Study: Influenza And Heart Attacks

# 6624

 

Each year during the winter months we see an increase in the rate of heart attacks and coronary related deaths.

 

During the middle-to-late 1990’s a study looked at more than 250,000 AMI’s (acute myocardial infarctions) and found that the rate of heart attacks in the winter ran 53% higher than during the summer.

 

Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction.

Spencer FA, Goldberg RJ, Becker RC, Gore JM.

 

 

Over the years this spike in `winter mortality’ has been blamed on a variety of factors.

 

Colder temperatures, increased respiratory infections (including influenza & Pneumonia), over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and holiday stress.

 

While cold weather combined with strenuous physical activity (like clearing snow from sidewalks) have often been blamed for this spike, even in balmy Southern California, studies have shown a 33% increase in heart attacks over the holidays.

 

When Throughout the Year Is Coronary Death Most Likely to Occur?

A 12-Year Population-Based Analysis of More Than 220 000 Cases

Robert A. Kloner, MD, PhD; W. Kenneth Poole, PhD; Rebecca L. Perritt, MS

 

Increasingly, inflammation is being seen as a contributor to Cardiovascular disease (CVD), and studies (like this one from the NIH) to `to determine whether a common anti-inflammatory drug can reduce heart attacks, strokes, and deaths’ are underway around the world.

 

One of the hallmarks of an infection is the body’s inflammatory response, which has led some researchers to suppose that some infections might increase one’s risk of having a heart attack.

 

Which brings us to a new study appearing in the Journal of Infectious Diseases that suggest Influenza - and other acute respiratory infections - can act as a trigger for heart attacks.

 

Influenza Infection and Risk of Acute Myocardial Infarction in England and Wales: A CALIBER Self-Controlled Case Series Study

Charlotte Warren-Gash, Andrew C. Hayward1, Harry Hemingway2, Spiros Denaxas2, Sara L. Thomas3, Adam D. Timmis5, Heather Whitaker6 and Liam Smeeth4

ABSTRACT (Excerpt)

Results. Of 22 024 patients with acute coronary syndrome, 11 208 met the criterion of having had their first AMI at the age of ≥40 years, and 3927 had also consulted for acute respiratory infection. AMI risks were significantly raised during days 1–3 after acute respiratory infection (incidence ratio, 4.19 [95% confidence interval, 3.18–5.53], with the effect tapering over time. The effect was greatest in those aged ≥80 years (P = .023). Infections occurring when influenza was circulating and those coded as influenza-like illness were associated with consistently higher incidence ratios for AMI (P = .012).

Conclusions. Influenza and other acute respiratory infections can act as a trigger for AMI. This effect may be stronger for influenza than for other infections.

 

In the same issue of J Infect Disease is an editorial called Increasing Evidence That Influenza Is a Trigger for Cardiovascular Disease.

 

Although both articles are behind a pay wall, CIDRAP NEWS has a brief summary of the study’s findings:

 

Study: Flu can trigger myocardial infarction

A couple of years ago we saw a study in the CMAJ: Flu Vaccinations Reduce Heart Attack Risk that found that those over the age of 40 who get a seasonal flu vaccine each year may reduce their risk of a heart attack by as much as 19%.

 

Almost immediately questions were raised over the way this study was conducted (see Vaccine/Heart Attack Study Questioned), and so the results are in dispute.

 

But today’s study adds to growing evidence that influenza may be a significant contributor to the number of heart attacks each year.

 

While more study will be needed to confirm this link, it does add another good reason to get that flu shot every year. Particularly for those of us over the age of 40, who are at greater risk of cardiovascular disease.

»» Read More

`Tis The Season

 

 

# 5971 

 

 

 

 

Although the reasons are less than entirely clear, every year during the winter months - more specifically from Thanksgiving to just after New Years Day – we see an increase in the rate of heart attacks and coronary related deaths.

 

This spike in `winter mortality’ has been blamed on a variety of factors.

 

Colder temperatures, increased respiratory infections (including influenza & Pneumonia), over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and the combined stressors of shopping, running up debt for gifts, traveling, meal preparation, and/or the stress that comes from dysfunctional family gatherings.

 

My guess is all play some part. 

 

But as a former paramedic, I can tell you that the holiday season always meant a lot of emergency calls.  Everything from cardiac arrests and car accidents to domestic violence and overdoses.

 

The rate of heart attacks in the winter run as much as 53% higher than during the summer. 

 

Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction.

Spencer FA, Goldberg RJ, Becker RC, Gore JM.

 

While cold weather combined with strenuous physical activity (like clearing snow from sidewalks) has often been blamed for this spike, even in balmy Southern California, studies have shown a 33% increase in heart attacks over the holidays.

 

When Throughout the Year Is Coronary Death Most Likely to Occur?

A 12-Year Population-Based Analysis of More Than 220 000 Cases

Robert A. Kloner, MD, PhD; W. Kenneth Poole, PhD; Rebecca L. Perritt, MS

 

 

Additionally, outcomes during the winter are worse – on average – than during the summer.  Again, there are theories as to why this might be so.

 

One idea is that during the holidays, people are more likely to delay getting treatment so as not to `ruin the holidays’ for friends and family.   They ignore chest pains, or other symptoms, hoping they will pass.

 

Another area of concern is that while hospital censuses are typically higher in the winter, the holidays may contribute to temporary staffing shortages.

 

A Duke University study looked at records of 134,609 heart attack patients admitted to the hospital in the middle 1990s.

 

They found that those hospitalized between December 15th and January 15th were slightly less likely to receive proven life saving procedures (angioplasty, beta blockers, even aspirin upon admission) than patients during the rest of the year.

And it isn’t just the time of the year that can affect the severity, frequency, and outcome of heart attacks, studies show that the time of day plays a major role as well.

 

Earlier this year, in A Bad Way To Start Your Day, we  looked at research that appeared in the BMJ Heart Journal that found that STEMI (ST segment elevation myocardial infarction) were more likely to occur during the dark-to-light transition period (6:00–noon).

 

STEMIs are serious heart attacks that affect a large portion of cardiac muscle and show up on EKGs (ST segment elevation) and produce a spike in cardiac enzymes (indicative of muscle damage).

 

The peak levels of cardiac enzymes released - Creatine kinase (CK) and troponin-I (TnI) – provide a good indication of the amount of coronary muscle damage.

 

By comparing peak enzyme levels in patients with their time of coronary onset, researchers were able to determine what time of day the most severe heart attacks occurred.

 

And the results  showed that heart attacks that began during the dark-to-light transition period (6:00–noon), showed roughly 20% more tissue death, compared with heart attacks with onsets between 6pm and midnight.

 

The current theory as to why this might be is that the body’s circadian rhythm influences the production of cardio-protective proteins called salvage kinases, which are released in greater quantities later in the day.

All of the above I hoping will inspire my readers to exercise a little moderation this holiday season, to remember to take your prescribed medications, and to pay attention to the signs and symptoms of a heart attack.

 

From the CDC’s Heart Attack Information page:

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

 

And while you are thinking about gifts for your family and friends this year, one gift you can give them is to take a CPR course – so you can help save their life if their heart should stop due to a heart attack, electrocution, anaphylactic reaction or drowning.

 

Compression-only CPR is now the standard for laypeople, and is easier to do than the old way.  The American Heart Association has produced this short video showing the importance of learning this life saving technique.

 

 

(Click Image to View on YouTube)

 

Taking a class only requires a few hours of your time, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

»» Read More

Fear Of Trying

 

 

Source American Heart Association

 

# 5961

 

 

A study just presented  at the American Heart Association’s annual Scientific Sessions held in Orlando, Florida over the weekend provides clues as to why only 30% of the lay public who witness a cardiac arrest attempt resuscitation.

 

The study, conducted by Perelman School of Medicine at the University of Pennsylvania found that among the people they interviewed, most lacked the skills and confidence to perform CPR - even when they had received CPR training in the past.

 

Nearly 3/4ths were unaware of the new `hands only’ method of CPR, although once instructed, most felt more confident in their ability to render aid during a cardiac arrest.

 

Excerpts from the press release follow, after which I’ll return with more.

 

University of Pennsylvania School of Medicine

Members of the public lack skills, confidence necessary to save lives with CPR, Penn research shows

Findings point to need for new training strategies, dissemination of information about latest CPR techniques and guidelines

ORLANDO – Even members of the lay public who have received CPR training are confused about how to perform the lifesaving skill and say they don't have confidence in their ability to do it properly, according to a study from the Perelman School of Medicine at the University of Pennsylvania which will be presented today at the American Heart Association's annual Scientific Sessions (Abstract #65).

 

"Despite hours spent in CPR training courses and passing an exam, our study shows that even people who have been trained in what to do during a cardiac arrest may ultimately be unable to recall when or how to perform the skill," said lead author Audrey Blewer, MPH, of the Penn Emergency Medicine Department's Center for Resuscitation Science. "We believe that new approaches to training members of the lay public, especially by providing more hands-on training time and information about the option to perform "hands-only" CPR can improve peoples' ability and willingness to respond to a cardiac arrest."

(continue. . . )

 

 

Witnessing a cardiac arrest, particularly of a loved-one, can be a terrifying and traumatic experience. Far too often, bystanders are paralyzed into doing nothing while they wait for rescuers to arrive.

 

As a paramedic, only rarely did I arrive on scene to find someone attempting to resuscitate a patient.

 

Almost inevitably, however, some kind soul had placed a pillow under the head of the victim to make them more `comfortable’, effectively closing off their airway.

 

Consequently, even with the advanced life support equipment we carried, our success rate in reviving these patients was dismally low.

 

The new hands only resuscitation method, which eliminates the need for mouth-to-mouth ventilation, makes doing CPR easier than ever before.

 

But hand’s on training is still important, if you expect to be able to react properly during an emergency. While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A CPR class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

NPM11: Early CPR Saves Lives

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

 

 

A final note.

 

One of the big contributors to sudden cardiac death at home is a failure to call 911 when coronary symptoms first appear. Often people will wait hours, hoping the chest pain will go away, before calling for help.

 

From the CDC’s Heart Attack Information page:

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

 

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

»» Read More

Study: Predictors Of Sudden Coronary Death

 

 

# 5714

 

 

According to The American Heart Association (data for 2009) every year an estimated 785,000 Americans experience their first heart attack, and another 470,000 suffer a recurrent heart attack. They also estimate another 195,000 `silent’ myocardial infarctions occur each year.

Making for just under 1.5 million coronary attacks a year (cite Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. Circulation. 2010;121:e1-e170).

 

While many people survive their first heart attack, for far too many Americans, their first heart attack is also their last. 

 

Every year American EMS units respond to roughly 300,000 cardiac arrests, and the vast majority of those prove fatal (cite  AHA CPR Stats). Why some people survive their first heart attack, and others do not, has been a subject of considerable interest for many years. 

 

The BMJ journal HEART recently published an article that looks at ECG and clinical predictors of sudden cardiac death. 

 

Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease

Elsayed Z Soliman, Ronald J Prineas, L Douglas Case, Gregory Russell, Wayne Rosamond, Thomas Rea, Nona Sotoodehnia, Wendy S Post, David Siscovick, Bruce M Psaty, Gregory L Burke

 

 

While this study found many commonalities between those who suffer sudden cardiac death and those who survive their heart attacks, researchers found several risk factors that appear to suggest a higher risk of sudden death.

 

• Black race/ethnicity (compared to non-black)
• Hypertension and increased heart rates
• Extreme high or low body mass index

Additionally, ECG readings showing a prolongation of QT interval (QTc) and abnormally inverted T waves were seen as possibly being predictors of a higher risk of sudden cardiac death.

 

This research was conducted at the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

 

The authors conclude by stating that these results need to be validated in another cohort.

 

A press release, with more details, is available on the Wake Forest Medical Center Website.

 

 

Predictors of Dying Suddenly Versus Surviving Heart Attack Identified

WINSTON-SALEM, N.C. – July 25, 2011 – Is it possible to predict whether someone is likely to survive or die suddenly from a heart attack?

 

A new study by researchers at Wake Forest Baptist Medical Center has answered just that.

 

“For some people, the first heart attack is more likely to be their last,” said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author of the study. “For these people especially, it is important that we find ways to prevent that first heart attack from ever happening because their chances of living through it are not as good.”

(Continue . . . )

 

 

While preventing that first heart attack is a laudable goal, this is an excellent time to remind my readers of the importance of learning CPR. 

 

This from the American Heart Association.

 

• Sudden cardiac arrest is a leading cause of death in the U.S.
• Everyone should know how to perform CPR in an emergency.
• Immediate, effective CPR could more than double a victim's chance of survival.
• Push on the chest at a rate of at least 100 beats per minute.
• Push to the beat of "Stayin' Alive" and you could save a life.
• Click here for more information on Hands-Only CPR.

Today, CPR is easier to do than ever.

 

Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

»» Read More

NSAIDs and Prior Heart Attacks

 

 

 

# 5550

 

 

Between over-the-counter sales and prescriptions, NSAIDs (non-steroidal anti-inflammatory drugs) are likely the most commonly consumed class of medication in the world.  Look in just about any medicine cabinet, and you’ll probably find a bottle of aspirin, naproxen, or ibuprofen.

 

While these drugs have long been associated with increased risks of gastrointestinal bleeding, it has only been in recent years that cardiovascular concerns have emerged. 

 

In 2004 Vioxx, a COX-2 inhibitor which had been marketed by Merck as being less likely to cause stomach bleeding, was abruptly pulled from the market after a study showed that prolonged use increased one’s chances of having a heart attack or stroke.

 

Bextra, another COX-2 inhibitor, was also recalled after it was linked to increased cardiovascular accidents and to several rare, but potentially deadly, skin disorders.

 

In 2005, the FDA required the inclusion of a `black box warning’ for prescription NSAIDs and a couple of  years later stiffened the labeling requirements on O-T-C NSAIDs as well.

 

The controversy over their safety has continued, and earlier this year the BMJ published an open access meta-analysis on the safety of NSAIDs.

 

Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis

Abstract

Objective To analyse the available evidence on cardiovascular safety of non-steroidal anti-inflammatory drugs.

Design Network meta-analysis.

 

Data sources Bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists of relevant articles, and reports citing relevant articles through the Science Citation Index (last update July 2009). Manufacturers of celecoxib and lumiracoxib provided additional data.

 

Study selection All large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug with other non-steroidal anti-inflammatory drugs or placebo. Two investigators independently assessed eligibility.

 

Data extraction The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. Two investigators independently extracted data.

 

Data synthesis 31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo.

 

Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death.

Conclusions Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.

 

 

It should be noted that while the risk of developing cardiovascular complications for those on NSAIDs was 2 to 4 times higher than placebo, in absolute terms the number of adverse events detected was fairly low.

 

Of the seven drugs examined, naproxen appeared to pose the least cardiovascular risk.

 

Jump ahead to today, and we’ve another study – this time appearing in the American Heart Association  Journal Circulation – that looks at the risks of NSAID use among those who have previously had a heart attack.

 

Researchers found that even short duration treatment (1 week) with NSAIDs resulted in a 45% increased risk of death or recurrent M.I. in those who had previously had a heart attack.

 

I’ve some excerpts from the abstract below, but follow the link to read it in its entirety.

 

Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction

A Nationwide Cohort Study

Anne-Marie Schjerning Olsen, MB; Emil L. Fosbøl, MD, PhD; Jesper Lindhardsen, MD; Fredrik Folke, MD, PhD; Mette Charlot, MD; Christian Selmer, MD; Morten Lamberts, MD; Jonas Bjerring Olesen, MD; Lars Køber, MD, DMSc; Peter R. Hansen, MD, PhD, DMSc; Christian Torp-Pedersen, MD, DMSc Gunnar H. Gislason, MD, PhD

Background — Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI).

<SNIP>

Conclusions— Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.

 

The authors write that there were some limitations to this study, most notably:

 

The main limitation of the study is inherent to the observational design. There is a lack of information about important clinical parameters such as blood pressure, body mass index, smoking habits, lipid levels, and left ventricular ejection fraction. Therefore, the effect of unmeasured confounders cannot be excluded.

 

While this study looked at the safety of NSAID use among those who have already had a heart attack, more study is needed to determine the overall cardiovascular safety of this class of medications.

 

The authors conclude by saying:

 

Further studies, preferably randomized clinical studies, are warranted to establish the cardiovascular safety of NSAIDs, but given the additional evidence from randomized trials and other observational studies of selective COX-2 inhibitors and nonselective NSAIDs, the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease.

 

The bottom line is, if you have a history of heart problems and wish to take NSAIDs (even those available over-the-counter), you need to talk to your doctor about the risks.

 

For everyone else, it is important to remember that no drug is 100% safe or benign – even those available O-T-C .

 

That doesn’t mean we shouldn’t use them, but it does mean we should weigh their risks against their benefits, before we take them.

»» Read More

A Bad Way To Start Your Day

 

 

 

# 5545

STEMI on EKG- credit Wikidoc.org 

 

Admittedly, there is no good time to have a heart attack, but new research is casting light on the fact that the time of day when a person has a myocardial infarction may affect its severity.

 

Last November (see A Different Kind Of Holiday Tradition) I wrote about the seasonality of heart attacks (they spike as much as 33% during the holiday season - between Thanksgiving and mid-January).

 

The reasons for this are not entirely clear, but may be due to a variety of factors:

 

Colder temperatures, increased respiratory infections, over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and the combined stressors of shopping, running up debt for gifts, traveling, meal preparation, and/or the stress that comes from dysfunctional family gatherings.

 

But as any paramedic will tell you, mornings are prime time for cardiac calls anytime of the year.

 

In fact studies have shown that people are 40% more likely to experience a heart attack between 4am-10am than any other time of the day (cite). 

 

But now there is growing evidence that myocardial infarctions that occur in the morning may cause more heart muscle damage than those that occur during other times of the day as well.

 

First the study which appears in the BMJ Heart Journal, then some discussion.

 

Heart doi:10.1136/hrt.2010.212621

Circadian variations of infarct size in acute myocardial infarction

Aida Suárez-Barrientos, Pedro López-Romero, David Vivas1,Francisco Castro-Ferreira, Ivan Núñez-Gil, Eduardo Franco, Borja Ruiz-Mateos, Juan Carlos García-Rubira, Antonio Fernández-Ortiz, Carlos Macaya, Borja Ibanez

Abstract

Background The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but there is no clinical evidence of this finding.

 

Objective To determine the impact of time-of-day onset of ST segment elevation myocardial infarction (STEMI) on infarct size.

 

<SNIP>

 

Conclusions Significant circadian oscillations in infarct size were found in patients according to time-of-day of STEMI onset. The infarct size was found to be significantly larger with STEMI onset in the dark-to-light transition period (6:00–noon). If confirmed, these results may have a significant impact on the interpretation of clinical trials of cardioprotective strategies in STEMI.

 

 

Essentially, researchers looked at cardiac enzyme levels of more than 800 patients in Madrid, Spain who were having an STEMI (ST segment elevation myocardial infarction).

 

STEMIs are serious heart attacks that affect a large portion of cardiac muscle and show up on EKGs (ST segment elevation) and produce a spike in cardiac enzymes (indicative of muscle damage).

 

The peak levels of cardiac enzymes released - Creatine kinase (CK) and troponin-I (TnI) – provide a good indication of the amount of coronary muscle damage.

 

By comparing peak enzyme levels in patients with their time of coronary onset, researchers were able to determine what time of day the most severe heart attacks occurred. 

 

And the results  showed that heart attacks that began during the dark-to-light transition period (6:00–noon), showed roughly 20% more tissue death, compared with heart attacks with onsets between 6pm and midnight.

 

The current theory as to why this might be is that the body’s circadian rhythm influences the production of cardio-protective proteins called salvage kinases, which are released in greater quantities later in the day.

 

The hope is that this kind of research will eventually lead to new therapies and treatments which might reduce the amount of muscle damage during heart attacks.

 

For now, the best defense is to remember to take your prescribed medications and to pay attention to the signs and symptoms of a heart attack, and not delay calling 9-1-1.

 

From the CDC’s Heart Attack Information page:

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

 

And while you are thinking about gifts for your family and friends this year, one gift you can give them is to take a CPR course – so you can help save their life if their heart should stop due to a heart attack, electrocution, anaphylactic reaction or drowning.

 

Compression-only CPR is now the standard for laypeople, and is easier to do than the old way.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

»» Read More

A Different Kind Of Holiday Tradition

 

 

# 5079

 

 

For reasons that are not entirely clear (or agreed upon), winter and the holiday season (generally Thanksgiving-through just after New Years) each year sees a marked increase in heart attacks, and coronary related deaths.

 

This spike in `winter mortality’ has been blamed on a variety of factors.

 

Colder temperatures, increased respiratory infections, over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and the combined stressors of shopping, running up debt for gifts, traveling, meal preparation, and/or the stress that comes from dysfunctional family gatherings.

 

My guess is all play some part. 

 

But all I can state with authority is that when I was a paramedic, the holidays meant a lot of emergency calls.  Everything from cardiac arrests and chokings, to domestic violence and overdoses.

 

A little research on my part confirms what I already knew in my . . . err, heart.  The rate of heart attacks in the winter run as much as 53% higher than during the summer. 

 

Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction.

Spencer FA, Goldberg RJ, Becker RC, Gore JM.

 

While cold weather combined with strenuous physical activity (like clearing snow from sidewalks) has often been blamed for this spike, even in balmy Southern California, studies have shown a 33% increase in heart attacks over the holidays.

 

When Throughout the Year Is Coronary Death Most Likely to Occur?

A 12-Year Population-Based Analysis of More Than 220 000 Cases

Robert A. Kloner, MD, PhD; W. Kenneth Poole, PhD; Rebecca L. Perritt, MS

 

 

Additionally, outcomes during the winter are worse – on average – than during the summer.  Again, there are theories as to why this might be so.

One idea is that during the holidays, people are more likely to delay getting treatment so as not to `ruin the holidays’ for friends and family.   They ignore chest pains, or other symptoms, hoping they will pass.

 

Another area of concern is that while hospital censuses are typically higher in the winter, the holidays may contribute to temporary staffing shortages.

A Duke University study looked at records of 134,609 heart attack patients admitted to the hospital in the middle 1990s.

 

They found that those hospitalized between December 15th and January 15th were slightly less likely to receive proven life saving procedures (angioplasty, beta blockers, even aspirin upon admission) than patients during the rest of the year.

 

 

All of which should serve as ample reasons to exercise a little moderation this holiday season, to remember to take your prescribed medications, and to pay attention to the signs and symptoms of a heart attack.

 

From the CDC’s  Heart Attack Information page:

 

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

 

 

And while you are thinking about gifts for your family and friends this year, one gift you can give them is to take a CPR course – so you can help save their life if their heart should stop due to a heart attack, electrocution, anaphylactic reaction or drowning.

 

Compression-only CPR is now the standard for laypeople, and is easier to do than the old way.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

»» Read More

MMWR: Sudden Cardiac Arrest Awareness Month

 

 

4951

 

 

 

Every year in the United States somewhere in excess of a quarter of a million Sudden Cardiac Arrests (SCA) occur – and the majority of them happen outside of the hospital.

 

With SCA, the heart suddenly stops beating, and the overall survival rate is a dismal 8%.

 

This can come as the result of a heart attack, a heart rhythm irregularity, electrocution, drowning, trauma, or a number of other causes.

 

As an EMT and later as a paramedic, I saw them on a daily basis.  Some shifts I might deal with 4 or 5.

 

Most of the time, even with a good response time, we were fighting a losing battle since most SCA victims had been `down’ – often non-breathing or pulse less – for several minutes before anyone called an ambulance.

 

Usually we’d arrive to find the family milling around worriedly, doing nothing (or worse putting a pillow under the victims head to `make them more comfortable’ – but in reality compromising their airway).

 

The window for resuscitation is short – as brain damage can begin after only 4 minutes without oxygenation of the blood.  

 

Every once in awhile, though . .  . we’d roll up on the scene to find someone doing CPR.   And those patients were far more likely to survive.

 

I’ve told the story before – but in the mid-1970s I was a CPR instructor, and I gave dozens  of high school CPR demonstrations over the years to hundreds of students.

 

One day my partner and I roll up on a scene to find a 16 year-old-boy doing effective CPR on his grandfather.  We took over, and the old guy survived.

 

Turned out, the grandson had taken my CPR class.

 

October 1st marks the start of National Sudden Cardiac Arrest Awareness Month which the Heart Rhythm Society first launched in 2009. 

 

The CDC’s  MMWR (Morbidity and Mortality Weekly Report) has an announcement this week on the start of SCA awareness month.

 

Announcement: National Sudden Cardiac Arrest Awareness Month --- October 2010

Weekly

October 1, 2010 / 59(38);1243

October is National Sudden Cardiac Arrest Awareness Month, dedicated to educating patients and the public about what sudden cardiac arrest is and how to respond to a cardiac arrest.

 

Sudden cardiac arrest is when the heart suddenly stops beating, resulting in no blood flow to the brain and other vital organs. Approximately 300,000 out-of-hospital cardiac arrests occur each year in the United States, with a median reported survival-to-hospital-discharge rate of 8% (1).

 

Rapidly implementing the "chain of survival" model (2) can help increase the chances of survival from sudden cardiac arrest. The steps in the chain include activation of emergency medical services by calling 9-1-1, starting cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED), and acquiring appropriate care. This year marks the 50th anniversary of CPR; updated CPR guidelines will be released later this year by the American Heart Association (AHA).

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Far more information is available on the Heart Rhythm Society’s press announcement, including resources for clinicians and the general public.

 

Every two minutes, someone in this country dies from SCA.  While not all of those deaths can be averted by rapid actions by bystanders, a significant number of them can.

 

So take the time this month to learn what to do to help someone – perhaps a friend or loved one – if they suffer a sudden cardiac arrest.

 

An investment of a little time and energy today could prove lifesaving for someone you care about tomorrow.

 

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Vaccine/Heart Attack Study Questioned

 

 

 

 

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A couple of days ago I posted a blog called CMAJ: Flu Vaccinations Reduce Heart Attack Risk, which gave a brief account of a study that linked the flu vaccine with a 19% reduction in heart attack risk for those over the age of 40.

 

When I pointed out in my final paragraph, that this `single study will not be the last word on this subject.’,  I had no idea how quickly additional words would begin to appear.

 

Within 24 hours of its release, criticisms of this study’s methods have been voiced, and its conclusions questioned.

 

Robert Roos, News Editor for CIDRAP has the details in a piece that appeared on that website last night. This is an excellent review, and details the problems that some researchers see with this study. 

 

Follow the link to read it in its entirety.

 

Study on flu shots and heart-attack risk questioned

Robert Roos News Editor

Sep 21, 2010 (CIDRAP News) – A case-control study using records on tens of thousands of people in the United Kingdom suggests that influenza vaccination reduces the risk of heart attack in people older than 40, but other researchers who have studied the benefits of flu immunization have raised doubts about the findings.

 

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Today’s example shows the folly of cherry-picking studies that support one side of a debate or another (a popular sport on the internet), or immediately accepting the latest study as proven `fact.’

 

While these criticisms don’t invalidate the results of this study, they do call them into question.

 

Perfect research projects and studies are impossible to mount, of course. 

 

There are always going to be limitations or deficits in funding, design, size, demographics, and time – any of which can influence the results.

 

Which is why no single study can be viewed as the final word on a subject. Absolutes are hard to come by in science, and results are rarely conclusive beyond a shadow of a doubt. 

 

So we rely on the preponderance of evidence, which requires weighing the results of more than one peer-reviewed study, along with their reception from the scientific community.

 

Imperfect?  Yes.  And sometimes messy, too.

 

Over time, peer-reviewed science does work, giving us a clearer picture of our world and how it works.  

 

But it’s an ongoing process.

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CMAJ: Flu Vaccinations Reduce Heart Attack Risk

 

 

Note:  This report has an update: see   Vaccine/Heart Attack Study Questioned

 

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From the Canadian Medical Association Journal (CMAJ) today we get a study that strongly suggests that those over the age of 40 who get a seasonal flu vaccine each year may reduce their risk of a heart attack by as much as 19%.

 

The same, alas, could not be said for the pneumococcal (pneumonia) vaccination.

 

Early vaccination was associated with a lower rate of heart attack than getting the shot after mid-November.

 

 

 

Influenza vaccination, pneumococcal vaccination and risk of acute myocardial infarction: matched case–control study

A. Niroshan Siriwardena PhD FRCGP, Stella M. Gwini MSC, Carol A.C. Coupland CStat PhD
September 20, 2010

Heart attack occurred less frequently in people who had had a recent influenza vaccination than in those who had not, but the same could not be said for pneumococcal vaccination. Siriwardena and colleagues found this association in a case–control study using a large database of general practice patients in the United Kingdom. If influenza vaccination does have the added benefit of reducing heart attacks, then it may be important to vaccinate early in the season, say the authors.

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Given the burden that influenza can place on a person’s health – particularly when that person has underlying coronary disease – it makes sense that some number of heart attacks are likely brought on by this illness.

 

Since yearly flu vaccines reduce the incidence of influenza, by that logic they should also tend to reduce the number of heart attacks as well.

 

And based on this study at least, that logic appears to hold. 

 

While a single study will not be the last word on this subject, for those of us over 40, this is a pretty good reason to get that flu shot every year.

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