Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

16 Tammuz 5760 - July 19, 2000 | Mordecai Plaut, director Published Weekly








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Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Know Your Enemy

Last week we spoke about heart attacks, how they happen and what occurs to the heart when they do. Now we will discuss what you can do about them and how to protect yourself.

First and foremost is to reduce your risks. Lose weight, reduce stress, exercise and stop smoking -- all these will help even now. Not an easy demand, but programs exist. Other risk can be reduced with medications: blood pressure must be measured at least once a year after you reach age 35, and high blood pressure must be treated even if you feel "great." (We'll discuss high blood pressure in a future column.) Cholesterol must be measured and treated if high (a low fat diet is a good idea in any case). Diabetics must take their disease seriously, and check their sugars frequently. People with strong family histories should consider a frequent stress test.

Chest pains should be taken seriously. All chest pain should be checked out by a physician, but the following are higher risk: Chest pain at rest, chest pain that radiates to the back, or down the left arm, chest pain that does not resolve within a few minutes, left-sided chest pain. Lower risks are chest pain that changes with breathing or movements, chest pains in people under 30, chest pain which is reproducible. Heart attacks are also more common in the early morning, and in people who are unconditioned and overexerting themselves.

In the acute stage, the doctor will take a good history and physical exam, and do an EKG. EKGs are not always that reliable but if they show a heart attack in occurring, therapy should be commenced immediately. Blood tests can also be done, though some are not reliable until 6 hours have passed. Early on, it is still a judgment call and a guarantee that "it isn't your heart" can never be given. Even stomach problems can mimic heart problems and vice versa (a gassy feeling in the chest can be a heart attack) and often the same medicines help both conditions. Feeling better after taking an antacid proves nothing. This all sounds very scary, but remember, we are talking about an experienced killer -- he knows how to do his work well.

Should a person collapse not have a pulse, CPR and early electrical shock can be life-saving. Learning CPR therefore is a must, and calling for help early is well-advised. Minutes do make a difference and your knowledge of CPR can save a life. Some hospitals concentrate on cardiac care and they may have better physicians and equipment. As outcome -- especially in heart attacks affecting the front part of the heart -- is related to the quality of the physician caring for the patient, it pays to do research in advance and request transport to such a hospital. Heart attacks in the front of the heart are often the most serious ones.

After a heart attack, a good rehabilitation program is a must for those who wish to resume a normal life. We don't keep people in bed for weeks after a heart attack any more. Medications such as beta blockers extend life; nitroglycerin can help with the pains of angina and post heart attack. A good doctor and a healthy attitude can return a person to a normal quality of life after a heart attack. If we take chest pain seriously, exercise and eat right, and all learn CPR, we can beat this killer. Write me in care of the Yated.

A Message from Glaxo, sponsor of this column: Heartburn, sour stomach, gas--if you suffer from these problems, then you know what misery is. Now in Israel and in many other countries, Zantac 75 is available without a prescription. Zantac blocks the manufacture of excess acid as opposed to neutralizing acid like antacids. It is easier to take, has no chalky taste, and is unquestionably safe.


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