Heart at­tack fa­tal­i­ties down 63% in a decade

The Washington Times Daily - - Life - DR. DAVID LIPSCHITZ STEVE BECKER

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.

WEST

East

South West

North

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.

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