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Feature Article of Sunday, 17 January 2010

Columnist: Akwele

Heart Attack

By Akwele

Kojo is visiting with his Uncle Kwame. His Uncle has just finished preparing fufu and palm-nut soup with smoked herring, kako, cow foot, wole and salted beef. It is not a secret that Uncle Kwame is the best cook in town. A lot of people love to eat his food. This day, Kojo is quite upset with him because he gave him just a piece of the meal. No sooner had Uncle finished eating than he started complaining, ”I have chest pain , I have chest pain.” To which Kojo retorted, “Uncle, if you hadn’t eaten two bowls of fufu and given me just a piece, you would not be having pain in your chest. Uncle, you are sweating and it is all from the hot pepper in the soup. His uncle is now holding on to his chest and neck. Kojo realizes that his uncle cannot catch his breath and his lips are turning blue. He is shaken now that he does not get much response from his uncle. He calls 911. They respond within minutes. Uncle Kwame is given aspirin to chew en-route to the hospital. This increases his chances of survival.

Heart attack – Myocardial Infarction, (MI) occurs when there is reduced blood flow to the coronary arteries leading to myocardial (heart muscle) ischemia which if not resolved can lead to necrosis (tissue death).

Risk factors include smoking, obesity, hypertension, family history, male gender, diabetes mellitus, sedentary life style (Job or lifestyle that requires a lot of sitting and not moving about much) and stress.

Signs and symptoms include chest pain that does not go away, it may radiate to the arm, back, neck or jaw. Diaphoresis, (sweating) nausea, vomiting and difficulty breathing. The person gets anxious and senses an impending doom. A woman suffering a heart attack will in addition to the above signs and symptoms feel like she has indigestion, feel weak and also have pain between her shoulder blades.

Diagnosis of heart attack include history, physical examination, blood work and EKG. Troponin is a protein released from heart muscle when it is damaged. The levels in the blood are elevated within one hour after the heart muscle is injured and can remain in circulation for about two weeks. The person’s blood is checked for this in addition to cardiac enzymes for a definitive diagnosis. Early treatment can lessen the amount of damage to the heart muscle. The physican treats the patient with different kinds of medication including nitroglycerin which is a vasodilator that opens blood vessels to improve circulation. Uncle Kwame received Morphine to relieve chest pain and anxiety that come with heart attack. Supplemental oxygen is given to improve oxygenation to the myocardium. Other medications are given according to the condition of the patient. Blood thinners are also given to thin the blood to improve circulation and to prevent blood clots that can travel to the heart, block the vessels and cause a heart attack. Some people may need surgery to open up occluded or blocked vessels to improve blood flow. When the person with a heart attack is stable, cardiac rehabilitation takes place. It includes exercise, medication and a heart-healthy diet.

The goal of rehabilitation is to assist the person to function to the best of his or her ability. Medication should be taken as prescribed. Low-fat, low-sodium diet and quit smoking. Maintain normal weight so that there is less stress on the poor heart. Chest pain should not be taken lightly although, sometimes it might be due to indigestion, yet one never knows when it is the “big one.” Stay fit.

Akwele is a Health Care Professional in the USA Reference: Lewis, Sharon M., Heitkember, M., & Dirksen, S. (2004) Medical-Surgical. 6th ed. St. Louis MI: Mosby Inc

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