Heart Attack Archive

Depression that develops for the very first time during recuperation from a heart attack affects recovery more than depression that started before the attack.

Recovering from a heart attack is tough enough without facing the fog of depression. Yet that's exactly what happens to nearly half of heart attack survivors. Depression is a painful, isolating, joyless state of mind that interferes with recovery and dulls life. It may even make it shorter "" people with post-heart attack depression are two to three times more likely to have another heart attack or to die prematurely compared with survivors who don't have depression.

Surviving a heart attack is cause for celebration. It's also a trigger for depression. Up to half of heart attack survivors get the blues, and many go on to develop clinical depression.

Early experiences with antidepressants weren't that promising because older tricyclic drugs such as clomipramine and nortriptyline sometimes threw off heart rhythms and further endangered the heart. This made doctors leery about recommending antidepressants, even when selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), and Zoloft (sertraline), and others came along.

After a Heart Attack

Questions to Discuss with Your Doctor:

• Have you had chest pain or pressure since you were discharged from the hospital?
• How severe is it?
• How long does it last?
• Does it stay in your chest or radiate to other parts of your body?
• Did you have this pain before your heart attack? What brings it on? How frequently do you get it?
• What were you doing just prior to the chest pain?
• Do you ever get chest pain or pressure at rest?
• What relieves the chest pain?
• If you take nitroglycerin, how many doses do you usually need to take before the pain goes away?
• How often do you take nitroglycerin?
• Do you get short of breath when you lie down or exert yourself?
• Do you awaken in the middle of the night short of breath?
• Do your ankles swell?
• Do you ever feel lightheaded?
• Have you fainted?
• Do you get rapid or pounding heartbeat for no reason?
• Do you know what each of the medications you are taking does?
• Do you know the side effects of each medication?
• Are you having any side effects?
• Are you taking an aspirin every day?
• Are you doing everything you can to modify the risk factors that can worsen your coronary artery disease (cigarette smoking, high blood pressure, high cholesterol, and diabetes are the most important risk factors)?
• Are you participating in a supervised exercise program?
• Are you resuming your normal activities?
• Are you sexually active?
• Have you returned to work?
• Have you been feeling depressed since your heart attack?
• Have you been able to reduce the stress in your life?
• Have you been fatigued?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your wrist, groin, and feet
• Listen over the major arteries in the neck, groin, and feet (for abnormal noises)
• Look at the veins in the neck to see if there is extra fluid in your body
• Heart and lungs
• Ankles and legs (for swelling)

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests for glucose, lipid panel (cholesterol levels) and C-reactive protein (CRP)
• Electrocardiogram
• Echocardiogram
• Exercise stress test

Immediate first aid works to minimize blood clotting triggered by plaque ruptures

How should you take aspirin for a heart attack? You've always been healthy, but you seemed to run out of steam at your wife's 60th birthday dinner last week. And now your chest feels heavy, as if you're in a vise. You take some antacids, even though it's 7:00 a.m. and you haven't even had breakfast. But you get no relief, and the pain is spreading to your jaw and shoulder. You call your wife, who takes one look at you and rushes to the phone. After calling 911, she brings you an aspirin and some water.

Your wife got it right: You may be having a heart attack, and you need to get to the hospital fast. You also need to get some aspirin into your system quickly — but should you chew the tablet or swallow it?

If you suffer from cardiac arrest, help is only a 911 call away. Paramedics can use defibrillators to shock your heart back to a normal rhythm. But unfortunately, every minute you spend waiting for their arrival reduces your chance of survival by 10%. Help may soon be closer than your local paramedic and it may come from an unlikely source — someone without medical expertise.

Until recently, witnesses to someone having a cardiac arrest were limited in the help they could provide — calling 911 and performing CPR (cardiopulmonary resuscitation). Now, portable automated defibrillators about the size of a laptop computer are available. These devices not only deliver a shock to restore a regular heartbeat, they also determine whether a shock is really needed, making it possible and safe for people without medical training to use.

Cholesterol-lowering statins seem to have long-lasting benefits against heart disease, according to a 20-year follow-up of a landmark Scottish study.

In the original study, published in 1995, more than 6,500 middle-aged men with high levels of harmful LDL cholesterol took either 40 milligrams of pravastatin (Pravachol) or a placebo daily for an average of nearly five years. For the follow-up, published in the March 15 Circulation, researchers used electronic medical records to analyze health-related events among the same men over the following two decades. They also tracked the men's use of statins after the original study ended. After five years, more than a third of the men in both groups were taking statins, but no further data on statin use was available after that.

Here's a rundown of the likely chain of events after you call 911.

For a suspected heart attack, paramedics can often perform initial testing in the ambulance while the patient is en route to the hospital. Image: Thinkstock

Every 43 seconds, someone in the United States has a heart attack. If one day that someone is you or a loved one, it may be helpful to know what's likely to happen, both en route to the hospital and after you arrive.

Be proactive to ward off clogged arteries that can lead to heart attack, stroke, and even death.

 Image: © CreVis2/Getty Images

Most people don't spend a lot of time thinking about atherosclerosis. After all, you can't see any buildup of waxy plaque that may exist in your arteries, and the disease doesn't make itself known until it's advanced. "It can progress for decades before you have symptoms like chest discomfort or shortness of breath," explains Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital.

Yet atherosclerosis quietly and invisibly puts many millions of people at risk for heart attack, stroke, leg amputation, disability, and even death.

New guidelines refine the recommendations for treating the leading causes of death and disability.

 Image: © Bill Oxford/Getty Images

Cholesterol, the waxy, fatlike substance that contributes to heart attacks and strokes, is among the best-known contributors to cardiovascular disease — and with good reason. For decades, doctors have recommended blood cholesterol testing, often during annual checkups. Nearly one in three American adults has high levels of LDL, the most harmful type of cholesterol. Expert advice on managing this common problem now takes a more personalized approach, according to updated guidelines released by the American College of Cardiology and American Heart Association last November.

"The new guidelines really codify and support what many preventive cardiologists already do," says Dr. Jorge Plutzky, director of preventive cardiology at Harvard-affiliated Brigham and Women's Hospital. They tailor treatment based not just on LDL values but also a person's overall risk, he explains.