Mr. Doctor by Dr. Blyden Noah . Copyright Dr. Blyden Noah , 2016
DR. BLYDEN BY DR. BLYDEN NOAH DR. Blyden Noah is a general practitioner living and working in Sweden. He is the author of the Dr.Blyden handbooks , Dr.Blyden radio podcasts ,novels , poems , DR. BLYDEN : HEART ATTACK factbooks about (MYOCARDIAL INFARCTION) HANDBOOK African and Sierra Leonean culture and traditional DR. BLYDEN NOAH . E-mail : religions , new games , new [email protected] . WEBSITE : https:// inventions etc . doctorblyden.jimdo.com/ or https:// Dr. Blyden independent.academia.edu/BlydenNoah Noah was born in Sierra Leone .
E-mail : nas.deen1@gma il.com Dr. Blyden Website : https:// doctorblyden.jimdo .com/ or https:// independent.acade mia.edu/ BlydenNoah 1 HEART ATTACK PART 1 : PODCAST - LISTEN HEART ATTACK PART 2 : PODCAST - LISTEN
NORMAL P , P-Q , R , S-T , AND T WAVES OF THE ECG
CHART
2 ECG OR EKG MACHINE
WHAT IS HEART ATTACK
Heart attack (myocardial infarction) means death or dying of
heart muscle . Heart attack is a life-threatening emergency so it is important the victim gets help as soon as possible . A person having a heart attack can die in 8-10 minutes . It is easy to tell a person having a heart attack : He grips the left side of his chest , massages his heart and has breathing difficulties . Do not joke with your heart ! Cardiovascular dieseases which includes heart attack , angina pectoris , TIA attack and high blood pressure are the number one cause of death globally according to WHO . Heart attack is the biggest killer of them all . More people die anually from cardiovascular diseases than from any other disease . 17.5
3 million people died worldwide from cardiovascular diseases in 2012 .
WHAT CAUSES HEART ATTACK
The heart is a balloon made up muscles and blood vessels
intertwined together . The blood vessels called arteries supply the heart muscles with oxygen which the heart muscles need to survive and do their job of pumping blood . If the heart muscles do not get this oxygen they will suffocate and die . What happens in a heart attack is the blood vessels supplying oxygen to the muscles of the heart is blocked by a clot and this leads to the suffocation and death of the segment of the heart muscle that is deprived of oxygen . How does this clot come about ? Blood fats and other blood debris attach to the inner lining of the blood vessels . The fat and other blood deposits pile up with time forming thick plaques . A portion of these plaques can detach from the vessel wall forming a clot . This clot can travel travel to the smaller blood vessels of the heart and block them .
THE SYMPTOMS AND SIGNS OF HEART ATTACK
Chest pain . Or chest pressure . Or chest discomfort . The
chest pain , pressure or discomfort can migrate to the neck , the left arm, the left shoulder , the back or the jaw . 4 Breathing difficulties
Nausea
Feeling faint
Sweating
The victim grips the left side of his chest and massages his heart
The victim is in distress , there is a frightened expression in
his/her face .
Sudden death . Heart attack is the number one cause of
sudden death in human beings . A person having a heart attack can die in 8-10 minutes .
TYPES OF HEART ATTACKS
ST-elevation heart attack: This is is also called ST- segment
elevation myocardial infarction (STEMI) . This is a heart attack in which the ECG chart (electrocardiogram ) shows ST elevation . This is the most dangerous type of heart attack . The affected blood vessel is completely blocked by the clot .A large portion of the heart muscles is damaged due the blocking of a large blood vessel supplying blood to the muscles of the heart . Electrocardiograph machine (ECG or
5 EKG machine) is an instrument used to messure the electrical activity of the heart by using electrodes placed on the skin .
Non ST-elevation heart attack : This is also called non-ST
segment elevation myocardial infarction (Non STEMI or NSTEMI) . This is a mild form of heart attack and there is no ST-elevation seen on the ECG chart . The affected blood vessel is not completely blocked by the clot . The victim has high levels of a heart protein called troponin. Troponin is released from the heart muscle when it is damaged .
Anteroseptal heart attack : This is also called anteroseptal
myocardial infarction . This is a heart attack in which the muscles of the front and right wall of the heart and surrounding the right chambers of the heart have died . The ECG signs for antero-septal heart attack are seen best in leads V2 , V3 , V4.
Anterolateral heart attack : This is also called anterolateral
myocardial infarction . This is a heart attack in which the muscles of the front and left wall of the heart and surrounding the left chambers of the heart have died . This heart attack affects a large area of heart muscle . The ECG signs for antero-lateral heart attack are seen best in leads V5 , V6 .
6 Inferior posterior heart attack : This is also called inferior posterior myocardial infarction . This is a heart attack in which the muscles of the back and lower wall of the heart have died . It is sometimes just refered to as posterior heart attack . The ECG signs for posterior heart attack are seen best in leads III and aVF .
Silent heart attack . Also called silent myocardial
infarction .This is a heart attack which happens without the victim knowing it . The victim has non or very little symptoms or signs of a heart attack . The victim gets to know about the heart attack months or years later during an ECG check which shows an old heart attack .
Old heart attack : Also called old myocardial infarction .
This is seen on the ECG chart months or years after a silent heart attack has happened . The ECG shows a deep Q wave which is the sign for an old heart attack .
DISEASES OR SIGNS WHICH CAN BE MISTAKEN FOR
HEART ATTACK
Angina pectoris : Chest pain or breathing difficultis during
physical activity due to the narrowing of the blood vessels supplying oxygen to the heart .
Pulmonary embolism : A clot in the blood vessels of the
lungs 7 Myocarditis : This disease is uncommom . It is the inflammation of heart muscles usually caused by a viral infektion . ECG can show ST elevation in almost all the leads .
Benign Early Repolarization : This is an ECG sign in which
there is ST elevation in the majority of the leads . This is not a heart attack . This condition is normal and is usually seen in young and healthy adults .
HOW HEART ATTACK IS DIAGNOSED
Diagnosis via symptoms and signs (See 'symptoms and signs
of heart attack' above
Diagnosis via Electrocardiograph machine (ECG or EKG
machine) . The electrocardiogram chart shows ST-segment elevation in a heart attack . This is the most significant and most characteristic sign in the diagnosis of a heart attack .
Diagnosis via blood tests which show high levels of a heart
protein called troponin in the blood .
Diagnosis via x-ray examination of blood vessels bringing
oxygen to the heart . These blood vessels are called called coronary arteries . This x-ray examination is called coronary angiography and it is used to find narrowing and clots in the blood vessels .
8 Diagnosis via myocardial scintigraphy . This is an x-ray type imaging technique that can show the areas of infarction (death) of the heart muscle as well as the blocked blood vessels .
Risk for heart attack can be evaluated with the cardiac
stress test or effort ECG . The cardiac stress test is done with the patient connected to the electrocardiograph machine whilst exercising on a treadmill or whilst pedalling a stationary exercise bicycle . Significant S-T segment depression on the ECG chart under effort is a sign of narrowing or a clot in blood vessels of the heart (coronary arteries ) .
Risk for heart attack can also be evaluated with the
echocardiogram machine . This is an ultrasound machine that shows the different parts of the heart and their capacities on a screen . The echocardiogram can show blood clots inside the heart .
9 HOW TO TAKE CARE OF YOUR HEART AND PREVENT HEART ATTACK .
1/ Check your blood pressure regularly e.g once a month . If
you have a high blood pressure (>140/90) see your doctor for medication .
2/ Check your blood's cholesterol (blood fat) level at your
doctor's clinic . If your blood fats levels are high take 1 tablet Atorvastatin (20 mg) or any other Statin medicine daily for the rest of your life .
3/ Eat a variable diet . Eat a lot of fresh vegetables and fruits
every day . For example 2 apples , one orange , one large tomato , a few lettuce leaves and some pieces of carrot every day .
4/ Lose weight . Stop smoking
5/ Change your lifesyle from a sedentary one to an active
one . Exercise regularly , for example walking as little as 30 minutes every day can help prevent stroke and other diseases such as obesity and diabetes . Do squat exercises several times a day , whenever you have spare time . This helps to burn abdominal fat and prevent abdominal obesity . Do as follows : Stand up and then squat on tiptoes for one minute . Repeat this exercise 5 or 10 times whenever you have spare
10 time . Abdominal obesity is a risk factor for stroke and heart attack.
6/ Reduce intake of sugar and fatty foods . Drink water
instead of soft drinks (soda ) or fruit juices . Drink 2 liters of water every day . Drink more when you are sick , irrespective of the disease .
Eat fruits instead of cakes and sweets . Eat less of fatty foods such as hamburgers , fried chicknens , pizzas etc . Eat more traditional home-cooked dishes which are less fatty .
ECG SIGNS BEFORE , DURING AND AFTER A HEART
ATTACK :
Before a heart attack : The ECG chart shows a normal curve
before a heart attack . The Q , R , ST and T waves are normal (see chart) .
11 Heart attack is minutes old : The ECG chart shows ST- segment elevation . This is the most significant and most characteristic sign in the diagnosis of a heart attack .
Heart attack is several hours old : ST-segment is still
elevated . The R wave is getting lower . The Q wave is getting deeper .
Heart attack is 1-2 days old : The Q wave is deep . S-T
segment is still elevated . T wave is inverted .
Heart attack is several days old : The Q wave is still deep .
S-T segment is normal . T wave is inverted .
From several weeks to several years after the heart attack
: The Q wave is still deep . S-T segment is normal or absent . T wave is normal or absent .
HOW HEART ATTACK IS TREATED . PRE-HOSPITAL
TREATMENT
If the victim is concious and has the symptoms and signs
of a heart attack as listed above :
Ring 112 or 911 or your local emergency toll free number for an ambulance to take the victim quickly to the hospital .
12 Give the victim 4 Aspirin (75 mg) tablets to help dissolve the blod clot causing the heart attack and also to prevent more clots forming .
Apply 1-2 sprays of nitroglycerin spray under the victims
tongue . Nitroglycerin is a nitrate and it widens the blood vessels of the heart thereby bringing more oxygen-rich blood to the heart muscles .
Give the victim oxygen via an oxygen mask or a nasal
cannula at the rate of 4-6 liters per minute . The mask or nasal cannula are connected to oxygen tanks . The oxygen is to help the victim breathe easily .
Give the victim morphine injection 1 mg/ml , 0.5-1 ml
intravenously . Morphine is a strong painkiller that relieves the victim's chest pain .
The patient is taken to the hospital for further treatment
when the ambulance arrives .
If the victim is unconcious :
Ring 112 or 911 or your local emergency toll free number for an ambulance to take the victim quickly to the hospital .
Check to see if the victim is breathing by placing your hand
near his nose . The feel of warm air on your hands confirm
13 the victim is breathing . Place the victim on his back . Lift the chin with your hand and tilt the head back . This is to open the victims airways and facilitate breathing . Check that the victim has a pulse .
If the victim is not breathing and has no pulse (check for
pulse on the wrists and neck ) start cardiopulmonary resuscitation or CPR .
How to do cardiopulmonary resuscitation (Heart-lungs
revival) :
Place the victim on his back . Lift the chin with your hand and tilt the head back . This is to open the victims airways and facilitate breathing .
Place the palm of one of your hands at the center of the
victim's chest , between the nipples . Place the palm of your second hand on top of the first hand . Press both hands down to a depth of 5 cm repeatedly at a rate of about 100 compressions per minute . Do 30 chest compressions . Then move on to rescue breathing as follows below .
Lift the chin with your hand and tilt the head back . Clamp the nose of the victim with your fingers . Place your mouth tightly against the victim's mouth and blow in air forcefully . You should see the victim's chest rising when you are blowing in air . Blow in 2 breaths for every 30 chest compressions . Continue with heart-lungs revival (CPR) until the ambulance
14 comes or untill the victim is brought to the hospital . If there are 2 rescuers one rescuer can do the chest compressions whilst the other can do the rescue breathing . If you are not comfortable with mouth-mouth rescue breathing then you can do mouth-nose rescue breathing . Close the victim's mouth tightly with the palm of your hand , cover his nostrils tightly with your mouth and blow in 2 powerful breaths . It is important to close the nose tightly for mouth-mouth rescue breathing and close the victims mouth tightly for mouth-nose rescue breathing . Continue with cardio-pulmonary resuscitation (CPR) until ambulance arrives or until the patient arrives at the hospital .
DEFIBRILLATOR
15 Defibrillator : If CPR does not revive the patient , try using a defibrillator if available . There are now simple and easy to use defribillators in airports , shopping malls , airplanes , train stations etc which anyone can use by just following the instructions written on them. How to defibrillate: 1/ Place the patient on a flat surface , lying on his back . Remove all clothes on the upper parts of his body 2/ Open the defibrillator package , remove the pads 3/ Place the pads on the victims chest as shown on the picture above . 5/ Follow the voice instructions 6/ Continue with CPR until the ambulance comes . CPR should continue for 30 minutes before the rescuers give up .
HOW HEART ATTACK IS TREATED AT THE HOSPITAL
Medicines to remove and prevent blood clots : Aspirin in
high doses . Statins which are blood fat lowering medicines .
16 Anticoagulants (fragmin , dalteparin ) are blood thinners and prevent the formation of blood clots .
Medicines to lower blood pressure and prevent irreguar
Percutaneous coronary intervention (PCI) : A thin flexible
tube (catheter) with a balloon attached is inserted through the skin in the arm or thigh into a blood vessel (artery) and the tube is then with x-ray guidance led all the way to the blood vessels of the heart where the blood clots are . The balloon on the catheter is then used to remove the blood clots in the vessel and the plaques on the vessel walls .
Coronary artery bypass grafting (CABG) : This is an
operation where a vein from the victim's body is used to bypass the blocked segment of blood vessel and thereby supply oxygen-rich blood to the affected heart muscle .
If a person having a heart attack is not quickly attended to he
can have a brain damage and die in 8-10 minutes . Do something to help the victim , do not just stand and watch , every minute counts . Place the victim on his back , lift his chin and do chest compressions . Just doing these 3 things might be enough to revive him or keep him alive until the ambulance or other professional help arrives . Do not do
17 rescue breathing if you are not comfortable with it , you can leave that to the medical professionals .
HEART ATTACK CASE STUDY
79 year old woman comes to the health center . She has
chest pain and nausea since a few days . The chest pain comes and goes . She is feeling tired . Her blood pressure is 130/80 , normal . ECG shows ST elevation heart attack affecting the front wall of the heart . The patient was given 2 160 mg aspirin tablets and 2 sprays of nitroglycerin under the tounge . An ambulance was called which took the patient to the hospital . X-ray imaging of the blood vessels of the heart showed blockage in them . PCI techique was used to remove the blockage and prevent new blockage from forming .
Put Your Heart in Your Mouth: Natural Treatment for Atherosclerosis, Angina, Heart Attack, High Blood Pressure, Stroke, Arrhythmia, Peripheral Vascular Disease
