Medical Emergency – Heart Attack

Heart disease, a term used to describe a variety of heart conditions, is the number 1 killer of men and women in the US.

 Examples of heart disease include:

  • High blood pressure
  • Angina
  • Unstable angina
  • Valve disease
  • Arrhythmia
  • Heart failure
  • Congenital and inherited heart conditions
  • Coronary artery disease
  • Sudden cardiac arrest
  • Heart attack (myocardial infarction-MI)

Out of all the above conditions, heart attack leads as the number 1 cause of death in men and women in the US.

 Every 40 seconds, someone in the United States has a heart attack resulting in about 805,000 people in the United States. Of these, 605,000 are a first heart attack.

What is a heart attack?

A heart attack occurs when one of the coronary arteries becomes blocked. The heart muscle is robbed of its vital blood supply and if left untreated, will begin to die because of lack of oxygen.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle.

Causes of heart attack

Coronary artery disease (CAD) is the main cause of heart attacks. Coronary arteries send blood to the heart. It is sometimes called coronary heart disease or ischemic heart disease. CAD is caused by plaque buildup in the walls of the coronary arteries. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As plaque builds up in the arteries, the artery walls become thickened, hard and narrow over time, which can partially or totally block the blood flow. This process is called atherosclerosis. Atherosclerosis takes about five years to develop.

Another less common cause is coronary spasm during this coronary spasm, your arteries restrict or spasm on and off, cutting off the blood supply to your heart muscle (ischemia). It can happen while you’re at rest and even if you don’t have serious coronary artery disease. Some causes of coronary spasm are extreme cold, smoking, stress, pain. Cocaine, methamphetamine

Most heart attacks occur when the hardened, built-up plaque shell cracks and ruptures. Platelets, a part of the blood that helps blood clot, come to the ruptured area, and form a clot. If the clot is large enough it can block the artery and block oxygen rich blood from reaching the heart. Without adequate oxygen the heart muscle starts to die, resulting in a heart attack. The hearts’ ability to pump declines depending on where and how much scar tissue develops.

Luckily, most heart attacks are survivable, with about a 90 percent survivability rate. These statistics are due to early intervention and prevention awareness.

Symptoms can vary between men and women

Symptoms of an impending heart attack can manifest up to a month to days and even hours before. Symptoms include:

  • Fatigue
  • Dizziness
  • Abdominal pain
  • Sweating
  • Swelling in Legs, Ankles, and Feet
  • Heart Palpitations

Symptoms of heart attack in progress

  • Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes or goes away and comes back.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Other signs such as breaking out in a cold sweat, nausea or lightheadedness
  • About 1 in 5 heart attacks are silent—the damage is done, but the person is not aware of it.

What to do if heart attack suspected- ACT QUICKLY

  • Call 911 immediately, quick intervention is key to survival- if in doubt, call. Many people avoid calling until heart attack is well under way.
  • Aspirin or no aspirin? Don’t give aspirin unless directed by emergency personnel or care provider. There are several reasons not to give aspirin, one being the increased risk of bleeding, another is allergy to aspirin and even interaction with other medications.
  • Keep calm, reassure patient, stay with them until help arrives
  • If the person is unconscious, no pulse and/or not breathing, initiate CPR, continue until help arrives. Brain death occurs 10 minutes after 10 minutes with no oxygen
  • If a defibrillator (AED) is available hook up patient and follow prompts- remove patient from liquid, metal surfaces and to a safe area. Know how and when to use the AED through previous training. A heart attack can spiral into a sudden cardiac arrest. If the patient has a pacemaker, do not apply pads directly over the pacemaker. Also do not apply pads over medical patches.

How heart attack diagnosed

  • Blood test- troponin level measures the amount of proteins in the blood. During a heart attack, heart muscle cells die and release proteins in the bloodstream.
  • EKG measures the electrical activity of the heart
  • Heart imaging tests such as cardiac CT scan

Risk factors for heart attacks

Note: Risk factors are the same for silent heart attacks as their symptomatic counterparts

  • Brush your teeth, get regular dental exams-The link between periodontal pathogens and cardiovascular disease (CVD) Recent studies have linked periodontal pathogens with atherosclerotic plaque in 80% of specimens, meaning that periodontal bacteria (among others) were identified in 80% of plaque in carotid artery specimens. (Atherosclerotic plaques leading to atherosclerosis)
  • High blood pressure
  • High cholesterol
  • Diabetic– adults with diabetes are twice as likely to have a heart attack or stroke
  • Smoker
  • Overweight
  • Physical inactivity
  • Genetic predisposition
  • Stress, especially chronic stress
  • Even young and healthy population can experience heart attack

Prevention

Lifestyle

  • Manage and reduce stress- Deep breathing, therapy, talking to friends and loved ones can significantly reduce and manage stress
  • Maintain healthy cholesterol levels through diet, exercise and stress management
  • Exercise regularly- consult your care provider regarding type, how often and how much exercise
  • Healthy diet-eliminate sugar, consult with your provider the ideal diet for you and your preexisting diagnosis and meds.
  • Quit smoking- smoking constricts blood vessels, and chemicals in cigarettes can cause the blood to thicken and form clots.
  • Brush teeth twice a day, replace toothbrushes as needed. Oral bacteria has been found in the fatty deposits of people with atherosclerosis.
  • Drink your water! Dehydration can cause your heart to beat faster, cause an irregular heartbeat or even palpitations. In addition, dehydration makes your blood thicker and constricts blood vessel walls. This can cause high blood pressure and put strain on your heart.

Meds

Along with preventative lifestyle choices it may be necessary to add medication(s). Some of these include:

  • Over the counter meds such as aspirin- consult provider before using
  • Beta blockers-some examples include- atenolol (Tenormin), metoprolol (Lopressor, Toprol XL) propranolol (Inderal). Beta-blockers-block the effects of adrenaline, which comes on in response to stressful situations.
  • Ace inhibitors- some examples include- benazepril (Lotensin), captopril (Capoten), enalapril-(Vasotec), fosinopril (Monopril), lisinopril (Zestril and Prinivil), qinapril (Accupril), ramipril (Altace). ACE (angiotensin-converting enzyme) inhibitors prevent the body from producing the artery-constricting hormone angiotensin. Arteries relax with ACE inhibitors which in turn lowers blood pressure.
  • Prescription blood thinners-examples include warfarin, clopidogrel
  • Statins- some examples include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol- Statins lower LDL cholesterol, reduce inflammation.

- Brooke Lounsbury, RN

Medical Content Writer

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The Silent Killer (Part 3)

5 Ways to Reduce Blood Pressure Naturally

The silent killer, aka hypertension can be controlled, even prevented by making some simple lifestyle changes. Below are some of the most effective ways to increase your health while decreasing your blood pressure.  This may reduce or eliminate your need for medication, along with reducing your r

  1. Nutrition

 

There are many nutritional approaches to reduce blood pressure, probably the most famous, is the DASH diet (Dietary approaches to stop hypertension) promoted by the National Heart, Lung and Blood institute, a branch of the National Institute of health, this diet plan has a proven track record of lowering blood pressure. According to the NHLBI website:

“The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:

  • Eating vegetables, fruits, and whole grains
  • Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
  • Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
  • Limiting sugar-sweetened beverages and sweets
  • When combined with a low sodium diet, the DASH diet was even more effective at lowering blood pressure. For more information on the Dash diet, check our this website.
  • Add citrus, especially grapefruits, lemons, limes, and oranges. They also fight cancer. A recent study revealed that when grapefruit and beetroot juice are combined, they provide a synergistic effect on systolic (top number, when blood is pumped through the system) which lowered blood pressure. Beetroot juice contains nitrites, Nitrites are widely known to relax blood vessels, which lowers blood pressure. Grapefruit juice contains an ingredient that allows nitrite to be more available for the body in a complex process that inhibits reoxidation of nitrite to nitrate.

2. Lose weight, if needed

Being overweight puts you at a substantially higher risk of cardiovascular disease, and especially hypertension.

Portion size and calorie reduction are effective weight loss strategies. In addition, there are many online and in person programs that can help with your weight loss journey. Some popular ones are:

  • Noom- This is an online interactive weight loss program that deals with psychology of eating along with health food choices. It is highly rated (9.8/10)and has earned the top weight loss plan off 2023 by
  • Weight watchers has in person and online programs. This time-tested program is still effective and popular.
  • Premade delivered to your door meals. Premade delivered meals have blossomed into a very popular way to combine the convenience of healthy foods with portion control. Meal delivery services offer diet and heart healthy menus. Some of the more popular meal delivery services are Factor, Hello Fresh, and Nutri System.

3. Get a dog – or any pet

Spending time with a pet, whether is a dog, cat or any other animal can help alleviate stress (one leading cause of hypertension) and promote improved mental wellbeing.

4. Community involvement

Being part of an active community has proven health benefits, including lower blood pressure, increased heart, and emotional health.

Friends, family, neighbors, social clubs, volunteer, and religious communities can offer the connectiveness and belonging, bringing meaning to our lives. Having a strong support system- having someone to call when in need- alleviates stress, which in turn lowers blood pressure.

5. Breathe – and meditate

 One of the most underrated ways to reduce blood pressure that is free and anyone can do are breathing and meditation exercises.

  • A study done out of University of Colorado, Boulder revealed that a 5 minute, 6 days a week breathing program lowered systolic blood pressure by 9mm hg, This technique, called High-Resistance Inspiratory Muscle Strength Training (IMST) was originated in the 1980s way to help critically ill respiratory disease patients strengthen their diaphragm and other inspiratory (breathing) muscles, IMST involves inhaling vigorously through a hand-held device which provides resistance. Imagine sucking hard through a tube that sucks back. In addition to lowered blood pressure, this 30-breath technique could also improve cognitive function as well.
  • Meditate- 20 minutes once a day has also been a time honored and proven method to improve both systolic and diastolic blood pressure markers. Mindfulness based meditation , has been shown to have a temporary effect on both systolic and diastolic blood pressure.

In addition, people that practice meditation-prayer on a daily basis are less likely to need blood pressure medication.

Along with the above recommendations, getting a good night’s sleep, limiting (less than 1 drink for women, 2 drinks for men per day) alcohol and stopping smoking (known to raise blood pressure) are all natural  ways to help control blood pressure.

- Brooke Lounsbury, RN

Medical Content Writer

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The Silent Killer (Part 2)

(Part 2)

Part 2 will discuss:

  • Physiology of blood pressure regulation,
  • Medications to help control hypertension

Blood pressure regulation is a complex process involving a series of body systems, hormones and input from the nervous system all working together to achieve and maintain homeostasis.

As this is a complex topic, we will keep our focus on systems that control blood pressure: one is the RAAS system, the other is the baroreceptor reflex. Both systems rely on input from hormones, receptors, and organs to help maintain a healthy blood pressure. In addition, nervous system responses (sympathetic, parasympathetic and/or autonomic) along with vagal nerve activity help regulate blood pressure. Our focus will be primarily on the hormones, systems and organs involved in blood pressure regulation.

RAAS, the system that controls long term blood pressure

The renin-angiotensin-aldosterone system (RAAS) is a complex multi-organ endocrine (hormone) system involved in the regulation of blood pressure. It regulates sodium and water by balancing fluid and electrolyte levels and regulates sodium and water absorption in the kidney. When this system is working properly, RAAS is activated when there is a drop in blood pressure (such as reduced blood volume). Once RAAS is activated it signals systems and hormones to increase water and electrolyte absorption in the kidney. This compensates for the drop in blood volume, which increases blood pressure.

Several organs, tissues and glands are involved in the RAAS, including:

  • Kidneys
  • Adrenal glands
  • Lungs
  • Heart
  • Blood vessels
  • Pituitary gland

Note, there are several other hormones such as thyroid and corticosteroids that play a part in blood pressure control. These hormones can indirectly play a part in blood pressure regulation.

What are the steps in renin-angiotensin-aldosterone system (RAAS)?

Five minute scholar has a simple video that briefly explains the process

  1. When blood pressure falls, kidneys release renin, an enzyme into the bloodstream
  2. Once released, renin splits a protein produced by your liver called angiotensinogen. The resulting split of this protein produces the hormone called angiotensin l. This hormone is inactive.
  3. In the lungs and kidneys, angiotensin converting enzyme (ACE) converts angiotensin l to angiotensin ll, an active hormone. This hormone causes small arteries to constrict, which in turn increases blood pressure. It also causes the pituitary gland to release antidiuretic hormone (ADH), also called vasopressin, and the adrenal glands to release aldosterone (a steroid hormone).
  4. Aldosterone and ADH work together and cause the kidneys to retain sodium. In addition, aldosterone causes kidneys to excrete potassium through urine.
  5. Water retention is the result of the increase in sodium, which in turn increases blood volume and blood pressure.

Short term blood pressure control

A short video explaining baroreflex regulation

(regulated by the nervous system and neurotransmitters)

There are baroreceptors located in the walls of blood vessels and the heart. They respond to sudden changes in blood volume-which signal the cardiovascular center of the brain to adjust the change in blood pressure. If baroreceptors detect a low blood pressure, it triggers vasoconstriction (narrowing of blood vessels) to increase the blood pressure. If high blood pressure is detected, vasodilation (widening of blood vessels) lowers the blood pressure.

In addition, there are renal baroreceptors, which are located within the kidneys. When these baroreceptors sense a sudden change in blood pressure (low blood pressure), it triggers the RAAS system to activate. The immediate response from baroreceptors results in short term blood pressure control until the RAAS system can take over.

Drug classes to control blood pressure

The following are just a few of the many medications used to control high blood pressure. Many of these drugs have other uses, from treating congestive heart failure to reducing likelihood of stroke or heart attack.

Ace inhibitors Lisinopril (Prinivil, Zestril) benazepril (Lotensin), enalapril (Vasotec) and others

ACE inhibitors prevent an enzyme in the body from producing angiotensin II which narrows blood vessels.

Calcium channel blocker – Amlodipine (Norvasc), diltiazem (Cardizem, Tiazac) and others

Calcium causes the heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.

Beta blockers (Not usually a first line drug to be used) Metoprolol (Lopressor, Toprol XL), atenolol (Tenormin) and others

Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline.

They cause the heart to beat more slowly and with less force, which in turn lowers blood pressure. They also help widen veins and arteries to improve blood flow.

Central agonist class-Clonidine (Catapres)

Central-acting agents lower heart rate and reduce blood pressure. This drug blocks signals from the brain to the nervous system that increase the heart rate and narrow blood vessels. As a result, the heart doesn’t pump as hard and blood flows more easily through the body’s veins and arteries.

Diuretics- Hydrochlorothiazide (Hydrodiuril, Microzide), furosemide (Lasix) spironolactone (Aldactone)

Diuretics work by reducing the volume in liquid in the body by releasing sodium and water. This in turn lowers blood pressure.

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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The Silent Killer

Part 1

High blood pressure (HBP) has been called the silent killer and with good reason. It is estimated that at least 20 percent of the population with high blood pressure have no symptoms.

In part 1 we will discuss:

  • Symptoms of hypertension
  • Health risks of uncontrolled hypertension
  • Stages of hypertension
  • Types of hypertension
  • How to take blood pressure at home

Part 2 will discuss:

 Physiology of blood pressure regulation, lifestyle, nutrition, and medications to help control hypertension.

Symptoms associated with hypertension:

  • Ringing in ears
  • Headache
  • Dizziness
  • Confusion
  • Visual disturbances
  • Difficulty breathing
  • Chest pain
  • irregular heartbeat
  • In severe cases blood in urine

In the US alone nearly half of adults in the United States (47%, or 116 million) have hypertension, defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80.

Health risks of uncontrolled hypertension

Uncontrolled hypertension increases your risk of kidney disease, cognitive decline, heart disease and stroke and more.

Stages of hypertension

(The top number is systolic and measures the pressure in your arteries when your heart beats

The bottom number is diastolic -when the heart muscle relaxes.) 

All blood pressure measurements over 120/80 mm Hg are considered elevated in adult population

As of 2021 AHA blood pressure guidelines:

  • Normal = less than 120 and less than 80
  • Elevated = 120-129 and less than 80
  •  Stage 1 = 130-139 or 80-89
  • Stage 2 = 140 or higher or 90 or higher
  • Hypertensive Crisis (call your care provider immediately) = Higher than 180 and/or higher than 120

Types of hypertension

Primary Hypertension

Caused by one or more of the following: poor diet, smoking hereditary alcohol, lack of exercise, obesity.

  • Blood pressure is high on three or more visits to care provider.
  • May have no symptoms, but you may experience frequent headaches, tiredness, dizziness, or nose bleeds.

Secondary Hypertension. 

Caused by a medical condition or medication.

 Examples include:

  •  Airway obstruction during sleep and sleep apnea.
  • An abnormality in the arteries supplying blood to the kidneys
  • Adrenal gland tumors
  • Thyroid disease
  • Medications that can cause HPB:
  • Pseudoephedrine, (Sudafed) 
  • NSAIDS (non-steroidal anti-inflammatory drugs 
  • Select antidepressants
  • ADHD medications
  • Birth control pills
  • Decongestants
  • Steroids and immunosuppressants

Resistant Hypertension

  • Defined as 3 or more hypertension medications prescribed and blood pressure still not controlled.
  •  20-30 percent of HBP patients have resistant hypertension. 
  • May be genetic.
  • More common in obese, older female patients. 
  • Underlying cause may be diabetes or kidney disease. 

Isolated Systolic Hypertension. 

  • Blood pressure defined as systolic over 140, diastolic is normal- below 90. 
  • Most common in people over the age of 65 and is due to the loss of elasticity in the arteries.

Malignant Hypertension. 

  • Rare, occurs in less than 1 percent of patients diagnosed with high blood pressure. 
  • More common in younger adults, especially African American men.
  • This hypertension type occurs in only about 1 percent of people with hypertension.
  •  It is more common in younger adults, African American men, and women who have pregnancy toxemia.
  • Blood pressure rises rapidly and can be a medical emergency.  
  • Symptoms include numbness in the arms and legs, blurred vision, confusion, chest pain, and headache.

White coat syndrome

  • White coat syndrome is a condition in which your blood pressure is high at your healthcare provider’s office, but you get a normal reading at home.
  • Can be an underlying risk for future health problems.
  • Left untreated, patients have a 36 percent increased risk of heart disease, 33 percent increased risk of death and 109 percent increased risk of death from heart disease.
  • Previously believed this syndrome was exclusively due to anxiety from clinic visits, however closer monitoring of blood pressures taken outside clinic setting point to unstable blood pressure readings. 

How to take blood pressure at home

Here is a short video on how to properly take blood pressure

Blood pressure should be taken at the same time in the same setting as often as your care provider recommends.

Excerpt from AHA

  • Don’t eat or drink anything 30 minutes before you take your blood pressure.
  • Empty your bladder before your reading.
  • Sit in a comfortable chair with your back supported for at least 5 minutes before your reading.
  • Put both feet flat on the ground and keep your legs uncrossed.
  • Rest your arm with the cuff on a table at chest height.
  • Make sure the blood pressure cuff is snug but not too tight. The cuff should be against your bare skin, not over clothing.
  • Do not talk while your blood pressure is being measured.
  • Take 2 readings, at least 1-2 minutes apart
  • Log your results. Attached is a pdf supplied by the AHA to log your readings

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

Join Our Newsletter

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