Warning Symptoms Precede Sudden Cardiac Arrest in most cases.

Warning symptoms, notably chest pain and dyspnea, occur during the 4 weeks preceding sudden cardiac arrest (SCA) in at least half of cases involving middle-aged adults, suggests a new study. The warnings are usually ignored, observe researchers, with few patients phoning 911 in response to what is almost always a fatal event.

The analysis is based on the Oregon Sudden Unexpected Death (SUD) cohort which was published online December 22, 2015 in the Annals of Internal Medicine.

It suggests that sudden death may not be as sudden as we have been thinking till now. There were people who had their symptoms not only in the 24 hours that preceded the arrest, but also in the 4 weeks that preceded their event.

 

The Oregon SUD study is a large, prospective, community-based study of deceased and surviving patients who had an SCA in the Portland, Oregon metropolitan area. The analysis included 839 patients between 35 and 65 years of age with SCA whose prodromal symptoms could be comprehensively assessed.

Of the 839 patients, 430 patients or 51% of the cohort experienced at least one symptom within the 4 weeks preceding their arrest. Men and women experienced prodromal symptoms with equal frequency at 50% vs 53%, respectively.

Symptoms also started more than an hour before SCA onset in 80% of patients; but in 147 of these patients, symptom onset occurred more than 24 hours before their arrest. Among this subgroup of patients, 93% had recurrent new episodes of symptoms during the 24 hours preceding their arrest.

The main symptom was chest pain, documented in 199 patients,” or 46%, Marijon observed. Of those, 76% had “intermittent typical angina,” he said.

Another 18% of patients had dyspnea as their apparent prodromal symptom; about one-third of this group had established congestive heart failure or a pulmonary condition.

 

What Can Be Done

An early call to 911 was associated with better survival odds in the current study suggesting that there is a potential to enhance short-term prevention of SCA by targeting public awareness of SCA.

Source: Warning Symptoms Can Often Precede Sudden Cardiac Arrest

Drugs for Angina or cardiac pain!

Angina pectoris, which is more commonly known as angina, is severe chest pain caused by a lack of blood (ischemia) in the heart muscle.

The commonest cause of angina is blocks in the coronary arteries which cause obstruction to the blood flow.

The common drugs which are used to treat angina are as follow:

1. Beta-Blockers: This is a class of drug which reduces the heart rate. Thereby, they reduce the oxygen requirement of the heart. This causes relief in angina. 

The drugs approved for this condition are Metoprolol,  Bisoprolol, Atenolol, Nebivolol and Carvedilol. These drugs are started in normal doses and then increased till the time patient is free of his symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate. 

If a patient is unable to tolerate the beta-blockers, the alternative group of drug which can be prescribed is called Calcium channel blockers. Some of the drugs used are Diltiazem and Verapamil. They can be used in patients with lung problems as they have no effects on lung function unlike beta-blockers.

2. Aspirin: the commonest drug prescribed to all cardiac patients. This is an anti-platelet drug and thus prevents clot formation in the arteries. It is given in a dose of 75-150 mg a day. It should be consumed after food to avoid gastric irritation.

3. Statins: These are drugs which reduce cholesterol and triglyceride levels. The prevent the formation of plaques or blocks in the coronary arteries. They also reduce the incidence of heart attacks in the patients. The common ones used are Atrovastatin, Rosuvastatin, Simvastatin etc. They are to be taken after dinner for maximum effect.

4. Nitrates: There are drugs which cause dilatation of the coronary arteries and are very helpful in relieving angina. They can be taken by keeping the tablet below the tongue (Tab Sorbitrate) or consumed with glass of water. They are also available as oral sprays or skin patches. They can cause headache or giddiness as their side-effect.

Most of the patients with angina can be easily controlled with drugs and can be symptom-free (pain free). The non-medical options are angioplasty or bypass surgery which can be reserved for patients with intractable symptoms.

Chest pain: Angina

Cardiac pain: Angina

 

Chest pain of any intensity should never be ignored. It should promptly be recognized, investigated and treated. The cardiac and vascular causes of chest pain can be fatal and so need to be promptly treated.

 

Chest pain can be due to a variety of reasons. It can be due to causes related to the heart, the lungs, food-pipe, spine and muscles.

Let us learn about how to differentiate between some of them!

 

 Some of the causes of chest pain are:

 

  • Cardiac pain: is also called Angina. It is caused by blockages in the heart blood vessels due to cholesterol deposition. The pain is classical in nature and easy to recognize. Most of the time it is described as heaviness in chest (compression or a tight feeling). Some of patient may have burning pain in chest. It increases on exercise. It decreases at rest. This is caused by blockages in the arteries which progress slowly over months and so called stable. The pain in this condition is called Stable Angina. They are confirmed by a test in which one exercises and the ECGs are monitored. The test is called treadmill stress test. Sometimes, the blockage gets complicated due to blood clot formation. This causes total occlusion of the artery and is riskier. The pain here is severe in intensity, sudden in onset and even at rest. It does not subside with routine medicines. It is called Unstable Angina. The condition is diagnosed by ECGs and blood tests. If not promptly treated, patients may progress to have a heart attack.

 

  • Lung pain: The covering layer of the lungs produces pain which is sharp and increases on deep breathing. This pain can be due to infection or other causes which need to be investigated. The lung tissues normally do not cause pain but can cause cough and breathlessness. Most of the time it is diagnosed by an X-ray of the chest and can be promptly treated.

 

  • Food-pipe/ Esophageal pain: This is caused by increased acidity and mild erosion of the food-pipe. The pain here is burning type, normally increases on an empty stomach. It is normally associated with belching and sour eructations. The test preferred is a Scopy of the upper gut where in a tube with a small camera is passed into the food-pipe to diagnose the problem. It is easily treated with antacids and drugs to reduce acid secretion.

 

  • Spine problems: Here, the pain is dull or sharp but always localized to the spine. It originates from the spine and most of the time radiates to the sides. Movement of the spine makes the pain worst. An X-ray or MRI of the spine may be necessary to assess the severity of the problem. Most of the time the pain subsides with medical treatment. It is relieved with analgesics and muscle relaxants.

 

  • Muscular pain: These are normally associated with soreness of the muscle and dull aching in nature. They are easy to recognize and so easily treatable with analgesic and some exercises.

These are the common causes of chest pain. One needs to be cautious when it is in the center of the chest and associated with breathlessness.

 

The take home message is: DO NOT IGNORE CHEST PAIN! SEEK MEDICAL ATTENTION IMMEDIATELY!