When Are You Most Likely to Have a Heart Attack?

Heart disease, including heart attack, is the world's No. 1 killer. A person's risk of heart attack depends mostly on a familiar repertoire of factors: exercise, smoking, diet, weight, genes. But our bodies' circadian rhythms also play a role, leaving us more prone to injury during certain hours than others. If you're guessing that the danger zone comes at the end of a stressful workday, guess again. Here to explain is Roberto Manfredini, professor of internal medicine at the University of Ferrara in Italy.

Q: What time of day am I most likely to have a heart attack?


A: The most dangerous times for heart attack and for all kinds of cardiovascular emergency - including sudden cardiac death, rupture or aneurysm of the aorta, pulmonary embolism and stroke - are the morning and during the last phase of sleep. A group from Harvard estimated this risk and evaluated that on average, the extra risk of having a myocardial infarction, or heart attack, between 6 a.m. and noon is about 40%. But if you calculate only the first three hours after waking, this relative risk is threefold.


The cardiovascular system follows a daily pattern that is oscillatory in nature: most cardiovascular functions exhibit circadian changes (circadian is from the Latin circa and diem, meaning "about one day"). Now, a heart attack depends on the imbalance between increased myocardial oxygen demand (i.e., a greater need for oxygen in your heart) and decreased myocardial oxygen supply - or both. And unfortunately, some functions in the first hours of the day require more myocardial oxygen support: waking and commencing physical activities, the peak of the adrenal hormone cortisol [which boosts blood-pressure and blood-sugar levels] and a further increase in blood pressure and heart rate due to catecholamines (adrenaline and noradrenaline), which show a peak when you wake up. All those factors lead to an increase of oxygen consumption but at the same time contribute to the constriction of vessels. So you have reduced vessel size and reduced blood flow to the coronary vessels.


You have to remember that blood coagulation is important in the genesis of what we call thrombi, the blood clots that can block the blood vessels and cut off supply to the heart. When we wake up, platelets, the particles in the blood that make thrombi, are particularly adhesive to the vessels. Usually we have an endogenous system - it's called fibrinolysis - to dissolve the thrombi. But in the morning, the activity of our fibrinolytic system is reduced. So we have a greater tendency to make thrombi that can occlude the coronary vessels. This contributes to further reduction of coronary blood flow. Thus, at the same time that you need more blood flow, you have less.


All these changes, however, probably are not so harmful in healthy people. But for a person with a plaque in the coronary vessel, if these changes occur at the same time and peak at the same time, the final result is a higher risk of heart attack during that specific window of morning hours.


Why is the risk also higher during the last part of sleep? Usually, during the night, the cardiovascular system is "sleeping," which is characterized by low blood pressure and heart rate. But the last stage of sleep - REM, or rapid eye movement, sleep [when we believe most dreaming occurs] - is a risk period for cardiovascular emergencies because when you dream, you have a dramatic increase of activity of the autonomic nervous system - even more than when you are awake. Probably each of us can remember waking up in the morning sometimes feeling very tired. That's because during that stage of dreams, we were running or facing some danger. Your heart was running, so it was consuming oxygen. And for similar reasons to those when you're awake, that activity is risky if you don't have a good vessel system.


It's probably difficult for people to minimize the effects of their own biological rhythms. For example, you cannot avoid your morning risk by simply waking up later. Some researchers have tried an experimental model, in which people were instructed to stay in bed for four hours after they woke up before rising. But the same pattern simply occurred four hours after waking, because the risk is linked to our activities. We can't be afraid of the catecholamines and the peak in blood pressure in the morning. It's part of our physiology. And for healthy people, it's not a problem.


It's important for doctors, however, to remember this risk when we give therapy. Usually people take hypertensive drugs in the morning, when they wake up. But this is already the higher-risk period - so is the last hour of activity of the pill they have taken the day before [and not all pills give 24-hour coverage]. We have to be sure that the pill we're prescribing is still active when patients need it most. It's not as easy as simply asking patients to take pills before bed instead of first thing in the morning, because during sleep we have a low heart rate and blood pressure. If you lower your blood pressure too much during the night, you risk reducing blood supply to the brain, and that can be harmful too

--Laura Blue
TIME.com

Life & Death

The new United States guidelines on who should and should not get care in catastrophic events and disasters that was released yesterday by a multi- disciplinary task force whose members includes people from various medical groups, military, academe and government agencies such as the Centers for Disease Control and Prevention, the Department of Health and Human Services and the Department of Homeland Security will surely elicit a lot of criticisms from various sectors by citing that Doctors and Health Practitioners should not be given the God-like task to determine who should receive treatment or not or to put it more bluntly, who should live or die.

The said guidelines is an ethical nightmare anyway you look at it since it will affect a lot of people and it is quite understandable for some people to oppose the said recommendations.

And it is never easy for any person, more so to people who have sworn to save lives to the best of their abilities to be confronted with this kind of dilemma but we need to bite the bullet when the worst- case scenario occur to preserve vast needed resources both in manpower and supply.

Aside from the obvious that cover people with the highest risk of death or very slim chance of survival owing to the degree or severity of an injury or illness, the guidelines also include-

• People older than 85.
• Those with severe trauma, which could include critical injuries from car crashes and shootings.
• Severely burned patients older than 60.
• Those with severe mental impairment, which could include advanced Alzheimer's disease.
• Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.


In this age of terrorism and super- bugs, I deemed it as a wise move (although with reservations) from the authorities to come up with the guidelines to follow in the event of a massive catastrophe so as to avoid the same confusion that occurred in various hospitals following the 9-11 Terrorist attacks where medical personnel were overwhelmed by the sheer volume of casualties.

Let’s just hope that the medical personnel that will be manning the triage if ever the circumstance calls for it will be knowledgeable and competent enough to handle this life and death questions in their midst.

You can read the controversial guidelines from the May 2008 issue of Chest, the American College of Chest Physicians Journal entitled DEFINITIVE CARE FOR THE CRITICALLY ILL DURING A DISASTER

The Vicente Sotto Memorial Medical Center Scandal

Primum non nocere

This morning, I saw the so- called Vicente Sotto Memorial Medical Center Scandal on YouTube and I was appalled by the way those medical professionals handled the situation wherein some doctors and nurses of the said hospital were seen laughing, videotaping and boisterous while performing an operation on an unidentified patient to remove a canister of body spray stuck inside his rectal vault.

Copies of the said video is now roaming the world wide web as well as in the form of multimedia messages being passed around on cell phones of every Juan and Juana de la Cruzes both in the Philippines and abroad which will further damage the already soiled reputation of the medical profession that is under fire and scrutiny after the exposé regarding the cheating perpetrated by some unscrupulous individuals in collusion with some Review Centers during the Nursing Board Examinations two years ago.

Based on my experience a case like this in the Philippines is quite unusual and you can expect that word will certainly travel fast in the four walls of the hospital, a patient’s privacy and confidentiality be damned (which is never practiced or observed anyway).

Also given the penchant of Filipinos for gossips and making other people’s business theirs, it’s not surprising that what could have been a hush- hush affair has turned into a circus that one could only imagine in a carnival freak show.

I have encountered several cases in similar situation in the United States wherein a patient will come in with abdominal pain or rectal pain and after a thorough physical and medical examination, we discovered to our horrors, foreign objects (e.g. toothbrush cases, soda cans and bottles, umbrella handles, etc.) stuck in places wherein they should not even be present.

In an ideal world, this could have been dealt with without any incident but in the real world even among doctors and nurses and other members of the medical profession who are supposedly and should be well- versed on patient‘s right to privacy and confidentiality, cases like the one that was seen in that Cebu hospital will always elicit curiosity, laughter and even ridicule for after all, humans are not perfect and we are prone to succumb to its frailties.

And yes, even in a country like the United States of America where you are expected to be always politically correct in everything, people in the medical field would react the same way like their brothers and sisters in the profession in any part of the world when confronted with the same scenario. The difference though is people here usually talk and make light of the situation privately and amongst themselves without resorting to histrionics and more importantly no jerk will take a video or a picture and worst, post it in YouTube for the entire world to see.

I’ve been in a similar situation in the past but I can say that all the people who were involved in the procedure as well as the staff who were curious enough to drop by and see for themselves the “unusual case” conducted themselves in a more appropriate and professional manner.

Obviously there was a failure in discipline and ethics here since the head of the team that operated on the patient allowed the unthinkable to happen under his watch. Add to the fact that this incident occurred in the presence of both medical and nursing students make it even worse!

And then we ask ourselves--

Did the members of the Medical- Surgical Team of the Vicente Sotto Memorial Medical Center violate the rights of the said patient?

Definitely.

Did the members of the Medical- Surgical Team renege on their duties and responsibilities as medical professionals?

Certainly.

Did the members of the medical- surgical team break their oath as medical practitioners?

Without a doubt.

Those involve should be held accountable for their actions and be meted the necessary sanction that merit the gravity of their indiscretion.

Lest we forget, aside from the Hippocratic Oath, members of the Medical profession should always bear in mind this fundamental tenet of Medicine---

First, Do No Harm (Primum non nocere).


Here's the video of the said scandal and watch it at your own risk. Let me just reiterate that the posting of this video here is not meant to cast aspersion on the character of the patient who will remain unidentified but done so for educational purposes only so that people in the medical profession will not commit the same mistake again.






Here's the latest news from ABS- CBN--
3 doctors, nurse face raps over YouTube 'rectum scandal'

Result of the Philippine Physician Licensure Examination

List of Successful Examinees as released by the Professional Regulation Commission.

A total of 1,054 out of 1,985 passed the Physician Licensure Examination given by the Board of Medicine in the cities of Manila and Cebu this month.

Please click on the links below:

Doctors A

Doctors B

Doctors C

Doctors D

Doctors E

Doctors F

Doctors G

Doctors H

Doctors I

Doctors J

Doctors K

Doctors L

Doctors M

Doctors N

Doctors O

Doctors P

Doctors Q

Doctors R

Doctors S

Doctors T

Doctors U

Doctors V

Doctors W

Doctors Y

Doctors Z

Philippine Nursing Board Examination Result

CONGRATULATIONS TO THE NEW REGISTERED NURSES AND WELCOME TO THE PROFESSION!


LICENSURE EXAMINATION HELD ON DECEMBER 1 & 2 2007
RELEASED BY THE PROFESSIONAL REGULATION COMMISSION FEBRUARY 20, 2008

List of New Registered Nurses A-G

List of New Registered Nurses H-M

List of New Registered Nurses N-S

List of New Registered Nurses T-Z

List of New Registered Nurses Retakers

Feetish

Many men don't bother to see a doctor when they have foot troubles, but there are five foot problems they should never ignore, says the American College of Foot and Ankle Surgeons:

* Heel pain. This is often caused by tissue inflammation but can also result from a broken bone, a tight Achilles tendon, a pinched nerve, or other problem.

* Ankle sprains. They always require prompt medical attention. Skipping medical care increases the likelihood of repeated ankle sprains and the development of chronic ankle instability.

* Big toe stiffness and pain. This usually develops over time, as cartilage in the big toe joint wears down and eventually leads to arthritis. The sooner it's diagnosed, the easier it is to treat.

* Achilles tendonitis. This causes pain and tenderness at the back of the foot or heel. This is usually the result of a sudden increase in physical activity. The risk of an Achilles tendon rupture can be reduced by treating the symptoms of Achilles tendonitis.

* Ingrown toenails. These can pierce the skin, allowing bacteria to enter the body. Men shouldn't try to perform dangerous "bathroom surgery" in such cases. A doctor can perform a quick procedure that will stop the pain and permanently cure an ingrown toenail.

Source: HealthDay News

Time Bomb

Here's an article from TIME Magazine written by Laura Blue that according to a new study, researchers have found a link between Anxiety and Heart Attack.

This is study is not really new but just a re- affirmation of that age- old belief with regards to the relationship between a person's frame of mind and disease.

So, to all of you out there, Relax and Enjoy Life. . :)

Read on...

It's no secret that men with angry, explosive personalities are at a higher risk of a heart attack. But they're not alone: Nervous, withdrawn and chronically worried people are courting coronary problems, too, according to a new long-term study in the Journal of the American College of Cardiology. Of 735 American middle-aged or elderly men who had good cardiovascular health in 1986, those who scored highest on four different scales of anxiety were far more likely to suffer heart attacks later in life. Men in the top 15% on any of the four scales, or on a combined scale of all four, had a 30% to 40% greater chance of heart attack than their less anxious peers.

Researchers have long known that problems of the mind can affect health. Other studies have looked at the relationships between heart-attack risk and factors like "Type A" personality, anger or depression. But "very few studies look at many psychological factors at one time," says Biing-Jiun Shen, lead author on the anxiety paper and an assistant professor of psychology at the University of Southern California. "I think that's a unique part of this study."

Using data from the U.S. Normative Aging Study, Shen reviewed the men's responses to a series of questions on the Minnesota Multiphasic Personality Inventory (a commonly administered personality test), and pulled out their scores on four separate anxiety scales that measured obsessive or compulsive thoughts; introversion and social exclusion; phobias; and a predisposition to become tense or have a physical reaction, like nausea or hyperventilation, to stressful situations. Even after accounting for other mood problems, like depression or anger, and for a whole host of physiological and demographic indicators — including age, body mass index, education, blood pressure, cholesterol levels and smoking and drinking habits — the effect of chronic anxiety was clear. It was also a stronger risk factor for heart attack than any of the other psychological problems in the study.

What's not so clear is why that might be. The relationship between stress, psychological problems and coronary disease or other physical woes is still not well understood. But it is the subject of intense scientific scrutiny. Many other researchers are trying to understand the interaction between mood disturbances like anxiety or depression and other health problems.

Shen notes the results of his study may not be universally applicable across populations. "We only looked at men who are older, around 60," he says. While men may suffer more heart attacks than women, women are far more likely to suffer from anxiety, just as they're more likely to suffer from depression. Gender aside, there's no reason to believe that the link between anxiety and heart attacks is straightforward. "We're not saying depression's not important. We're not saying anger's not important," Shen says. "Different factors can be essentially different for different groups." Still, psychological problems are often related, which means that different problems can affect the body in the same ways. The bottom line is that more study will be needed before we know how much sway our brains have over our heart function — and how much we can control what happens in the mind to prevent a heart attack.