Sunday, December 11, 2011

Sodium can be a Killer

The sodium component of salt (salt (sodium chloride) is 40% sodium, 60% chloride) is vital for controlling the amount of water in the body, maintaining the normal pH of blood, transmitting nerve signals and helping muscular contraction. Salt is present in all foods in varying degrees, and almost all processed foods contain added salt.
  • Sodium is a mineral found in many foods. It helps keep normal fluids balanced in the body. But most people in developed countries consume much too much sodium.  The recommended daily limits differ by country: 
  • U.S. 1500 mg of sodium (Adequate Intake level) & 2300 mg (Tolerable Upper Limit)  . The U.S. average daily usage is 3,436 mg of sodium [1].
  • UK 2300 mg, 
  • Canada 1000-1500 mg recommended (the average usage in Canada is 3,100mg/day)).[3]
In Canada, the recommended daily limit is further divided by age.
            1000mg            less than 3 yrs
            1200                4-8 yrs
            1500                9-50
            1300                51-70
            1200                over 70 yrs

And, all these recommendations are even lower if you are in a high-risk group[2].

Now look at the amount of sodium in your diet.
  • Salt - 1 oz(28 gms) contains 6,852 mg of sodium.

Some people think that sea salt and kosher sale are healthier but their numbers are even worse, by weight, than regular table salt.
  • Sea Salt - 1 oz(28 gms) contains 13,104 mg of sodium.
  • Kosher Salt - 1 oz(28 gms) contains 10,453 mg of sodium.
But sea salt and kosher salt do have larger crystals, which means they take up more space and, in theory, are lower in sodium by volume standards.
Look at some other quantities of table salt:
  • Salt - 1 Tsp(6 gms)            contains            2,325 mg of sodium.
  • Salt - 1 Tbsp(18 gms)       contains            6,976 mg of sodium.
  • Salt - 1 Cup(292 gms)       contains        113,174 mg of sodium.
When salt intake is reduced, blood pressure begins decreasing for most people within a few days to weeks.

People who have experienced heart problems or have high blood pressure should follow a low-salt diet and be serious about taking advice from their health care professional. Reducing sodium has been proven to be one of the best ways of lowering high blood pressure, especially in combination with broader dietary changes.

Why worry about high blood pressure?
High blood pressure often leads to heart disease and/or heart failure and as a result, is considered a major risk factor.

What is high blood pressure?
High blood pressure is also called hypertension.
  • One in three American adults has hypertension, this represents about 50 million people. Up to half of them don't know it until they suffer a stroke or myocardial infarction (heart attacks). This is why hypertension is known as the "silent killer."
  • 34 million adults have high normal blood pressure. At least 1/3 of all heart attacks and strokes occur in people with high normal blood pressures.
  • Fewer than half of all Americans have ideal blood pressures.
High blood pressure is more common in:
  • People with family members who have a history of high blood pressure, cardiovascular disease or diabetes
  • African Americans
  • People 60 years and older
  • Women who take oral contraceptives
  • People who are overweight

Heart Failure & a Low-Sodium Diet
To educate yourself about sodium and diet, there are several areas to be aware of:
  • More than 4 million people in the United States suffer from congestive heart failure (CHF), according to the Cleveland Clinic[2]
  • Heart failure, the leading cause of hospitalization in people over the age of 65, means your heart is not strong enough to pump blood and deliver oxygen efficiently to all parts of the body.
  • A person with chronic heart failure often has to change his eating habits to make it easier for the heart to do its job.
  • A low-sodium diet is the same thing as a low-salt diet, according to the Heart Failure Society of America.
It is important to avoid salt when you have CHF or any form of heart disease because the condition causes the body to retain sodium. Water accumulates in the legs, ankles and abdomen and can cause shortness of breath or weight gain. Excess sodium makes the body retain water, and this extra fluid makes your heart work harder. And, if your heart can't work harder, it fails.

In future posts, we will discuss:
  • sodium in packaged foods
  • applied salt
  • cooking at home
  • fruits and vegetables
The U.S. Food and Drug Administration (FDA) has defined what nutrient content claims in food must mean[4]:
  • Sodium-free in U.S. food must mean that there is less than 5 mg per normal serving and that the food contains no ingredient that is sodium chloride or generally understood to contain sodium
  • Low in sodium in U.S. food must mean that there 140 mg or less per normal serving (and only 50 mg if normal serving is small)
  • Very Low Sodium must mean that there is 35 mg or less per normal serving.
  • Reduced Sodium must mean that there is a minimum of 25% less sodium per normal serving than an appropriate reference food.
With these restrictions, even when the sodium is reduced, the salt content may still be too high for you.

The message here is that sodium-free
doesn't mean free of sodium.


Saturday, December 10, 2011

Yale University Study on Heart Attacks wants Your Help

This is some information on a survey study that Yale is currently conducting.  It is about patients who delay getting medical help during acute myocardial infarctions (AMI) and acute coronary syndrome (ACS) events.  The study team knows that there isn't an effective intervention for getting people to the hospital much earlier than the typical median time of around 4 hours, even though it is known that one gets the most therapeutic benefit if they are in the hospital emergency department within the first hour of acute symptoms onset.

The difference between this study and others is that this one emphasizes:
1.    the behavior of the individual; and,
2.    the behavior of those around her or him in getting care. 

This study focuses on:
1.    a broad range of behavioral variables of :
    a.    decision making;
    b.    perception and interpretation of symptoms;
    c.    situational setting;
    d.    the advice and perceptions of lay others helping the individual;
    e.    the day and time of day;
    f.    prior experience with EMS systems and the health care system; and,
    g.    how the individual’s evaluation and level of concern changed over the care-seeking period.
2.    trying to compile a national sample of individuals rather than one taken from one hospital or community. 

The study team knows, from generally accepted data, that people delay on the second and subsequent events.  This is known as ‘cumulative adversity’.  People seem to delay a bit longer before seeking help because:
1.    they do not want to repeat the same experiences;
2.    they want to make certain that the event is real; and,
3.    they don’t want to burden family or friends if unwarranted.

The problem being studied in this effort is how do you get someone to drop all of their social activities to get medical care.  If you ask anyone what they would do if they had an AMI and they all say that they would seek care immediately. But few people drop everything and go.
1.    have to be certain it is a real problem;
2.    have to finish the task at hand;
3.    need to make arrangements if they are to be hospitalized;
4.    have to cancel appointments
5.    make sure they are clean enough for a doctor visit;
6.    don’t want to bother others, especially the hard working doctor in the middle of the night; and,
7.    don’t want to be taken out of their office or home by EMS personnel. 

They only agree to go when the signs and symptoms become so overwhelming that they have few choices or when someone takes charge of the situation and calls 911.

The text for this blog is from a previous interview with Angelo A. Alonzo, PhD, Research Scientist, at Yale University in New Haven, Connecticut and it is copied here as an encouragement for you to join the study.  It will take, at most, 30 minutes of your time. For me, it was only 16 minutes. So, please go to:

Sunday, November 27, 2011

Everything is Normal Until it’s Not

With serious illness, things that were normal before are not anymore. You're grateful to be alive but, some days, something is missing. There is this cloud over your head; a nagging feeling that things aren’t quite like they used to be.

It’s hard to put your finger on it – to describe to others what you are feeling. And others don’t understand why you can’t explain it.

It can be as simple as realizing your own mortality. 

You likely don’t have a fear of dying but you do have a fear of not being there for your family, of seeing your kids graduate, of seeing your grandchildren grow up.  And you feel that you can’t control any of this.  No one else seems to understand. Yet, you are the only one who can take the treatments or can die. Some days you may feel very alone.

Every ache and pain scares you.

All of this is normal.

If you are reading this, you are one of the lucky ones. What you are experiencing is still better than the alternative. (an estimated 17.5 million people died from cardiovascular disease in 2005, representing 30% of all global deaths. Of these deaths, 7.6 million were due to heart attacks & 5.7 million due to stroke. )  You have been given a second chance at life and the sooner you accept that your life must change, the longer you will live.

You and your body are in this life together.  You were living your life as you wanted but you were taking your body for granted.  A heart attack is one way that your body demands your attention.  Control over your life changes.  Your priorities in life change.  Your focus changes.  Your body demands it.  Listen to your cardiologist.  He speaks for your body.

You need to learn all about the requirements of your new life; this is your new normal

1.    You realize that you can’t do all the things that you used to do.  An example is sports. You probably used to do more than you can now.
2.    You have to spend more hours on your health each day than in the past.  Don’t take your health for granted; make it a priority.
     a.    You have to spend more time learning about your health.
     b.    You have to spend more hours on exercise than before. And exercise is now critically important to your continued health.
     c.    You have to pay much more attention to food because it is now more important than ever before.
     d.    If you weighed too much before your heart attack, now is the time that you must lose it.
     e.    Some days, you will need more sleep than before. (Studies show that a nap of 30 minutes or more at least three times a week produces a 37% lower risk of dying from heart disease. (
3.    You must reduce the stress in your life.
4.    You need to surround yourself with positive people.  Consider speaking with a counselor (a minister, a priest, a mental health professional, a family social worker).
5.    Involve your family as much as you can. This is also a major event for everyone in your family, except maybe the dog.  Yet, even the dog knows that you have suffered a trauma.  You may not realize that some days things are different; you are different. Try to be considerate and understanding.
6.    You may feel healthy but you now find that you’re not going to live forever, that you should plan for the future.  Things like wills, life insurance and health care become a priority.
7.    Once the necessities of life and death have been addressed, then consider one more.  Make a list of things that you have wanted to do but have been putting off until later. This is later.

You cannot ignore the trilogy of diet, exercise and stress.

Start each morning with:
          “I’m going to live, live, live until I die and not get the two confused.” 

Saturday, November 19, 2011

Organize your Medications - Set timers to not miss meds

The medications that you are taking for the recovery from your heart attack are critical to your ongoing good health.  In most cases, the choice of drugs, the quantities and the frequency have been carefully considered by your cardiologist, taking into account the other aspects of your health.  These parameters will be checked by your pharmacist as he knows, or should know because you always use the same drugstore, what other medications you are taking. By the way, be sure to keep your pharmacist up to date when your physicians have you stop taking a drug so that they can keep your records current.

I think that, before you take any new medication, you should research it on the internet. Look for side effects, how to use the medication and any conflicts with what you are already taking.  Sometimes you will find that an error has been made. Go back to the pharmacist first and your doctor second to correct such an error.

Also check on what to do if you miss a dosage or you take too many.  Know these things before they happen.

Some of the heart meds may need to be spaced out through the day so that they don’t interact incorrectly.  Some can counteract an earlier med from the same day.

To lessen the chance of making a mistake, use pill packs to plan your medications one week at a time.  You will then not have to think at each pill-taking time and you will be much less likely to make a mistake.

I also like to use reminders with alarms.  In particular, smart phones and computers can be give you visible and audible reminders.

Thursday, November 10, 2011

Prepare to Manage Your Medical Appointments

Your medical appointments are very important to your recovery and continued good health.  This article will detail things that you should do to manage your appointments.

1. Prepare for your medical appointment
  • Make a list of questions and prioritize them
  1. You will need to know various things about your condition, your meds and what you should be doing next.  You will have questions as the days between appointments go on and, unless they're written down, may be forgotten. Make a list of questions to be addressed.
  2. When you do meet with your doctor, if you are organized, you’ll be able to get the answers and information that you need. You will also likely get more time with your doctor and the time you do get will be more productive.
  3. Most doctors will appreciate you being organized and considerate of their time.
  4. Doctors also appreciate when you have times and dates of symptoms written down, and do not have to rely on your memory.
  5. Be prepared to answers all of their questions.
  • Prepare a food diary
Your doctor will want to know what you eat. You should keep a detailed diary so that you will know what you ate. I recommend keeping track of calories, sodium, cholesterol, total fluid intake and total fat.

  • Prepare a symptoms diary
You need to be able to answer questions accurately about how you feel, what pains you may have and what your reactions are to various meds. Write down daily everything that you are experiencing.

  • Decide what to take to the appointment
  1. List of questions and concerns.
  2. List of current medications and doses (include over the counter medications).
  3. Food and symptoms journal.
  4. Blank paper for notes.
  5. Spouse/friend/family member (your advocate) to assist.

  • Research and prepare for your appointment
Get on the internet and find information on your condition and your medications. Check for drug interactions that they may have missed.

  1. Gather information from reputable websites. Government health websites and those maintained by medical associations, large nonprofit groups dedicated to a single medical condition, and university medical centers have the most trustworthy, up-to-date medical information.
  2. Make notes and write down any questions.
  3. Don’t try to diagnose your symptoms or self prescribe your remedies.
  4. By being knowledgeable, your doctor’s instructions will be more understandable by you.

  • Prepare your list of meds and take them with you

Your doctor needs to know what you are taking, from all sources, to be able to understand if you’re experiencing any problems with drug interactions or if you’re taking any drugs you really don’t need. You should also have only one pharmacist. National pharmacies now keep good track of their customers’ meds and can advise you, and your doctor, about dangerous interactions.

2. Detail your family history

Tell your doctor everything that they should know about you.
This includes your past health history, your family’s health history, and your own lifestyle history at your next annual check-up. When discussing your own past, include major illnesses, allergies, and drug reactions. Summarize the major illnesses of your first-degree relatives (parents, siblings, aunts and uncles, grandparents), and pay special attention to medical conditions such as diabetes that seem to run in families. Clue your doctor in on your own lifestyle—tell her how much you exercise, what and how you eat, whether you have a pet you enjoy, how stressed you are, whether you smoke tobacco or drink alcohol, any over-the-counter or prescription drugs (from another doctor) that you take regularly. Tell about any recreational drugs that you use or have used in the past.  And be totally honest. Your life may depend on it.

3. Have an advocate

With a major illness, it is difficult to remember and understand everything that your doctor will tell you. It is important that you have someone else with you to help with this information and to ensure that you don’t miss anything important. This person can also help you remember the questions that you wanted to ask the doctor.
  • This advocate can be a family member or a good friend. It should be another person who knows about your health and your concerns and can help you listen carefully, ask the right questions, and even help you make important decisions during a doctor’s appointment. The person you chose should be supportive and understanding of your needs.
  • When experiencing stress, it’s easy to miss details and significant information. If you have a doctor’s appointment coming up where you expect to discuss significantly important test results, treatment plans, prognosis, etc., ask a supportive person in your life to come along. Not only will they be able to support you, but you’ll have an extra pair of ears to take in the information and help you to process your options later.
  • Bring a notebook and write down everything your doctor says …
  • It’s easy to forget key information after you’ve left the doctor’s office, so write down everything your doctor says.
  • Remember: Your doctor will welcome another adult with you.

4. Detail your lifestyle

You probably already know that to avoid another heart attack, you have to manage your lifestyle and likely change the things that caused you to have this one.  These changes will include the trilogy of diet, exercise and stress reduction. You will have to make changes. And, we will talk about these in a later post.

But, for now, we are discussing your doctor’s appointments. The doctor needs to know about your lifestyle to be able to diagnose what caused your heart condition and how to prepare a program of response to treat this one and avoid another one. So, be honest with your doctor.

5. During the appointment  

Ask your questions. Have your questions printed, if possible, with a copy for the doctor. Give him the list. Most doctors can quickly read the questions and give you answers immediately. Remember that they have done this before.
  • Take quick notes and have your advocate do the same. You will forget facts if you don’t write them down now.
  • Ask if you can communicate by email if you are comfortable doing this. Then, you won’t another appointment for the questions that you either forgot or are unclear about.
  • Take down some quick notes on answers to questions, or other comments made by the doctor. Ask for the spelling of tests, medication, or other unfamiliar words. You can go over your notes after the appointment and further flush them out.
  • Ask the doctor if there is any reading material (books, pamphlets, etc.) available that may help answer any questions you might have. Some questions about tests, procedures, and medications may be thoroughly answered through pamphlets, and the doctor can offer some highlights during your appointment.
  • Most doctors are very busy and they will appreciate your being organized and efficient. You will get better service from them.

Wednesday, November 2, 2011

Anxiety & Depression 2

Does psychological counseling as part of cardiac rehabilitation reduce the risk of dying?

Heart patients who underwent psychological counseling as part of cardiac rehabilitation programs have greater reductions in psychological distress, blood pressure, heart rate, and cholesterol levels than people who underwent cardiac rehabilitation without a counseling component.  Some studies found that people who participated in cardiac rehabilitation with psychological counseling were less likely to die or experience future heart problems but counseling done outside of a cardiac rehabilitation program did not appear to provide the same benefits.

How important is emotional support from family and friends?

Social ties and emotional support from friends and family are important during the recovery process. Social ties can include a spouse, close family members, and friends, as well as participation in group activities (social gatherings, religious organizations, etc.). Socially isolated heart attack survivors are four times more likely to die than survivors with social ties. Heart problems, such as chest pain (angina) or another heart attack, also occur more often in isolated individuals. Emotional support from friends and family helps prevent depression, which in turn can reduce your risk of dying. It's important to discuss your fears and concerns with your family members because people who suppress their feelings tend to do worse over time.

How can I cope with the reactions of my friends and family to my illness?

It's very common for your family and friends to experience anxiety, depression, and fear after you have a heart attack or heart procedure.  Studies of people who had a heart attack, angioplasty or bypass surgery found higher levels of anxiety and depression in the spouses than the patients.  It's actually possible that your spouse's stress could delay your recovery.

Sometimes the reaction of your friends, children, or significant other may manifest as denial of the severity of your illness or even anger. This negative reaction may be a coping mechanism used to deal with their feelings of fear. Your family members and friends may be afraid that you'll have another heart attack, or die. It may ease their fears to know that there are steps you can take to reduce your risk of future heart problems, such as taking your medicine as prescribed, eating healthier foods, and getting more exercise.

Depression And Anxiety Can Double Chances Of Heart Ailments

In an article in ScienceDaily (
 Jan. 18, 2008), a study found that major anxiety and/or depression, can double a coronary artery disease patient's chances of repeated heart ailments. This is one of the first studies to focus on patients with stable coronary artery disease -- not those who were hospitalized for events such as a heart attack.

“Both major depression and generalized anxiety disorder were more common in cardiac patients than in the general community." "On average, cardiac patients without these disorders had about a 13 percent chance of a repeated cardiac event over two years, compared to 26 percent of those with either major depression or anxiety."

 “ . . . anxiety and depression can have a strong impact on people with stable coronary artery disease"

Major depressive disorder was diagnosed in roughly 7% percent of patients while about 5% had generalized anxiety disorder.

"since both disorders may respond to antidepressants."

ref: University of Montreal (2008, January 18). Depression And Anxiety Can Double Chances Of Heart Ailments. ScienceDaily. Retrieved November 2, 2011, from /releases/2008/01/080118093328.htm

Wednesday, October 26, 2011

Anxiety & Depression 1

When I began to write this article, I was thinking of the aspects of depression and anxiety that occur after a heart attack, and also after any serious life-threatening illness.  But I found that depression and anxiety can also lead to a heart attack.

So let me begin with the after effects.  Depression and anxiety do occur with many people after a major illness.  The depression is because they recognize, often for the first time, their own vulnerabilities and that they might die sooner than they had expected.  The anxiety occurs because they are entering the unknown.  They don’t know what is going to happen to them, both medically and elsewhere in their life.  Will their job still be there ?  Will they still be able to participate in all the things that they were able to do in their lives, only yesterday ?  Although age is not a requirement for depression and anxiety, age can exacerbate the issue.

Your symptoms may vary from day to day. You might have some phantom chest pains, which will scare you.  There will some things that you just can’t do yet. Simple things, like walking very far.  And you will be learning the new limits of your body.  And you will hate it, because you haven’t had these limitations before.

So, you will be tired, you can’t drive for at least a month, maybe three.  You friends and family will sympathize but they can’t really feel it like you can.

And depression and anxiety can make you short-tempered and angry.

Why do I feel anxious?

As many as 30% of patients report feeling anxious or depressed after a heart attack or heart surgery. When you arrive home, you  are expecting to start feeling better. Your feelings of anxiety may be due to a mixture of reasons. You may be worried that you're going to have another heart attack, or you may have doubts about the success of your operation. These fears are a natural reaction to the stress of the event; they often resolve as time passes. It takes time for the implications of the condition to sink in, and the uncertainty of work prospects may worry you.  Your friends and family will likely not be able to understand why you feel anxious; they think you should be relieved to be alive and on the mend.  And on your intellectual level, you feel this too.  But on the emotional level, you still have these feelings and they can last for long time.

Is it normal to feel anxious after a heart attack or bypass surgery?

Anxiety is common after a heart attack or heart surgery; up to one third of heart patients experience anxiety. Anxiety levels are highest in the first 12 hours after a heart attack. Many studies have shown that anxiety is more common in women than men after a heart attack or bypass surgery. For most heart patients, levels of anxiety return to normal after hospital discharge. If you can't shake your concerns, you may have an anxiety disorder. About half of anxious heart patients still experience symptoms up to a year after their heart attack.

Here are the symptoms of anxiety as outlined by the U.S. National Institute of Mental Health:
  • Unable to relax or concentrate
  • Easily startled
  • Fatigue
  • Headaches
  • Muscle tension and muscle aches
  • Trembling or twitching
  • Irritability
  • Sweating or hot flashes
  • Feeling lightheaded or out of breath
  • Nauseous
  • Going to the bathroom frequently
  • Trouble falling or staying asleep

Am I depressed?

You may experience fatigue, tiredness, irritability, or flairups of temper.  And these can happen quickly and unexpectedly. These could be signs of depression. Soon days will be better than others.  You will be tired and need naps.  These are important for your depression and the physical rebuilding of your body.  But even having these can depress you.  But don’t fight it.  Some cardiologists recommend having a short nap each day.  These naps can cut your risk of reoccurrence by a large margin.

About one in five people suffer from major depression after a heart attack, bypass surgery or angioplasty.  Some degree of depression occurs in up to a third of all heart attack survivors.  And, women generally experience more depressive symptoms than men after a heart attack or bypass surgery.

Here are the symptoms of depression as outlined by the U.S. National Institute of Mental Health:
  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, waking up early, or oversleeping
  • Loss of appetite and weight loss, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain 

Can depression affect my recovery?

Many studies have found that depression increases the risk of dying after a heart attack.  In women, depression appears to increase the risk of dying from a heart-related cause within the first year of a heart attack. The effects of depression can also last a long time; depression one month after surgery can be associated with the recurrence of chest pain up to 5 years later. If you're depressed, you may also be less likely to take your medicine or make the lifestyle changes prescribed by your healthcare provider.

What can I do?

As a survivor, you need to confront potential underlying fears and anxieties. You are encouraged to:
  • Be patient.  Anxiety and depression after a heart attack are usually  temporary.
  • Discuss feelings with your doctors, family and friends.
  • Keep a journal. Sometimes, writing about feelings can help a heart attack victim feel better.
  • Arrange for counseling if these persist for more than four weeks. .

Making friends and family aware of possible problems can help their understanding of your situation. It can also be reassuring for you and your family to know that problems are usually temporary.

You may like to join a cardiac support group as it can be useful to share your concerns with people who have been through the same experience. Contact your local heart association or your own doctor for direction
Rehabilitation programs are another excellent option. They provide information on healthy eating and managing risk factors for coronary heart disease; they also run exercise programs, and I will write about each of these in future posts.

Also available are counseling and stress relieving activities for people who have had heart attacks or heart surgery. You will usually be contacted by a rehabilitation nurse before you leave hospital. If you find it difficult to attend a rehabilitation program, you may be offered a self-help Heart Manual from your local hospital to use at home. It is important to discuss any problems with your doctor as he or she may be able to help you resolve your anxieties. If your anxiety or depression becomes severe, and there is no sign of improvement, you may need treatment from your doctor or a professional counselor or therapist

There may also be loss of libido or impotence for men, which may be due to anxiety or depression, the chest discomfort after surgery, or else due to certain medications such as beta-blockers or diuretics. If you think your medication may be affecting you in this way, ask your doctor about changing it. Your doctors are an excellent resource for you.  Don’t overlook this avenue.

Charles Spurgeon said it best: “Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength”.

Thursday, October 13, 2011

You May Not Present as a Heart Attack to the Paramedics

We have likely all heard of the warning signs of a heart attack. And we didn’t pay attention. And that’s normal. Until you have one.

So, as you are reading this blog, you have an interest in heart attacks and that’s probably because you’ve recently had one, or someone you know has and you want to know more. Or, maybe you’re getting a bit older and want to be prepared.

The most common symptom of a heart attack is chest pain, usually described as crushing, squeezing, pressing, heavy, or occasionally, stabbing or burning. Although this pain can occur at any time, a great number of patients experience it in the morning, within a few hours after awakening. Chest pain tends to be focused either in the center of the chest or just below the center of the rib cage, and it can spread to the arms, abdomen, neck, lower jaw or neck. Sometimes, when a heart attack causes burning chest pain, nausea and vomiting, a patient may mistake his or her heart symptoms for indigestion.

So here are the normal warning signs of a heart attack. The body likely will send one or more of these warning signals:

  • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
    • If you do experience chest pain and the pain is severe, you should seek immediate medical care. Even if the chest pain is not severe, emergency care is needed if the chest pain is crushing or squeezing or is accompanied by one or more of the following symptoms
    • shortness of breath
    • discomfort or tingling in the arms, especially the left arm
    • pain in the back
    • tightness or pain in the lower jaw
    • profuse sweating
    • fainting
    • nausea
    • lightheadedness or loss of consciousness.
  • Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning, or heavy weight. It may be located in the chest, upper abdomen, neck, jaw, or inside the arms or shoulders.
  • Anxiety, nervousness and/or cold, sweaty skin.
  • Paleness or pallor.
  • Increased or irregular heart rate.
  • Feeling of impending doom.
Not all of these signs occur in every attack. Sometimes they go away and then return again. If some of these symptoms occur, get help fast. For others, in the event of cardiopulmonary arrest (no breathing or pulse), call 911 and begin cardiopulmonary resuscitation (CPR) immediately. Your life or the life of someone else may depend on your actions.
However, you still may be having a heart attack and have different symptoms. One of these is sharp pain in the scapula (shoulder blade). This is not common and so, it is hard to diagnose as a heart attack. When the paramedics do arrive, they may do an EKG so that they will know how to best treat you and which hospital to take you to. And this still may not give the right indications. Here’s a question for you to review: Can pain in the jaw or teeth be an indication of a heart attack? The answer is yes. Heart pain can radiate to the jaw and teeth. It is more common for heart-related discomfort to affect the lower jaw than the upper jaw. It is important to know that a heart attack can have symptoms other than chest pain, and these symptoms should be checked immediately. Pain in the upper teeth also can indicate other conditions, such as a sinus infection. It's important to get evaluated by your doctor to know the cause of your symptoms. Remember:
  1. In 25% of adults, the first sign of heart disease is sudden death from a heart attack.
  2. In about 15% of cases, the patient never reaches a hospital for treatment and dies quickly after symptoms begin.
  3. How long heart attack symptoms last varies from person to person.
  4. Heart attacks strike almost one million people in the United States each year, causing almost 200,000 deaths.

In a future post, we’ll review what will happen when you do reach the hospital.

Saturday, October 1, 2011


This is the preliminary list of topics that I intend to blog about, probably over the next year. There is so much information about surviving a heart attack. If you have other topics that you would like me to cover, please send a comment or an email to drj at

You may not present as a heart attack to the paramedics
Heart attack vs heart disease
Could be physical or hereditary
Discuss depression & anxiety
Stents are not perfect
Have a health advocate to help you remember the answers at appointments
How to Maintain a Healthy Heart
Take control of your heart policy - your life depends on it
Ask your G.P. anything
Your G.P. has the capacity to find answers for you
Questions to answer your doctors (see my list)
Talk about some meds
Organize your meds - set timers to not miss meds
Your meds make you healthier than the next guy on the street
Educate yourself - books, pamphlets, internet
Advice to patient

The importance of fluid intake
Low sodium guidelines for heart failure
Sodium consumption for all ages
Stay away from processed foods - foods to avoid
The importance of weight control
If you exceed your diet numbers one day, it will affect you the next
Food recommendations
Recipe recommendations
Get help from a nutrition coach
Value of Blue Menu foods
Food values to watch (calories, sodium, cholesterol, fat)
Heartsmart cookbooks - beware of sodium values
Use measuring spoons as serving spoons
'Diet' doesn't have to mean bland food

The importance of exercise
Talk about the rehab track program & hands over the head
Get help from an exercise coach
Exercises (how much, which ones, re-hab, do it)
Heart needs aerobic exercise e.g. gym stick, recumbent bike
Get help from a walking partner

Your family has to understand how important a regimen is to you
Depression & Anxiety from any major illness
Keep a food and exercise diary
The importance of naps
The importance of stress
Sleep apnea
New wardrobe

Tuesday, September 27, 2011

New Blog

This is a new blog to talk about topics for heart survivors. We will discuss food, exercises and other things that I have found to be useful during the past year. So as not to repeat, see 'About Me' to see what we intend to cover.