Apr 28

During National Heart Week this year, 2-8 May, the Heart Foundation is asking the question: “Will you recognise your heart attack?”

Heart attack warning signs vary from person to person; and they may not always be sudden or severe. Although chest pain or discomfort is the most common symptom, some people will not experience this symptom at all. Jaw, neck, back or shoulder pain can also be a warning sign of a heart attack.

So, pain, pressure, heaviness or lightness in one or more parts of your upper body – sometimes in combination with other symptoms such as nausea, dizziness or shortness of breath – are all causes for concern.

Whatever the symptoms, all heart attacks have one thing in common, that is, the sooner you receive treatment, the less damage will be done.

The heart is a beating muscle that pumps blood continually to the rest of the body. The so-called coronary arteries supply the heart with the oxygen and nutrients that it needs to function.

Red blood cells, white blood cells, and other components of blood flow freely through the arteries to the heart and other parts of the body. In a healthy person, the inner walls of the arteries are smooth and uniform in thickness.

However, arteries can become blocked over time by the build up of fatty deposits of cholesterol called plaque. The greater the build up of plaque, the greater the risk of heart attack. Blockage of the arteries can also occur at the site of a crack in the plaque. When this happens, blood cells and other components can clump together at the site, forming a blood clot, or thrombus. This can grow to completely block blood flow to the heart muscles. If the artery remains blocked, the lack of blood permanently damages the area of heart muscle supplied by the artery.

The extent of damage sustained by the heart during a heart attack depends on the severity and location of the blockage, and the speed at which medical treatment is received. So learning the warning signs is critical. If you think you could be having a heart attack, call 000.

Along with early recognition of heart attack, prevention strategies are of paramount importance.

According to the National Heart Foundation, it could be small life-style changes that might make the biggest difference in improving heart health – small changes that we can put into effect ourselves and that are not at all costly and are well within our personal price range. Nevertheless, simple as these changes are, they are often the most difficult to implement, because they involve changes in our sometimes firmly entrenched behaviour.

Weight management is essential. Healthy eating is making sure you still get all the nutrients you need for good health while reducing the amount of energy (kilojoules) you take in. The good news is that many foods that are low in energy are also packed full of essential vitamins, minerals and fibre.

Being physically active is important too and the activity doesn’t have to be over vigorous. Bush walking, cycling or swimming are all fine; whatever takes your fancy. Aim for about 30 minutes of moderate intensity on most days of the week; and this can be accumulated in bouts of 10 minutes or so if this is more convenient.

You can get more healthy heart tips from the “Heartsite” at www.heartfoundation.org.au or visit your nearest Self Care pharmacy – pharmacies providing the Pharmaceutical Society’s health information. There are fact cards on Exercise and the Heart, Weight and Health, Fat and cholesterol and High Blood Pressure. Call 1300 369 772 for more information, or check out the Pharmaceutical society website at www.psa.org.au and click on Self Care pharmacy finder.

©2010 Pharmaceutical Society of Australia

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Dec 09

The Australian Prescriber is a journal published four times a year and provides independent objective and up-to-date information about medicines to health care practitioners – doctors, dentists and pharmacists.

windowseat

The latest issue (December 2009) discusses plane travel and the possible problems with DVT – deep venous thrombosis. The topic is timely with many travellers heading to and from Australia during the holiday season.

DVT is a condition in which a blood clot, or thrombus, develops in a deep vein – usually in the lower leg. Symptoms of DVT are principally pain, swelling and tenderness around the affected area. The good news is that DVT can be detected by medical testing and effectively treated.

However, if the DVT is not identified and treated, there is the risk of developing a so-called thromboembolism. This can occur when the blood clot breaks away from the vein in the leg and travels through the body to the lung, where it lodges and blocks blood flow. The chest pain and breathing difficulties from what is then known as a pulmonary embolism might be the early signs of a fatal outcome.

Some eight years ago, following the death of a young English woman returning home from a trip to Australia, the World Health Organization (WHO) initiated a study to determine the causes of and possible prevention strategies for DVT. This project was known as the WRIGHT study – or WHO Research Into Global Hazards of Travel.

The WRIGHT study showed that the risk of developing DVT nearly doubles after travel lasting four hours or more. But it seems the risk applies not only for travel by plane – train, bus and automobile passengers also have that same increased risk when they remain seated and immobile for more than four hours.

It all happens because periods of prolonged immobility cause stagnation of blood in the veins, thus promoting clot formation.

Interestingly, plane travellers who have the window seat are more likely to get a DVT. Apparently window seat occupants just hate to leave the view to exercise their legs.

Apart from immobility and duration of travel, there are a number of other factors which increase risk. These include being overweight, being very tall or very short (taller than 1.9 metres or shorter than 1.6 metres) having varicose veins and the use of so-called combination oral contraceptives.

One study within the project, which examined airline travel in particular, found that taking multiple flights over a short period of time also increases the risk. This is because the risk of DVT does not go away completely after the flight is over; the elevated risk remains for up to four weeks.

The Australian Prescriber article summarises a number of comparatively high risk factors. These include recent surgery, active cancer, and congestive heart failure; but prolonged immobility during long haul flights remains the major problem – and this risk factor is largely preventable.

Doing regular sprints through the cabin is not usually practical, but exercising the calf muscles with up and down movements of the feet at the ankle joint will keep the blood flowing – and you can certainly do that from your window seat.

For those of us in the low risk category for DVT, the best options are keeping mobile and keeping well hydrated – plenty of water and fruit juice – but we should limit our intake of alcohol and caffeine containing drinks.

There is no evidence that aspirin protects against DVT; but some studies have shown that wearing lower-leg compression stockings might help.

If you have a high risk factor, or even a combination of moderate risks, check with your doctor before travel; an injection of what’s known as low molecular weight heparin may be suitable.

It used to be called “economy class syndrome”, but if doesn’t really mater in which end of the plane you travel, if you don’t move around you risk a DVT.

So before you make your next move pick up the Travel Health fact card from your nearest Self Care pharmacy (locations are on the Pharmaceutical Society’s website at www.psa.org.au/selfcare). There’s more information about DVT and many other travel health issues as well.

©2009 Pharmaceutical Society of Australia

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