Heart attack fatalities down 63% in a decade
There has been much good news about heart attacks in recent years. From 2000 to 2010, the number of heart attacks in the U.S. decreased by 27 percent and encouragingly, fatalities fell by 63 percent.
While the benefits have been seen at every age, in every ethnic and racial group and in both sexes, declines have been far greater in men than in women. The reason for this remains unclear.
The measurable improvement in heart attack survival can be traced to a nationwide improvement in identifying common risk factors, as well as to more rapid diagnosis and treatment, which have reduced the death rates of those who reach the hospital.
More important are the public health efforts to encourage smoking cessation, lower cholesterol and treat high blood pressure.
A paper published in the New England Journal of Medicine reported that from 1999 to 2008, the percentage of high blood pressure patients who received adequate treatment increased from 40 percent to 80 percent. During that same time period, the cholesterol levels of these patients improved by 9 percent. And if a heart attack patient is alive upon arrival at a hospital, the chances of survival for more than a year is now 95 percent.
As the number of fatalities decreased and the accuracy of diagnosis increased, the clinical presentation has become more atypical. Classic symptoms of an acute heart attack previously were described as crushing chest pain — a feeling as if the chest was gripped in a vise. The pain radiated up into the jaw and down the left arm, sweating was common and a sense of imminent death was usual.
Today, we know heart attacks occur with less obvious symptoms. Mild chest discomfort or a feeling of pressure may occur, or the only symptom could be an unexplained shortness of breath. The pain may present in the neck, arm, upper abdomen or even the back.
The message is clear. Sudden onset of unexplained discomfort in the chest or other unusual symptoms that occur for the first time should never be ignored or dismissed. It is far better to be safe than sorry. If you are concerned, immediately take an aspirin and call 911.
The sooner you arrive at the hospital, the better. Once in the emergency room, an EKG (electrocardiogram) and blood tests can rapidly diagnose a heart attack. Within 90 minutes of initial symptoms, an angiogram should be done, and if a blocked vessel is identified, an angioplasty and the placement of a stent can open the blockage, restore blood supply and avoid further damage to heart muscle.
Within 24 to 48 hours of having a heart attack, most patients are up in a chair, then home within a few days. Following a period of rehabilitation, they are able to return to a complete and full life.
The key to recovery is a comprehensive approach that includes medications and committing to a hearthealthy lifestyle. Every patient should be treated with aspirin and a beta blocker that reduces the risk of developing an irregular heart rhythm and more heart attacks. Most heart attack survivors are prescribed a drug called an ACE inhibitor, which helps prevent heart attacks as well as heart failure — a leading cause of disability and death.
After a heart attack, it is critical that elevated cholesterol, diabetes and high blood pressure are rigorously treated and that a cardiac rehabilitation program is instituted. This involves supervised exercise and educational efforts aimed at reinforcing the importance of living a heart-healthy lifestyle that includes dietary changes and stress management, if necessary, as well as sticking to a prescribed medication regimen. Unfortunately, only a small fraction of patients participate in rehabilitation programs that if followed would improve their quality of life and reduce the risk of future heart attacks and other diseases.
While great strides have been made in treating heart disease and identifying risky behavior, it remains the leading cause of death. In 2009, the Centers for Disease Control and Prevention attributed 599,413 deaths in the United States to heart disease, even more than to cancer, 567,628.
While new treatments have done much to prevent death and reduce the risk of second heart attacks, the focus for all should be doing everything possible to be fit and healthy, while working with our physicians to address the key risk factors that, if corrected, could prevent a heart attack from occurring.
It is said that one learns best by making mistakes, and this is especially true in bridge. For example, take this deal from the match between Argentina and the United States during the 1962 world team championship.
At the first table, where Bobby Nail and Mervin Key (believe it or not) were North-south for the U.S., the Argentine West led the jack of clubs against three notrump, dummy playing the deuce, East the three and South the seven. West continued with the nine, taken by declarer’s ace. Key then cashed the A-K of diamonds, caught West’s queen and wound up with 11 tricks for a score of 660 points.
At the second table, where the Argentine South was also in three no-trump, the defense likewise started with two rounds of clubs. But here declarer made a costly error when he played the ace of diamonds at trick three, led a spade to the king, then returned the jack of diamonds and finessed. West took the queen and cashed his clubs to put the contract down one, giving Argentina a 760-point loss on the deal.
It is hard to justify declarer’s diamond finesse. Presumably, he hoped to find East with the queen. But if that was South’s reason for taking the finesse, it was unsound, because he was risking the loss of the contract without in any way improving his chances of making it.
Cashing the A-K of diamonds offers a much better chance for the contract. If the queen falls from either hand, South is home. If the queen does not fall, declarer can play a third diamond, hoping East has the damsel.
If East has the queen, the contract is secure even if he has another club to return, since in that case West could not have started with more than four clubs.