely on that alone or take it as an adequate substitute for medical attention.

Continuing STROKE
While the brain itself may be unlikely to recover, with today’s medical technology, we can often regain the compromised bodily functions with therapy since the body may respond by reallocating regions of the brain so there is no permanent loss in apparent mental function. And new therapies are being researched.

That word “sudden” in all of the warning signs: Stroke is not something that slips up on you gradually week by week, or even day by day, but overtakes you within minutes (or even seconds). The conditions leading to stroke -- well, that is another subject and part of the purpose of this book.

Other warning signs may include double vision, drowsiness, nausea or vomiting. Sometimes the warning signs (notably the 5 listed above) may last only a few moments and disappear -- Transient Ischemic Attack (TIA) -- ‘mini-stroke.’ Although brief, they may identify an underlying condition that should not be ignored. While I would not advocate dashing to the hospital every time you feel drowsy or nauseated, it is true that vigilance is one of the keys to longevity, and incidents that are not otherwise explained should be part of your running mental record that you will wish to share with your doctor when next you see him.

Allow me to describe my stroke, happily a mild one whose effect depended on the area of the brain where the clot lodged. I awoke early morning aware that my brow was being rubbed, but when I looked the hand and arm seemed floating in space, to be detached from my body. I arose and found that my left hand could not return to the home keys of my computer keyboard without visual control and I had no sense of where my left arm was located with respect to my shoulder. In the days following there was partial recovery, but my typing skill has been decidedly compromised.

CONTRIBUTING FACTORS for both stroke and heart attack. There are several:
1. Genetics -- if your family has a history of cardiovascular problems. This you cannot change but must work around.
2. Build-up of plaque in the arteries, and that is influenced by:
3. Stress -- especially emotional -- or should I say distress?;
4. Exercise, or lack of it;
5. Diet, including consumption of saturated fats, trans-fatty acids, and cholesterol (in meats, eggs and dairy products);
6. Smoking tobacco;
7. Inflammation of arteries, which may trigger plaque deposits or their disruption. (This is a current research topic.)

You will note in the Table of Contents that there are chapters devoted to each of the voluntary or life style contributing factors. For instance the chapters on love, communication, disagreements and conflicts deal with factors underlying your emotional state. Substance abuse is entirely voluntary, so much in the public dialogue that I need say little. There are extensive suggestions on dealing with stress; inclusion of massage offers one means of reducing stress. The chapters on pleasuring and sexual delights are intended to offer specific information on improving these facets of life with a committed partner and hence help decrease stress from this perilous background. Chapters on diet and exercise offer specific information on foods and an exercise regimen. And Physical Bases discusses cholesterol and provides pertinent information on cholesterol, your heart, blood pressure, stroke, weight management and sex. All of these have as their one motivating factor reducing your risk of heart attack or stroke.

DIABETES: Let me note here, simply, that heart attack and stroke are events brought on by bodily conditions; diabetes is one contributing condition and not an event. In your running observations of self and assessment of bodily performance, you may note warning signs that suggest medical evaluation. Such as frequent urination (especially noticeable at night), excessive thirst, otherwise unexplained weight loss, fatigue or general ill feeling.

TAKING YOUR BLOOD PRESSURE:
I have learned to place more confidence in a sphygmomanometer (an arm cuff inflatable by the operator, a mercury column --or round pressure gauge with pointer -- to measure pressure, and a stethoscope for listening) than in automatic devices. Of course your hearing acuity figures in. [Since writing this my hearing has degraded and I have acquired an automatic device with battery driven inflatable arm cuff and readout, and I am well satisfied with consistency and reliability of measurement.]

Let me try to explain what you will hear in listening with a stethoscope as the mercury column drops (or as the pressure gauge reading decreases). Initially, the pressure is pumped high enough to cut off blood flow completely; as pressure drops, there is no sound since there is no blood flowing. Then, when the pressure has dropped sufficiently that blood may once again squirt through, a thumping sound is discernible, one thump with each beat of the heart. The thump may decrease somewhat in loudness as pressure continues to drop; then the thumping sound disappears when the pressure allows ready passage of blood. The pressure at which the thump is first heard is the systolic; the pressure at which the thump is heard no more is the diastolic.

Taking blood pressure is something of an art so don’t be surprised if successive measurements differ a little or if measurements taken by different people differ somewhat.

MEASURING YOUR PULSE (RATE OF HEART BEAT):
Wrist:
1) Turn hand palm side up
2) Use index or middle finger of other hand -- not thumb
3) Sense pulse on thumb side of upturned wrist (very near tendon)
4) Apply firm but light pressure and count for 10 seconds (watch or clock with sweep second hand) and multiply by 6.
Neck:
1) Use index or middle finger of either hand -- not thumb
2) Slide fingers diagonally from jaw bone to side of windpipe
3) As 4. above
Heart rate monitor (using chest and wrist units): Enough said already; it’ll give you a read-out.

There are wrist watches that convert a (manually) measured pulse to pulse rate; their primary function is that of telling time, with pulse rate apparently as an after thought. There are also heart rate monitors, with one unit attached to the chest -- to sense heart beat and broadcast a signal -- and a receiver with read-out attached to a wrist (similar to a wrist watch) that give a continuous read-out (which will display minor differences because of differences in synchronization of heart rhythm with initiation of time intervals within the wrist piece). Mine is sealed so batteries in both chest and wrist units are water-resistant and can be used in the swimming pool.

SIDE ISSUES

In our area there is a program, that I would commend to other communities, called VIAL OF LIFE. A pressure-sensitive decal is placed on an outside door where it can be seen by emergency personnel; there is in the refrigerator, near the door, a vial containing medical information that hospital emergency personnel may need, and the decal near the door serves notice to seek the vial for use in the emergency room. To serve its purpose it must, of course, be kept up to date.

TIAs: I present the thought, with no further comment, regarding accumulated effects of Transient Ischemic Attacks. There may be a residual effect of any TIA, and there may be accumulated effects, although the effect of any one TIA may be remedied by the body in the ordinary course of its operation.

DEMENTIA: As we grow older we notice various reductions of ability; while geriatrics is a comparatively new specialty, I am curious about the boundary between normal aging (and the cumulative effect of heart attack, stroke and TIAs) and dementia. With advancing years there is concern for mental decline. The term 'dementia' refers to a collection of symptoms caused by one of many disorders that affect the brain. People with dementia have difficulty with memory, language, motor skills, reasoning and emotional control; I'm uncertain if sense of balance should be included. Doctors commonly diagnose dementia if a person is conscious and has impairment of two or more brain functions. Risk factors parallel those for heart attack, stroke and diabetes.

THERAPIES: There are whispers in the news and advertisements of drugs that can reduce arterial plaques. And there are therapies that presently lie outside conventional medical practice but which should be pursued at least as an intellectual exercise. Chelation has been approved for ridding the body of heavy metals (such as mercury); it has been suggested for plaque reduction. Hyperbaric oxygen has been used with stroke patients, and omental transposition has been studied with victims of stroke and spinal injuries. I will not pretend to offer specific information but I have not myself pursued chelation because of concern for loosing fragments of plaque (as well as the possibility that happiness with the success of chelation may be the placebo effect), and I have not pursued hyperbaric oxygen because of my assessment of cost/benefit.

IN THE AFTERMATH OF HEART ATTACK OR STROKE:
Following heart attack or stroke there may be an emotional roller coaster; it is extremely helpful to have family and friends who can help you.

They may share your fears and try to be protective. To the extent possible you need to control your own attitudes and activities to prevent an overly protective effort. In dealing with a bad habit (such as cigarette smoking) you may need assistance from others if it is a habit you inwardly wish to retain although outwardly you fully recognize the burden the habit imposes on your body.

To family and friends: Let him do for himself (within his limits); help as needed but don't nag. Be a good listener. Practice good health habits yourself and take care of your own needs. Accept help.

HEART FAILURE and more recent information
While the information under HEART ATTACK is traditionally offered by public agencies, the pace of research is grueling and we have to sort through new information for what seems most credible.

I was surprised to learn that few victims experience stabbing pain, likely due to ventricular fibrillation, and fall to the floor (a Hollywood heart attack). About half have the textbook signs -- pain, pressure or squeezing in the chest -- possibly accompanied by burning or heartburn in the chest or stomach, and shortness of breath. About a quarter have non-typical symptoms -- face or jaw pain, fatigue, nausea, profuse sweating. And about a quarter have a ‘silent’ attack with no recognized symptoms and don’t know they have had a heart attack. These data suggest an altered understanding of what a heart attack is -- See discussions of arterial plaque in the chapter on Physical Bases -- and adds a distinction between heart attack and heart failure.

While possibly an outgrowth of weakening of the heart muscles as a consequence of heart attack, heart failure is essentially a different cardiac problem. Heart muscles may, for a variety of reasons, progressively become less able to exert enough pressure to provide an adequate flow of blood; the end point of this progression is heart failure. It is for these victims that machines are under development (and in use) to augment or replace these failing muscles.

Of course there are other possible heart problems such as congenital flaws in heart valve performance, which may respond to surgery or, in extreme cases, require machine replacements. Hopefully you and your doctor are aware of your congenital peculiarities.

POLITICS: While I have no idea what medical schools have done in increasing the number of seats for students during the past few decades, I recall well public discussion during the run-up to passage of the law that produced Medicare. The American Medical Association insisted there were already too many doctors. That generation of doctors is now retired but we are now beset with shortages of practicing physicians. It should have been obvious that availability of government assistance for medical costs would drive up demand, and costs for medical assistance is driven by competition (although new technologies are also expensive). Inflation (which is also pushed by medical costs) is a factor, but a large portion of the increased cost of your doctor’s attention is a direct result of too few seats for matriculating medical students. (It should also be obvious that the growing list of diagnostic tools need medically-trained personnel.) To my mind there is a pressing need for medical schools to respond to competitive pressures by increasing the number of seats for entering students so the percentage of rejected applicants can be reduced. That won’t reduce the onerous paperwork burdens Medicare has imposed on doctors (due to public demands to rein in costs), but it will assuredly help.

Extracted from the book by Ken Wear, July 2002, plus more recent information. This is only a portion of the life style and health information contained in the book; it is presented here for its vital educational value. This chapter is specifically excluded from copyright of the book as a whole so you may copy it and/or distribute it freely .

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