Diagnosis of Recurrent Brain Tumor.

The advantages of positron imaging in diagnosis of various malignancies have been touted by proponents of positron emission tomography (PET) technology. While PET lacks the anatomic resolution of CT and MR imaging, it is quite sensitive to small foci of increased metabolic activity, such as small tumors.ECRI conducted a short-form technology assessment of PET for diagnosis of recurrent brain tumor, comparing it to single photon emission CT (SPECT) and to CT and MRI.A total of 22 published journal articles with PET clinical trial results were examined. Eight of these met our criteria for analysis:$#183; Study was reported in the English-language peer-reviewed literature, as a full article rather than an abstract only$#183; Study compared results of the positron imaging modality to results of a reference test (surgical pathology or clinical follow-up) in patients with recurrent brain tumor and in patients with radionecrosis or other treatment-related changes.$#183; Interpretation of the positron results was blinded to the reference standard$#183; Study reported sufficient data to permit calculation of sensitivity and specificity.$#183; Study did not include any pre-treatment patients, or reported them separately.$#183; At least ten patients total in recurrent tumor and control groups.Studies were included irrespective of their prospective or retrospective design, and irrespective of the role of MR or CT in acquiring or analyzing PET results.Meta-analysis of these trials yielded a summary ROC with a very broad confidence interval. The summary ROC derived from five clinical trials of thallium-201 SPECT also had a very broad confidence interval.14 of the 22 PET studies reported that CT and/or MRI was used in a complementary role to PET: CT and MR images were used to identify lesions to be analyzed with PET. 10 of the 17 SPECT trials also used CT and/or MRI for localization purposes.We concluded that PET appears to have some capability for differential diagnosis between brain tumor recurrence, but there is insufficient evidence for proving this hypothesis or for estimating the sensitivity and specificity of PET. We were unable to draw any conclusions about whether PET is more effective than SPECT for this particular diagnostic task.

Best Treatment for Prostate Cancer?

Prostate cancer treatment is complex. Knowing which treatment will give the greatest life expectancy is a difficult decisions. Doctors and patients much choose among prostatectomy, radiotherapy, watchful waiting, hormone therapy and other treatments. Looking over past data, researchers have learned the survival rates for each of these treatments in a Swiss population.

Prostate Cancer Treatment, Longevity and LIfe Expectancy
Which Prostate Cancer Treatment Gives The Best Life Expectancy?

Prostate cancer treatments cover a wide range of approaches that impact life expectancy differently. Believe it or not, no formal clinical studies have been done to determine how best to treat localized prostate cancer. These studies would be extremely difficult to do -- they would take up to 10 years to complete, people would have to be randomly assigned to different treatment groups and the cost would be quite high. So instead, researchers have taken data from the past to compare treatments. This is called a retrospective (or historical) study. Keep in mind that there may be factors unknown to the researchers reviewing medical charts that impact the outcome.
Life Expectancy and Localized Prostate Cancer.
Swiss researchers examined the treatment and outcomes of 844 patients diagnosed with localized prostate cancer sometime between 1989 and 1998.

Five different types of treatment were applied (the "n" indicates the number of participants):prostatectomy (surgical removal of the prostate) n=158
radiotherapy (radiation treatment) n=205
watchful waiting (monitoring the cancer) n=378
hormone therapy n=72
other treatments n=31
prostatectomy (surgical removal of the prostate) n=158
radiotherapy (radiation treatment) n=205
watchful waiting (monitoring the cancer) n=378
hormone therapy n=72
other treatments n=31
Survival and Lie Expectancy in Localized Prostate Cancer.
The researchers looked at the survival rates for each group and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment. Overall, 10-year survival was:83% for prostatectomy
75% for radiotherapy
72% for watchful waiting
83% for prostatectomy
75% for radiotherapy
72% for watchful waiting
Those who had hormone risk had decreased survival rates at 5 years, but this is almost certainly because their cancer was a much more aggressive type when they were diagnosed.
Is Prostatectomy the Best Treatment for Prostate Cancer Then?
You cannot conclude that from this study. What we don't know is why certain people were given the treatment they received. It could be the Swiss doctors have a preference. For example, they might prefer a prosatectomy when the cancer presents a certain way and radiotherapy when it "looks" different. In other words, this study tells us that prostectomy is the most effective OR that doctors tend to send patients with less threatening tumors for prostectomies OR (more likely) a complex combination of both (and throw in some other factors too). Confused yet? Sorry about that. But it is important that you understand the limitations of these studies. Ask your doctor what factors he or she uses to decide on treatment and engage with that discussion.

What Are Prostate Cancer Basics?

Prostate Cancer Basics

Whether you or someone you know has been recently diagnosed with prostate cancer or you are simply interested in learning more about this important disease, there are three key questions that need to be answered.

What Is the Prostate?

The prostate is a small, walnut-sized gland that exists only in men. It is situated just below the bladder and just in front of the rectum in the lower pelvis.

The bladder acts as a storage area for urine. When the bladder is emptied, the urine travels through a thin tube called the urethra to the penis and then out. The very beginning of the urethra as it leaves the bladder passes directly through the prostate. This fact accounts for why so many men with either prostate cancer or BPH (benign prostatic hyperplasia) develop trouble urinating. As the prostate enlarges, the urethra is pinched off, leaving a smaller tube to carry urine from the bladder to outside the body.

The prostate’s primary function is to produce much of the fluid that makes up semen. Semen acts to protect sperm as it makes its way out of the body.

The prostate is present from before birth and grows in response to male hormones such as testosterone. Blocking the production or effects of these hormones is one of the primary treatment options for prostate cancer.
What Is Cancer?

Cancer is most simply explained as cells in a certain part of the body that have started to grow in an out-of-control and unregulated fashion.

The human body is made up of billions of tiny units called cells. These are the smallest structures in the body that can be considered to be living. They can only be seen under high-powered microscopes. Cells normally go through a life cycle of growth, division, and death. When this occurs in an orderly fashion, cells are created and die in roughly equal numbers. They also normally stay confined to the area of the body in which they were meant to be.

Unfortunately, certain cells sometimes begin to multiply much faster than they die. When this happens, these abnormal cells squeeze out nearby normal cells. These abnormal cancerous cells can also spread outside of their original site in the body and spread to other areas. When cancer from one body site has spread to other areas of the body, the cancer can be said to have “metastasized". This is always an unfortunate occurrence as cancer that has spread is much harder to treat in general.

A cancer is named after its original site in the body. For example, prostate cancer, even if it were to spread to the bones or to the colon would still be called prostate cancer and not bone or colon cancer. This would more appropriately be called “prostate cancer with metastasis to the bone.”

All types of cancer are different. For example, prostate cancer is very different from lung cancer. The two are caused by different factors, diagnosed in different ways, and treated differently. Regardless of the type of cancer, the underlying problem is the unregulated and abnormal growth of the cells in that part of the body.
What Is Prostate Cancer?

Since cancer is the uncontrolled and abnormal growth of cells in a certain area of the body, prostate cancer is simply the uncontrolled and abnormal growth of cells in the prostate.

Some men have BPH (benign prostatic hyperplasia). This is often confused with prostate cancer. With BPH, prostate cells multiply faster than they should. This causes the prostate to enlarge and the patient to develop difficulty urinating. With prostate cancer, the cells not only multiply faster, but also behave abnormally by spreading outside of the prostate if not caught in time. BPH is not cancer, but can show some of the same symptoms.

The prostate is made up of many different types of cells. The gland cells (those cells that actually work to produce the fluid that is released into the semen) however, are nearly always the cells that become cancerous. The technical medical term for cancer that arises from gland cells is adenocarcinoma. Thus, the technical term for prostate cancer is prostate (or prostatic) adenocarcinoma.

Early detection, prompt diagnosis, and effective treatment are the mainstays of good prostate cancer care.

Hair Dye Allergies

Hair Dye Allergies – Introduction

About 5% of permanent hair dyes users develop allergy, mostly in the form of an allergic contact dermatitis with redness and itching in the head area, but systemic reaction with involvement of the whole body skin and other organs is possible in severe cases. Hand dermatitis affects considerable percent of hair-dressers . The main cause is substance PPD. 
PPD (4-ParaPhenyleneDiamine, C6H8N2)

PPD is widely present on the market since 1909, and it is still used in over 2/3 of permanent hair dyes. Commercial hair dye product typically comes in two bottles: the one with PPD based dye (non-oxidized and thus colorless) and the other with oxidizer or developer, usually hydrogen peroxide (H2O2). In the hair dying process initially the peroxide is used to break down the natural hair pigment melanin, and then the PPD is used to replace melanin. When PPD reacts with peroxide it becomes partly oxidized and colored — it is this form which may cause allergy. Fully oxidized PPD does not cause allergy, so PPD sensitive persons can wear fur coats dyed with PPD safely . PPD can be also found in some dark colored cosmetics and temporary tattoos. In France, Germany and Sweden, PPD was banned as a hair dye because it was thought to be too dangerous for health .

Alternative names for PPD: PPDA, Orsin, Rodol, Ursol.
PPD and PPD Related Substances

Other hair dye substances thatcan cause allergy: 6-hydroxyindole, Isatin, p-Methylaminophenol

Substances related to PPD that may also cause an allergic reaction:

Azo groups (chemically: R-N=N-R) used in temporary hair dyes, ballpoint pen inks, gasoline and as coloring agent in foods and medications
Local anesthetics benzocaine and procaine
Sulfa drugs
Para-aminobenzoic acid (PABA) in sun-protective creams
Para-aminosalicylic acid used for treatment of tuberculosis.

Hair dyes producers misleadingly use certain terms. “Hypoallergenic” hair dyes should less likely cause allergies, but this is not proven. “Fragrances free or unscented” only means the product has no odor, but this does not reduce their potential allergenic action. A hair dye that is completely “natural“ can still trigger an allergic reaction in a sensitive person.
Types of Allergies Caused by Hair Dyes

Allergic contact dermatitis (ACD) is an immunologic skin reaction occurring in a genetically predisposed individual; the risk of becoming sensitive rises with coloring frequency . At least 10 days after initial use of PPD is required for an individual to develop a specific sensitivity. On the second and subsequent exposures to PPD, an allergy reaction can develop in 6-72 hours (delayed hypersensitivity). In this process, PPD molecule are attacked and destroyed by certain immune cells (macrophages and lymphocytes), resulting in creating of skin granuloma, redness or vesicles. Affected areas – eyelids, ears, skin at hair line, beard or neck - are usually well demarcated but may propagate beyond the site of contact with a hair dye. Symptoms are itching or burning feeling.

Contact urticariacan develop in minutes to about 1 hour after exposure. PPD triggers production of IgE antibodies and release of histamine causing dilation of skin vessels and leaking of blood plasma into the skin resulting in skin redness and edema (swelling of the eyelids) . Contact Urticaria Syndrome (CUS) with red patches over the entire body, and bronchial asthma with wheezing, sneezing, difficult swallowing and vomiting can appear.

Anaphylactic shockis extremely rare but life threatening condition. Facial swelling, grasping for air, blood pressure fall, and death, if not immediate help is available, is a usual sequence of events. It was reported that a 38 year mother died in UK in August 2000 shortly after changing her hair dye. She was asthmatic before, and she firstly developed anallergy with scalp itching after using her old hair dye for some months. After changing the dye, anaphylactic shock developed, and she died within an hour after applying it.
Allergy Sensitivity Test

Hair dye consumer can apply a solution (i.e. dye and developer mixed together) behind the ear or on the inner side of the elbow for 48-72 hours. If no irritation or rash occurs during this time, the test is negative and the hair color may be considered as safe to use. If a rash of a certain size (according to test scale) develops, this is a sign of allergy.

Dermatologist will use a patch test. A patch with a 2% PPD in petrolatum is applied to the upper back and checked after 48 hours. Negative reactions show no skin changes; positive reaction can vary from a mild rash to prominent blisters or ulcers. In “ready-to-use” T.R.U.E. patch test, 24 possibly allergy causing substances (including PPD) are tested at once.
Treatment of PPD Allergy

In acute severe hair dye dermatitis caused by PPD, the hair and scalp has to be washed thoroughly with a mild shampoo. 2% hydrogen peroxide solution or compresses with potassium permanganate in a 1:5000 dilution have to be applied to completely oxidize the PPD. To soften the crust, a wet dressing of olive oil and lime may be used.

The patch test has to be made afterwards to determine if there an allergy to PPD exists, or there is only a non-allergic contact dermatitis present. In the case of proven allergic dermatitis, corticosteroid cream, which reduces allergic immune response, can be applied.

Discussion heart attack

Q. what should I do to prevent heart attack?

A1	The American Heart Association recommends that heart attack prevention begin by age 20. This means assessing your risk factors and working to keep them low. For those over 40, or those with multiple risk factors, it’s important to calculate the risk of developing cardiovascular disease in the next 10 years. Many first-ever heart attacks or strokes are fatal or disabling, so prevention is critical. The sooner you begin comprehensive risk reduction, the longer and stronger your heart will beat. For the full article and a quiz to test your heart health:http://medicaladv.blogspot.com/2009/12/miscellaneous-heart-disease-subjects.html
A2	whooooohooo! because i have a very bad genetics in that part- i'm a bit obsessed by it. heart problems caused by numerous things: smoking, fat in the blood, high cholesterol, Diabetes, your genetics and some other things (but not as important as those five). you might want to check them up and prevent them from happening. here is a tutorial about heart attacks: http://medicaladv.blogspot.com/2009/12/miscellaneous-heart-disease-subjects.html
A3	There are many things that can cause a heart attack. Stress is one of the biggest factors in our society today and its hard to prevent .Yoga or other relaxing techniques can really help in that area. Omega-3 fish oils are very good for the heart function.OPC-3 plays a very good role in blood circulation and helps to prevent platlets from clogging arteries. It contains a red wine extract, grapeseed extract,bilberry and pycnogenol. If you are taking Cumidine or another type blood thinner, it is not recommended to take this product. The best thing to do is talk to your Doctor.Ask him about these natural products for prevention. Exercise and prevention are the best tools we have available to us. Healthy eating habits and maintaing a healthy weight are very important. Regular check-ups with your doctor are extremely important even if it's just a yearly physical. Take care and best wishes.

Q. What causes Cardiomegaly?

My Husband has had a physical checkup and has found to have Cardiomegaly. What does it mean and what causes it?

A1	Cardiomegaly means an enlarged heart and it is a sign of an underlying problem. It can have many causes, including: High blood pressure Heart valve disorders Weakness of the heart muscle (cardiomyopathy) Severe anemia Thyroid disorders Excessive iron in the body (hemochromatosis) Abnormal protein buildup in an organ (amyloidosis)
A2	Cardiomegaly is a condition wherein the heart enlarges. Cardiomegaly occurs if the heart is more than 50 percent bigger than the inner diameter of one’s rib cage. It can be caused by many different things, but mostly it is because of low heart output, otherwise referred to as a cardiac failure.

Q. What causes blood clots?

My father had a heart attack which was caused by a blood clot. Am I at risk for developing blood clots too? How do I prevent it from happening?

A1

I found a website that checks your risks for inheriting your family's illness, including blood clots. They have a test you can do which is called "Free Risk Assessment for Thrombophilia": http://medicaladv.blogspot.com/2009/12/how-does-heart-attack-damage-heart.html

A2

If your Father has a history of blood clots, you might have inherited thrombophilia (a predisposition for blood clotting). Also, the older you get the risks for developing blood clots, increases. In order to prevent blood clots, it is important to reduce or quit smoking and to control high blood pressure. High cholesterol levels also present a risk for blood clots and may be checked by your doctor. A healthy diet and regular exercise also help to reduce the risk of heart attack and stroke.

Q. What Are the Signs and Symptoms of a Heart Attack?

I am 63 years old, suffering from chronic hypertension and diabetes for many years now. I know I'm at a very high risk for developing a heart attack, and I would like to know- what are the signs of having a heart attack?

A1

The onset of symptoms in myocardial infarction (MI or- heart attack) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen, where it may mimic heartburn. This can be accompanied by general bad feeling, fatigue, sweating, palpitations, nausea or vomiting. At any sudden onset of debilitating chest pain, you must seek medical help.

A2

The complaint that most patients undergoing a heart attack (or- myocardial infarction) come with to the emergency room is severe sharp chest pain, that may or may not be related to physical activity. This pain can be described as pressure or burning sensation. It often radiates to other places such as the left arm, neck or jaw. Sometimes there are other gastrointestinal complaints such as nausea and vomiting. Sometimes there is even trouble breathing that requires ventilation. This combination of signs and symptoms is a "red flag" and it is advised to be examined by a doctor.

Q. What Are the Risk Factors for Developing a Heart Attack?

A2

The risk factors that are known to be connected with higher risk of developing myocardial infarction ("MI" or- heart attack) are the ones causing atherosclerosis: older age, tobacco smoking, Hypercholesterolemia (especially high LDL-cholesterol levels and low HDL-cholesterol levels), diabetes, high blood pressure, obesity (especially with BMI over 30) and stress. Familial history of heart disease or heart attack at a young age (under 50) is also a considerable risk factor.

Q. Is it true that Zocor helps to prevent heart attacks?

I am a 54 years old male, and I have family history of cardio vascular diseases. My physician prescribed me Zocor and said it will lower the chance for heart attacks. If it is true how come not all of the population is taking this drug? Is it really a good way to prevent cardio vasculare diseases?

A1	Zocor is a drug that is used to lower the risk of heart attack. It works by lowering the LDL (the bad cholesterol). The reason why not everyone is taking it is that not every one has a high bad cholesterol.
A2	there are several drugs that are used to decrease the chance of a heart attack and i heard Zocor is one of them. it is a good prevention method but it won't help every one and it shouldn't be used without the GP's recommendation

Q. why?

i got Heart attack 4 yrs ago... and to this moment i feel good but... there r some pain i don't understand it...here in my city when i go to hospital to chick...all thay can do...open my cheast.. lol.. i need to know.....last 3 yrs i were play basket ball matchs ..now i cann't my wight become heaver..why !! i don't eat much !1..many quistion..

A1	yes i got shortness of breath when i start walk only..but after a mints of walk.i back normal..and everyday i used to Climb the stairs 14 floors i don't feel efforts or shortness of breath ..and .. i got more fatty..in spite of i don't eat much.. but.. I Aterv i'm lazy.. i did ECO and i don't know how i can send u the picture i scanned it to my computer..can I send it to u ?
A2	First, if you are experiencing weakness, shortness of breath or aches during resting or exercising, you should turn to a doctor to get examined and get an ECG done. Especially because you already had one heart attack, you need to be more alert for signs and symptoms of a cardial problem that may occur. Also you have to maintain a low-fat, low-cholesterol diet, and take your medications as given.

How Drugs Work in Your Body

Drugs work in your body in a variety of ways. They can interfere with microorganisms (germs) that invade your body, destroy abnormal cells that cause cancer, replace deficient substances (such as hormones or vitamins), or change the way that cells work in your body.

There are more than 8,000 medications available either by prescription or over-the-counter. Some can be used to treat several different health conditions. Aspirin, for example, can be used to treat pain, inflammation, and fever. In addition, aspirin can prevent heart attacks if taken on a regular basis.

The following information is a basic overview of how some drugs work to improve your health.
Fighting Infections
An infection occurs when microorganisms, such as bacteria or viruses, invade your body. Medications used to treat infections can kill germs directly or prevent them from multiplying and growing.


Some medications used to treat infections include:
Augmentin (amoxicillin/clavulanic acid), used to treat ear infections
Bactrim (trimethoprim-sulfamethoxazole), used to treat urinary tract infections
Lamisil (terbinafine), used to treat ringworm
Pen-Vee K (penicillin), used to treat strep throat
Valtrex (valacyclovir), used to treat herpes infections
Targeting Cancer Cells
There are three types of medications used to treat cancer. Chemotherapy attacks cancer cells directly and stops or slows their growth and spread. Biological therapy helps your body’s immune system fight cancer. Lastly, antiangiogenic therapy blocks the growth of new blood vessels to a tumor, which may cut off a tumor's supply of oxygen and nutrients. Some cancers are treated with a combination of these medications.

Some medications used to treat cancer are:
Adriamycin (doxorubicin), a chemotherapy agent used to treat a number of cancers, including bone, breast, stomach, lung, bladder, leukemia and lymphoma
Avastin (bevacizumab), an antiangiogenic therapy used to treat cancers of the colon, rectum, or lung
Intron-A (interferon alpha), a biological therapy used to treat malignant melanoma
Herceptin (trastuzumab), a biological therapy used to treat breast cancer
Platinol (cisplatin), a chemotherapy agent used to treat many types of cancer including bladder, lung, and head and neck
Replacing Missing or Deficient Substances
Your body needs certain levels of amino acids (or proteins), vitamins and minerals to work properly. If these substances are deficient or missing, you can develop health conditions such as scurvy (vitamin C deficiency), anemia (iron deficiency), and pernicious anemia (vitamin B12 deficiency). Recent medical studies have suggest that a lack of vitamin D may increase the risk of heart attack in men. Your physician, therefore, may recommend a vitamin D supplement.


You also can develop a deficiency disorder caused by a lack of hormones in your body. Hormones regulate many of the functions in your body, and a deficiency in one or more hormones can cause serious health problems. Diabetes (insulin deficiency), hypothyroidism (thyroid hormone deficiency), and short stature (growth hormone deficiency) are some examples.

Some medications used to treat hormone deficiency disorders are:
Androgel (testosterone), used to treat hypogonadism (low testosterone in men)
Humalog (insulin lispro), used to treat diabetes
Humatrope (somatropin), used to treat short stature due to growth hormone deficiency
Premarin (conjugated estrogens), used to treat symptoms of menopause
Synthroid (levothyroxine), used to treat hypothyroidism
Changing How Cells Work
Most common chronic diseases -- such as asthma, type 2 diabetes, hypertension, arthritis, heart disease, and some types of mental illness -- are caused by an abnormality in how the cells in your body function. These abnormalities may be caused by aging of cells, genetics, wear and tear on the body, and lifestyle issues such as smoking, lack of exercise, poor eating habits, and environmental stress and pollution.

Most medications prescribed or sold over the counter target one or more of these cell abnormalities. For example, some medications used to treat pain and inflammation interfere with the production of chemical substances that are released by cells in response to tissue damage. These chemical substances, also known as mediators, are responsible for the pain and swelling in arthritis and injuries.

Some medications used to treat depression work by increasing the amount of a chemical messenger in the brain. Additionally, some other medications make cells more or less sensitive to hormones in the body. Beta blockers, such as Tenor min (atenolol) and Toprol XL (metoprolol), are used to treat hypertension by making heart cells less sensitive to the body’s adrenaline. Some oral diabetes medications, such as Actos (pioglitazone) and Avandia (rosiglitazone), make muscle cells more sensitive to insulin.

Some medications that alter the function of body cells are:

Arthrotec (diclofenac, misoprostol), used to treat arthritis
Lipitor (atorvastatin), used to treat high cholesterol
Nexium (esomeprazole), used to treat GERD (heartburn)
Viagra (Sildenafil), used to treat erectile dysfunction
Zoloft (sertraline), used to treat depression

Drug Interactions: Reducing Your Risk

What Is a Drug Interaction?

Drug interactions occur when one drug interacts with another drug that you are taking or when your medications interact with what you eat or drink. Drug interactions can change the way your medications act in your body. Drug interactions can make your medications less effective or they can cause unexpected and potentially dangerous side effects.

Your risk of having a drug interaction increases with the number of prescription and over-the-counter medications that you use. Moreover, the type of medications you take, your age, diet, disease, and overall health can all affect your risk. The elderly are at greater risk for drug interactions than younger adults since a larger proportion of seniors take prescription medications or over-the-counter products.

There are three important types of drug interactions:

Drug-drug interactions occur when two or more drugs interact with each other. Interactions can occur with prescription drugs, over-the-counter drugs, vitamins, and alternative medications such as supplements and herbal products.

Some examples of drug-drug interactions include:
Mixing a prescription sedative to help you sleep with an over-the-counter antihistamine for allergies can cause daytime drowsiness and make driving or operating machinery dangerous.
Combining aspirin with a prescription blood thinner such as Plavix (clopidogrel) can cause excessive bleeding.
Some over-the-counter antacids interfere with the absorption of antibiotics into the bloodstream. Certain medications used to treat fungal infections can cause serious side effects when combined with cholesterol-lowering medications such as Lipton (atorvastatin).
The herbal supplement ginkgo balboa can cause bleeding if taken with aspirin.

Drug-food interactions occur when a drug interacts with something you eat or drink.

Some examples of drug-food interactions include:
Dairy products, such as milk, yogurt and cheese, can interfere with the absorption of antibiotics into the bloodstream.
More than 50 prescription drugs are affected by grapefruit juice. Grapefruit juice inhibits an enzyme in the intestine that normally breaks down certain drugs and hence allows more of a medication to enter the blood stream.
Vegetables containing vitamin K, such as broccoli, kale and spinach, can decrease the effectiveness of drugs, such as Coumadin (warfarin), given to prevent blood clotting.
Mixing alcohol with some drugs is particularly dangerous. Alcohol interacts with most antidepressants and with other drugs that affect the brain. The combination can cause fatigue, dizziness, and slow reactions. A small amount of beer, wine, or liquor can increase your risk of stomach bleeding or liver damage when mixed with over-the-counter anti-inflammatory drugs and medications used to treat pain and fever. These drugs include aspirin, ibuprofen, and acetaminophen.

Drug-condition interactions may occur when a medication interacts with an existing health condition.

Some examples of drug-condition interactions include:
Decongestants, such as pseudo ephedrine found in many cough and cold preparations, can increase blood pressure and may be dangerous for people with hypertension. 
Beta blockers, such as Toprol XL (metoprolol) and Tenormin (atenolol), used to treat high blood pressure and certain types of heart disease can worsen the symptoms of asthma and COPD.
Diuretics, such as Hydrodiuril (hydrochlorothiazide), can increase blood sugar in people with diabetes.
What Can I Do to Help Prevent Drug Interactions?
Before starting any new prescription drug or over-the-counter drug, talk to your primary healthcare provider or pharmacist. Make sure that they are aware of any vitamins or supplements that you take.
Make sure to read the patient information handout given to you at the pharmacy. If you are not given an information sheet, ask your pharmacist for one.
Check the labels of your medications for any warnings and look for the "Drug Interaction Precaution". Read these warnings carefully.
Make a list of all your prescription medications and over-the-counter products, including drugs, vitamins, and supplements. Review this list with all healthcare providers and your pharmacist. 
If possible, use one pharmacy for all your prescription medications and over-the-counter products. This way your pharmacist has a record of all your prescription drugs and can advise you about drug interactions and side effects.

Treatments and drugs

Hormone therapy
Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring.

Discuss the various options with your doctor to determine which might be best for you.
Prescription medications
If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include: 

Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures. 

Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

In 2007, the Food and Drug Administration (FDA) approved the first once-yearly drug for postmenopausal women with osteoporosis. The medication, zoledronic acid (Reclast), is given intravenously at your doctor's office. It takes about 15 minutes to get your annual dose. One published study found that zoledronic acid reduces the risk of spine fracture by 70 percent and of hip fracture by 41 percent. 

A small number of cases of osteonecrosis of the jaw have been reported in people taking bisphosphonates for osteoporosis. These cases have primarily occurred after trauma to the jaw, such as a tooth extraction, or cancer treatment. Risk appears to be higher in people who have received bisphosphonates intravenously. While there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you're taking and discuss your concerns.

Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.

Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.

Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the FDA recommends restricting therapy to two years or less.

Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women older than 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.

Emerging therapies
A new physical therapy program has been shown to significantly reduce back pain, improve posture and reduce the risk of falls in women with osteoporosis who also have curvature of the spine. The program combines the use of a device called a spinal weighted kypho-orthosis (WKO) — a harness with a light weight attached — and specific back extension exercises. The WKO is worn daily for 30 minutes in the morning and 30 minutes in the afternoon and while performing 10 repetitions of back extension exercises.

Miscellaneous Heart Disease Subjects and Other Heart Conditions

What is an angina attack?
Angina is a lack of blood and therefore oxygen to the heart muscle that does not cause damage. It may be a warning of a future heart attack.

What exactly is the difference between an angina attack and a heart attack?
In angina there is no death of the heart muscle tissue. It is reversible. There is enough blockage to cause pain, but not enough blockage to cause death of the muscle. Often angina, ie chest pain, is a warning signal for a possible heart attack.

What is the difference between a heart attack and congestive heart failure?
Congestive heart failure is an inadequate pumping of the heart. It may be caused by the damage that occurs in a heart attack, but it may also have other causes such as infection of the heart muscle.

Can congestive heart failure develop simply from age?

Yes, as muscles weaken with age.

What are heart arteries?

The coronary arteries are direct branches of the ascending aorta (the major blood vessel arising from the heart. There are 2 major arteries, the right and the left coronary artery. The left one branches into the left anterior descending artery (also known as LAD which is the most frequently occluded vessel in a heart attack) and the circumflex. The circumflex forms a connection with the right coronary artery. The right coronary artery gives rise to 3 branches, the anterior right atrial branch which goes to the sinoatrial node (the natural pacer of the heart), the marginal artery and the posterior descending branch. See this site for diagrams.

Does blood get to the areas of the heart in any other way besides arteries?
Thesbian veins are small and fairly insignificant vessels that empty directly into the left chamber of the heart.

Are there other ways arteries get blocked besides clogging from plaque?
Yes.

How can that happen to an artery?

This happens if there is a tear in the artery.

Who would be at risk for this?

This may especially occur in young women post par-tum,, after the birth of the baby. 

What can be done to prevent this from happening?

Nothing.

How is stress related to heart attacks?

Stress may increase the heart rate and blood pressure which increase the demand on the heart muscles.

What does genetics or family history have to do with heart attacks?

The risk factors such as high cholesterol and high blood pressure may be inherited, but there may be other factors which have not yet been identified.

What are collaterals?

Collaterals are arteries that develop spontaneously in response to an existing blockage as natural bypasses in the heart to help improve blood flow to the heart muscles. Exercising can help improve the development of collaterals.

Heart Disease - Cardiovascular Drugs and Medications FAQ

Why does smoking put a person at more risk for a heart attack?

Nicotine can cause vaso constriction, ie decrease the diameter of the blood vessels. It can also increase the heart rate initially. In addition to nicotine cigarettes may contain other toxic substances which may damage the blood vessels. I mention smoking here in this section because nicotine should be thought of as a drug, and specifically a drug that can complicate cardiovascular disease.

What does taking a baby aspirin each day do to help prevent a heart attack?

Aspirin makes it less likely for the blood to clot.

Platelets and platelet products are needed for blood to clot. This is useful when we have a cut or a nose bleed, but the same process may also facilitate the clot formation which leads to a heart attack. Aspirin blocks the formation of a factor called prostaglandin which is needed to produce another clotting factor called thromboxane A2, a powerful promoter of platelet aggregation. It therefore, indirectly, lowers the platelets ability to clump together to form a clot. Small amounts of aspirin 75-100 mg are needed for this process. Typical baby aspirin measure 81 mg each.

Who should be taking a baby aspirin as a preventative treatment each day?
Not everyone is recommended to take aspirin as a heart medication.

Evidence from basic research has provided strong support for the net benefits of aspirin in decreasing the risk of cardiovascular disease (CVD) in a wide range of patients. People who are at high risk for heart disease or other vascular diseases ( primary prevention) or people who have already suffered a cardiovascular event such as a heart attack, angina, or stroke ( secondary prevention) should take aspirin.

You should not start aspirin therapy without first consulting your physician. The risks and benefits of aspirin therapy vary for each person. If you’re taking aspirin and you must undergo even a simple surgical procedure or dental extraction, you must tell the surgeon or dentist your aspirin dosage.

What is a clot busting drug?

Tissue plasminogen activator (tPA) which is a thrombolytic or clot busting agent.

When would a person be given a clot busting drug?
This is usually done if the patient goes to a hospital that doesn’t have the capability to do angioplasty. The patient is usually then transferred after the tPA treatment to a facility that is able to do the angioplasty procedure.

What are the side effects of clot busting drugs?
Stroke, gastrointestinal bleed.

What is nitro glycerin?

It is a vasodilator that dilates all blood vessels and not just the heart blood vessels. This is why a common side effect is headache.

Is that the same nitro glycerin that explodes like dynamite?
Yes.

What does nitro do to your heart that helps?
It drops the blood pressure and the heart beats more effectively.

When should you take a nitroglycerin pill?
It should be taken for chest pain that occurs on exertion, or any typical cardiac chest pain with which the patient is familiar and recognizes as heart pain as opposed to muscular pain.

Why do you put nitro under your tongue instead of swallowing them?

Absorption into the arterial system occurs faster thus providing better treatment.

Does nitro lose it’s potency over time?
Yes. Monitor the expiration date on the bottle and keep your nitroglycerin prescription updated regularly.

What kinds of things make nitro loose potency faster?
Heat and sunlight. It should be kept in an airtight sealed container in a cool dark place.

Who should carry nitro with them all the time?

Any one with a history of heart attack or angina.

What is the best way to carry nitro?

In the brown bottle that it comes in which reduces the light exposure.

Should a heart attack patient take erectile dysfunction medication?

Yes, they may as long as the patient is stable and he is not taking nitroglycerin type medications. There are some nitroglycerin type medications that are taken regularly or there are circumstances where nitroglycerin may have been taken on that day.

Are there common non-prescription drugs that a heart attack patient should avoid?
In general it is best to check with your doctor about over the counter medications. There are certain medications such as Sudafed which may increase the heart rate or blood pressure and therefore increase the demand on the heart. If the patient is on aspirin or other blood thinner then ibuprofen or other non-steroidal anti-inflammatory medications should be avoided.

What is a beta blocker drug?
Beta blockers are a class of medications which is used after heart attacks and in treatment of arrhythmias. Their main cardio protective effect is to lower the heart rate. 

Why would a patient want their heart rate lowered?
This reduces the oxygen supply and demand ratio in favor of the patient.

Are there different types of beta blockers?
The 2 main types of beta blockers are cardio-selective which mainly effect the heart cells and to a smaller extent the lung, and the non-cardio-selective B-blockers which effect the body in general. Examples of the cardio-selective blockers are atenolol, bisoprolol, and metoprolol. Non-cardio-selective blockers include propranolol, carvedilol, and nadolol.

What are the side effects of beta blocker drugs?

Some common side effects of beta blockers are Fatigue, depression, erectile dysfunction, or asthma exacerbation.

Why would a person take the drug Plavix after a heart attack?

Plavix (clopidrogel) is taken to reduce the risk of another heart attack by reducing blood clot formation.

What does Plavix do that makes it different from taking asprin?

There are multiple stages to the clotting process. While aspirin effects this process indirectly as described in the previous question, Plavix works directly on the platelet.

Clopidogrel works by preventing a natural substance called ADP (adenosine diphosphatase) from binding to its receptors on platelets. ADP is one of the chemicals in the body that cause platelets to clump together and start the process of blood clotting. As clopidogrel stops ADP from binding to platelets, it reduces the likelihood of clots forming in the blood.

Life After A Heart Attack

Does a person ever recover from a heart attack?

Yes, but the level of activities that they may resume depends on the degree of the heart attack. Daily life after a heart attack may look just as before the heart attack with no negative effects. A heart attack that caused more damage to the heart muscle tissue may result in a more limited list of activities for daily life. In any case, anyone suffering a heart attack needs to pay attention to their diet, exercise and other aspects of their post heart attack life to insure that they do not experience another heart attack. This may start by making sure any cigarette smokers use their heart attacks as a wake up call to quit smoking!

What sports can a person take part in after a heart attack?

This depends on the size of the heart attack. Work closely with your doctor, but exercise after a heart attack becomes an important part of recovery and resuming a normal life.

What sports should be avoided after a heart attack?

Scuba diving may need to be avoided because it causes a vagal reaction which causes a decrease in blood pressure.

Which heart disease patients should still scuba dive?
It depends on the severity of the heart attack. If the blocked artery has been corrected such as through bypass surgery or angioplasty and if the patient then has a normal stress test then diving is permitted in warm waters. However, in a person who has had extensive muscle death after a heart attack, then diving is not permitted due to the inability of the muscles to keep up with the pumping requirement needed. It is not recommended for most people with coronary artery disease who have not corrected the problem to dive.

How soon after a heart attack can a person fly in an airplane?

A person may fly in an airplane as soon as there is recovery from the heart attack.

How often can a person fly after a heart attack?

There is no restriction.

Should a person who has had a heart attack avoid saunas or steam showers?

They should be careful in these circumstances as they may cause a drop in blood pressure which may effect blood flow to the brain and to the heart. This may cause the patient to pass out or lose consciousness.

Should a person try to live a normal life after a heart attack or should they restrict certain regular activities?
The level of activity depends on the severity of the heart attack. If a large part of the heart muscle is involved and rendered ineffective then there may be more limitations on the physical activity. However, if the heart attack is mild and it is not complicated by heart failure then normal life activity may be resumed.

When can a heart attack patient drive a car again?

A heart attack survivor may drive in 2-4 weeks depending on how severe the heart attack was and if there were any complications.

How long until a heart attack victim can go back to work?

Depending on the type of work, patients can go back to work very soon after discharge from the hospital.

What if they have a physically demanding job?
A physically demanding job will need a longer time and will be evaluated based on follow up stress tests.

Are there some things I should never eat again ever for my whole life?
It depends on many variables such as your weight, cholesterol, blood pressure, and sugar levels. In general it is best to avoid fats, especially animal fats and saturated fats, desserts that are high in sugar and butter. Restrictions on diet for patients with a history of heart disease may remain in effect for the rest of their life.

I’ve talked to people who feel depressed after a heart attack, what is the relationship between depression and a heart attack?
It is believed to be mainly situational.

What can help a heart attack patient through any depression?
Cardiac rehab and anti-depressants may help through depression. In the January 24, 2007 issue of JAMA1 a study was published that showed that “citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with coronary artery disease and major depression” and that interpersonal psychotherapy did not add any benefit to the treatment.

Can a heart attack patient ever have sex again?

Yes. Sex is usually ok when a person can achieve 4-5 mets on a treadmill test without symptoms or other complications such as arrhythmia or significant ST changes (some people use ability to climb two flights of stairs without problems as their guideline for resuming sex). Usual heart rate with sex is 110-120 so when this heart rate can be achieved safely sex is usually ok. Interesting however is that the data on death and sex is from a study on business men who died suddenly - the study was from Japan. Additional circumstances included being with an unfamiliar partner, having eaten a large meal, having had an excess of alcohol and sex is added to this mix - not a generally good thing to do! It is appropriate to treat sex just like any other physical activity with the exception of adding the emotional environment to the mix! Really important is to also address the concerns of the "spouse or significant other" often the patient is ready to resume sex and the partner is scared to death!

Operations: Which is Best for you?

What do the doctors do to your heart when they perform a heart bypass operation?

They use segments of healthy veins or arteries from other parts of the body to bypass the blocked parts of the coronary vessel.

What is a double bypass, triple bypass or quadruple bypass?

It refers to the number of vessels that are fixed.

What are the dangers of bypass surgery?
Stroke, heart attack, arrhythmias, kidney failure, death.

Will a bypass last forever or does it have to be redone?

A bypass doesn't last forever. In general, after 10 years patients may have an event such as angina, another heart attack or arrhythmia. 

What is angioplasty?

Opening of the blood vessel by a balloon and possibly placing a stent.

What is a stent?

A stent is a metal lattice work which is used to prop open the vessel to increase the lumen size.

What is the difference between a regular stent and a drug coated stent?

A drug coated stent has medication on it which reduces the risk of re-clogging of the vessel. 

Are stents likely to reclog?

Regular non-coated stents are more likely to re-clog. There is a 30% chance in the first year. Drug coated stents have a lower chance of 10%, but they can form an acute clot sometimes. For this reason a blood thinner is recommended after placement of the stent. 

Can stents be put in at all hospitals?

No.

Do stents set off metal detectors at airports?


No.

How many stents can be placed in a person?

It varies, and the number may be several.

What will the stents feel like inside the patient?

There is no sensation with the stent.

What makes some people candidates for angioplasty and others for bypass?

This depends on many variables including the expertise of the heart center, but in general the more technically challenging an angioplasty may be then the more likely that a bypass will be preferred. Also patients with left main artery disease or 3 vessel disease especially in diabetics may be recommended for bypass rather than for an angioplasty.

Do the doctors always clear out all blockages?

No, there's usually some blockage left. It can't be mashed into the wall. 

Why would they leave blockage in a patient's heart?


Not all blockage is significantly limiting the function of the heart.

Exercise After A Heart Attack

What is the difference between aerobic and anaerobic exercise?

Aerobic exercise promotes cardiovascular fitness by raising your pulse to a targeted level. It helps to strengthen the heart strengthen your heart, and allows the heart to pump more blood.. Some examples of aerobic exercise are walking, jogging, bicycling and swimming. Heart rate has to be maintained for at least 15 minutes to obtain the cardiovascular benefits.

Anaerobic exercise focuses on specific muscles and their size,endurance, and strength.Weight lifting and resistance training are examples of anaerobic exercise. 

How long should each aerobic exercise session be?

This varies depending on the patient’s physical condition and goals. In general 1 hour a day at least 5 days a week is recommended. For aerobic fitness shorter durations of 10-15 minutes two to three times a day may be beneficial. For weight loss, longer exercise durations of at least 30 minutes is preferred. Longer is better: at least 30 minutes with 40 to 60 minutes preferred to burn fat. Here are some studies with their recommendations 1.

How many times each week should I exercise?

Aerobic exercise is recommended every day as best and at least 5 times a week.

In general CR (Cardio Rehabilitation) programs last one hour [15 min warm up and strength exercises 30 min of aerobics (walking, biking, dancing etc. - always based on heart rate guidelines of 70% of maximal safe heart rate and 15 minutes cool down with stretching and relaxation) There is no benefit to attempting to obtain a higher heart rate above 70% your maximum. Everyone is encouraged to exercise daily for at least 30 minutes with specific guidelines based on their heart health etc. Most people go to formal CR classes 3 times per week. Levels are advanced based on capacity and other criteria such as orthopedic concerns, age, balance, other co-morbidities.

Wouldn't hard exercise make it more likely to have a heart attack?

This depends on your physical condition. If you are in a good physical shape then appropriate exercise should not cause a heart attack, but if you are not conditioned then increasing physical demand on your body and heart may cause symptoms or heart attack.

However, it should be noted that there are those who are in good physical shape but who experience a heart attack due to plaque rupture and not to is chemia. It is unknown if these ruptures may be triggered by exercise.

What range should you try to keep your heart rate in when you exercise?

A general rule is 190-your age which equals 85% of maximum heart rate. An exercise prescription may also be given so that if the exercise is supervised then the patient can go to 85% of maximum heart rate obtained on a treadmill test. If the exercise is unsupervised, then the goal is 70% of maximum heart rate obtained on a treadmill test. Use this calculator for a rough guide, but ask your own doctor for personal exercise recommendations.

Is there a minimum heart rate I should try to achieve during exercise?

To provide a benefit to your heart you should try to attain at least 50% of your maximum heart rate during a aerobic exercise session.

How many times each week should I exercise?

Aerobic exercise is recommended every day as best and at least 5 times a week.

In general CR (Cardio Rehabilitation) programs last one hour [15 min warm up and strength exercises 30 min of aerobics (walking, biking, dancing etc. - always based on heart rate guidelines of 70% of maximal safe heart rate and 15 minutes cool down with stretching and relaxation) There is no benefit to attempting to obtain a higher heart rate above 70% your maximum. Everyone is encouraged to exercise daily for at least 30 minutes with specific guidelines based on their heart health etc. Most people go to formal CR classes 3 times per week. Levels are advanced based on capacity and other criteria such as orthopedic concerns, age, balance, other co-morbidities.

What is supervised aerobic exercise?


Most times this refers to participation in a cardio rehab program. You attend an exercise session at a center staffed by nurses and physical therapists trained in working with patients post heart attack. During exercise you wear a heart rate monitor and the staff keeps a close watch on your heart rate.

How can you tell what your heart rate is?

You can check your own pulse, but a much easier and more reliable method would be to get a personal heart rate monitor.

What is a personal heart rate monitor?


These devices usually consist of two parts. An elastic strap with a transmitting device goes around your chest. Heart rate data goes wirelessly from the transmitter in the strap to a special watch on your wrist. You can read your heart rate on the watch as well as other useful functions. Some models sense your heart rate right from your wrist and do not require a chest strap.

What other functions do heart rate monitors have?

Almost all act as a standard watch, most as stop watches. Many have alarms to let you know if you are excersizing at a heart rate too low to help your heart as well as an alarm if you get your heart rate over your target to where it might present a danger. Some models interface with a computer for tracking. Often standard treadmills, exercise cycles, steppers or other cardio machines in a gym have heart monitors built in that read the signals from your regular chest strap transmitter on their own display without the need to wear the watch part.

How much do personal heart rate monitors cost?

The most well known personal heart rates monitors come from Polar, you may even see on cardio machines that they work with Polar equipment. In some cases people use "Polar" for heart rate monitors like they use the name "Kleenex" for tissues, but Polar represents a specific manufacturer. Polar heart rate monitors start at about $80. Other brands without the Polar name will do the job too and even work with Polar cardio machines as they all use the same frequencies to transmit your heart rate from the strap to the receiver either in the heart monitor watch or the gym equipment. You can find personal heart rate monitors starting at around $40 or less. With fancy features you may see some personal heart rate monitors priced over $400.

Where do you buy personal heart rate monitors?

Online, many sites will even offer free shipping on Polar or inexpensive heart monitors. You may find personal heart rate monitors in a local sports store too, try the running department or sports watch areas.

Are there special personal heart rate monitors for women?

Yes, a personal heart rate monitor for a woman might have a smaller watch face on the monitor and a smaller wrist band.

If you are wearing a personal heart monitor with an alarm in you exceed your target heart rate would that be considered supervised aerobic exercise?

No, for definition as supervised exercise you need trained staff with you in addition to having your heart rate monitored. This should not belittle the benefit of wearing a personal heart rate monitor when you exercise on your own?

Why would you want a personal heart rate monitor for unsupervised aerobic exercise?

Patients find these devices very helpful. Keeping your heart rate in the desired range during aerobic exercise holds the key to gaining the cardio benefits of the workout. If you do not get your heart rate up high enough you are not doing enough to help your heart. If you increase your heart rate too high you risk another heart attack. Taking your own pulse while you exercise can be difficult and inaccurate. Personal heart rate monitors help you to keep in the proper range and get the most out of your aerobic exercise time. Many people also find comfort in the heart rate readings to know they have a safe pace. People instructed by their doctors not to exceed a certain maximum heart rate might find themselves scared to push to hard and not workout hard enough, or go too hard because they have no accurate way to see their own heart rate and risk problems. A personal heart monitor helps on both ends of the spectrum, allowing the patient to exercise with more comfort and confidence. After a heart attack this can become quite important.

Where should you set the upper and lower limits on your personal heart rate monitor?


While you can use some of the information above as a start, this question really should be answered by your own physician based on your own age, health, risk factors and medications.

What do medications have to do with it?

Drugs such as beta blockers change your heart rate, so when recomending the proper heart rate for aerobic exercise the effect of the medicine must be taken into account.

What should you do if you exceed your target heart rate and the alarm on your heart monitor sounds?

Generally slow down. In most cases you should not abruptly stop your exercise unless you also have other symptoms. Look and the monitor and slow up until your heart rate gets back into the proper range and continue your workout. You can check you your own doctor for a personal answer to this part, but sometimes for a very short period of time if you have the proper conditioning going over a bit can be acceptable. An example of this would be someone who has returned to good physical condition and exceeds their target heart rate just before the top of a hill while bicycle riding. Going a little further at just a little over the target rate would be alright, but ask your own doctor what you should do in such a case.

My personal heart rate monitor stopped working?
Start by checking both the batteries, remember there is a battery in the wrist monitor and another in the chest transmitter.

Why does losing weight help lower the risk of a heart attack?


Losing weight helps lower lipids/cholesterol, blood pressure and the general work load on the heart.

If adjusting diet and exercise isn't enough what drugs can help?

Lifestyle changes do make a difference in heart disease. In addition to diet and exercise cholesterol lowering medications and anti-hypertensives help reduce the risk for heart disease. Learn more in the heart drug FAQ.

Does excersise help your heart in any other ways?

Exercise may help develop collaterals.

What are collaterals?

Arteries which grow to help circulate blood by circumventing the clogged arteries.

The Role of Cholesterol in a Heart Attack

At what levels should I be alarmed by my total cholesterol?

Total cholesterol should be less than 200 but it depends on the composite health picture of the patient, ie , how many other risk factors are present. We look at the good and bad cholesterol more than the total cholesterol. Here are some heart healthy good cholesterol and bad cholesterol numbers suggested by the American Heart Association.

What is the difference between good cholesterol and bad cholesterol?

Good cholesterol or HDL (high density lipoprotei ) helps protect against heart disease. Bad cholesterol or LDL (low density lipoprotein) and is associated with heart disease. 

How do each of these cholesterol types operate to help fight or cause the heart disease?

LDL transports cholesterol and invades the endothelium or lining of the blood vessels. When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the heart arteries and make them less flexible. This condition is known as atherosclerosis.

HDL transports cholesterol from the arteries to the liver where it can be eliminated from the body. Some experts believe that that HDL removes excess cholesterol from arterial plaque, thus slowing its buildup.

How low is too low for the levels of good cholesterol?

HDL of less than 40 is too low for men1, and less than 50 is too low for women2.

What can be done to lower bad cholesterol?

Exercise, diet, weight loss, eating less animal fats, using cholesterol lowering medications such as statins , cholestyramine, and ezetemibe.3.

What can be done to raise good cholesterol?

Niacin, fenofibrates, fish oil, exercise, weight loss.

What are the differences between the advertised cholesterol lowering drugs?

Cholesterol lowering medications include
Statins
Ezetimibe
Fibrates
Bile acid binding resins
Niacin


Statins are the most commonly used medications. They are in the class known as HMG CO-A reductase inhibitors. They work by blocking the production of the cholesterol in the liver. They are highly effective at lowering total cholesterol and LDL cholesterol. They also lower triglycerides and modestly raise HDL, the good cholesterol.. They have been used since the 1980s and overall are considered to be safe. They include Pravachol, Lipitor, Zocor, Lescol, Mevacor, and Crestor.

Crestor is a very powerful statin that has been shown to reduce LDL cholesterol better than any of the other statins. However, at higher dosages 40 mg or more, it has been shown to have a slightly higher than expected amount of muscle inflammation associated with it.

Side effects of statins may include nausea, malaise, elevation of liver tests and muscle aches or cramps.

Zetia, or ezetimibe, works by inhibiting cholesterol absorption in the intestine.

It lowers cholesterol modestly (15-20% compared with statins at 35%) when taken on its own. It is often used in combination with a statin thereby providing patients with a dual mechanism of reduction of cholesterol to further reduce LDL in those patients who are not yet at their goal cholesterol, despite being on a statin.

The side effect profile of ezetimibe is essentially similar to placebo, based on the medical literature; however, some patients will complain of abdominal discomfort. In the overwhelming majority of patients, however, no side effects are noted.

Fibrates lower the production of triglycerides and can increase HDL production. Some brand names are Lopid, Tricor and Atromid. Side effects may include heart burn, abdominal pain, bowel movement changes, elevated liver enzymes, and muscle aches.

Bile acid resins such as Questran, Colestid, WelChol work inside the intestine. They bind bile from the liver that is flowing into the intestine and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach.

Niacin is a B-complex vitamin which in high doses in prescription form (Niaspan) lowers LDL and raises HDL.

The side effects of flushing, itching, tingling, and headache can be severe. These symptoms may be reduced if the dose of niacin is raised slowly and if it is taken at night with food and if aspirin 165 mg is taken about 30 minutes before taking the niacin. It is also reported to help if it is taken with a cup of yogurt.

Are there everyday things I should avoid if I am on some of these drugs?

Grapefruit juice increases the levels of the statins and it is best avoided. Alcohol consumption should be discussed with your doctor.

What are fenofibrates and where would you get them?

They are another class of cholesterol lowering medications which are given by prescription.

After one heart attack how likely is it the patient will have another?

This is unknown, but having one heart attack does increase the risk of having another episode.

How Does A Heart Attack Damage the Heart

How does a heart become damaged from a heart attack?

A part of the muscle dies from lack of oxygen and blood to that area.

Is the damage from a heart attack always permanent?

Depends on the degree of the damage, but the damage is usually permanent because that part of the tissue dies. There may be some other tissue that is not dead but is not functioning properly, stunned myocardium, but with improved blood flow this part of the heart muscle may come back.

How can they tell if you had permanent damage after a heart attack?

There are non-invasive tests which can look at the heart and assess its function. These include an echo cardiogram, radionuclide studies or MRI to see how well the heart muscle is pumping. 

Echo cardiogram is described in the hospitalization question. 

Cardiac nuclear imaging allows assessment of heart function under induced stress (nuclear stress test). It involves injecting a small amount of a radioactive substance such as Thallium or Cardiology into the circulatory system and tracking it as it passes through the heart. The patient lies on a special table and a camera (gamma camera) which is able to see the radioactive isotope creates pictures as the isotope passes through the heart. When exercise is not possible, pharmacological agents such as dobutamine, adenosine, or dipyradimole (Persantine) are injected to induce stress. 

The thallium (radioactive substance) mixes with the blood in the bloodstream and enters heart muscle cells. If a part of the heart muscle doesn't receive a normal blood supply, less than a normal amount of thallium will be seen. The first pictures are made shortly after the exercise test and show blood flow to the heart during exercise. The patient then lies quietly for 2-3 hours and another series of pictures is made. These show blood flow to the heart muscle during rest.
If the test is normal during both exercise and rest, then blood flow through the coronary arteries is normal. The coronary arteries supply blood to the heart muscle.
If the test shows that perfusion (blood flow) is normal during rest but not during exercise (a perfusion defect), then the heart isn't getting enough blood when it must work harder than normal. This may be due to a blockage in one or more coronary arteries.
If the test is abnormal during both exercise and rest, there's limited blood flow to that part of the heart at all times.
If no thallium is seen in some part of the heart muscle, the cells in this part of the heart are dead from a prior heart attack. (They have become scar tissue.)


Cardiovascular magnetic resonance imaging (CMRI) is an increasingly available diagnostic method. It uses powerful magnets to look inside the body. Computer-generated pictures can show the heart muscle, identify damage from a heart attack, diagnose certain congenital cardiovascular defects and evaluate disease of larger blood vessels such as the aorta. For cardiac imaging breath holding is frequently needed. Unlike radiographic imaging methods.
It's non-ionizing and has no known biological hazards.
It can produce high-resolution images of the heart's chambers and large vessels without the need for contrast agents.
It's intrinsically three-dimensional.
It produces images of cardiovascular structures without interference from adjacent bone or air.
It has high tissue contrast.


The disadvantages of the cardiac MRI are:
The technology is not as widely available.
Pacemakers/defibrillators are relative contraindications for MR imaging.
It is currently not suitable for claustrophobic individuals.
Motion during imaging results in significant image artifacts.
Technology is not suitable for portable (eg, bedside) studies.


How is pump function measured?

It is measured with an echocardiogram. In general the systolic function (how well the heart muscle squeezes and pushes out the blood and the diastolic function (how well the heart muscle relaxes) are measured. Pump function is measured by the ejection fraction which is the amount of blood pumped by the left ventricle (the largest chamber of the heart) divided by the amount of blood that the left ventricle contains.

What would be normal pump function?

Normal ejection fraction is more than 55% of the blood volume.

How low can you go before it would affect your life and how would you be affected by the reduced pump function?

Any decrease in the pump function below the normal level may impact a patient’s life. A reduced pump function may cause decreased energy level and a decreased exercise tolerance, increased fatigue, shortness of breath, and fluid accumulation in the legs and in the lungs. It also may disrupt normal sleep and cause increased somnolence during the day. Depression may also occur.

Hospital: When to go and What to Expect(About Heart)

When should you take your self to the hospital if you think you are having a heart attack?

Timing is every thing 1. If you think you are having a heart attack, call 911 ASAP. Do not drive yourself to the hospital or have someone else drive you. Call 911 which is different than calling an ambulance. 

What can they do in the hospital to tell if you are having a heart attack?

An electrocardiogram (ECG or EKG) is a is a painless non-invasive test that measures the electrical activity of the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. It can be used to detect if damage has been done to the heart muscle and in what general area of the heart the damage may have occurred. It also detects the rate and rythym of the heart.

Blood tests are done to detect cardiac enzymes. The blood test most commonly used to confirm the existence of heart muscle damage is the creation  kinase (CK). A small fraction of the CK enzyme, CK-MB, is often measured as well. CK-MB shows an increase above normal in a person's blood test about six hours after the start of a heart attack. It reaches its peak level in about 18 hours and returns to normal in 24 to 36 hours.

Tests can measure the amount of other cardiac muscle proteins called troponins, specifically troponin T (cTnT) and troponin I (cTnI). These proteins control the mechanism which contracts or squeezes the heart muscle. Troponins specific to heart muscle can detect minor heart muscle injury ("microinfarction") not detected by CK-MB. Normally the level of these special heart enzymes in the blood is very low because these enzymes normally exist and stay inside the heart muscle cells. When the heart muscle is damaged, these enzymes are released into the blood stream. It increases significantly within several hours (on average four to six hours) of heart muscle damage. It peaks at 10 to 24 hours and can be detected for up to 10 to 14 days. Levels of these cardiac enzymes compared to normal help doctors determine if you have a heart attack underway and its severity.

Echo cardiogram is a painless non-invasive imaging study which allows real-time imaging of the heart. It can assess how well the heart is or is not pumping. It uses high-frequency sound waves (ultrasound) to create an image of the heart . The sound waves measure the speed and direction of blood flow as well as wall motion and thickness of the heart chambers. It is commonly used for the evaluation of cardiac anatomy and physiology. It is similar to an ultrasound that is performed on pregnant women.

Cardiac catheterization is an invasive procedure used to detect the blocked arteries. See the page on operations for details.

CT coronary angiogram is a newer imaging study which may be done in some centers as a screening test for chest pains that are more atypical.

Coronary CT angiography (CCTA) has a relatively low technical burden for both the operator and patient and is quick to perform. The scanning time to acquire a three-dimensional dataset of the entire heart can take as little as 15 seconds. There are two types of CT scanners used for CCTA: electron beam computed tomography (EBCT), and multi-detector row or multislice CT scanners (MDCT or MSCT). MDCT scanners are much more widely available than EBCT scanners; as a result, most CCTA procedures are currently performed with MDCT scanners. To facilitate scanning and optimize image quality, most patients undergoing CCTA with current MDCT equipment receive oral or intravenous beta blockers to slow the heart rate to less than 60 to 70 beats/min. Sublingual nitroglycerin is sometimes given immediately before the scan to achieve maximal vasodilation.

Radiation exposure DCT scanners typically have higher spatial but lower temporal resolution than EBCT, and they impart a higher effective radiation dose to the patient when used for CCTA. In comparison, the effective radiation dose is 0.04 to 0.06 mSv from a routine chest x-ray, 2.0 to 5.0 mSv from an average diagnostic x-ray coronary angiogram, and the average annual background radiation in the United States is approximately 3.6 mSv.

Limitations The following patient-related factors can interfere with the diagnostic quality of CCTA images: 
Heart rate greater than 60 or 70 beats/min.
Irregular heart rhythm (atrial fibrillation; frequent atrial or ventricular extra-systoles). 
Inability to sustain a breath hold for at least 15 to 20 seconds.
Severe coronary calcification or the presence of coronary artery stunts, since image reconstruction artifacts related to radio-dense material such as calcium or metal can obscure the coronary artery lumen. 
Small vessel caliber (eg, distal segments of the left circumflex, marginal branches, and left anterior descending); segments with a diameter less then 1.5 mm can usually not be assessed for steno-sis 


These technical and image quality problems may be overcome with improvements in future generations of CT scanners.

Injection of iodinated contrast medium is required for both EBCT and MDCT coronary angiography. Thus, CCTA is contraindicated in patients with a history of allergy to iodinated contrast medium and relatively contraindicated in patients at high risk for contrast nephropathy (eg, diabetics with a serum creatinine concentration above 2.0 mg/dL.

How long does a heart attack patient need to stay in the hospital?

It varies depending on how complicated the case may be. In general 3 days is the average stay for an uncomplicated heart attack.